Normal shift with a different partner than usual. He is a friend of mine though so we have fun together. I was so happy I happened to have the J-man this day! We get paged for a long distance transport from Southern Oregon to Portland, 4 and a half hours away. Luckily a Portland crew is going to meet us halfway there so we can transfer the patient. We go to the hospital to pick up our patient and find a pleasant lady, dressed in normal clothes and ready to go.
"She is just going up north for some tests" the nurse tells me. She goes to take the patients IV out. I ask if they will use it up there and we decide to leave it in. A decision I will later be extremely glad we made. Our patient stands with some help and walks to our gurney. She has some oxygen on but other than that doesn't need anything. On our way down to the ambulance my partner and I discuss the fact that he can tech this call. As we put our bed into the ambulance we notice she is still breathing hard from her small exertion. We decide I will take it and we start down the road. I give her a breathing treatment but it doesn't seem to help. By the time we are half an hour pout of town she is breathing quite hard. I start another treatment. I put her on CO2 capnography and find her values are quite high. She is starting to panic, not able to breathe well. I know from experience this is a bad sign. At this point its half an hour to the next hospital or forty-five minutes back to mine. I yell at my partner to floor it and light-er-up! She takes that moment to stop breathing.
"Get me a firetruck!" I yell up to him.
"I don't know how to reach them," he yells back.
"Call our dispatch and have them call their dispatch and get a firetruck to meet us at the next exit!" I yell as I try to breathe for my patient. Two exits later a shiny red truck is waiting for us on the side of the road, lights ablaze. As soon as we come to a stop the side doors and back doors fly open and three firefighter pour in.
"How can we help!" one asks and again I am reminded how great a community the emergency services is. I direct one to put her on the heart monitor, my partner to access the luckily retained IV and a third to pull up the drugs needed to RSI (Rapid Sequence Intubation). Basically we paralyze the patient, put a tube down her throat and breathe for them. I notice one firefighter is unusually twitchy. As I am setting up my equipment I he finally gets the courage to tell me he is a paramedic student. Ahhhhh.
I ask if he would like to try the intubation and he nods eagerly. I remember those days! I give him my spot in the airway chair and watch him try to tube. "Got it!" he says. I look at the monitor and my Co2 detector. I pull out my stethoscope and listen over her lungs and stomach. Nope. Its in her stomach.
I wedge my way in and pull the tube. I take a look and place it. Good reading and good breathe sounds. "You know where the Hospital is here?" I ask J-man. Yep he does. The intern and 1 firefighter ride with me as we work on stabilizing the poor woman's vital signs. Finally we arrive at the foreign hospital and deposit our patient. I thank the firemen and start my chart. J-man is out cleaning the ambulance when a nurse comes and finds me. She nicely informs me the doctor thinks she needs to continue to Portland for further care. okay.
Let me point out t few things here. We are not a portable hospital despite what we think. An ambulances job is to stabilize and transport. Not extended critical care. We do not have the equipment needed for that kind of care. I call J-man in and ask him if the Portland crew can come south a little farther and get the patient or if we should meet them at the per-determined site. I continue my chart.
J comes in with an odd look on his face. Apparently our well meaning dispatcher heard us divert to the hospital and took it upon himself to cancel the Portland crew. "Well turn their asses around!" I snip at him. My crabbiness can be explained by the fact I am 5 months pregnant, nauseated and hungry.
In walks J again. He tells me the Portland crew is not equipped to handle an intunated patient. Apparently in big city Portland they have vent cars that transport those. We have a single use port-vent we use. It is very easy and I can teach a monkey to use it in about ten minutes. I tell them I will teach them how. Ten minutes later they call back and say they have a broken windshield wiper and have to turn around. I tell them to stop at any gas station and buy a new one. Better yet, stop where they are and I will give them one of ours if they will just meet us! No go. They are headed back.
A brilliant idea hits me! Fly her! Of course!! Had she been intubated before we left they would have flown her. They would never had sent her by ambulance. Words with my supervisor send J in to see me again. This time he just chuckles and shakes his head. No helo. I take a deep breathe. What can I do?
I go out to see the doctor. "ok" I say. "I will take her to Portland. But I am pregnant and need to eat. Can she wait ten minutes?" The doctor obligingly shows me to the break room where sandwiches greet my rumbling tummy. As I gorge myself on crappy hospital food J walks in again. He looks at me and chuckles again. I stop eating and roll my eyes. It's coming. "What now?" I ask.
"We are out of oxygen." What! We were low but still in acceptable limits when we left. Our patient was not supposed to be needing 100% oxygen for the whole trip so we should have been fine. But the two breathing treatments and then over thirty minutes of highflow oxygen as we breathed for her tapped the tank. My portable ventilator is oxygen dependent. it will not work without it. We are 2 1/2 hours from Portland and have three full pony (small) bottles. Not enough. We explain our dilemma to the hospital and they loan us two more.
Allright! Lets do this. We start out into the torrential downpour that crippled our Portland counterparts. (Trust me. Their supervisor got an earful when we arrived!) An hour into our transport the patient begins to wake up, the sedative the hospital gave had worn off. I have two doses. The first I gave when I intubated her earlier. I give her the second now. We are half an hour away when I put our last pony bottle on. A sudden jerk of the ambulance awakens me to our surroundings. We are getting off the freeway. What? There is no way we are there yet.
"What are you doing?" I yell up to J.
"Gotta get fuel," he yells back. Are you freaking kidding me?????
We get back on the road again and I hear a beep beep beep. I look a the heart monitor which also monitors her breathing, oxygen saturation and Co2. I have been changing batteries the whole trip and they need changing again. One problem. I am all out. Almost to our exit. We can make it.
My oxygen bottle runs dry.
I remove my vent and start to manually ventilate my patient.
Beep Beep Beep! Replace Batteries! The monitor repeats every few minutes. My patient begins to stir.
"Are we there yet?!?!?!?!?" Almost. I am out of oxygen, sedative and batteries. My patients hand is now grabbing for the tube and she is gagging. I hold it down.
"Do you want me back there to help or keep driving?" J yells back at me as he swerves through traffic. We are off the freeway now heading for the hospital on the hill.
"Just drive," I respond. We can do this. And we do. He pulls in the parking lot and throws open the back doors. He has enlisted the help of two medics outside the ER to help us out. This hospital is huge and we have no idea where we are going. They have no idea the condition the patient is in. They are expecting a walking, talking woman. We wind our way through the hospital. I was able to hook back up to one of our first pony bottles that I had changed slightly prematurely and still had a little more to give. On medic is leading the way, my partner is at the patients feet steering and the other medic is dedicated solely to keeping the patient's hands pinned down.Finally we deliver her into the competent nurses hands and head down stairs. Just another day.
As a side note I recently ran this woman again. She survived our ordeal and is back home in Southern Oregon. Her mystery diagnosis was Guillian-Barre Syndrome from a bad flu shot. Her respiratory muscles became paralyzed suddenly. I was excited to see her again and she thanked me profusely for the help we gave her that day. These are one of the calls that make it worth it. Even though everything that could have gone wrong did, it still turned out good. And much thanks to J-man!!
Tonight I am not quite so disgruntled.....
No comments:
Post a Comment