A Call That Went Right
At first, it didn't sound like much of an emergency. Someone had passed out, the dispatcher told us. She was awake now, but because of her age, the call had been classified as a cardiac problem.
We arrived to find the woman on the floor, right where she'd collapsed. According to another woman present, she'd been unconscious for about three minutes. When I asked if she felt any pain, she replied with a grin. "Why, no. In fact, I feel pretty good."
She hadn't been injured in the fall, but something still wasn't right. Her face was quite pale, and her clothing felt moist. As every health care provider knows, these can be ominous signs, indicating shock of some kind.
An EMT took her blood pressure. It was normal at first, but when he took it again a couple of minutes later, it had dropped to just seventy. My partner connected her to a cardiac monitor, and that's when we discovered the problem. She was indeed having a heart attack, without even feeling it. The evidence was right there on the paper.
We carried her out the door to the ambulance. I gave her some aspirin while my partner started an IV. We would have liked to given her some nitroglycerine, to open up her coronary arteries, but her blood pressure was too low for that.
On the way to the hospital, my partner started a second IV. A patient needs two IVs before undergoing cardiac catheterization. If our diagnosis was correct, and the woman was having a heart attack, the second IV would reduce the delay in going up to the cath lab.
Meanwhile, I was talking by radio to the emergency department. We wanted the staff to be ready when we arrived.
And so they were. The triage nurse looked up from her desk as we wheeled the woman into the emergency department. She didn't bother with any paperwork. "Go right in," she said. 'They're waiting for you."
Another nurse welcomed us into the treatment room. A moment later, we were joined by a pair of doctors. Having heard my report on the radio, they asked no questions. Instead, they asked to see the EKG we'd taken.
Taking it from my pocket, I handed it to one of the physicians. He was a cardiologist, I noticed. "Inferior MI," he said. "We'll go upstairs as soon as she has two IVs."
"She's already got two IVs," my partner said.
The cardiologist looked over at the patient and saw the twin plastic bags hanging from the ceiling. "Oh, good," he said. "I'll call them, to let them know we're coming, and we'll go right up."
Many things could have gone wrong on this call. Triaging the situation as a cardiac emergency was more a matter of luck than anything else, but it worked to the patient's benefit, because paramedics were dispatched immediately. We diagnosed the heart attack immediately. Both IVs went in on the first try, and the patient was totally cooperative. Triage nurses sometimes insist on taking vital signs at the door, even when the patient is dying, but this nurse had the good sense to dispense with such formalities. And the doctors actually believed us. That doesn't always happen. It's frustrating to watch the seconds tick by, as a doctor repeats all the questions and procedures we've already performed in the field. This time, though, that didn't happen. The patient went upstairs for her catheterization within thirty minutes of being wheeled into the ED.
While the cardiologist was on the phone to the cath lab, I stepped back into the patient's room to say goodbye. She was partially upright in her bed, looking perfectly healthy, and again she smiled when I wished her well.
"This is the most remarkable thing," she told me in a cheerful voice. "They tell me I'm having a heart attack. But to be honest, I feel just fine."
"This wasn't what you had in mind when you woke up today," I said.
"No," she replied, laughing a little bit. "Not at all."