Though out my travels and just daily life, I have found a few things to hold true no matter where I am or what I am doing. Women will always change their mind, pt's will always place themselves in a location that is going to be a huge pain in the ass to get them out, no one knows how to drive properly except the 16 y/o on their road test (because they have to), and the story that EMS gets is different from that of the RN, and RN gets a story that is different from what the doc is told. It's a frustrating pattern that makes the other levels seem as though they are not doing a thorough job, but in all reality it is just that information is forgotten, remembered, and then given at different stages in care. Again, it's frustrating.
The story that I have involves mostly that last part of that short yet long list of universal truths. Oh and btw, anyone that says they drive the "correct" way 100% of the time is either lying or is obviously not paying attention to their personal driving habits. Ask a cop about and they will tell you that follow anyone for a mile and you will catch them breaking a traffic rule. Anyway, as I digress...
Recently my partner and I were dispatched to a call for an overdose. Usually when some in this industry get such a call, they only really get excited if the pt is unconscious. Per our dispatch information, this one wasn't. So we will still move with the same sense of urgency, but not with the same energy as one would with an unconscious pt. So we do the lights and sirens thing to the scene to meet fire and PD there. So far so good, right? Right. We grab our usual equipment and head on into the dwelling of said pt.
Once we get in there, we find a late 30's to early 40ish person on the couch who looks a bit sleepy but is breathing and conversing when they are not trying to fall back asleep. The FD states that they are having trouble getting a BP. That's not good for this FD. They are usually on it, so I assume that this pt is indeed hypotensive. So bing, bam, boom! We throw on the monitor to get our vitals and sure enough, the pt is hypotensive. Like 64/30. For those of you that are not familiar with the normal BP parameters, that is bad! And of course, the pt is in the basement with very a very narrow staircase and big, heavy furniture everywhere. Moving this person is going to take some muscle. Not because they are 500lbs, thankfully they are not. But because they went to the local furniture liquidator and asked for the bulkiest, heaviest, pain in the ass to move furniture they had. But as I have said before and I say it again, the FD in this area is always go great and got that part of the call done very quickly.
Now that we have emerged from the basement in what seemed like an eternity, we can really start doing all the ALS stuff that we need to. Since there wasn't a huge delay in getting out of the house we opted not to start right then and there. So our pt is still hypotensive, still sleepy, and still wishes for personal bodily harm. While we were redecorating the basement to move this pt we got a story (our EMS version of if) from the family. This individual has tried this before and the current "cocktail" consisted of a TCA, some OTC analgesics, and possibly some other medication. They were not sure.
So 2 big IVs, O2, the cardiac monitor, and a large bolus of diesel fuel are in order. Btw, that last part means driving fast. Just FYI. And we are off! Enroute things don't change very much but they don't get any worse. At least we are preventing this person from getting any worse. Or that is what we tell ourselves anyway.
Upon arrival to the hospital we give report to the RN and the pt actually starts to volunteer information and of course it is different than some of the stuff that we originally had. Thanks! And then the doc and the family show up. Now the whole truth comes out. See how that feels, RN? Just saying. Anyway, with this polypharmacy mess we brought in they started giving a lot of calcium. I won't go into the details as to why or how it works, but if we were given that information earlier we could have started giving that medication sooner. Ugh! It's a bit frustrating from time to time.
The same thing happens with heroin OD pts. They tell me "I don't do drugs". They tell the nurse, well I just wanted to try it" or "I am trying to quit". They tell the doc "I have been an IV drug user for 20 years. I usually get a vein in my thigh but have been known to sniff it and I am Hep A,B,C positive as well as have HIV". Perhaps EMS is viewed as an authority figure in such situations? Who knows, but hopefully my RN and MD colleagues recognize this pattern and take this type of pt behavior for what it is worth.
