The last shift that I worked was a pretty easy shift if you only look at the sheer number of calls that we did. In 12 hours we only did 2 calls, but both of them were ALS calls. I told my partner that we are actually working real EMS today. I know that is not reality, but it was nice to only have to do rescue and ALS while on an ALS rescue truck. Just saying...
Anyway, our first call of the day was for acute mental status changes at a doctors office. We get there and find our pt who just looks like "one of those patients". They are lying on an exam table/bed in the doctors office and are awake but are not what you would call alert. This pt was unable to tell us where they where, what time of the day it was, the date, the president, who was recently shot in the face in Pakistan, or anything else. There was also talk of the pt possibly having menengitis because of neck and head pain with a fever. So we had to rely on bystanders, medical staff, and physical exam to get some answers. This pt had surgical scars everywhere, so I assumed that the medical history was extensive. But again the pt could not tell me anything other than "I dunnooo". At least there was a good looking family member there. Should have asked for her phone number, but that's another story in and of it's self.
Anyway, as I digress, the pt had fluctuating vitals signs but I am assuming that it was from them not being the most cooperative with the BP cuff and not sitting still. First it was low then it was high. They had a radial pulse the whole time so I wasn't too worried about hypotension. We had a new medic on scene with us from the local fire department and my partner and I decided to allow him to utilize some of his newly acquired ALS skills. So he started looking for an IV. I don't know if I was being impatient or he was taking too long, but I decided to look in the other arm. I was at the head of the stretcher in the truck and ended up finding one in the pt's hand. They were a bit of a vascular challenge but we got a line. Nothing big, but it did the job. Fluid and med access. We also did the stroke scale, which was inconclusive, and checked her pupils. As it turns out she had small pupils that were slow to react. This prompted me to look at the pt's medication list. This ended up showing a number of pain medications and also showed that the pt has a hx of medication abuse because she was prescribed Suboxone.
For those of you that don't know, Suboxone is a combination drug that is used to help people with their addiction to narcotics. It is a mix of Narcan, an opioid blocker (more on that drug later) and a narcotic, buprenorphin. The idea is that the mix of the blocker and the narc will help the pt ween off the meds and help them control their addiction. I personally think that it is a load of crap and this medicine is used as a crutch rather than a therapeutic modality. From what I have seen, it is an enabler in pill form.
Now then, back to the story. So our pt that is presenting with altered mentation, small pupils, and just not acting right is given some Narcan IVP. If we were wrong about the possibility of a narcotic overdose, there would be no effect from the medicine and would be benign otherwise. But the pt responded to the medicine well. They became a bit more coherent and not slurring their speech as much. I have to give props to my partner that day for doing a good assessment and immediately asking for the med bag to give some diagnostic/therapeutic Narcan. Way to go man.
Our second call of the day was for a fall. The gravity must be different in the area we run ALS because everyone falls down. It wouldn't be a normal shift if we were not dispatched to a fall once a day. So we get our call and get there to find a very old but talkative WWII vet. As it turns out, he had a bout of syncope or near syncope that brought him to the ground. CBG, ECG, V/S, and stroke scale are all completed along with a head to toe assessment. Everything checks out fine with the exception of his ECG/Heart rate. Via the pulse ox, it was 38-45. So we as we get him on the monitor we see an irregular rhythm that was not A-fib. We do a 12 lead and as it turns out this gentleman has a 2nd degree type one heart block. Also known as wenckebach. Hemodynamically, he was stable enough. So IV, O2, and constant monitoring and a trip to the ER was in order. No real change in status and the pt tolerated very well. The point here is that what the call comes in for and what you end up finding can be two very different things.
All and all a good shift on the rescue truck. Hopefully it will be my new full time position. We will know soon enough. By for now.
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