It was the end of a normal day at the station. The


medics are just getting to bedafter running a half a dozen calls for an assorted minor medical and trauma problems. The
paperwork was finished. The reports were entered into the computer. The truck was
even restocked. They were just about into dreamland but, as with most nights at this
particular station, sleep was not to be.

Several miles away, in a small, well kept apartment, Angie Briggs, a
eighty-year-old woman awoke to the feeling that the life-giving air was being denied to
her. She tried to sit up, but the feeling would not subside. Walking made it worse. She
also noticed that, even though the temperature in her room was comfortable, she was
dripping with sweat. The longer that she waited, the harder it became to breath. So,
realizing the fact that her doctor was probably asleep, she did the next logical step, she
called her daughter, who lives in another state. The daughter realized that her mother
needed more help than she could give over the phone, tried to persuade the mother to call
an ambulance, which, of course, the mother refused to do, stating that it wasn’t necessary.
The daughter then took it upon herself to call EMS from her own house.

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The medics were notified of the problem through the usual method, a series of
tones over a radio that cause a loud horn to blare and all the station lights to come on,
much to the annoyance of the fire lieutenant. This alarm was immediately followed by the
dispatchers voice giving all the applicable information on this call.

“Med unit 2, respiratory call, 103 Royal Terrace Boulevard, apartment 7, in
reference to a 80 year old woman with shortness of breath.”
Not that the EMS crew were listening at this point. They are busy getting into
their jumpsuits and putting their boots on. It does not matter if they are eating, sleeping,
watching TV, or even taking a shower, they are required to be in the ambulance and en
route to the scene within two minutes.

“Med Two’s en route.” Stated EMT Jennifer Meyers in a sleepy voice
” Copy med 2 is en route to 103 Royal Terrace Blvd., apartment 7.” Now they are
listening. “This is in reference to a 80 year-old female who is in severe respiratory
distress. Received the call from her daughter that is out of state. Patient sounds very
short of breath.”
“Copy”
“I’m pretty sure that it is in the first entrance into the apartment complex. Should
be the third or fourth building on the left”, stated Doug Murphy the paramedic on duty.

It took only a few minutes for the ambulance to arrive at the scene. After dispatch
was informed of their arrival, Doug and Jennifer removed the stretcher that was already
loaded with the monitor, the airway bag, and the med box. As he approached the front
door, Doug took notice of the condition of the walkway, of the location of the bushes, and
any outside furniture that might impede exiting the house with a stretcher loaded with a
person. He did the same quick evaluation upon entering the residence.

After knocking, an elderly, heavy-set woman opened the door. The medic could
see immediately that she was is serous trouble. Her clothes were soaked, wet with sweat,
every time she took a breath, a faint popping sound could be heard. The medic also could
see the front of her neck pull in along with every breath and that her general color had a
faint, matted bluish color about her. Doug knew that without immediate treatment, this
lady would die.

Doug quickly lowered the stretcher and took the equipment off of it. “Why don’t
you sit right here.” Doug told Mrs. Briggs
” I’m fine, really. I told my daughter that I would see my doctor in the morning. I
don’t know why she called you?” Mrs. Briggs stated. The medic was surprised that she
could talk at all.

“When did you start having trouble breathing?” Doug asked as he was turning on
the oxygen bottle
“About an hour ago. I woke up and couldn’t catch my breath.” Pointing to the
oxygen mask that the medic was placing on her face.”I really don’t need any of that.”
” I think you do. You need to let me do my job and treat you.This condition will
only get worse.”
“No, I think I’ll wait till the morning.”
“Listen, you don’t have until the morning. To be perfectly blunt, I doubt you have
a hour. You need to let me treat you now. Your lungs are full of fluid.”
“How do know that?” asked the patient.

“I can hear it, even without my stethoscope.” retorted the medic. ” I can take care
of this problem with medicines, but I need to do it now.” Looking at his partner. “How’s
the blood pressure?”
The medic’s partner had been busy taking the patients blood pressure and pulse,
and was now in the process of applying the electrodes on the patients chest for the
monitor.

“180/90, pulse 100 very irregular.” came the reply.

While his partner began to set up the IV bag, the medic finished putting on the
monitor leads. After he turned the machine on, he then began listening to the patients
chest, carefully listening to each lobe of the lungs, trying to judge just how far the
crackles, or rales, go up into the chest. This allows him to determine how full of fluid
Annie’s lung were.

“Your lungs are three-quarters the way full.” Doug then took a look at the
monitor. “Do you usually have skipped heart beats?” questioned the medic.

“Yeah, it’s been like that for a while.” answered the patient.

He then asked the patient. “Have you ever had an IV before?”
“Yes. Do I really need one now?”
“Yes ma’am, you sure do.” answered the medic. A rubber tourniquet was placed
around the patients arm tight enough to stop the return blood flow, or venous blood but
not too tight enough to cut off the arterial blood flow. He then looked for and found a
vein in her wrist, prepped the site with alcohol, and stuck a needle that was covered by a
thin catheter into the vein. After he removed the needle, leaving the plastic catheter in the
vein, he took a sample of blood from the site and connected the IV line. He then released
the tourniquet and opened the IV line to make sure he had a good flow. The drip rate was
set so it would only drip once ever few seconds. After he taped the line down to the
patient’s arm, he finished this particular procedure by making sure that all the dirty needles
were safely placed in a sharps container. He didn’t want any accidental needle sticks.

“Ma’am, are you allergic to any medicines that your aware of?”
“No, not that I can think of.”
“OK, This is what we are going to do. First, I’m going to give you some Nitro
with a spray. What I need to you to do is open your mouth and put your tongue at the top
of your mouth” Stated the medic.

Mrs. Briggs complied, almost. She opened her mouth and kept her tongue at the
bottom of her mouth. “Tongue up.” The patient complied.
“Good, now take a breath in.” When she did, the medic sprayed the Nitro into her
mouth. Having her inhale when he sprayed the Nitro kept it from going back into his face.
Talking to the patient “Ma’am, I’m going to give you some Lasix though the IV
line. Hopefully, it will pull some of that fluid out of your lungs and back into your
bloodstream. Is that oxygen helping?”
“A little.”
“Good” The medic replied. He then proceeded to slowly give the Lasix. The
standing orders that he works under (after all, a non-physician cannot give medicine
without a physician willing to assume responsibility for it) allows him a dosage range up to
80 mg. for Lasix. If the patient was not in such distress, he would have opted for double
of the home dosage. However, this time he chose for the full eighty.

After being secured in the ambulance, Jennifer went back to make sure that the
residence was locked up. Doug then retook the patients blood pressure (which had not
changed) and listened again to her chest, detecting a slight clearing of the lungs.

“Ma’am, I need to ask you again if you are allergic to any drugs.”
“No, I’m not.”
“Have you ever taken Morphine before.”
“No, why?”
“Because I’m going to give you some in a minute”
“Why? I don’t hurt anywhere.”
“We’re going for another effect that it has. It helps pull that fluid out of your
lungs.” Seeing a look of confusion in the patients eyes, Doug asked “Do you understand
what is happening?”
“No”
“For some reason, your heart cannot keep up with the flow of blood coming into
it.” The medic explained as he drew up the Morphine from the vial. “When this happens
to the left side of the heart, the blood backs up into the lungs, causing the blood plasma to
leak into the tiny air sacs in your lungs. This is what is causing you to be short of breath
and to have that crackling noise when you breath. All the medicines I am giving you cause
your blood vessel to dilate, or get bigger. The Nitro causes this all over the body. The
Morphine does it in the arms and legs. And the Lasix pulls it out of the body by making
you have to pee a lot. The Morphine will also help you to relax somewhat. Just let me
know if you start felling nauseous.” Doug took a alcohol wipe and cleaned the injection
port of the IV tubing, then inserted the syringe’s needle into the port. “I’m giving you the
Morphine now.”
By this time, Jennifer had finished locking the apartment.

“You all set?” She asked, sticking her head in the back of the truck.

“Yup, let’s go.”
On the way to the hospital, the patient started improving; her blood pressure and
pulse were going down, and the patient was breathing a lot easier. The rales were even
noticeably diminishing. The medic had called the hospital over the radio notifying them of
the patient that he was bringing in and her current condition. The patient, due either to
her finding it easier to breath or due to the Morphine, began talking.

“How long have you been a fireman?” The patient asked
“Never have been, I’m a paramedic.” The paramedic retorted. “We have a dual
system in this county. We work with and are stationed with the fire department, but we
are under a different chain of command.”
“What does that mean.”
“I don’t put out fires, they don’t give people needles.”
By the time that the ambulance got to the hospital, the patients lungs were almost
clear of any rales that the medic could hear. And, as expected, the patient requested a
bedpan as quickly as possible.

“Which room would you like us in.” Doug asked a nurse.

“What’ch ya got” came the reply.

“Heart failure.”
“Room 10 will be fine.”
“Thanks.” responded the medic as he wheeled the patient into the treatment room.
While the nurse went to get her paperwork, the medic and his partner lifted the patient
onto the hospital stretcher, transferring the oxygen tubing
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