Tuesday, March 31, 2009

Breaking The Rhythm

Well- most of you know I spend my nights picking up busted up bronx and brooklynites and taking em to the hospital, but few of you really know what this job is like beyond the stupid stories i tell when drunk, so i thought i'd use this space to give you some idea of the day to day of the job.

Although, as i often say, this work is hardest cuz of just how much junk and non-emergency shit we deal with, really like %90 is total nonsense (from nosebleeds to stubbed toes- possibly the title of my memoir?...nope) but last night, amidst allllll that bullshit, my partner and i caught one of those few calls where we paramedics really get to actually do something that makes a damn difference to someone.

It was 530 am, a rainy dawn in Harlem. Call came in as a "diffbreather," i was sleeping in the stretcher (sooo comfortable...really, and not the bad dream factory you would imagine) and Ortiz was passed out in front, having exhausted all possibilities of online poker. Bleary eyed, we zipped over to an apartment complex on 130th by the FDR, lugged our 40 lbs of equip out the bus and headed up a few flights of stairs.

The dude was about 40, sweating profusely, clutching his chest and struggling to breath. He said this has happened before, his heart goes too fast, he can feel it pounding away in his chest. Far as calls go, this is fairly serious- meaning if left like this, yeah he'll drop in not too long, but probably won't go down in the next 10 seconds. Probably won't, but easily could.

Ortiz is the kinda partner that you can jump into action with and know he's taking care of his end of things without anyone having to speak. I'm taking the blood pressure, he's putting the guy on the monitor for an ekg. Sure enough, the dude's tachying away at 208 times a minute, whereas your heart really should be going between 60 and 100. Going this fast, his heart is not pumping effectively, the chambers aren't filling up fully, system's backing up, oxygen not being distributed well, etc etc until he's dead. And as his heart continues to become hypoxic (oxygen deprived) it can easily jump into any number of even more killuquick rhythms and make ass him out right quick.

Now, I'm getting an IV while Ortiz getting down all the guys info, past medical history, meds, etc.

But first a quick note about Adenosine: that's the drug we gotta use to bring this heart back into normal working order but it's a hardcore mess of a drug- the half life is about 10 seconds, meaning it needs to get where it's going, the heart, QUICK or it won't work at all. This means u gotta get a big needle into a big vein that's as close up the arm and towards the chest as possible and you gotta push the drug in fast and follow it with a big shot of saline to get it all the way thru.

This dude's veins are not big, in fact they're hiding. I finally find a juicy one, pop in the needle but there's no flash back, nothing to tell me i'm in, just empty catheter. And here's one of those cases where u really need that iv in there, not just some just-in-case c.y.a. nonsense. I dig a little, the guy doesn't mind cuz he's really more worried about his crashing heart, prod where the vein once was with my gloved finger, turn to the left a little then right and finally see a dot of dark blood in the chamber, followed by a small flood to confirm it's in. I advance the catheter, pop off the turniquet and connect up the line as Ortiz passes me a bag of saline to link it up with (see what I mean about him- the guy's on point!)

So now we're good, IV in, ready to go, but we still gotta push the shit, hope it works and it feels like everything's taking too long. All the while the guy's moaning in the background as his heart is racing along on the ekg.

I put the syringe of adenosine in the port, give Ortiz a flush of saline that he puts in beside mine. I count to 3, push the shit and he immediately pushes his. Then we step back and watch.

Now the crazy thing about Adenosine is that to work it actually stops your heart and restarts it again. I mean literally, you can watch it on the monitor, and the patient always goes "Oh...oh oh oh oh...ooooooo....uhhh" in some kind of painful/orgasmic dance with death and then let out a big sigh as their heart comes back at a reasonable rate. If it comes back at all... So when we give it we always step back and just kind of watch, ready to either jump into fevered action or grin and chuckle with the dude.

We watch. Still at 208, now 210, 206... he's still hurting. A minute passes with no change. We set up the next dose, 12 mg this time, grumbling slightly to ourselves and wondering if we're gonna end up tubing the dude.
When we're in position I count 3 again and we both push, flushing all that good stuff right down into his troubled heart. For about 30 seconds (seems like forever) he's the same and then:

Supraventricular Tachycardia, a pause, and back to normal...

A pause. He throws a couple ugly looking PVCs, which means the hearts irritable, then it stops dead for a second or two, (dude: "oh...oh oh oh ...uh...) and (sigh...) come back at a very reasonable 124 beats a minute. And he's smiling now. So am I. So is Ortiz, although there's certainly a little edge to both our grins as we pack up our stuff and plop the guy on our stairchair to bring him out.

Dawn's breaking over the east river outside. The morning commute is chugging along the FDR and two trains crisscross on the bridge above. A light rain is falling.

With the vague tingling thrill that comes from finally doing something tremendous and worthwhile after so much crap, we cart our now jovial patient off to our ambulance and away...

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