Friday, July 04, 2008

Gut feelings

My last post was about assessment. This one is about gut feelings. I get them. I know when I'm about to walk into something bad. And it's usually when I get it, very bad. I got it on the way to the Airport and when we walked in to a cluster of a cardiac arrest. (We brought him back, not only brought him back, but had him walking and talking, CAOx3 by the time we got to the hospital, they were doing CPR when we got there, he was D-E-D dead. and very much alive when we dropped him off at the hospital) I got one when we forced entry into a house and found a pt laying prone on the floor who looked up at us and took her last breath. I got one when I listened to that kids lung sounds from the last post. And most recently got one with a pt who called us after a syncople episode in his backyard. Pt was SOB and passed out. Even out in the heat pt was pale, cool and diaphoretic. You know how they teach that kis are either sick or not sick. Well this works on adults too. They are either sick or not sick. And this pt was very much sick. S-I-C-K. Cardiac sick. Pt had that look. Had a gut feeling. So pt got high flow O2, and a 12 lead. which came back normal. So pt got two more 12 leads 5 mins apart. Also normal. But something was not right. Pt was sick. Pt was hypoxic, fighting to breath. SPO2 was normal. But Pt was fighting the mask, and skin condiction never improved. Then as we were pulling into the hospital, pt respiration increased from 26 to 38. SPO2 dropped and near syncope. One more 12 lead. HUGE ST elevation in inferior and anterior leads with some slight elevation in lateral leads. The pt infarcted right in front of me. nearly arresting. I RAN him into the ER waving 4 12 leads in my hands. "Doctor! Doctor!, you need to come with me, He's literally infarcting right now! right as we pulled in. the bottom two are the first ones I did, the top one is the one I did right now like 30 seconds ago"

So gut feelings. Listen to them. They are normally right

1 comment:

Mackenzie said...

I google searched for "EMS Tattoo" and I came upon your journal here. You seem like a very interesting and confident person. I'm a brand spanking new EMT and spend most of my days stressed and scared shitless of something I did or am about to do. But I keep coming back. It's nice to know that at some point it becomes second nature. I'm glad someone is writing about EMS because few people truly understand the field. Keep on keepin' on Miss Medic.