True Life is Stranger than Fiction

True stories from the ER, and the streets of EMS.

Tuesday, May 30, 2006

An enigma, wrapped up in a puzzle, wrapped up in a conundrum

I ran w/MedicJon ("Hazbulance") Sun. and we ran a doozy of a call (as you can surely tell by the title of this post).
We got a call for an Unconscious at a nearby hotel. We get there and find a lady who is semi-conscious, laying on the bathroom floor in a pool of her own urine. The type of semi-consciousness we witnessed would not be inconsistent w/someone who had low blood sugar or was postictal, or maybe had ODed on Opiates. There was Insulin and liquid Methadone in the hotel room. Her blood sugar was normal so we pretty much put our stock in the Opiates.
We dragged her out of the bathroom and loaded her up on our cot. She was with it enough to swat at us w/her arms, but not w/any accuracy. She was also, for all intents and purposes, non-communicative.
Once in the back of the unit, I started an IV, and this chick had crap for veins. This further pushed us down the Opiates trail. I got one in (Supah-stah!), but I had to float it, and leave the catheter part of the way out. It was tenuous at best, and on top of that, I had to hold her arm straight for it to work. She fought the IV a bit, to be expected. I held her arm while Jon pushed 1mg of Narcan. I kept the IV flowing, but not too much longer after that. As we're waiting for the Narcan to take effect, her respiratory effort was getting less and less. I said something to that effect, and asked how long we should wait for it to work. Before we could really decide, she was nearly apneic, so Jon laid the head of the cot down and we called for the Engine Co. to come back-things like this never happen before we release them, dontchaknow.
Well, of course her jaw was clenched, and her two front snaggle teeth securely clamped down over her bottom lip. So, Jon wrenched an OP airway in her and started bagging while I went for an EJ. She had a pretty one, until I went for it... then it magically disappeared. Doh! By this time, we've pulled a driver off the Engine and are headed to the ER. Calls like this make you grateful for a short transport time.
Jon gave her another mg of Narcan IM (that never did anything either), then he and I switched seats so he could make a couple more attempts at a patent IV, but no luck. I was not getting really good compliance bagging, but it was the best we could do. We showed up at the ER w/a respiratory arrest, no line, no tube. Fan-freakin'-tastic.
We transfer her over to their stretcher, and I tell our Asst. OMD that they'll probably have to put in a central line. He kinda pooh-pooh's that, but I ended up being right. Took 'em 3 tries, too. I felt like even more of a rock star, then. =) They also got her intubated. 'Round about the time they'd blown both femoral line attempts and they were poking her subclavian area, she up and went into VTach... then VFib. I hate it when that happens!
Jon and I stood by/assisted while they worked her for a good 40-60 mins. (I'm guess-timating) I mostly felt in the way, but Jon was doing some damn fine compressions with one hand. His turn to be the rock star!
The staff threw everything in the book at this lady, and nothing was happening. We were all ready to throw in the towel when she suddenly developed a perfusing rhythm again. The Primary RN was trying to figure out what rhythm to chart and Jon said "UFB". Can I get an Amen?
Well, we never did figure out what her underlying problem was. She had a bad case of metabolic acidosis, but more so than a witnessed, agressively-worked arrest would cause. She was on her 3rd amp of Bicarb, but had a serum Bicarb of 10, Ph of 7. They were talking about starting a Bicarb drip by the time we finished all our paperwork and were ready to head out. Her other labs were remarkably unremarkable, esp. for a person who had died.
We left the ER and immediately got punched for seizures way down on the Interstate, so we ran down there, picked up the postictal patient, and ran him in. When we dropped him off, I asked the Primary RN how our lady was doing, and her words were "She's hanging on by a thread." The RT told me her lungs were full since all told, she'd gotten like 3L of NSS, and the woman barely weighed over 100lbs. Whoops!
Real interesting call. Plus, we had fun. A good day in all!

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