The night started out pretty crappy, the ED was busy, we were short people including no ED Tech which left me doing all the patient moving and such. The first couple of hours involved nothing that even remotely resembled paramedic level work.
Things did pick up for a little while when a patient walked in with chest pain. I pushed his wheelchair from triage to one of the trauma rooms and found his story to be very suspsicious. Sudden onset while watching TV. High cholesterol and hypertension history. Mid-sternal chest pain with a heavy, pressure feeling in his neck, jaw, and left arm, mild shortness of breath, nausea, diaphoresis. It was a good story and a good presentation. His first ECG didn’t look too bad but one done just 5 minutes later looked significantly worse. One of the nurses and I “team tagged” him and in a very short time managed to get three IV’s, a full set of blood work, serial ECG’s (showing ischemia in the anterior and lateral portions of the heart) nitroglycerin, both sublingual and IV drip, aspirin (4 baby aspirin, chewed, not swallowed), oxygen, morphine, Lopressor (a beta blocker to reduce the workload on the heart), Zofran (an anti-nausea medication), a bolus of heparin (to thin his blood), Integrilin (a medication to make is blood “more slippery”), the cath lab team activated and in, the patient undressed and prepped for a trip to the cath lab, the paperwork done, and the patient with pain dropping from 10/10 to 1-2/10. Total time from triage to turn over to the cath lab team? 38 minutes. I thought that was pretty good and I felt pretty satisfied and downright happy to have been involved in a significant intervention.
Later in the evening we would learn that the patient had done really well in the cath lab with two blockages cleared from the blood vessels on his heart. No stents could be placed due to the location of the blockages near areas where the blood vessels divided but still, an MI was stopped and further damage prevented. Mission accomplished in my book.
Even later in the evening I would learn that the cardiologist (a man who is a legend in his own mind) felt that our times were too long and we should have been able to get him into the cath lab at least 10 minutes earlier. “The ER still needs to get their act together for these kinds of patients” was the comment he made to the ED attending physician. He neglected to mention that if we had had the patient ready 10 minutes earlier the cath lab team would not have even been in the building but, well, lets not get bothered by the details shall we?
The remainder of the night was spent doing the usual lock and lab slave accompanied by all the jobs that the ED Tech normally would have done. By the end of my shift I was pretty tired but still felt that the one significant intervention I had been involved in had made the night a more positive experience than negative. I really like it when I get to do things that a paramedic is good at and make a difference.
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