Friday, 21 August 2009

Bang and the dirt is gone!

Working as a Solo responder
Cat A chest pain 8 miles away
Get there in 7 minutes despite traffic
Well looking lady with mild chest discomfort (4/10 at worst) with no previous history
O2, Aspirin & Nitrates = pain free
Complete paperwork whilst waiting for a crew
Told that crew are coming from over 20 miles away
Asked "Do you want them on red?"
Reply "Er Yes"
Nearer crew comes clear and arrives a little while later
Patient still pain free
More obs on truck
12 lead ECG showing inferior MI (heart attack)
Still no pain, what to do?
Get a line in and take some bloods
Get husband into truck
Go through thrombolytic check list
Now patient is experiencing mild chest discomfort
Before checklist completed patient goes into cardiac arrest
Immediate CPR whilst defib pads applied
Charging, stand clear & shock
1 minute CPR
Charging, stand clear & shock
1 minute CPR
Oh crap this is turning into a training scenario, all colour now drained. She ain't gonna make it
Charging, stand clear & shock
CPR then blip blip blip
Pulse check = palpable carotid and radial pulses
20 seconds of BVM ventilation
Patient responding
Patient bradycardic at 30 bpm and not improving
500 mcg IV Atropine done
Pulse 68, BP 115/74
GCS 15/15
Consent given
Heparin and Tenectaplase given (or as I like to call it drain cleaner aka cillit bang)
Pain free
Husbands jaw picked up off the floor
Soon into resus and off down to CCU
JOB DONE!

Check up on patient on my way home
ECG back to normal
Patient pain free and doing well
Transferred to cardiac centre a few days later for angiogram
No further treatment required
Discharged home
Thank you letters to the service, myself and the double tech crew that backed me up

Message to crew: Thanks for getting there when you did and thanks for a great team effort
Message to patient: Glad you are now OK, thought we were going to lose you briefly
Message to self: Be proud of what you do no matter how many routine or inappropriate jobs you go to
There will always be that one person who will require your skills where you will make a difference

3 comments:

Anonymous said...

Good job nice one, it does make it worthwhile.

Thought it was 2 mins CPR between shocks though?

mac said...

Yep you're right. Dunno why I put 1 minute. Doh!

medicblog999 said...

Nicely written Mac.

Job Done!!!