BLS turned very very ALS

     So it was just "one of those days" where we seemed to be stuck in BLS priority 3 purgatory. Nothing exciting was happening and the day was dragging along. Then our pagers go off! Is it a rescue? A trauma? Should we launch the bird? No. It's another priority 3 nursing home call. Ugh! So after putting our "happy to be here, proud to serve" faces, we turn our bus (because that is what it is today) and head to the facility.
     When we get there the staff doesn't seem excited, but the patient appears to look kind of sick. However, sometimes with this patient population, that could very well be their baseline. So we get our pt packaged up and collect the necessary documentation and get a set of vitals once we start rolling. No sooner as we put the vehicle in drive, things took a turn for the unexpected.
     Our patient is hypotensive, tachycardic and septic. This drastically changes our approach to this situation. So I inform our LOL who is no longer considered to be in NAD and is probably not too far off from CTD. Look up the acronyms on Google or urban dictionary, two out of the three are not exactly "official". I tell my partner the situation and he asks if I want to divert to another facility. Not at the moment, as of right now I can still treat this. I put my patient on some oxygen and an IV gets started and then my patient informs me that they have a PICC line. Well, that could have saved me some time, but thank you, LOL who is now in acute distress.     
     And the fluid resuscitation begins! First bolus goes in kind of slow and there was no real change to the pt's status. So in true ghetto medic fashion, I slap a BP cuff on the IV bag to create a pressure bag to get some fluid in a bit faster. I have to admit, I always love doing that. Mainly because the hospital looks at you like you are crazy when you walk through the door with that hanging. So my Mcgyver set up is getting the job done. However, bolus number two is not. Pt was reassessed and still found to be hypotensive and very tachycardic. I poke my head through the "doorway" up to the cab of the truck and tell my partner to "step it up". I called ahead to the receiving hospital and gave them a quick run down on the situation. At this point we were about 10 minutes out from our destination.
     So boluses three and four do not touch the heart rate but bring up the BP slightly. Still hypotensive but higher than what it was. As we roll into the super hospital, the staff looks at my BP cuff pressure bag with a look of "you can't do that" mixed with "I wish I thought of that". I give report and they take over pt care.
     Point of all of this is tow fold. One is to always be on your toes , because you never know when you are going to be sucked out of priority 3 purgatory. And two, you have to make the most of your equipment to do the best job you can. After all, as they say in the USAF "flexibility is the key to air power".