Same preceptor, different call.
This time its for shortness of breath secondary to asthma. When we get there, the patient looks like death is just around the corner. She is breathing about 34 times a minute, doubled over in the tripod position and using just about every muscle in her body to breathe. Looking at her as I walk up to the front stoop where she is sitting, I can see how hard she is working. I can see the struggle.
I dont even try to talk with her, I know she cant answer. I take out my stethoscope and listen at four spots along her back. I can hear light wheezes, but not much else. Hardly any air movement. Despite this body heaving underneath my scope, her back pressing upward and downward as she tries to force air out of her plugged-up lungs, the battle is already being lost.
I look at my partner, who stands patiently despite the tremor of the situation. He gives me my moment to take the lead and I do. "Epi. Now." I say. He is already nodding, diving into the bag and finding the vial. I get the patient on oxygen with a nebulised breathing treatment.
"What concentration," he asks me- testing.
"One to one thousand," I fire back, reaching for the syringe. He pulls it back slightly.
He hands me the needle, I push it in. I remember to put the needle in the mini sharps box.
We put the patient on the stretcher and then into the ambulance. Flip on the lights, monitor goes on, oxygen moved over to the main in-house bottle. O2 saturation is at 85% despite the oxygen, treatment, and epinephrine. The patient doesn’t look any better. Lungs sound the same. We do routine ALS, exchanging glances all the while between ourselves. My preceptor looks at me like I am his partner, we work together as fluid as can be. He says things with his eyes that I - as another medic - understand. This patient is in trouble. We might need to tube her. How about another epi.
He gets the line while I call medical control for orders. My report is crisp and clean.
Enroute to your facility, 20 minutes out with a 51- five one - year old female from home in respiratory distress. The patient has a history of asthma, right now working very hard to breathe. Diffuse wheezes in both lungs, the patient isnt moving very much air. She had 3 puffs from an albuterol MDI prior to our arrival and we've given her 0.3 mg Epi SQ, 2 breathing treatments DuoNeb, all without change. Currently respiratory rate labored at 34 per minute, o2 saturation 84%. Blood pressure 167/72, heart rate 123. This patient has no cardiac history, I'm calling for a second 0.3 mg SQ epi and 125 mg solu medrol. Again our ETA is 20 minutes.
The doc gives us the orders without hesitation. "Drive safe," he tells us.
I draw up the medication and push it in. We reassess, reassess, and reassess. The patient is getting better. I can hear air movement in the lungs now. O2 saturation is up to 95%. She can speak now. "Thank you," she tells us. "Thank you thank you, you guys are awesome, thank you!"
We pull into the hospital and wheel the patient into the emergency department. They have a room waiting for us with a doctor already there. Three nurses standing at attention. Our patient is crying, deep sobs with long, clear breaths in between. I listen to each breath and marvel at how smooth they are. The ED team looks at us like we are crazy. "Is this the asthma? The one with the epi?"
I look at them with triumph on my face. "Yep. It is."
My partner and I, sitting in the EMS room, hunch over our run forms in silence. He stops for a moment in the middle of his writing, looks at me slightly. As stoic as can be. "Now that was more like it."
He goes back to writing. I can hardly do anything but grin at the blank run form.