Tuesday, February 15, 2011
I've already mentioned that people love to hurry us along for even the lonliest little toothache or whatever, but as time goes by you can kinda distinguish between the guy that is just wants to someone around and the person who really and truly fears for their loved one's life. This guy was definitely the second. Then he mentioned, as we hustled through an outer open area and up some stairs, that his wife had just delivered a baby five days ago.
Now here's where any medic or EMT worth their salt should have the word 'eclampsia' dancing through their mind. Not as a definite, cuz we gotta wait till we see the patient and all that, but between the call information and the husband's story, you have a pretty textbook eclamptic patient. What it is is an obstetrics disorder where the blood pressure shoots through the roof causing blurred vision, massive headaches, edema in the extremities and sometimes blood backing up in the lungs. All that is pre-eclampsia, when the patient actually goes into a full tonic-clonic seizure it becomes eclampsia proper, which is gets its name from the Greek word meaning "shining forth." It's rare we see even a pre-eclampsia in the field and rarer still to see a fully seizing pregnant woman, but sure enough when we walk in we find the patient just finishing her last convulsion and settling into a postictal stupor complete with snoring respirations, drooling, rolling eyes and occasional tremors. (I've heard varying reports but apparently it can happen up to 4 weeks after delivery.)
So, like I said, I'm BLS and don't have any medicines with me and really there's nothing worse than being at the scene of some magnanimous disaster and utterly helpless to do anything about it (See previous posting for more on that...) The family is going through all the motions of utter freakout, from screaming that she's going to die (her mom) to trying to shut the gloomy screaming lady up (her husband) to bawling and pointing (her nieces and nephews). The pregnancy wasn't high-risk, plus it's over, and she has no medical problems so you can see they were all taken totally off guard when she suddenly seized after complaining of headaches and blurred vision all day. I call for a medic bus to back us up and my partner and I start getting her ready to go. Baby's sleeping quietly in her crib the whole time.
The medics are waiting for us downstairs. I give the story as I'm fighting the stairchair with the lady in it over some bumpy pavement, praying she doesn't seize again and topple. We're on the bus and let me tell you, when I'm working BLS and medics show up I generally make it my business to be quiet and stay out the way, mostly because the worst thing in an emergency is three alpha medics yelling three different things. Plus, the guy working was a friend of mine and knows what he's doing. HOWEVER, just when it seems like we've fallen into the whole swing of the job and everything's moving along smoothly, he goes for an utterly different medication, Dextrose in fact, which would infer a treatment modality for a whole other situation than what we're dealing with.
I really don't like doing that, especially when there's a student, another medic and an EMT all right there. The guy looked at me cock-eyed. I ran down the list of symptoms and watched it dawn on him. "Why didn't you say all that when we got here?"
"I did!" I had!
"Oh! I didn't hear you. And I figured my partner'da given me the story." She hadn't.
A moment went by where we all kinda looked at each other. Then I don't know if anyone said anything or what but we all just fell back into the business of treating the patient, now truly on the same page. Magnesium Sulfate relaxes the smooth muscles and can ease/prevent the eclamptic seizures. We also treat asthma with it and a rare form of v-fib called Torsades de Pointes. You have to mix 2 gms of it up in a 50 ml bag of saline and set the drip rate to deliver it over 10 minutes, which is a little project unto itself, so while the other medic is doing that I get on the phone with our telemetry doctor to get clearance to give the medicine.
Talking to telemetry can be an outrageous experience. There's a medic that you have to get through to actually speak to the doctor and he's always angry about the fact that he's wasting away in an office while you're out there having fun in the street and he always manages to find something to pick a fight over. I brush through him as quickly as I can, doing everything possible not to take the bait of his irritability. Then some absurd pop song comes on, because I'm on *&*&#^#*! hold of all things and finally the doctor gets on. I spit the situation out quick to him and make it very clear with my tone that I know what I'm doing, because certain doctors enjoy verbally shredding medics when they smell uncertainty. "Alright give the mag," he mumbles, hangsup and returns to his cave.
When I get back in the bus I see the medic has asked the student to draw up the 2 gms of Mag, which he's done, but now he's got the syringe full of medicine and is reaching for the patient's IV, about to mainline it. I can't say for sure that his would kill her, but anytime you dilute a medicine in saline and drip it over 10 minutes it's for a reason. Both me and the other medic yell "NO!" and lunge at the student who realizes his mistake and cringes. We gank the syringe from him. "Sit down," the medic says.
We put the mag in the bag and I hop in the driver's seat while they set the drip rate. Get on the mic to give our notification as I peel off into traffic. She saves her last seizure for when we roll up into the ER bay, which makes getting her out of the bus and into hospital but we eventually manage and the doctors swirl in on her as we yell out the story once again. After some messiness, they break the seizures and she's sleeping quietly when I leave, her worried husband holding her hand and shaking his head.