Recently the phone rang at the station without the fire radio toning out. That is usually not a good sign. I pick it up and dispatch tells us that we have a emergent cath call out of the local hospital that needs to go priority one downtown to the waiting cardio team. We are so totally on this one! My partner groans and mumbles something about where is the MICU right now. Whatever.
So we roll priority 1 up to pick up our pt. This guy was not at all what I thought he would be. I thought we were taking “The Dude” from “The Big Labowski” to the cath lab. Long hair, mannerisms, probably a thirst for white russians, and what not. The only thing he was missing was a white Russian. However, el dude-a-rino had a bumped troponin and was looking pretty ill. NSTEMI ill. So I tell the guy we are going to get him packed up and have a safe and fairly comfortable ride down to the city from the country. The roads around here are not the greatest.
After talking with the nurse and pt, I learn that he is an ER doc. I was kind of surprised, but if the Dude was going to be a doc, he would totally work in the ER. Just sayin’. He said the whole episode stared a few hours earlier in the day and that he was still at about a 7/10 in pain. He had the whole shebang, diaphoresis, an elephant on his chest, dyspnea, and nausea. His vitals were pretty good though. Slightly brady with a touch of hypertension. Oh and this is on 20mcg of IV NTG. The RN bumps him up to 30mcg before we leave and the guy is still in pain after that and 2 of Dilaudid. Our orders were to increase the NTG as needed for pain and to keep his BP above 100 mmHg. Got it.
Now I treat all pts as though I am loading them into a helicopter/airplane. No bubbles, pumps set, IVs check, etc, etc. You need to make sense of the chaos that is the tubing and wires of multiple pumps, the monitor with 12 lead, bp cuff, spo2, and so on. If he was intubated, it would have been even more of a challenge. At any rate, we get him all dialed in and secured we make our way out to the truck.
Our pt is currently nauseous and diaphoretic. And the ER has already discharged him, so it is our med box to the rescue. I really didn’t want him to vomit in the truck. Not that there was a rug on the floor that tied the room together or anything, but no vomiting = a good trip. He gets a normal dose of the amazing antiemetic, Zofran. I am speaking from personal experience that this med is wonderful. It doesn’t get you high, it just takes away nausea like the big kid took your lunch money. Great stuff.
At this point we are starting our decent from green country side to grey urban waste land. While we are enroute, the pt states his chest still hurts. He just bought 5 more mcg/min of nitro and a reassessment. A short time later he states that it didn’t help with his pain and so I get him up to 40mcg/min with no relief. His pressure was still good, but I wanted to help him with his pain and the drug box is already cracked. Since he was on a moderate dose of nitro, I decided to go with Fentanyl for pain management. He tolerated two separate doses of the med well. He received two because he was still in pain. It brought his pain down some, but not completely. Now I’m no cardiologist, but I’m pretty sure the only way to get rid of his pain was the cath.
So we get to the facility and The Dude is doing pretty well. Well enough to make comments about how hot the nursing staff to me and to say hello or more accurately “What’s up” to everyone passing us on the way to the lab. I have to say he was a lot of fun to take care of. And when we finally transferred him to the bed in cardiac holding he shook our hands and said things like “Great job, man” and “Thanks a lot, bro”. It made you feel good inside to know that you helped get your patient to definitive care in a fast, safe, and laid back kind of way.
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