Alive:Improved

The call goes out as "Trouble Breathing"

CC-Rider and I are together again. Our driver, SmokeyJoe, is a recent Paramedic who's still getting his ride time in. He left the USMC and started paramedic school when he was 32. (Sound familiar?)

CC-Rider says to the both of us, "This is your call! I'm driving!" She clearly has much faith in us.

The "trouble breathing" is a woman sitting on the floor in the open front door of her house when we arrive. Her face, lips and neck are about twice the size they should be and she speaks to us in a pattern like this:

"I...GASP...ate...GASP...a...GASP...pistachio...GASP..." (you get the picture).

"Ma'am, are you allergic to anything?"

"Yes...GASP..nuts...GASP!"

I look at SmokeyJoe over the top of my glasses and see his eyebrows do their best to meet his hairline.

Ooooookay! it's GO TIME!

I don't need my stethoscope to tell me that she's closing up. From a foot away I can hear a noise like "HeeeeEEEEEEP!" every time she breathes in. My stethoscope does tell me that she's not moving any air in her lungs other than the very center of her chest. Basically, this means that her allergic reaction is causing the muscles around her bronchioles (the smaller pipes that lead from your windpipe, or bronchia, to the business parts of your lungs) have all squeezed down really hard and are blocking any air from getting to the parts of her lungs that will enable her to get oxygen into her body and carbon dioxide out.

This is what we call, "bad."

Her husband hovers nervously in the foyer. SmokeyJoe and I waste no time. We practically fling her onto our cot, dash the 10 yards to the medic unit and load her up. CC-Rider is already there and bobs her eyebrows at me, asking what to do.

"Epi, IM." I tell her, indicating her to inject 0.3mg of epinephrine into my patient's arm muscle. This is a pretty cool drug. The paramedics in the UK accurately call this drug adrenaline. That's what it is. It's the thing that makes your lungs open up, heart race, blood vessels constrict and dries up any secretions in your mucous membranes. (Pseudo-ephedrine, or sinus medications is a form of this). The dose we give people having allergic reactions (anaphylaxis) is, for the human body, HUGE!

It works quickly and very well, however, it just buys us time. It'll probably wear off before she's done having an allergic reaction. SmokeyJoe tries and fails to get an IV line on twice. I tell him to start a neb of albuterol. This is a drug that acts directly on the aforementioned bronchioles and cause them to open up. We deliver it by nebulizing it so the patient breathes it directly into the lungs (quickest way to get it where it's needed).

Meanwhile, I drop the IV perfectly into the patient's left arm. This is significant in that it's my first successful IV in over a year (not a lot of chances to start one when you're a teacher) and I was nervous that I had "lost" my skills. CC-Rider jumps in the driver's seat and we roll. Our patient is breathing easily and has the hyper, nervous laugh that comes with getting jacked up with more adrenaline than your body can make in an hour.

She's not the only one breathing easier. SmokeyJoe and I are already confident in the fact we had a "save."

What I mean is, had we not arrived (or arrived late) this one would have closed up and suffocated. She'd be dead at age 33 and her husband would be a lost and confused man, having watched his young wife die before his eyes.

We turn her over to the friendly staff at the local hospital and in the part of my paperwork that says, "Condition of Patient Upon Arrival at Destination:" I gladly choose "Alive:Improved."

Life? It's good.

--maddog

Epiloge: I saw her a few hours later when we brought another patient at the same hospital. The sight of her happy (normally sized) face made up for the "died-despite-all-we-did-and-we-did-it-right" condition of my current patient.