One lesson that is always hard to learn in medicine is that despite all the knowledge, diagnostic tools, and medicines at the disposal of the clinician, patients still die. Although there have been other patients that I have not revived in the past, a few weeks ago, I had my first solo "oh $&?!" patient as a paramedic. As I walked into the residence, I was met by a panicked engine company crew and a patient who was in a tripod position on the floor. The patient was spitting up pink frothy sputum and was one word dyspnic. The engine company had already placed the patient on high flow oxygen and had attempted to get a baseline set of vitals. It was immediately apparent that the patient needed CPAP if not intubation.
The patient did not like the idea of a mask strapped to his face, so an online order was received from the receiving ER for Valium. The patient was quickly transported on CPAP. He was so diaphoretic that the leads slid off and I was only able to glimpse a ten second strip that showed elevation in 2,3, and AvF leads. I could not obtain a 12-lead and arrrived in the ER in less than 5 minutes.
The ER doctor immediate ordered RSI (rapid sequence intubation) and I was sent to advise the family as to what was going on with their loved one. It is always hard to talk to families and I found myself, as I have done in the past, made the procedure seem like a routine step and not the drastic step it represented. I quickly had to leave for a possible cardiac arrest call. I came back into the ER several hours later to discover that the patient had coded and died in the ICU. In retrospect, I did everything could in the short amount of time that the patient was in my care. This is small solace, but it is a lesson that I hope never to forget as my knowledge increases, my tools become more complex, and the list of medications and procedures at my disposal grows at an exponential rate in the long journey that lies before me.
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