Sick or old?

One of the reasons I like EMS is because it can be intellectually challenging. I had a call recently that I thought was going to turn into an episode of House.

I was paged to an elderly female who had fainted. BFD. Geriatric DFO. I let the probie take patient care while I sat back with my “I’m-trying-to-look-cool-and-get-a-date-from-being-in-uniform” shades on.

Probie: Hey m’am we’re the band-aid brigaid. What seems to be going on today?

Patient: *blank stare*………*blink*

Probie: Uh…. *gives me the puppy look*

NA: *grunt, stooping down directly in front of patient to make eye contact* Hello, M’am? Are you alright? What’s going on?

The patient finally started responding. She wasn’t tracking well, but did better when I spoke louder.

Sick or old?

You were taking a hot shower when you started feeling “not well” then bent over to pick something up and almost passed out. Caught herself and deny any injury. Deny (and bystanders confirm) any of loss of consciousness. Well, fine. You look okay to me right now. But you’re old and you deserve to be thrown on a monitor just on that alone. Sadly we’re just a BS, er, BLS agency – we’re not very good but we try hard. Probably not a big deal.

Sick or old?

Radial pulse is strong and regular at a good rate. Blood pressure is normal. Respirations appear fine. Cold and clammy but she’s half dressed and still wet. Fine, have probie get a towel to dry her off, get her dressed, and get the blanket from the vanbulance. Yes I’m fine with your son giving you a ride home.

That cough sounds nasty. It started after you almost fell? Okay…

Lung sounds are clear. Sats are good. No chest pain or difficulty breathing. Just a cough. Not a PE?

Sick or old?

PD have contacted the son to give her a ride home. Fine, treat and release. She seems to be doing okay. But Intermediate class taught to think about the “why” not just the “what.”

Why did you almost fall? I don’t like what I’m seeing. My gut says you need a better work up. Something. is. wrong.

Peripheral vasodilation from the warm water after your work out? Negative orthostatics.
You don’t look hypoglycaemic. And my meter tells me the same.
Auscultate heart sounds. Normal.
Stroke exam? Extremely minor facial droop, minor arm drift. No speech slurring. Pupils are equally round, but you have a minor relative afferent pupilary defect. TIA? or just old? At least I have a leg to stand on when I tell you to go the ED after your son gets here.

More coughing. Some extra saliva. “I feel like I might vomit.” GI Symptoms? No belly pain. Check blood pressure across both arms, auscultate between the scapulae. No, probably not a AAA. MI? Certainly not a normal presentation.

My spidey sense is tingling.

Sick or old?

Oh what’s that? Saw your doctor today and he wants you to come back for blood work tomorrow? Well that would have been great to know the first time I asked. Yes and the meds you couldn’t remember earlier are warfarin and a beta blocker. Fantastic. Definitely and ED trip for you. But no need for ambulance, no, your son will be here soon and the cardiac centre is only a few blocks away.

I’m getting the stair chair when dispatch tells me the son is at least 20 minutes out. I get back inside.

Probie: She got really dizzy again and her pulse dropped to 40, but it’s back up now.
NA: *under breath* balls.

I smell something cardiac and I want a monitor. I call for City Fire. By the time they arrive her palpable pulse is irregular. 3-lead shows a-fib and she’s throwing PVC’s left and right. The medic’s face tells me it’s time to go and quickly. We calmly put her in the stair chair and get her out to the rescue.

I don’t know what happened after she left my care, but I’d like to think that this time I made the right call.

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