Seattle EMS at its best

[Juilin]

First patient of the day yesterday. Arrive on scene to a 65 y/o m c/o weakness. The Seattle Fire Department had also responded and were waiting for us when we pulled in lights and sirens. The first thing I noticed was that of the four man engine crew, two were outside, one was in the next room (from the patient) with his head stuck out of the window and the Lt. was at least 100 feet out in the hallway. Of course, this left the patient alone slouched against his bed. No surprise he had become incontinent and had a massive bout of diarrhea (and I do mean massive). The fire department gives me a quick report, said that the patient's initial complaint was chest pain and that he had had a stint put in his coronary artery 2 weeks ago. The patient allegedly took 2 NTG 5 min apart which relieved the symptoms but left him feeling weak and unable to walk--to the bathroom. There was supposedly a medic evaluation prior to our arrival but they had since left w/o giving me so much as a report, verification of a 12 lead being run, or even any indication that they had been there other than 'the firefighter told me so.'

Well the Lt. hands me my copy of the run-sheet, me and my partner get the patient onto the stair chair, turn around, and they're gone. Thanks guys. Managing to get this 250 pound guy down 4 flights of stairs without hurting ourselves, we place him on the gurney at the base of the stairs. Then the highlight of my day. The landlord of the apartment complex comes up to wish the patient luck and tried to be nice by picking up the dirty linen we used to cover our stair chair. She notices the 3lbs of liquid peanut butter and I wave her off saying that I'll take care of it. She immediately says, "OK," hurries out of the front entrance and vomits at least 8 times in the hedges before running off down the street. Simple amusement. Well guys, we get him into the ambulance and I immediately note that he's alert and speaking in complete sentences, moving good air, L/S are clear, and proceed to the C of the ABC's. Reaching for a quick pulse I note that his skin is WPD, feel the first 'thump' on his radial, wait, wait some more, still waiting...."thump" there's the second one 5 to 6 seconds later. I immediately take a set of V/S, B/P 100/60ish R20 P30 SWPD PERRL. Yes his rate was genuinely 30. I took 5 sets of vitals on a 10 minute transport and he was anywhere from 20-50 with a mean of about 30.

The odd thing was that he was completely asymptomatic. No C/P or any Px for that matter. No SOB, Diaphoresis, Anxiety or restlessness, Skin color and quality were normal, also used the Cincinnati stroke scale which he presented negative on everything. Grips were bilat and = somewhat weak. PushPull the same. B/P was a little low but he had just taken two NTG not an hour and a half ago so, correct me if I'm wrong, that seemed within reason. Having already had the medics dump this guy, and being the closest available unit to the hospital I decided to take him in quickly. At the ER, they immediately gave him some atropeine which he did not respond to at all. He eventually was taken up to the Cath lab and I think they started pacing him. I don't really know after that point but at the end of our shift we were able to swing by the hospital and apparently he was still alive. My story of the day.

Juilin

[Ridryder 911]

Welcome to the city.. I am sure the moderator will suggest this to go into a blog..... Sounds like it was his lucky day to survive.

R/R 911

[Nate]

What ever happened to "general impression" and a quick checkout before you start moving them down four flights of stairs. Also, what kind of paramedic leaves a chest pain patient? :shock:

[WelshMedic]

It's a shame that you can't use monitoring at a basic level, I would have liked to have seen his rhythm. My hunch is that it was some kind of AV-block. He might have been smelly,but that's no excuse for neglecting your duty of care - he should never have been downgraded to BLS. Take this further!

Carl.

[Dustdevil]

You're obviously a liar. Seattle Medic One is the best and most respected EMS system in the United States.

They would never make such a mistake.

[/sarcasm]

[vs-eh?]

Well the Lt. hands me my copy of the run-sheet, me and my partner get the patient onto the stair chair, turn around, and they're gone. Thanks guys. Managing to get this 250 pound guy down 4 flights of stairs without hurting ourselves, we place him on the gurney at the base of the stairs.

Call them back. Why risk injuring yourself? If fire is with us on a medical call they have to wait until one of us clears them. Same if it is a fire call, we just can't simply clear ourselves...

[Ridryder 911]

Sounds like he an infarct .. or fart while he had a B.M. and vagal down as well. The old "toilet" incidence. He then went into a brady sustained rythm.. block or not he gets a new pacer....

R/R 911

[Juilin]

I recruited some maintenance workers to help us with the lifting, I would have called them back but the patient needed to get out of there and I wasnt going to wait for 4 lazy firefighters to drag their butts back out of bed and come back. I've already filed an incident report and I think the hospital has as well. They were of course surprised and angry to get a patient like that which had been downgraded to BLS. As far as his rhythm, I asked the ER doctor and he said Sinus Brady but then trailed off into something else I didnt understand. My knowledge on dysrhythmias is limited.

[cosgrojo]

I never feel comfortable asking non-EMS/Public Service personnel to help lift. If anything would have happened on the way down the stairs, you and the service you work for would be held liable for involving inappropriate personnel. I don't care if the Fire-fighters left. Call them back. And I would have re-started ALS. 2 Nitro in an hour and a half with a patient with known cardiac history AND a pulse in the 30's..... yeah, ALS is coming back. If they don't want to, we would go have a brief chat with the medical control Doc and see what he feels about it. Chances are, the medics would get their butts kicked. Your assessment was very good, now just make sure you make the right decisions based on your assessment. Remember, it's your license.... guard it well.

[chicagoambo]

was this an Als engine?