A Medical Experience

A Medical Experience
It was the end of a normal day at the station. The medics are just
getting to bed after running a half a dozen calls for an assorted minor medical
and trauma problems. The paperwork was finished. The reports were entered into
the computer. The truck was even restocked. They were just about into
dreamland but, as with most nights at this particular station, sleep was not to
be.

Several miles away, in a small, well kept apartment, Angie Briggs, a
eighty-year-old woman awoke to the feeling that the life-giving air was being
denied to her. She tried to sit up, but the feeling would not subside. Walking
made it worse. She also noticed that, even though the temperature in her room
was comfortable, she was dripping with sweat. The longer that she waited, the
harder it became to breath. So, realizing the fact that her doctor was probably
asleep, she did the next logical step, she called her daughter, who lives in
another state. The daughter realized that her mother needed more help than she
could give over the phone, tried to persuade the mother to call an ambulance,
which, of course, the mother refused to do, stating that it wasn’t necessary.

The daughter then took it upon herself to call EMS from her own house.

The medics were notified of the problem through the usual method, a
series of tones over a radio that cause a loud horn to blare and all the station
lights to come on, much to the annoyance of the fire lieutenant. This alarm was
immediately followed by the dispatchers voice giving all the applicable
information on this call.

“Med unit 2, respiratory call, 103 Royal Terrace Boulevard, apartment 7,
in reference to a 80 year old woman with shortness of breath.”
Not that the EMS crew were listening at this point. They are busy
getting into their jumpsuits and putting their boots on. It does not matter if
they are eating, sleeping, watching TV, or even taking a shower, they are
required to be in the ambulance and en route to the scene within two minutes.

“Med Two’s en route.” Stated EMT Jennifer Meyers in a sleepy voice
” Copy med 2 is en route to 103 Royal Terrace Blvd., apartment 7.” Now
they are listening. “This is in reference to a 80 year-old female who is in
severe respiratory distress. Received the call from her daughter that is out of
state. Patient sounds very short of breath.”
“Copy”
“I’m pretty sure that it is in the first entrance into the apartment
complex. Should be the third or fourth building on the left”, stated Doug
Murphy the paramedic on duty.

It took only a few minutes for the ambulance to arrive at the scene.

After dispatch was informed of their arrival, Doug and Jennifer removed the
stretcher that was already loaded with the monitor, the airway bag, and the med
box. As he approached the front door, Doug took notice of the condition of the
walkway, of the location of the bushes, and any outside furniture that might
impede exiting the house with a stretcher loaded with a person. He did the same
quick evaluation upon entering the residence.

After knocking, an elderly, heavy-set woman opened the door. The medic
could see immediately that she was is serous trouble. Her clothes were soaked,
wet with sweat, every time she took a breath, a faint popping sound could be
heard. The medic also could see the front of her neck pull in along with every
breath and that her general color had a faint, matted bluish color about her.

Doug knew that without immediate treatment, this lady would die.

Doug quickly lowered the stretcher and took the equipment off of it.

“Why don’t you sit right here.” Doug told Mrs. Briggs
” I’m fine, really. I told my daughter that I would see my doctor in
the morning. I don’t know why she called you?” Mrs. Briggs stated. The medic
was surprised that she could talk at all.

“When did you start having trouble breathing?” Doug asked as he was
turning on the oxygen bottle
“About an hour ago. I woke up and couldn’t catch my breath.” Pointing
to the oxygen mask that the medic was placing on her face.”I really don’t
need any of that.”
” I think you do. You need to let me do my job and treat you.This
condition will only get worse.”
“No, I think I’ll wait till the morning.”
“Listen, you don’t have until the morning. To be perfectly blunt, I
doubt you have a hour. You need to let me treat you now. Your lungs are full
of fluid.”
“How do know that?” asked the patient.

“I can hear it, even without my stethoscope.” retorted the medic. ” I
can take care of this problem with medicines, but I need to do it now.” Looking
at his partner. “How’s the blood pressure?”
The medic’s partner had been busy taking the patients blood pressure and
pulse, and was now in the process of applying the electrodes on the patients
chest for the monitor.

“180/90, pulse 100 very irregular.” came the reply.

While his partner began to set up the IV bag, the medic finished putting
on the monitor leads. After he turned the machine on, he then began listening
to the patients chest, carefully listening to each lobe of the lungs, trying to
judge just how far the crackles, or rales, go up into the chest. This allows
him to determine how full of fluid Annie’s lung were.

“Your lungs are three-quarters the way full.” Doug then took a look at
the monitor. “Do you usually have skipped heart beats?” questioned the medic.


“Yeah, it’s been like that for a while.” answered the patient.

He then asked the patient. “Have you ever had an IV before?”
“Yes. Do I really need one now?”
“Yes ma`am, you sure do.” answered the medic. A rubber tourniquet was
placed around the patients arm tight enough to stop the return blood flow, or
venous blood but not too tight enough to cut off the arterial blood flow. He
then looked for and found a vein in her wrist, prepped the site with alcohol,
and stuck a needle that was covered by a thin catheter into the vein. After he
removed the needle, leaving the plastic catheter in the vein, he took a sample
of blood from the site and connected the IV line. He then released the
tourniquet and opened the IV line to make sure he had a good flow. The drip
rate was set so it would only drip once ever few seconds. After he taped the
line down to the patient’s arm, he finished this particular procedure by making
sure that all the dirty needles were safely placed in a sharps container. He
didn’t want any accidental needle sticks.

“Ma’am, are you allergic to any medicines that your aware of?”
“No, not that I can think of.”
“OK, This is what we are going to do. First, I’m going to give you some
Nitro with a spray. What I need to you to do is open your mouth and put your
tongue at the top of your mouth” Stated the medic.

Mrs. Briggs complied, almost. She opened her mouth and kept her tongue
at the bottom of her mouth. “Tongue up.” The patient complied.

“Good, now take a breath in.” When she did, the medic sprayed the Nitro
into her mouth. Having her inhale when he sprayed the Nitro kept it from going
back into his face.

Talking to the patient “Ma’am, I’m going to give you some Lasix though
the IV line. Hopefully, it will pull some of that fluid out of your lungs and
back into your bloodstream. Is that oxygen helping?”
“A little.”
“Good” The medic replied. He then proceeded to slowly give the Lasix.

The standing orders that he works under (after all, a non-physician cannot give
medicine without a physician willing to assume responsibility for it) allows him
a dosage range up to 80 mg. for Lasix. If the patient was not in such distress,
he would have opted for double of the home dosage. However, this time he chose
for the full eighty.

After being secured in the ambulance, Jennifer went back to make sure
that the residence was locked up. Doug then retook the patients blood pressure
(which had not changed) and listened again to her chest, detecting a slight
clearing of the lungs.

“Ma’am, I need to ask you again if you are allergic to any drugs.”
“No, I’m not.”
“Have you ever taken Morphine before.”
“No, why?”
“Because I’m going to give you some in a minute”
“Why? I don’t hurt anywhere.”
“We’re going for another effect that it has. It helps pull that fluid
out of your lungs.” Seeing a look of confusion in the patients eyes, Doug asked
“Do you understand what is happening?”
“No”
“For some reason, your heart cannot keep up with the flow of blood
coming into it.” The medic explained as he drew up the Morphine from the vial.

“When this happens to the left side of the heart, the blood backs up into the
lungs, causing the blood plasma to leak into the tiny air sacs in your lungs.

This is what is causing you to be short of breath and to have that crackling
noise when you breath. All the medicines I am giving you cause your blood
vessel to dilate, or get bigger. The Nitro causes this all over the body. The
Morphine does it in the arms and legs. And the Lasix pulls it out of the body
by making you have to pee a lot. The Morphine will also help you to relax
somewhat. Just let me know if you start felling nauseous.” Doug took a alcohol
wipe and cleaned the injection port of the IV tubing, then inserted the
syringe’s needle into the port. “I’m giving you the Morphine now.”
By this time, Jennifer had finished locking the apartment.

“You all set?” She asked, sticking her head in the back of the truck.

“Yup, let’s go.”
On the way to the hospital, the patient started improving; her blood
pressure and pulse were going down, and the patient was breathing a lot easier.

The rales were even noticeably diminishing. The medic had called the hospital
over the radio notifying them of the patient that he was bringing in and her
current condition. The patient, due either to her finding it easier to breath
or due to the Morphine, began talking.

“How long have you been a fireman?” The patient asked
“Never have been, I’m a paramedic.” The paramedic retorted. “We have a
dual system in this county. We work with and are stationed with the fire
department, but we are under a different chain of command.”
“What does that mean.”
“I don’t put out fires, they don’t give people needles.”
By the time that the ambulance got to the hospital, the patients lungs
were almost clear of any rales that the medic could hear. And, as expected, the
patient requested a bedpan as quickly as possible.

“Which room would you like us in.” Doug asked a nurse.

“What’ch ya got” came the reply.

“Heart failure.”
“Room 10 will be fine.”
“Thanks.” responded the medic as he wheeled the patient into the
treatment room. While the nurse went to get her paperwork, the medic and his
partner lifted the patient onto the hospital stretcher, transferring the oxygen
tubing