sirengirl
Forum Lieutenant
- 238
- 32
- 28
Yesterday was my first full shift at work after being released as a paramedic. Thought I'd share this craziness and ask for input....
EMS brought in a ~58ish y/o C/m who was an OD; pt known to have methodone and codeine. Pt was cyanotic, unresponsive, satting in ~70s-80s on EMS arrival with obvious aspiration, last seen 2330 previous evening (EMS rolled in our doors at 1330). Pt given 2mg narcan on scene and transported. On arrival pt is satting in 80S, putting up a bit of a fight, but still generally comatose.
Pt is transferred into ER bed, blood taken, and 2mg more of narcan administered per MD. Pt is now screaming in pain, and only intelligable words are about back pain and that it hurts. Pt BP in 130s to 140s, tachy in 120s, still satting mid 80s with a non-rebreather that he is trying to pull off, saying he can't breathe. RR around 26. EKG taken is tachy but is insignificant for STEMI. I work in the ER as their transport system for admits and transfers, so doc has me start paperwork to take the patient 38 miles up the interstate to our sister hospital for admit to the ICU.
Labs start coming back, and nurse does a double take. States that pt's troponin is 5.20, and lactic acid comes back at 11.9, pH is 7.32, and several other lab values for kidney and metabolism are out of whack. Doc immediately cancels me and asks the triage tech to contact a helicopter; Pt's bood pressure is now 110s and quickly drops into the 80s.
Doc hangs lopressor, BP drops further into the 60s before slowly starting to climb back up. Pt still combative and agitated, chopper has diverted for 50-car pileup on interstate for 2 trauma alerts and ETA is now 30+ minutes.
Pt suddenly vomits, does not even attempt to turn head to the side, and begins to aspirate. Stomach contents appear to be undigested beef stew (keeping in mind pt has not eaten at all this day due to OD). ER crew suctions and ventilates, preparing to intubate. Doc gets a difficult intubation with the Glidescope but manages to secure the tube and confirm placement. RT comes in with an NG tube and as chopper is now 10 minutes out, bag patient until they arrive and assume control of the patient. Call to flight time is an hour and a half. My drive time up to main campus is 40 minutes traffic speed.
The best we can guess, pt self-medicates for back pain, as the boyfriend told us there is some kind of metal implants in the back that the pt cannot go through airport security because of. We figure that he OD'd on the self medication and had a cascade reaction of kidney failure, cardiac muscle wasting, and rhabdomyolosis when he was brought out of it.
Anyone's thoughts? I'm far too ignorant to really understand what went on with this guy. My stepmum works in the ICU he was flown to, so hopefully in a couple days when she has a shift, I'll get an update on him (assuming he made it). Looking back on it, I realize what an absolute clusterf:censored: of a call this would have been, as halfway down the interstate he would have crashed and I would have been struggling by myself to get my partner to pull the ambulance over and come help me hang dope, then suction, then tube the guy on the side of the road.... Still, that's about a million times more exciting than stuff usually is at my job...
Any insight on the guy?
EMS brought in a ~58ish y/o C/m who was an OD; pt known to have methodone and codeine. Pt was cyanotic, unresponsive, satting in ~70s-80s on EMS arrival with obvious aspiration, last seen 2330 previous evening (EMS rolled in our doors at 1330). Pt given 2mg narcan on scene and transported. On arrival pt is satting in 80S, putting up a bit of a fight, but still generally comatose.
Pt is transferred into ER bed, blood taken, and 2mg more of narcan administered per MD. Pt is now screaming in pain, and only intelligable words are about back pain and that it hurts. Pt BP in 130s to 140s, tachy in 120s, still satting mid 80s with a non-rebreather that he is trying to pull off, saying he can't breathe. RR around 26. EKG taken is tachy but is insignificant for STEMI. I work in the ER as their transport system for admits and transfers, so doc has me start paperwork to take the patient 38 miles up the interstate to our sister hospital for admit to the ICU.
Labs start coming back, and nurse does a double take. States that pt's troponin is 5.20, and lactic acid comes back at 11.9, pH is 7.32, and several other lab values for kidney and metabolism are out of whack. Doc immediately cancels me and asks the triage tech to contact a helicopter; Pt's bood pressure is now 110s and quickly drops into the 80s.
Doc hangs lopressor, BP drops further into the 60s before slowly starting to climb back up. Pt still combative and agitated, chopper has diverted for 50-car pileup on interstate for 2 trauma alerts and ETA is now 30+ minutes.
Pt suddenly vomits, does not even attempt to turn head to the side, and begins to aspirate. Stomach contents appear to be undigested beef stew (keeping in mind pt has not eaten at all this day due to OD). ER crew suctions and ventilates, preparing to intubate. Doc gets a difficult intubation with the Glidescope but manages to secure the tube and confirm placement. RT comes in with an NG tube and as chopper is now 10 minutes out, bag patient until they arrive and assume control of the patient. Call to flight time is an hour and a half. My drive time up to main campus is 40 minutes traffic speed.
The best we can guess, pt self-medicates for back pain, as the boyfriend told us there is some kind of metal implants in the back that the pt cannot go through airport security because of. We figure that he OD'd on the self medication and had a cascade reaction of kidney failure, cardiac muscle wasting, and rhabdomyolosis when he was brought out of it.
Anyone's thoughts? I'm far too ignorant to really understand what went on with this guy. My stepmum works in the ICU he was flown to, so hopefully in a couple days when she has a shift, I'll get an update on him (assuming he made it). Looking back on it, I realize what an absolute clusterf:censored: of a call this would have been, as halfway down the interstate he would have crashed and I would have been struggling by myself to get my partner to pull the ambulance over and come help me hang dope, then suction, then tube the guy on the side of the road.... Still, that's about a million times more exciting than stuff usually is at my job...
Any insight on the guy?
