As we’re pulling up behind the BRT, Louis and I recognize the SRO from last week. This time we were called for chest pain – one of the EMS bread and butter calls. Standing in front of the lobby is a man in his late sixties wearing a camouflage jacket with a heavy-set woman standing next to him. A few firefighters are standing with him while the engineer sits in the cab. He’s old-school – he doesn’t go on medical calls.
Walking up I catch the eye of the fire medic. He tells me it’s a chest pain call and asks our unit number for his paperwork. Seconds after giving him my number their engine is pulling away. The patient and I are still standing on the sidewalk. That’s the way it is sometimes in the Big City – fire crews are tired of medical calls and take off as soon as they can.
I look at the fire sheet that the LT handed me before they bugged out to get the patient’s name. “Hey Jessie, so what’s going on today?”
“It’s my chest man, it just don’t feel right.” Louis is getting the gurney because if this is an actual chest pain call I don’t want to walk the patient and put more strain on the heart.
“Okay, so how bad is the pain?”
“No pain, man, it just feels like it’s thump’n too fast.”
I reach down and feel his radial pulse. Just a quick look but it’s upwards of 150 beats per minute. Would’ve been nice if the fire department had actually taken some vitals.
I’m getting Jessie settled on the gurney, “So what were you doing when this all started?”
“I was having sex man!” He’s got a big smile on his face; he’s proud of this proclamation. His wife, standing next to him holding his medications in a bag, hits him on the shoulder. “Hey cut it out!” he chides her, then back to me, “It’s the first time in a year.”
Despite the fact that this is an “emergency” he’s in a good mood and joking around with us and his wife. He knows something is wrong but he’s a playful man and won’t let it get him down. “Well, I’m sorry you didn’t get to finish you’re business.”
“Oh, I finished my business, don’t worry about that. I called y’all after I was done.” We all have a laugh as we’re wheeling him towards the ambulance.
I look over at the wife as we’re about to load the gurney in the ambulance. “Can’t you see this is a fragile old man, don’t you know you have to do all the work?” I’ve got a mock-accusation tone to my voice – I’m having fun with them as I sense they’re okay with it.
In the way that only a heavy set African American woman can pull off with credibility, she puts her hands on her hips, leans towards me, and with head bobbing for emphasis, “I WAS doing all the WORK, just ASK him!” Jessie just smiles…Louis and I are attempting to maintain our composure, but we’re only half effective.
I put Jessie on the heart monitor and run a 12-lead EKG. He comes back with Atrial Fibrillation with Rapid Ventricular Response at 162 beats per minute – no chest pain and no heart attack that my monitor can see. So basically, he’s got a fast and irregular heart beat – the electrical impulse reaches the ventricles of the heart and starts over sooner than it should. It’s not really a lethal rhythm that would require shocking him right now as his blood pressure is fine for the moment. It’s a rhythm that will either subside on its own or persist until he fatigues and becomes unstable. I can help it start subsiding by administering a sedative to help him relax. Some counties have beta blockers and anti-disrhythmics for use in this situation but unfortunately we don’t have that in our protocols. If he becomes unstable I can shock his heart back into a decent rhythm, otherwise it’s just best to help him relax and hope that it’ll resolve on its own.
As we’re driving to the hospital I start an IV and give him four milligrams of Versed to help sedate him and relax the heart. Because of his age and potentially unstable condition, he gets immediate attention at the ED, and a room close to the front where the nurses can keep an eye on him. The 12-lead that the ED runs comes back the same as my monitor’s interpretation and they pretty much just keep an eye on him until he calms down.
After a few more calls I take a patient back to the same hospital and get a chance to check on Jessie. He’s smiling and putting on his camouflage jacket as he’s getting ready to go home. “You doing a’right Jessie, ready to head out?”
“Oh yeah, I’m all good. I got me a fine woman to go home to!”