We dispatched for one of the 100 or so “Difficulty Breathing” calls we get per shift, one of which might turn out to be legitimate. OK, I exaggerate a bit, but some days it seems that way. EMS dispatch is not an exact science, although the people who design and sell canned triage systems will tell you otherwise. That’s a tale for another day, one which I’ve probably talked about in the past.

Back to our story.

The address was familiar, mainly because lately we’ve been there about once a month. Each time the patient is very ill. In fact, each time she’s more ill than the previous time. Which isn’t uncommon, but is often very sad because most of our patients are pretty nice and once you’ve treated someone several times you tend to form some sort of attachment for the nice people.

This particular lady has an extensive medical history which included cardiac disease, Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, Diabetes, Hypertension. She also still smokes, which we know because her apartment reeks of cigarette smoke.

When we saw her last time, she almost needed to be intubated. My partner did a great job coaching her with the CPAP and we avoided intubation. Which is good for the patient because intubation brings with it the potential for complications. We don’t like complications, even if they happen hours or even days later.

Usually we find this lady in her apartment, working hard just to get a little bit of Oxygen into her system. This time was different, she was on the front stoop of the building, sitting in a chair and not quite breathing. She was trying, but nothing much was going on in the respiratory department.

We quickly moved her to the stretcher and started ventilating her with a BVM. That helped, but not much. Intubation was in order and we prepared to do just that. While one of the EMTs ventilated, my partner grabbed some equipment and I applied the cardiac monitor. I pressed the PRINT button and this is what rolled out on the paper.

That is ugly right there folks.

Normally, I configure the Initial Rhythm to print out a cardiac wave form, pulse waveform, and End Tidal CO2 waveform, but I was bit busy this time and printed out the default. Which is why I don’t have all those similarly ugly wave forms to show you, but I do have a list of numbers from the Code Summary function.

Note the Initial Rhythm time of 0316. That shows a heart rate of 44 beats per minute and an Oxygen saturation of less than 50%. Normal saturation is 94-100%, so less than 50% is bad. In fact it is incompatible with life.

My partner did a great job intubating the patient. The fact that she was unconscious from hypoxia probably helped him and it also sped up the process since we didn’t have to give any medications to sedate her. That came later, after the intubation was complete.

Oxygen is a wonderful thing. It certainly perks patients up. In this case a bit too much as the patient woke up and started fighting the tube. Which meant that we had to sedate her. Sort of a roll-a-coaster type thing, but it’s what we do.

Here is a better looking strip. The patient was doing better as well. Still sick, but a bit better. A big change in about 10 minutes.

So, we saved her life, for now. We transported her to the hospital where they started working on the bigger job of trying to keep her alive and get her better. Chances are she won’t get better as in well, but better as in stable. She might get better enough to be discharged to her home, but I wouldn’t bet on that. In fact, if I were to bet, I’d bet that we won’t see her again.

Time will tell.