Television shows would have you believe that ambulance crews spend
their days pulling one life after another back from the maw of death,
rushing from rescue to rescue in between bouts of supply-room sex with
hollywood-gorgeous members of the opposite sex. The reality is sadly
less interesting. Most of our calls are little more than expensive taxi
rides. Few of our patients need anything more than a lift. Few of us
are hollywood-gorgeous, and the supply room contains an abundance of
spiders and a lack of places suitable for love-making.
Still,
we sometimes get to do things that approximate life saving. A month or
two ago, we were called for a man down at a local factory. It was
early summer, just starting to get really warm, and factories tend to be
hot and poorly ventilated. As we went en route, I reviewed treatments
for heat exhaustion and dehydration. Of course, diabetes was another
possibility, and I reminded myself to grab the glucometer and some
dextrose.
We were met at the gate by a manager, who
explained that the patient, a man in his 60s, had suddenly collapsed.
"What was he doing before that?" I asked.
"He was just cleaning up when he grabbed his chest and fell down," the manager replied.
"He
grabbed his chest? Does he have heart problems?" The manager says
none that he's aware of, but I'm already shifting to double-time
movements. I snatch the cardiac monitor out of the truck and speed walk
inside. There, I find the patient laying on the ground. He's awake,
but pale and diaphoretic (sweaty.) It's not all that hot in the
factory, but his chest is so sweaty that I have trouble getting the
monitor leads to stick. When I finally do, I'm initially confused by
what I see on the monitor. Heart attacks usually show up on an EKG in
the form of ST segment elevation. Essentially one part of the QRS
complex, that squiggly line that represents the heart's electrical
activity, is higher than the rest. This man's ST segment is so elevated
that I initially have trouble figuring out which part of the complex is
which. After a few seconds, my brain engages, and the readout resolves
into a complex that screams 'heart attack.'
Several
EMTs and firefighters have arrived, and my partner asks what I need.
"Load and go. Let's get him in the truck now. I'll do the 12-lead
there." If we were moving at double-time before, we're now in a full
sprint. We scoop the patient up, put him on the cot, and move him to
the ambulance. On the truck, we move even faster. My partner hooks up
the 12-lead (a more detailed EKG), and I start an IV and give nitro and
aspirin, followed by Fentanyl. The 12-lead prints, and I examine the
tracings before looking at the machine's diagnosis. For once, the
machine and I agree. It's a STEMI, medical speak for heart attack.
Kevin jumps out, speed walks to the driver's seat, and we pull out with
the sirens screaming. In back, I recheck vitals and prepare another
round of medications. I grab the phone, hit the speed dial for the
local hospital, and clamp the phone between my ear and shoulder as the
ambulance rocks side to side, speeds up and slows down. I tell the
nurse on duty what I'm bringing in. My usual laconic phone manner is
gone, and I'm rattling off vital signs and medications in the same way I
used to call out fire mission information in my days as a Marine
artilleryman.
Moments later, we pull in to the
hospital. We wheel the cot in, and the hospital staff quickly sets up
their own EKG, and draws blood. The local hospital doesn't have a cath
lab, and I step out and visit the bathroom, knowing we're going to be
taking the patient down the road to a bigger facility. By the time I
come back, the doctor has confirmed my diagnosis. The patient has never
even left our cot, and we wheel him back out to our truck.
Over
the next forty minutes, I'm busy with medications and monitoring. I
contact Midtown hospital and call a Code STEMI, alerting them that the
cath lab needs to be up on running on our arrival. When we arrive at
Midtown, the cardiologist and cath lab nurses are waiting for us at the
ER door. We don't break stride, and I hand the EKG print outs to the
doctor and give my report as we speed walk to the cath lab. Moments
later, our patient is on the table, and Kevin and I are making up the
cot and getting ready to return to the station.
A few
hours later, I call the hospital for an update. Our patient is doing
well, and expected to go home in the next several days. At the
beginning of my next shift, I find an image of the patient's heart and
the cath lab report on the day room table. The left anterior descending
artery had been totally blocked-not only had the patient had an MI, he
had one of the worst ones possible. But he survived. Sometimes you get
a good save. But there's still no sex in the supply room.
