Firefighters already on scene were taking the man's vitial signs, so I took a report from a family member in the hallway. The patient has been feeling "tired" for about 3 weeks now. He is normally fairly active, but as of late he has hardly found the energy to do much more than sit in bed, watch TV, and read. He doesn't have any particular pain or discomfort, no shortness of breath, no problems with appetite, fluid intake, or bowel movements.
I try to scare a complaint other than "tired" out of the story, but despite my probing questions there truly seems to be little else. The man smiles at me and thanks us for arriving so quickly. He apologizes for having to call 911, "but this weakness just wont go away."
The firefighters report the vital signs to me as BP 90/50, HR 60, RR 20. The man looks a little bit pale, but there is nothing that really screams "sick" about his presentation. We get the stair-chair and wheel the man out to the stretcher, telling a few jokes along the way.
Mostly out of boredom, and partly because of the reported blood pressure, I decide on a whim to work the patient up instead of passing off to my BLS partner. It is a 10 minute drive to the hospital, so I decide to do everything en route and we start on our way.
Sitting on the bench seat I take another set of vital signs.
...And then I take them again to make sure I heard right. The blood pressure is more like 76 over 30, and the heart rate rate, well... I'd better put him on the monitor.
I stared disbelievingly at the monitor for a few seconds, turning my head back and forth between the patient and the yellowish screen. The patient looked fine. ...Like anyone you might see walking down the street. And yet the numbers told quite a different picture. Heart rate hovering between 28 and 32, a dangerously low blood pressure.
The patient sat on the stretcher looking at me. He had asked for a few extra bath blankets, and there he was, buried in cloth pulled snug to his chin, watching as I reached for the yellow medication bag.
He clears his throat. "Is there something wrong?"
11 comments:
nice catch, man.
Ditto, nice job on being vigilant, despite seemingly normal circumstances.
Ack!
can we say lets try some atropine?
you should post this on our site too.. how come i cant get any sick patients?
Holy mother of atropine
The one thing I found to really like about the system I did my field time for medic school was there habit to 'stay and play' for a good perecent of serious medical cases. Get the line, get the tube, start the fluid, maybe give a medication, all things depending but in general get everything in place that needs to be done before getting and going. I think it came out of the short transport in an urban system but still saw more acomplished doing that then 'load and go'
Not saying what you were doing was wrong and its clear a full ALS assessment found something was going on and you were about to do something about it.
Hello! I've just found your blog and I am at about the same place as you (check out my blog if you like - Dr Kitty's Weblog if anyone else is interested. It's brand new).
I know how it feels... It's like being in love with 2 different people. That's how I think of it.
Good luck with your mission.....
(Ps I'm going to email you)
"Anonymous,"
Sure, that system have have gotten do do all their cool skills in spite of the short transport time, but did the patient benefit? Definitive care is not the back of an ambulance.
No doubt definitive care is getting to the hospital but when we have the ability to provide care, not doing so is a waste of Advanced Care. I would hope we have moved past the years of finding a patient, throwing them in the truck and running.
Good catch.
Want me to send you some new underwear?
-MM
"Ah, yes sir. Your saliva will be drying up in a moment here... not to worry..." Well done.
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