Sunday, June 17, 2007

- Weirdest Call Ever

Ok, so we're tooling around one day in Metropolitan Area when we get a call, no lights and sirens. Something hasn't felt right all day, with both Dancing Partner (henceforth referred to as "Rio" - c'mon, Duran DURAN, ya'll!) and myself in a keyed up, electric mood. The calltaker says it's a lift assist for an unconscious middle-aged male. We start heading to the call and look at each other - something's not right. We tell piss-patch that we're going to go priority due to traffic (which was a good idea, as it was around lunch) and drive to the scene, a home in a VERY NICE part of Metropolitan Area. We get down with all of our equipment.

We walk into this VERY NICE home to find an unconscious male passed out in the hallway - laying directly in the middle, in his skivvies, with his head all the way against the door at the end of the hallway. He is breathing 26 times a minute. Something ain't right, little cowpoke, a voice murmurs in my empty, pointed head. A cowboy voice, apparently.

"How'd he get here?" I ask the nicely dressed lady, who, I note is extraordinarily calm.

"He was passed out sleeping on the floor. I was going to leave him, but then I noticed his respiratory rate was about 26. His pulse feels tachycardic." This lady is no Becky Bystander, I think to myself. I guess she sees me looking at her."I used to be an ER nurse" she says, grinning.

And she married the ER doc, I think to myself. "This is as far as I could drag him," she continues."He's my brother. He just came to live with us a few days ago."

I nearly knock over a Fabrage egg on a nice stand (on a nice table, in the nice hallway), and squat on the other side of Rio. Using my paramedic observation skills, I note that his breathing is Real Fast, Not Good and that is pulse is Real Fast, Not Good and that Uh Oh, He's Not Looking or Making Talky! I throw him on the monitor as Rio practically gives the man an Indian burn for a sternal rub, to which he does not respond. Sinus Tach at 130. Hmmmm, I think to myself. Cowboy voice was right. Someone's poisoned the waterhole. I grab a CBG as my partner gets a His-Tree and Fiscal. The CBG comes back as 132 and I hook up the 12 lead, following our protocol....although I think if his rate picks up much more the QRS's will be too close together to give us any picture. Dr. Lifepak shows nothing unusual and the BP is 152/88, sats are at 100. Eyes are PERL, skin is warm and dry, with a strange redness on the chest and belly. An allergic reaction? OD? Heart Problems? Turds, I can't figure it out. The Former Nurse tells us that he moved in with them recently after some personal issues up north, where he lived. Apparently he'd had a messy divorce and and spiraled into depression, drinking himself deep down into a hole. OD seems likely.

"I was just trying to get him in the car. I called you guys and then realized how bad he was, so I tried calling back, but yall pulled up as I picked it up." I look at Rio from across the patient and she gives me a little nod - let's boogie.

"We're going to work him up," Rio tells the lady. "We're going to bring him in hot since he's not really responding for us, OK?"

Nicely Dressed Former Nurse nods her consent. We drag him across the NICE hardwood floors to our stretcher and load him. He still has not come around for us. Partner starts trying for an IV and we hightail it to Our Lady of Somethin' or Other. As we pull up my partner is sticking the man's IV. He has been a hard stick and she only just got it. "I gave him Narcan enroute, but either it hasn't kicked in yet or nothing's happe-"

The man chooses this moment to make a strange gurgling noise and slumps over my partner like he's a 100 year old old quadriplegic stroke victim making a pass at his sweetie at St. Jimmy's Home for Disposable Family Members. His breathing has gone from Real Fast, Not Good to No Breathy, Uh Oh! Cowboy voice in my head was right! Someone HAS poisoned the waterhole!

I tear open a BVM and straighten him up. I can't figure out why I can't get a good seal as we jam out of the back and rush him into the ER. Finally Rio yells at me "Jesus, Medicmarch, give me the damn bag." She lays down the head of the stretcher. "Were you trying to dry his contacts?!" I suddenly realize that, with the patient sitting up, I was forced to try to bag him in that position, and my seal was going on him backwards - imagine yourself straddling a BVM mannequin but using your normal grip on him. Doesn't work too freakin' well, does it? I was blowing air into his eyes instead of his mouth and nose.

"Dagnappit! Nice Job, cowpoke!" drawls Cowboy voice in my head.
"Shut it!" I yell.
"What?" My partner says.
"Book it!" I say.

We wheel him into hallway, our bagging much to the suprise of Seen It All Twice Nurse, who up until now has been unaware of this most recent plot twist. He waves us into Cardiac in a manner reminiscent of Gomer Pyle trying to land Air Force 1 using only his hands and a goofy look on his puss. Fantastic Hair Doctor sweeps into the room like a villian in a melodrama. I manage to give a report of the events thus far and I guess since I didn't spew crumbs at him and managed to emphize the important words like "Repritory" and "Arrest" and "Unknown Cause, possible OD" he takes over."Let's get a tube! What's his rate! Is there a pulse?! Why do my scrubs make my pecs look like sculpte!d bricks?" or something like that.

I, for the life of me, decide I have no idea what's wrong with this patient. Probably the OD, but maybe not.

Nicely Dressed Former Nurse/Pt's Brother comes in the room. "I was going through his meds, and He's taken all of his Lunesta, and these." She throws down two empty boxes of OTC sleeps aides. The culprit rears his ugly head. The dirty Varmint is Quick-Doze!

We get him tubed and on a vent...blood gasses are drawn and a tox screen comes back for benzos but nothing else. The ER staff takes over, and Rio and I stock the rig and ride off into the sunset.

Six hours later, he codes. He never regained consciousnesses. Seen It All Twice Nurse tells us the culprit is his pH - a very acid 6.2

They decide that all the man's sleeping pills, combined with his failing liver (apparently badly damaged from his drinking) , was enough to screw with his system enough to make him so tachypenic, which made him acidoditc...which killed him. S.I.A.T Nurse tells me " I've never seen anyone survive below a 6.7 - although I'm just a backwoods nurse from a shithole in Northern Louisiana."

So anyone ever had anything like this before? My partner and I' had never seen it, and we didnt talk about it in P-class. I'll watch out for it now, I guess, but to be honest, if they hadn't come up with that theory, I wouldn't've known what killed the guy. A good learning experience, I guess, but not one I'd repeat again.

Ah well. Screw it. Hop a long, little dogie!




Loving Annie said...

Gee, and here I thought his sister had poisoned him...

Never heard anything like this before, but I have heard ph acidity/alkalinity levels are tied to being healthy...
The more alkaline you are, the better, I think.

Anonymous Therapist said...

I've never seen anyone survive a pH lower than 6.9, myself. 6.2 is impressive. That's actually the most acidotic I have ever heard of. Ever.