I really had no desire to come to work tonight. I spent the morning at the District Courthouse and didn't get to spend much time with my family today which made me unhappy. I arrived at work feeling like I needed to have an easy day and spend my time getting projects to points where they could be shelved for the week while I am on vacation next week.
It wasn't going to happen that way though. I came in to a storm of problems that needed immediate attention. Right away I had to deal with access problems with our computerized PCR. We have an online PCR that is mandated and provided the state and our billing service is able to directly download our data directly into their billing systems. Unfortunately today they found that they were not downloading our data but data from one of the fire departments we respond with. Some investigation on the part of our general manager and the Bureau of EMS showed it to be a problem with the way the billing company's access was originally set up. I spent an hour back and forth between the billing company and the State trying to get the problem resolved.
FedEx then dropped a package in my lap which led to the next couple hours being filled with work. We use cellular phones to transmit 12 lead ECGs to our receiving hospitals to give them a heads up of patients that might need the cath lab to be activated.The system we have in the receiving hospitals is really antiquated. We use cell phones that depend on technology that the FCC has told the cellular companies that they did not need to support beyond January 2008. Here we are 2 1/2 years later still depending on this technology that allows us to dial into the US Robotics 14.4 baud modems at the hospitals to send the 12 leads. The major problems is that cell phones that are able to do this are few and far between and getting fewer as time goes on.
In the past 3 weeks the crews managed to lose one phone and break another. Fortunately for us, even though the phone is no longer manufactured, our rep was able to locate a pair of phones for us and ship them out. I spent a couple of hours activating and configuring the phones and started the process of mating them to the bluetooth modules in our Lifepak 12s. I didn't get to finish so I have at least one task for tomorrow already.
I didn't get to finish the task because I was interrupted by dispatch sending me to intercept with the ambulance in a neighbouring town for a patient with chest pain. The dispatch sounded pretty promising, chest pain radiating to the jaw, back, and arms, nausea, difficulty breathing, sweaty, and grey. I arrived on scene a couple of minutes after the first responder and before the ambulance. The first responder called me on the radio to make sure I was bringing in my monitor, I already had it in hand as well as my ALS bag and drug kit.
When I entered the room I saw a heavy set middle aged man, ashen, sweaty, seated in a chair. He already had oxygen in place and vitals sings were underway. I set the monitor down and started to put the leads on to get a 12 lead ECG. I got the limb leads on just as the patient went unresponsive and stopped breathing. I quickly looked at the monitor while I was opening the defibrillation pads and slapping them on the patients chest. Ventricular fibrillation, I charged the defibrillator, cleared everyone off, and deliver one shock. Right after the shock the two of us grabbed the patient and brought him to the floor and CPR was started. Less than 30 seconds later we stopped CPR, not exactly what the protocols tell us to do but when the patient started talking we decided it was time to stop.
Excellent! We secured the patient to a backboard just to put handles on him and carried him out of the house to the stretcher and off to the ambulance. I did a quick 12 lead ECG and started transmitting it to the ED even before I looked at it. I looked at the 12 lead while I was getting ready to start the line, Sinus with lateral and septal ischemia. During the course of the transport we managed to get one line started, he was a terrible stick, get him some lidocaine (a rhythm stabilizing medication, Zofran (an anti-nausea medication), and another 12 lead that showed the same thing.
As the crew pulled the stretcher form the back the patient went unresponsive again, more Ventricular Fibrillation, I told the crew to drop the wheels and let go of the stretcher and delivered another shock when they were clear. By the time we hit the ED room the patient was talking again.
The ED doc and the cardiologist were pretty happy with our treatment and the patient was on the way to the cath lab 10 minutes after he came in.
I had mixed feelings about the call, I was exceedingly happy that we had s significant intervention with what looks very promising for a good outcome. I was less than happy with my own performance, I had terrible time with the IV and just felt off balance through the entire call. I can't help but wonder if it is a result of dealing with a call volume probably 10% of what I used to do before I moved. I need to deconstruct the call and see what I needed to do better and work out some ways to remediate myself.
Still, I made a difference tonight and that makes it all worthwhile.
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