Ms.Medic
Forum Captain
- 251
- 1
- 0
So its 11pm, I was riding my first paramedic shift for the service Ive worked as a basic in for a few years. I had my paramedic partner with me, along with a basic. We were dispatched to a call where the dispatcher stated the caller was a 76 y/o m stating he "was having a heart attack". My paramedic partner looks at me as we were walking in and says, "its all you girl, Im not even here". Holy crap, now Im about to be the one in cardiac arrest. Anyway, I walk in and the woman says he was in the bathroom having "loose bowels". I knock on the bathroom door and ask him if he is okay, he says he'll be right out. He walks out and immediately I could tell he wasnt lookin good. He looked sick. So my findings and treatment are below, and this being my very first als call to do by myself, I want you guys to look over it and see what I could have done better, or differently, or anything that would be some neat advice.
Initially: We walk into the call with cardiac on the brain, but not ruling out anything.
BP 108/52 manual 110/48 auto
PR 68
rr 16
SPo2 97 placed on 15lpm via NRB
bgl 119
lung sounds clear
3 lead occasional PVC's
12 lead NSR
etco2 36
hx=htn x2 yrs, 6 months ago had a ct scan due to possible stroke, but no diagnosis/findings to suggest a stroke, no cardiac hx at all
meds=lisinopril, trazadone, asa
Physical/mental assessment= EXTREME diaphoresis, pale, cool, A+Ox4, neurological exam= perfect
Okay, we let dispatch know we were out with one stable patient, and would advise on transport decision asap
As I continue my assessment, and reassessed vitals approx 3-5 min later, things started to change:
BP 114/58 manual 114/64 auto
PR 76
rr 18
SpO2 97 O2 same
12 lead, NSR
etco2 38
A+Ox4
When assessing his pupils again, I could see a slight sluggish response on the right, but very slight, I had to look 6 times before making my decision that yes, for sure there was a slight sluggish response, I check for neuro deficits, again VERY slight weakness on left side. HOLY CRAP, now Im kickin it into oh :censored::censored::censored::censored: mode, there is an onset of a stroke happening right before me. How neat is that. I start explaining to the patient what I feel is going on and that time is everything when dealing with a stroke, and that I really would appreciate it if he would let me put him on a helecopter to fly him downtown, but that it also could be nothing, at least it would be "peace of mind". The man was very calm, very appreciative, and accepted my suggestions. I get on the radio and call for county to dispatch phi, we load him into the back and head for the airport. I work in a very rural area, and the closest appropriate facility is Hermann Memorial downtown. We were also in an area that no aircraft would be able to land in (trees everywhere), but anyway, in route I start bilateral IVs, explain to the patient what was about to take place, and then I reassess his neurological deficits, heres what I find:
A more defined sluggish right pupil, more defined left sided weakness, a right side facial droop ?.? unexplainable. I tell him to stick out his tongue and it deviates to the right side, BP is now 149/62, PR is 82, and now the patient is starting to repeat himself, and is slow to respond to questions, looking a little confused on how to answer me. HOLY CRAP. This is awesome, not for the patient, but for me to get to witness and treat. The flight crew is here now, I give him the report,and send them on their way.
The flight medic that was on the aircraft also works for us part time, so when he got the report he called me and told me that when they did the scan, the found a bleed on the right, but closer to the middle, parietal lobe of the brain. Very small, very deep in the brain, but it was definately there... WOW.
Its not very often that you get to witness the onset of a stroke like that and watch the detioration, in 7 years, Ive never been able to, but that was absolutely amazing to watch and treat, not that there was much I could do for him, but I did however get to recognize it and get him to an appropriate facility well within our 90 minute range. He was at the hospital in approx 50 minutes from onset.
Given the info, I was wanting to know from you experienced guys, what could I have done, assessed, or treatment wise, done differently. I think I did well, but theres sometimes a lot of things you could have missed doing that would have helped, or thought about something else too. AND, I also wanted to share a really neat call with you.
Initially: We walk into the call with cardiac on the brain, but not ruling out anything.
BP 108/52 manual 110/48 auto
PR 68
rr 16
SPo2 97 placed on 15lpm via NRB
bgl 119
lung sounds clear
3 lead occasional PVC's
12 lead NSR
etco2 36
hx=htn x2 yrs, 6 months ago had a ct scan due to possible stroke, but no diagnosis/findings to suggest a stroke, no cardiac hx at all
meds=lisinopril, trazadone, asa
Physical/mental assessment= EXTREME diaphoresis, pale, cool, A+Ox4, neurological exam= perfect
Okay, we let dispatch know we were out with one stable patient, and would advise on transport decision asap
As I continue my assessment, and reassessed vitals approx 3-5 min later, things started to change:
BP 114/58 manual 114/64 auto
PR 76
rr 18
SpO2 97 O2 same
12 lead, NSR
etco2 38
A+Ox4
When assessing his pupils again, I could see a slight sluggish response on the right, but very slight, I had to look 6 times before making my decision that yes, for sure there was a slight sluggish response, I check for neuro deficits, again VERY slight weakness on left side. HOLY CRAP, now Im kickin it into oh :censored::censored::censored::censored: mode, there is an onset of a stroke happening right before me. How neat is that. I start explaining to the patient what I feel is going on and that time is everything when dealing with a stroke, and that I really would appreciate it if he would let me put him on a helecopter to fly him downtown, but that it also could be nothing, at least it would be "peace of mind". The man was very calm, very appreciative, and accepted my suggestions. I get on the radio and call for county to dispatch phi, we load him into the back and head for the airport. I work in a very rural area, and the closest appropriate facility is Hermann Memorial downtown. We were also in an area that no aircraft would be able to land in (trees everywhere), but anyway, in route I start bilateral IVs, explain to the patient what was about to take place, and then I reassess his neurological deficits, heres what I find:
A more defined sluggish right pupil, more defined left sided weakness, a right side facial droop ?.? unexplainable. I tell him to stick out his tongue and it deviates to the right side, BP is now 149/62, PR is 82, and now the patient is starting to repeat himself, and is slow to respond to questions, looking a little confused on how to answer me. HOLY CRAP. This is awesome, not for the patient, but for me to get to witness and treat. The flight crew is here now, I give him the report,and send them on their way.
The flight medic that was on the aircraft also works for us part time, so when he got the report he called me and told me that when they did the scan, the found a bleed on the right, but closer to the middle, parietal lobe of the brain. Very small, very deep in the brain, but it was definately there... WOW.
Its not very often that you get to witness the onset of a stroke like that and watch the detioration, in 7 years, Ive never been able to, but that was absolutely amazing to watch and treat, not that there was much I could do for him, but I did however get to recognize it and get him to an appropriate facility well within our 90 minute range. He was at the hospital in approx 50 minutes from onset.
Given the info, I was wanting to know from you experienced guys, what could I have done, assessed, or treatment wise, done differently. I think I did well, but theres sometimes a lot of things you could have missed doing that would have helped, or thought about something else too. AND, I also wanted to share a really neat call with you.
