A Medical Experience

It was the end of a normal day at the station.  The medics are just getting to bed

after running a half a dozen calls for an assorted minor medical and trauma problems.  The

paperwork was finished.  The reports were entered into the computer.  The truck was

even restocked.  They were just about into dreamland but, as with most nights at this

particular station,  sleep was not to be.

Several miles away, in a small, well kept apartment, Angie Briggs, a

eighty-year-old woman awoke to the feeling that the life-giving air was being denied to

her.  She tried to sit up, but the feeling would not subside.  Walking made it worse.  She

also noticed that, even though the temperature in her room was comfortable, she was

dripping with sweat.  The longer that she waited, the harder it became to breath.  So,

realizing the fact that her doctor was probably asleep, she did the next logical step, she

called her daughter, who lives in another state.  The daughter realized that her mother

needed more help than she could give over the phone, tried to persuade the mother to call

an ambulance, which, of course, the mother refused to do, stating that it wasn't necessary.

The daughter then took it upon herself to call EMS from her own house.

The medics were notified of the problem through the usual method, a series of

tones over a radio that cause a loud horn to blare and all the station lights to come on,

much to the annoyance of the fire lieutenant.  This alarm was immediately followed by the

dispatchers voice giving all the applicable information on this call.

"Med unit 2, respiratory call, 103 Royal Terrace Boulevard, apartment 7, in

reference to a 80 year old woman with shortness of breath."

Not that the EMS crew were listening at this point.  They are busy getting into

their jumpsuits and putting their boots on.  It does not matter if they are eating, sleeping,

watching TV, or even taking a shower, they are required to be in the ambulance and en

route to the scene within two minutes.

"Med Two's en route."  Stated EMT Jennifer Meyers in a sleepy voice

" Copy med 2 is en route to 103 Royal Terrace Blvd., apartment 7."  Now they are

listening.  "This is in reference to a 80 year-old female who is in severe respiratory

distress.  Received the call from her daughter that is out of state.  Patient sounds very

short of breath."

"Copy"

"I'm pretty sure that it is in the first entrance into the apartment complex.  Should

be the third or fourth building on the left", stated Doug Murphy the paramedic on duty.

It took only a few minutes for the ambulance to arrive at the scene.  After dispatch

was informed of their arrival, Doug and Jennifer removed the stretcher that was already

loaded with the monitor, the airway bag, and the med box. As he approached the front

door, Doug took notice of the condition of the walkway, of the location of the bushes, and

any outside furniture that might impede exiting the house with a stretcher loaded with a

person.  He did the same quick evaluation upon entering the residence.

After knocking, an elderly, heavy-set woman opened the door.  The medic could

see immediately that she was is serous trouble.  Her clothes were soaked, wet with sweat,

every time she took a breath, a faint popping sound could be heard.  The medic also could

see the front of her neck pull in along with every breath and that her general color had a

faint, matted bluish color about her.  Doug knew that without immediate treatment, this

lady would die.

Doug quickly lowered the stretcher and took the equipment off of it.  "Why don't

you sit right here."  Doug told Mrs. Briggs

" I'm fine, really.  I told my daughter that I would see my doctor in the morning.  I

don't know why she called you?" Mrs. Briggs stated.  The medic was surprised that she

could talk at all.

"When did you start having trouble breathing?"  Doug asked as he was turning on

the oxygen bottle

"About an hour ago.  I woke up and couldn't catch my breath." Pointing to the

oxygen mask that the medic was placing on her face.   "I really don't need any of that."     

  " I think you do.  You need to let me do my job and treat you.   This condition will

only get worse."

"No, I think I'll wait till the morning."

"Listen, you don't have until the morning.  To be perfectly blunt, I doubt you have

a hour.  You need to let me treat you now.  Your lungs are full of fluid."

"How do know that?"  asked the patient.

"I can hear it, even without my stethoscope." retorted the medic.  " I can take care

of this problem with medicines, but I need to do it now." Looking at his partner.  "How's

the blood pressure?"

The medic's partner had been busy taking the patients blood pressure and pulse,

and was now in the process of applying the electrodes on the patients chest for the

monitor.

"180/90, pulse 100 very irregular." came the reply.

While his partner began to set up the IV bag, the medic finished putting on the

monitor leads.  After he turned the machine on, he then began listening to the patients

chest, carefully listening to each lobe of the lungs, trying to judge just how far the

crackles, or rales, go up into the chest.  This allows him to determine how full of fluid

Annie's lung were.

"Your lungs are three-quarters the way full." Doug then took a look at the

monitor.     "Do you usually have skipped heart beats?"  questioned the medic.

"Yeah, it's been like that for a while."  answered the patient.

 He then asked the patient.  "Have you ever had an IV before?"

"Yes. Do I really need one now?"

"Yes ma`am, you sure do." answered the medic.  A rubber tourniquet was placed

around the patients arm tight enough to stop the return blood flow, or venous blood but

not too tight enough to cut off the arterial blood flow.  He then looked for and found a

vein in her wrist, prepped the site with alcohol, and stuck a needle that was covered by a

thin catheter into the vein.  After he removed the needle, leaving the plastic catheter in the

vein, he took a sample of blood from the site and connected the IV line.  He then released

the tourniquet and opened the IV line to make sure he had a good flow.  The drip rate was

set so it would only drip once ever few seconds.  After he taped the line down to the

patient's arm, he finished this particular procedure by making sure that all the dirty needles

were safely placed in a sharps container.  He didn't want any accidental needle sticks.

            "Ma'am, are you allergic to any medicines that your aware of?"

"No, not that I can think of."

"OK, This is what we are going to do.  First, I'm going to give you some Nitro

with a spray.  What I need to you to do is open your mouth and put your tongue at the top

of your mouth"  Stated the medic.

Mrs. Briggs complied, almost.  She opened her mouth and kept her tongue at the

bottom of her mouth.     "Tongue up." The patient complied. 

"Good, now take a breath in."  When she did, the medic sprayed the Nitro into her

mouth.  Having her inhale when he sprayed the Nitro kept it from going back into his face. 

Talking  to the patient "Ma'am, I'm going to give you some Lasix though the IV

line.  Hopefully, it will pull some of that fluid out of your lungs and back into your

bloodstream.  Is that oxygen helping?"

"A little."

"Good" The medic replied.  He then proceeded to slowly give the Lasix.  The

standing orders that he works under (after all, a non-physician cannot give medicine

without a physician willing to assume responsibility for it) allows him a dosage range up to

80 mg. for Lasix.  If the patient was not in such distress, he would have opted for double

of the home dosage.  However, this time he chose for the full eighty.

After being secured in the ambulance, Jennifer went back to make sure that the

residence was locked up.  Doug then retook the patients  blood pressure (which had not

changed) and listened again to her chest, detecting a slight clearing of the lungs.

"Ma'am, I need to ask you again if you are allergic to any drugs."

"No, I'm not."

"Have you ever taken Morphine before."

"No, why?"

"Because I'm going to give you some in a minute"

"Why?  I don't hurt anywhere."

"We're going for another effect that it has.  It helps pull that fluid out of your

lungs."  Seeing a look of confusion in the patients eyes, Doug asked  "Do you understand

what is happening?"

"No"

"For some reason, your heart cannot keep up with the flow of blood coming into

it."  The medic explained as he drew up the Morphine from the vial.  "When this happens

to the left side of the heart, the blood backs up into the lungs, causing the blood plasma to

leak into the tiny air sacs in your lungs.  This is what is causing you to be short of breath

and to have that crackling noise when you breath.  All the medicines I am giving you cause

your blood vessel to dilate, or get bigger.  The Nitro causes this all over the body.  The

Morphine does it in the arms and legs.  And the Lasix pulls it out of the body by making

you have to pee a lot.  The Morphine will also help you to relax somewhat.  Just let me

know if you start felling nauseous."  Doug took a alcohol wipe and cleaned the injection

port of the IV tubing, then inserted the syringe's needle into the port.  "I'm giving you the

Morphine now."

By this time, Jennifer had finished locking the apartment.

"You all set?" She asked, sticking her head in the back of the truck.

"Yup, let's go."

On the way to the hospital, the patient started improving; her blood pressure and

pulse were going down, and the patient was breathing a lot easier.  The rales were even

noticeably diminishing.  The medic had called the hospital over the radio notifying them of

the patient that he was bringing in and her current condition.  The patient, due either to

her finding it easier to breath or due to the Morphine, began talking.

"How long have you been a fireman?" The patient asked

"Never have been, I'm a paramedic."  The paramedic retorted.  "We have a dual

system in this county.  We work with and are stationed with the fire department, but we

are under a different chain of command."

"What does that mean."

"I don't put out fires, they don't give people needles."

By the time that the ambulance got to the hospital, the patients lungs were almost

clear of any rales that the medic could hear.  And, as expected, the patient requested a

bedpan as quickly as possible.

"Which room would you like us in."  Doug  asked a nurse.

"What'ch ya got" came the reply.

"Heart failure."

"Room 10 will be fine."

"Thanks." responded the medic as he wheeled the patient into the treatment room.

While the nurse went to get her paperwork, the medic and his partner lifted the patient

onto the hospital stretcher, transferring the oxygen tubing