Monday, November 12, 2012
911: unresponsive, breathing, has vomited.
Scene: Small house, Pt is in a small bed room, bed is against 3 walls.
General Impression: Older lady, not alert or oriented, pale, and covered in emesis.
Pt withdraws from pain. moving only the left side. At this time both pupils were equal but nonreactive.
Pts family says she went to ER recently for high blood pressure, over 200 systolic.
Rescue got a weak carotid pulse. We poked her and got 202 for a sugar, We pulled her out and my medic and I carried her out of the house and put her on the stretcher. we moved to the truck so we could work. I put in a nasal airway and started bagging. As soon as i bagged her a few times and she got some O's she started maintaining her airway. I bagged a few times then set up the 4 lead while medic started a line and finished the 12 lead. tried to insert an oral airway but she had a active gag reflex.
Monitor had sinus tach, 130-140, BP 161/117, O2 Saturation at 96% on 10 liters while being bagged. Crackle in lower left lobe. Glucose 202
Rescue drove code 3 to ER. We got her into the ER, while I was still bagging her. Moved her over to ER bed, PA decides to RSI her, and the beautiful thing is this RSI was ACTUALLY RAPID! By the time the Resident walked from the providers office to the room the nurse had all the drugs drawn up, respiratory had the vent and such ready on stand by. we were still bagging her to hyper oxygenate before they tried to tube her. finally everyone's in place. The resident goes for the tube. everything is going well, shes talking herself through the whole thing. "Blade in place, chords visualized, I need suction." But they forgot to turn on suction so I got the honor of "saving the day" she was suctioned and intubated. Then rushed to CT while I cleaned up our truck... and it was bad.
When CT came back they found she had a massive hemorrhagic stroke during the night. I wish I could have got a picture but that wasn't an option. about a quarter of her right hemisphere was completely white. the veins were completely collapsed and gray matter was pushing across the center line.
They called the neurosurgeon at the major hospital in Maine and they said not to attempt transport. there was to much damage.
This is my first MAJOR medical call. I wish I had done better at something, but over all the call didn't go bad. If we had got to her sooner we might have been able to save her but it had been hours since it started.
National Registry Paramedic with hope of becoming an ED intensivist. I love what I do and have fun doing it. I enjoy reading and listening to #FOAMed by the many people smarter than I am. I enjoy blogging, podcasting, making videos, and spending time with my lovely wife on the beach.