Tonight's call

[Asysin2leads]

Here we go. Pencil's down, turn off the lights, eyes front, people.

Called for unconscious, 57 year old female, 32nd floor of office building, arrive to find patient laying on floor, feet on pillows, oriented and lethargic. Patient states she started feeling ill during meeting, complaining of dizzyness, neck pain and headache. Negative SOB, negative chest pain, negative syncope. No pertinent medical history except for fracture of the wrist, no meds, no allergies. Patient states she feels better laying on the floor, denies other complaints.

PE:PERRL, negative cyanosis, trachea midline, negative accessory muscle use, equal chest expansion, lungs clear bilaterally, abdomen soft, non-tender, negative incontinence, PMS present x 4 in extremities, negative facial droop, grips equal, strong.

Vitals: BP 240/140, HR 52, SP02 100% RR 12, GCS 15

EKG: Sinus bradycardia, rate 52, 12 lead: isoelectric.

Patient has become increasingly confused. States age now is '22'. ETA to hospital: less than 5 minutes. Obtained IV access while enroute, gave notification for stroke to hospital, pushed 25gm D50, 100mg thiamine strictly to get obnoxious QA people off of back, who believe giving dextrose blindly is better than checking blood sugars with expensive glucometers. I knew what was going on and she needed dextrose like I need a kick in the head, but my unit is flavor of the month among administration and I have to keep everything on the up and up. Enroute, patient has become completely unresponsive, is now giving snoring respirations as we arrive at the hospital. If I had two more minutes I would have intubated, but we arrived at the hospital before I got the chance.

Patient is intubated at hospital, CT scan shows massive subarachnoid bleed, with herniation through foramen magnum. Patient is as of this writing been declared brain dead. While I know we did all we could on this call, after I ruled out any sort of cardiac cause (as soon as I saw the vitals I was 99.999% sure what was going on, but wanted a 12 just to make absolutely sure) we did the 100 meter dash to the stroke center, I got an IV enroute and satisified our AMS protocol, but still this call was damn depressing. I've never gotten used to people going out on me, and I probably never will.

[mediccjh]

Head bleeds suck, bro.

Last month, I had one whose GCS dropped from 13 to 3 in about 5 minutes, the ride to the hospital. I had no help between my location and the hospital, and I couldn't tube her in the back by myself, nor would I tell my partner to pull over the bus and get in the back to help me tube her since she needed surgery.

It just sucks.

[Timmy]

My heart goes out to you Asysin2leads its tough, but at least you guys can do all that advanced stuff, give drugs and transport to hospital. All I can do is give 02 and hope the medics get here bloody fast! Yes I have been in the same situation at a flower and garden show of all places…

[raptor]

The best drug we have in our van is deisel! Transport is treatment. If none of the other stuff happens, for various reasons, then you still did what the patient wanted! Take them to hospital! Well done on that, you did it extremely quickly! Kudos!

[JCicco345]

I agree head bleeds suck. We had one last month, where she was caox4, talking with us c/o n/v/headache. Within the blink of an eye she went unresponsive, decorticate posturing, slow shallow respirations. Also, out of curiosity, D50 to a patient like that who is awake and not hypoglycemic, how is that justified. Especially in the case of a bleed where the d50 is actually detrimental. D50 will increase the oncotic forces in the brain, which will cause an even greater increase in ICP, right ???

[becksdad]

You know, Asys, I think Dust alluded to something in a previous post about it being much different when somebody dies in front of you instead of when they're already gone when you get there. I think this is probably true. But what would you have told another Medic to do that wasn't done?

Head bleeds do suck. This lady had classic signs, too, as you already know. Sudden onset severe headache, deteriorating mentation, Cushing's triad (although you didn't say if resps were erratic, a little on the low side, but I bet they were changing). What can you do? Call the alert and beat feet to definitive care. Respiratory support. With my limited knowledge, I can't think of another thing. I think that's why bleeds suck. You pretty much watch with nothing to do. At least cardiacs you can do the MONA thing, place your pads, administer other drugs depending on presentation, get 12 leads, etc. You feel as if you're doing something for the patient. Trauma alerts, too. There's stuff you can do.

I really do feel for you, man. But I agree with everyone else - I don't think there's a thing you could have done that wasn't done. JMHBLSO

[Michael]

Jeez. Sorry to hear.