1: having an edge or point that is not sharp
3: slow in perception or understanding; obtuse
2: Slang: a cigar stuffed with marijuana.
1: cause of motion or change
2: an agency or influence that if applied to a free body results chiefly in an acceleration of the body and sometimes in elastic deformation
1: an injury (as a wound) to living tissue caused by an extrinsic agent
2: an agent, force, or mechanism that causes trauma
“Okay Ronald, you need to calm down and listen to me for a minute. Things are going to start happening very fast and I need you to focus. I know you can feel your heart beating way too fast and it hurts.” My cardiac monitor, sitting on the captain’s chair over Ronald’s shoulder, spits out a second 12-lead strip. Same interpretation as the first one: ***ACUTE MI SUSPECTED***
“I need you to chew up these aspirin while I explain what’s going on here. Whatever was in that blunt you smoked, maybe crack or meth, is making your heart beat too fast.”
He’s scared, staring at me with big, round, bloodshot eyes with that “doom” look that I’ve seen often with cardiac etiology. His heart is racing at 166 beats per minute, irregular, and his blood pressure is through the roof at 210 over 120. He smoked 20 minutes ago with some people he didn’t know and the weed came from an unknown source, so he has no idea what it was laced with.
When he told them he needed an ambulance they told him to “get the fuck out!” He called 911 from his cell phone a few blocks away.
Given the fact that he’s only 32 with no cardiac history it’s likely that his heart just can’t handle the fast rate and it’s causing some localized ischemia. Regardless of the etiology – whether it’s just the drugs or the unlikely occlusion of the coronary artery – I’ll activate him to the cardiac receiving center. They’ll have a cardiologist standing by when I get there to decide if he gets a trip to the cath lab or just monitoring until he calms down.
The siren starts to wail as we pull out of the parking lot where he sat waiting for us. I figure I’ve got maybe six minutes until we get there, just enough time to do what I can for him.
I hit transmit on the cardiac monitor and dial in the cardiac hospital. Bouncing down the road I place his hand on my knee and lift my heel up off the floor, making my leg an extra shock absorber so I can match the bouncing of the rig. As the needle finds a vein and gets a good blood flash I hear the monitor doing a modem handshake with the hospital to transmit my 12 lead.
Nitroglycerin and morphine are contra-indicated for his heart rate. It took a while to get used to that footnote in the protocols when I switched to working in this county because in my previous county it was part of our protocol. But so be it, I’ll play by the rules.
Fortunately we have decent sedation protocols for extreme anxiety, and I have just enough time to get two rounds of Versed on board before I get to the ED. Admittedly, I feel a bit strange treating a possible MI with a sedative but that’s what he needs right now. Ronald is really worked up, half from the unknown drug and half from the reality of the situation.
Versed is a decent drug – it’s used for procedural sedation in the hospital, like doing a reduction on a dislocated shoulder – give enough of it and you can put someone completely out, give just a little and it reduces anxiety. If you can titrate just right and walk the line between the two you can put someone in a very relaxed state yet they can still interact. It also has amnesia properties so people may not remember the pain they experience. That’s what I’m shooting for with Ronald but he’s a heavy guy so I don’t think I have enough time to get him there.
Backing into the ED another crew who heard us coming in code-3 opens the back doors and helps me unload the gurney. Walking into the critical care room the cardiologist comes in holding my transmitted 12 lead. I hand him the two follow up prints while I give a quick run down of the treatment I did and how Ronald responded.
They do a full cardiac work-up on him, and run their own 12 lead which comes out with the same interpretation. I always feel a little better when their machine and mine say the same thing.
They draw blood and send it to the lab to look for elevated troponin levels, the byproduct of distressed cardiac tissue. They’ll also run a tox screen to see what was in the blunt. Walking out, after giving a report to the staff I hear the cardiologist make an order for Ativan, another sedative. The ED has better drugs than I do but at least I got Ronald to the right place and started him in the right direction.
Off to the next call – my pager is buzzing on my belt and my dispatcher is chasing me out of the hospital for the calls that are stacking up.