"Imagine running a 1/4 mile sprint, as fast as you can, while breathing through a drinking straw"
The call went out as a severe asthma attack. We arrive on scene to find the patient sitting on a couch in the lobby in the "tripod position" and struggling mightily to breathe. The tripod position is where a person is sitting, leaning forward and their two arms are extended down and in front of them so their body and arms make a tripod. This is a common position that people take when they're having trouble breathing.
That night, Shannon drove and Sonja rode in the back. They're both experienced EMTs. Shannon works for a transport company as an EMT-B. The patient responds to my voice but can't do much else. Her initial blood oxygen perfusion is at 72% and her pulse is 124. Yikes! We get O2 at 25 lpm via a Non-Rebreather Mask. I listen for lung sounds as she's breathing and I hear nothing. No air moving at all.
The boyfriend states that she had just taken her inhaler and she takes steroids for her asthma too. Last dose on the steroids was that morning. I call for Shannon to get the stretcher and start putting a BP cuff on her (knowing full well her blood pressure's going to be very low) when the medics arrive. Phew!
We move her to the stretcher, They give her an injection of Epinephrine and we keep the O2 going. Her blood oxygen is now up to 82%. At this point the patient is starting to look like she's having seizures. She's got some frothy blood at her lips and she's thrashing around a bit. Sonja is trying to get information from the boyfriend but he's on the phone walking next to the stretcher. I look at him and say. "Sir, you need to hang up the phone and talk to my partner."
"But I'm talking to her mother." he says, pointing to the patient.
"Your girlfriend needs you to talk to my partner right now. That's more important that talking to her mom."
This guy's an off duty police officer. He's doing his best to stay calm and the presence of 5 people in uniform is helping. He gets it. His focus goes from over my shoulder to my face. He says, "I'll call you back," snaps the phone shut and goes over to Sonja.
We load the patient into the back of the medic unit. Shannon's going to drive their unit, Sonja's going to be an extra pair of hands and I'm left with an ambulance and no driver. I call the station and they send someone out.
The medic unit hasn't rolled yet so I hop in the back to see if I can help. The boyfriend has been installed in the front of the ambulance where he can't get in the way. I see the patient's condition has deteriorated quite a bit. One of the medics is trying to run an intubation tube through her nose and keeps getting her stomach. The other one is trying to get an IV started. Sonja is bagging the patient to assist her respirations and the patient is starting to thrash around. They need a bit of help.
I start the suction unit and get it to the Medic working the intubation. He thanks me and uses it to clear her airway that has now become a bit gunky. I then help the other medic secure the IV he finally started on the patient's ever-swinging arm. I then notice that Sonja's bagging the patient pretty fast. I remembered an entry by MedicMom where thinking about her blog made her re-assess her respiration rates. I told Sonja to slow it down a bit and her focus shifted from trying to get a mask seal to paying attention to the patient's breathing effort. At this point, the patient's blood oxygen level is down to 52% but I'm not sure if it's accurate as the patient keeps knocking off the sensor.
They decide to roll. I hop off and put my ambulance back together as I wait for my driver. In about 5 minutes the utility truck shows up with Thumper (previously referred to as "H"). I call her Thumper because she reminds me of all the good spirit in thumper in the movie Bambi. She's about 5 feet tall, qualified to do just about everything at the firehouse, finished her Undergrad in 3.5 years and is going to veterinary school in the Fall. Pretty awesome.
We get to the hospital in time to meet the medics on their way out. Sonja told me that the patient was doing a lot better. The paramedics spent a good 5 minutes going over the whole thing with us. As I was riding to the hospital with Thumper, I realized I should have put her on the stretcher right away, put a nasopharageal airway in and bagged her to assist respirations. I brought this up to the medics and they agreed that it would have been a good idea if I had the time. They were only 3 minutes behind us.
One of them said I should have hit her with an Epi-pen auto-injector. We just recently started carrying them on our BLS ambulances and It didn't even occur to me. Of course, after the fact, it made perfect sense. We talked a bit about asthma. It was amazing how easily it could have killed this woman. One of the medics said, "Imagine running a 1/4 sprint, as fast as you can, while breathing through a drinking straw." Ugh! I asked the medic a few questions about his airway management, the Nasal intubation and about what he did after I left the ambulance. It was pretty cool. I'm pretty excited about begin a medic. I gotta watch the "Hero worship" thing, though. Pretty soon I'll be asking for autographs. Heh heh.