“Medic 9, take the response. 24 Right in Front of You Drive for the difficulty breathing. Enter through the back door.”
Long Lost Sister and I sign out on scene as the dispatcher finishes talking. By dumb luck, the address truly was Right in Front of Us. Computer Aided Dispatch has worked for once. We gather our gear and head around the back of the small ranch house.
The back door leads directly to a set of stairs which descends into a darkened basement apartment. I can hear our patient breathing before I see him. He’s breathing at least twice as fast as he should be, so I start to coach him as we feel our way down the stairs.
“Try to slow your breathing. In through your nose, out through your mouth,” I chant as we enter the room.
He answers in one-word sentences.
Our patient sits on the edge of a couch in a dark room. We flip the light switch as we enter, but of course it doesn’t work. I reach for my trusty mini-Maglite, only to find that it has fallen out of its holster somewhere, probably in the cab of our truck. We can see enough to know that our patient is sitting bolt upright with his hands on his knees in the classic ‘tripod’ position of distress.
LLS begins treatment with high-flow oxygen while I set up a nebulizer. The engine company arrives, and we hear the crew crashing down the basement stairs behind us.
times,” our patient offers.
Oh crap. If an asthmatic has been intubated once, the chances of him crashing and needing it again increase astronomically.
The firemen enter the room with their flashlights, and we can now see that the patient is blue. As blue as my uniform.
He knows where this is leading.
Crap. Crap. Crap. Our portable radio won’t reach the dispatcher from here, but Fire Alarm is closer. “El Tee, get us some backup please. BLS, priority 1.” The message is relayed, and the cavalry is dispatched.
We throw all of our pharmacological tricks at Mr. Tripod and load him onto the stair chair. The firefighters whisk him up the stairs into the sunlight in what seems like record time. As we load him into the ambulance, our backup arrives. O.T. hops in the front seat and glances in the mirror for instructions. “Local Community Hospital, O.T., and don’t spare the diesel.”
Diesel is our last line drug; when all else fails you drive quickly.
Mr. Tripod is fading fast. His middle-aged body can’t keep breathing at this pace, and he’s not getting enough oxygen to his brain. He needs a breathing tube, but we can’t do it. As long as he’s conscious, I don’t have the tools or medications I need. In our area, the hospital is the only one who can paralyze patients.
We ride a medical knife edge – if he gets better he won’t need the tube, but we can’t tube him until he gets worse.
It’s a short, wild ride to LCH. We call ahead to have the doctor and respiratory therapist ready. Our patient is getting sleepy, but he still protests when he hears the radio patch.
We attempt to use a bag-valve-mask to force supplemental oxygen into his lungs, but he fights us off. Confusion is mixing with sleepiness; a sure sign that he’s close to crashing.
We wheel quickly into the trauma room at LCH to find the entire team waiting. The doctor has the necessary drugs ready, and Mr. Tripod receives endotracheal tube #8 before we can gather our equipment and leave the room.
Now we can all breathe easier.