Contrarian Patient

Dispatched just before the end of the shift for yet another “Problem Breathing” call. Reading through the comments in the computer entry wasn’t very enlightening. In fact, it wasn’t enlightening at all. We arrived to find the fire department first responders and a BLS ambulance on scene. The fire fighters were leaving as we entered and one of them told us that the patient was diaphoretic and cyanotic. They had given her some Oxygen and she “looked better”.

She must have looked like hell before, because when we first laid eyes on her she looked like she was dying. Probably because she was. He skin was cold. Her skin was wet. Her skin was pale. She was using every erg of her energy just to breath, she couldn’t spare any to answer my dumb questions or to even look at me when I called her name.

“We’re going to need to intubate her.”, opined my partner.

Ever the optimist I suggested maybe CPAP would do, but he was a bit,  shall we say, skeptical.

He got a blood pressure, which was high enough for me to give her a double spray of Nitroglycerin. After that we decided everything else could wait until we got to the ambulance which was just outside the door of the house. At least she lived on the first floor of a house and not the upper floor of an apartment  building.

Even though I didn’t think she could hear me, I told her what we were doing. My partner went out to the ambulance to set up to intubate her and I helped the BLS guys move her outside and put her on a stretcher.

In the ambulance my partner put in an oral airway and started to ventilate the patient with a BVM. I set about starting an IV and putting on the monitoring equipment. He waited until I had the IV in place, just in the event that we were going to need medications to effecuate the intubation.

As he ventilated the patient, using BLS methods, the patients numbers started to improve on the monitor. Heart rate slowed a bit, oxygen saturation improved, ETCO2 looked good. Oh, and her skin went from that lousy pale damp look to being kind of rosy in the cheeks.

“OK, I’m going in.”, he told me.  “Right.”, I replied since I had nothing else to say.

He opened her jaw, just as every paramedic has been taught and then inserted the blade of the laryngoscope to get a look at her airway.

Then the patient did the damnedest thing.

She woke up. Remember we had been calling her name and talking to her all along, but with no response.

She reached up with both hands and pushed my partners hands away from her face.

We were a  bit surprised. Which is an understatment.

“Christianna*, can you hear me?”, I asked.

“Yes.”, came the reply.

And so intubation came off the table to and we went back to Plan A, which was CPAP.

Before we applied the mask, I asked a few questions and she answered appropriately. Then the CPAP went on and the conversation stopped.

By the time we got to the hospital, which was not very long, she was sitting up, nodding appropriately to questions, had skin which was warm, dry, and rosy in color. In short, she looked good, especially for someone who had been pretty close to dead 15 minutes ago.

I don’t think the hospital staff completely believed my partner when he gave them the report and told them what had happened. The patient just looked too good.

Life would be so much less complicated if the patients would always act as the textbooks tell us they should. They don’t, which is what makes this job so interesting and at times even challenging.

*Not her real name