Not just another fall

The thing I love and hate about EMS is that at any given time you may be called upon to utilize a skill or exercise some knowledge that you have not used in a long time or in the case of some people, ever. And these situations can come when you least expect it. That is why you never really know what you are getting until you get there. A call for a "fall" can be anything from fall down go boom from standing height to a cardiac arrest, or someone that fell off of a building after getting electrocuted.  The point is, you never really know. This call was no different.
     We were dispatched to a local rehab center for one that had fallen. At first thought, most would not think that this would be the most exciting call that probably wouldn't require more than a c-collar and a trip to the hospital. Don't assume anything because the mixture of the EMS brand of chaos coupled with Murphy's law tend to make for obscure and challenging situations. But I digress...
     When we get there, we find our LOL in obvious distress. She wasn't looking well and seemed very confused. OK, what could this be? Diabetic, hypotensive, a dementia patient that fell and just hasn't gotten up yet, or something else? Definitely something else.
      This pt had that glazed over look but was still breathing. The radial pulse was kind of weak and slow. Really slow! Like 20-24 beats a minute slow (normal is 60-100 a minute)! @#$%! MONITOR, GO! My partner slaps on the monitor leads and pads. The result of this action is a narrow (good) but very slow (not good) cardiac rhythm that is very symptomatic requiring immediate intervention.
     Now I am not sure why this phenomenon happens, but it seems as though when people are in dire straits and have super crappy vital signs, they seem to say very simple but very odd things. I once had a pt with a dissecting thoracic aorta with a horrible blood pressure and all she could tell me was "It hurts".  This Pt's only request was that she was hot and that we should take her pants off. Really? Really. We didn't take her pants off because it wasn't medically necessary. Anyway, back to the story.
      Flip the switch to the left and let's start pacing! Oh and we should probably start working on an IV or two as well. We start at a rate of 80 and are steadily increasing the mA (energy) until we get a good spike or capture. Unfortunately, this doesn't happen as easily as we would like. However, at this point we have an EJ in place and can try some pharm therapy! Since the pacer isn't really working at this point but isn't making things worse, we leave it on. Unfortunately, the pacer pads either got disconnected or someone turned down the energy because the pt went from a slow heart rate to no heart rate! I look at the monitor and am certain that everyone in the room could hear stream of profanities running through my head. Thankfully what came out of my mouth was much more politically correct. Something along the lines of "Crank it back up!" Thankfully we get a better paced rhythm this time. Not the best, but better. As soon as we get our pt on to the gurney and ready for transport, I take a better look at the monitor and decide to up the energy level on the pacer. Boom! Capture! We have a good pulse, a good BP, and now 2 IVs. Let's go!
      The ride was bumpy and loud, but we were able to get some fluid into the pt as well as make it to the hospital alive. Our pt would appear to pass out from time to time and just when we think we would have to start CPR and even more invasive with our treatments, she would wake up. We would have to yell her name or do a sternal rub but she was still alive. Oh and the fire department drove for us so we got there lickety split but I question their safe driving record from time to time. Although I always appreciate it when they drive for us.
     Once we get there and hand over care, the pt no longer requires TCP treatment and has a better blood pressure. Was this due to our treatments or was she just trying to make us look bad? Just kidding. Per the doc, it was probably a sick sinus syndrome, a heart block from an MI, or a bout of symptomatic bradycardia. Whatever the case may be, she will be getting a permanent pacemaker placed and hopefully will not have to deal with this issue again. Gotta love it when a call goes from blah to "PRIORITY 1" to a probable hospital discharge.  Good job everyone!