So we were dispatched for a low-priority call, for someone who is “sick” and unable to get out of bed. Usually, when a 50-something year old male is “too sick to get out of bed,” he has either a) Man Flu, or b) Acute lazy syndrome. Usually.
My partner and I were met at the front door of a typical middle-class home in a typical middle-class neighborhood by a typical looking housewife. “My husband has diarrhea and has been vomiting all day” she says.
Sure enough, there is a guy in his 50s laying in his bed. This guy doesn’t look too good, though. He is sure enough sick. He appears pale, and sickly. He complains of general malaise and vomiting all day, accompanied by diarrhea, much like his wife says. While my partner obtains a quick set of vital signs, I ask the patient about his medical history, but he says he is too weak to talk. His wife hands me a medication list.
His medication list includes Norvasc, Lasix, Coumadin, Lisinopril, Lipitor, Plavix, Metformin, Humalin, Aspirin, and Atenolol. So his history is pretty clear. His wife mentions that he had a pacemaker implanted about 7 or 8 months ago. Sure enough, there is a conspicuous lump in his upper chest.
Partner of the day reports a blood pressure too low to hear, but she thinks she palpated 90 systolic. His room air O2 saturation is 93 percent, his pulse is weak at 50, and his blood sugar is 48.
All of that seems normal for someone with these complaints, aside from his curiously low heart rate, so we decide to attach the monitor:
I will leave the interpretation up to you, the reader. But I’m not sure what the monitor was seeing with those mythical pacer arrows at the bottom of the strip.
Partner establishes an IV of Dextrose 5% while the fire crew comes up with a plan to get this gentleman from his bed down a narrow hallway, around a corner, down 5 steps, and onto our stretcher, all while I grab a 12-lead:
This seems to me to be a pretty straight forward ECG, and I was pretty confident in my interpretation, and what the problem was with this guy. But again, I will leave the interpretation up to you all.
The patient was moved to the stretcher without a problem, and loaded into the ambulance, and we began transporting to Local Hospital. While enroute, the Lifepak spit out another 12-lead:
Again, the interpretation is up to you. The change is pretty obvious, though, which serves to reiterate the importance of leaving the ECG leads on the patient.
As somewhat of a side note, one thing I particularly appreciate with the new Lifepak 15 is the STJ Level measurement on the right side of the printout.
The handoff at the hospital was easily completed, and we left the patient in capable hands. We returned to the hospital a few hours later, and got some information on the patient from his nurse.
I’ll discuss that information, with lab results, in the next post.