ALS-a-go-go!

"... Medic Local. 125 _____ Road, The Step Club, Chest pain, Trouble breathing. Ambulance XXX, Medic XX, Respond on Channel two."

I know exactly where the address is (I've lived here my whole life) and I know the Step Club is a meeting place and hangout for recovering substance abusers. It's right next to the grocery store and in the basement of the barber shop.

I'm assuming it's a heart attack but I'm also ready to be greeted by someone who's fallen off the wagon and making a scene (it's happened before).

We roll and, this time, my LT is driving. He's also in charge of the EMS side of things at my station so, I'm kinda glad he's along. I'll get to "strut my stuff."

We arrive on scene in 2 minutes and find a man being walked out to our ambulance by a friend. He looks like crap but he's walking, alert, oriented and answers my questions appropriately. I ask him if he can climb into my ambulance and he says yes. I'm prepared to help him up but he has no trouble. Good.

In the ambulance we get him situated and get his complaint:

"My heart's racing and I have a funny feeling in my chest."

"Does your chest hurt at all?"

"No, it just feels funny

I give the guy a full check out. The pulse oximeter(PulseOx) is showing he's got a pule of 114 and saturating at 99% on room air (no oxygen supply) and talking. I check his pulse manually and it feels strong but irregular. I look over at the PulseOx and compare what it's rhythm says to what my fingers tell me. The PulseOx clips onto a finger tip and reads the electrical impulses of a heart rate along with how saturated the blood's hemoglobin is. These are great things to know but they don't mean anything by themselves.

I notice that his wrist doesn't always pulse when the PulseOx is saying he should. He's dropping beats, or, his heart's not beating all the time. That would explain a "funny feeling" in his chest!

Otherwise, this guy is unremarkable. He's 49, healthy-looking, sober and has a good mental status. He says it all started when he was on the treadmill earlier that day. The rest of my exam reveals clear lungs, eyes: PERL (Pupils Equally Reactive to Light), skin: warm, pink and dry, no edema at the lower extremities and his carotid and distal pulses match in all 4 extemities. I take a careful listen to his heart in 4 places and it's giving me an unusual "harrumph" at the apical point that's faintly echoed at S2. Hmmmm.....

I look across the cot at LT. "Medic Status?"

He checks via radio and I hear they're about 3 minutes out.

"Medics? What's wrong with me?" asks the patient. He's worried.

"I don't know." I say honestly. "There's definitely something funny going on with your heart. The paramedics have much better equipment for looking at your heart and more advanced interventions if you need them. I'd be a lot more comfortable with them here."

"Oh, man. This is bad. I don't know what's wrong with me. I work out every day...."

He's worried and it's making him more anxious which is making his heart rate go up again.

"Look, you're about to be in an ambulance with 2 EMTs and 2 paramedics. If anything is going to go wrong, this is the best time for it, okay?"

"Okay." He's calming down again. I watch his pulse go from 105 to 88.

The paramedics arrive and climb in. I give my report to the lead medic. I tell him about the guy's pulse and the pulseOx reading on room air, the patient's family history of heart disease (brother and mother had heart attacks) and exercise intolerance(the symptoms appear when he exerts himself. I also tell him of the "Pertinent negatives:" No unusual lung sounds, No briuts in his carotid, no edema in the extremities, skin condition, etc..

The medic leans his head over to look over my right shoulder. I follow his gaze thinking someone got in the cab of the ambulance.

"Hm, I was looking for a paramedic patch on your shoulder but all you're wearing is a Basic patch. You don't sound like a typical EMT-B."

"Oh! Uh..thanks. I'm going to 'medic school" (I'm actually BLUSHING!!!)

"Really? Where?"

"Up at _______."

"Yeah, I've talked with ______ (My advisor) a couple times. I'm thinking of taking the management program there."

We turn our attention back to the patient.

"You remember your 12-Lead placement?" he asks me.

"Sure!"

"Great! there's the kit. Go to it!"

He directs his partner to start an IV line and, as I'm setting up the leads for the EKG, I notice she must be new at this. She doesn't warn the patient that she's going to stick him, she has a hard time finding the vein (She went for one she could see easily and it kept rolling away.) and once she's got the vein, the guy's bleeding all over the place because she forgot to take off the tourniquet.

Fortunately, she's paired up with a pretty squared away medic. He decides that we're taking the patient to a cardiac specialty center that's a longer drive than 3 other local hospitals. He's clearly more concerned about the patient than getting back to his dinner or TV show (There IS hope!). He also decides to ride in the back of my ambulance with me helping while his partner follows us in the medic unit.

On the way he takes a good 12 lead and 3 lead strips. He hands them to me for interpretation prior to saying anything and we discuss how it could or could not be a Type 2 Mobitz II AV heart block. He then asks me what drugs I would give this patient and the only one I can think of that was appropriate would be Aspirin. He's not in obvious need of Nitroglycerine (no chest pain), His pain and blood pressure don't indicate Morphine and I'd already started him on 15 liters per minute of O2.

"The aspirin is in the top of the drug box next to you. Go ahead."

He quizzes me some more. We talk some more. At the hospital, we hand off the patient, re-stock our rigs and he wishes me luck.

All in all, a very enjoyable call.

Up next:

Maddog rides the fire engine! Unresponsive patients respond!

Stay tuned!

--maddog