this call happened in the early morning hours of 8/17/09. i was working that night on medic 14 stationed out of city #7 with another paramedic RVC. call came out and it was just around the corner from the station and we beat the first responders there. the call came out a 10C (chest pains, hot call), we arrived and the wife escorted us to the second floor of a very nice, well kept home. the pt was a 54 y/o male who was laying supine in bed and c/o chest discomfort, pt had a strong radial pulse that was irregular with gaps noted by me upon palpation, i just assumed we would see some PVCs on the monitor and the pt's b/p was good and he was talking to us fine and not in distress. the fire fighters arrived and slogged up the stairs rubbing the sleep from their eyes and i turned and told them we were good and that we would just use the stairchair to get the pt down to the stretcher (we recently got new stairchairs that work wonderfully). they left as my RVC was placing the electrodes on the pt. i was kneeling next to the bed writing down the pt's hx, we were going to do a 12-lead in the house and give some ASA and then move the pt, when i heard my partner ask the pt "do you have a pacemaker" and it immediately said "oh, shit". and there it was, v-tach with a pulse on the monitor. my partner placed the 12-lead cables on the pt while i ran down and stopped the FD from leaving and asked them to grab our stairchair. i came back up as the ECG was printing and it was upright in V6 to confirm, without a doubt, v-tach. again the pt was c/a/o x4 and was hemodynamically stable, if had not been it would have been some cardioversion. an IV was established and amiodorone was mixed in D5W with a 60 gtt. set and administered. we kept the pt and his wife fully aware of what was going on. after the 10 minutes the pt converted into a NSR with occasional runs of PVCs/V-tach but the pt stated he was feeling much better and stated something like he wanted to run down the stairs, but of course he was helped to the stairchair and brought down the stairs still attached to the monitor. the compartment the stairchair is in is very cluttered and i just had the FD place it in the passengers seat. so our new stairchair rode shotgun as my partner ran us emergency traffic to the hosptial. below is our activity log and after is the narrative found on our run chart.
| 08/17/09 02:30 | 226 | 140 / 90 | 107 | 97 | 16 | Wide Complex Tachycardia (IRR) | 4/5/6 | WCT - S | 4 | |||||||||||
| Manual Cuff | Normal | |||||||||||||||||||
| 08/17/09 02:34 | ||||||||||||||||||||
| Cardiac | v-tach with pulse12-Lead EKG performed by RVC. was successful. | |||||||||||||||||||
| 08/17/09 02:35 | 159 | 132 / 90 | 104 | 99 | 16 | Wide Complex Tachycardia (REG) | 4/5/6 | WCT - S | 4 | |||||||||||
| Auto. Cuff | Normal | |||||||||||||||||||
| Initiate IV | Peripheral IV initiated by RVC with 18 ga. at Left Antecubital. Attempts: 1 successful | |||||||||||||||||||
| 08/17/09 02:37 | ||||||||||||||||||||
| Medication | Amiodarone,150 MG via IV - PUSH given by ParamedicX mixed in 100 cc D5W flow with 60 gtt set ran over 10 minutes | |||||||||||||||||||
| 08/17/09 02:42 | 122 | 126 / 84 | 98 | 100 | 16 | Wide Complex Tachycardia (IRR) | 4/5/6 | WCT - S | 0 | |||||||||||
| Auto. Cuff | Normal | |||||||||||||||||||
| Cardiac | runs of v-tach, irregular, perfusing on normal beats with strong radial pulse, non-perfusing during v-tach runs12-Lead EKG performed by PX. was successful. | |||||||||||||||||||
| 08/17/09 02:50 | 118 | 130 / 84 | 99 | 100 | 16 | Wide Complex Tachycardia (IRR) | 4/5/6 | 0 | ||||||||||||
| Auto. Cuff | Normal | |||||||||||||||||||
| pt moved by stairchair and stretcher to ambulance, pt on monitor at all times, paddles attached to pt since before medication admin | ||||||||||||||||||||
| 08/17/09 02:55 | 100 | 110 / 70 | 83 | 100 | 16 | Wide Complex Tachycardia (IRR) | 4/5/6 | WCT - S | 0 | |||||||||||
| Auto. Cuff | Normal | |||||||||||||||||||
| Medication | Normal Saline,150 MG via IV - PUSH given by PX fluids given enroute | |||||||||||||||||||
| 08/17/09 03:00 | 106 | 136 / 68 | 91 | 100 | 16 | Wide Complex Tachycardia (IRR) | 4/5/6 | 117 | 0 | |||||||||||
| Auto. Cuff | Normal | |||||||||||||||||||
| bsl checked at this time | ||||||||||||||||||||
| 08/17/09 03:05 | 98 | 140 / 66 | 91 | 100 | 16 | Wide Complex Tachycardia (IRR) | 4/5/6 | WCT - S | 0 | |||||||||||
| Auto. Cuff | Normal | |||||||||||||||||||
54 y/o male woke from sleeping with heart palpitations and slight chest discomfort and called 911. pt laying in bed at first EMS contact, FD arrived at same time as EMS, pt c/a/o x4 and talking well without resp distress, pt radial pulse irregular but strong with gaps of non-perfusion, pt placed on monitor showing v-tach with a pulse, pt hemodynamically stable and on second floor of home and decided by EMS on scene to treat on scene. pt given 12-Lead, confirming, and IV est. pt given 150 mg amiodarone via 100 cc D5W over 10 minutes with 60 gtt set. pt converted out of constant v-tach on the monitor to runs of v-tach and pt stated he was feeling much better and that the discomfort in his chest was gone and when pt was moved to stairchair pt stated he would be able to "run down the stairs" if we wanted him to. pt moved by stairchair and stretcher to ambulance with constant monitoring. pt with rare skin disease and prolonged admin of prednisone and lasix with constant fluid retention in lower legs and periodically into abd. pt legs wrapped in bandages due to pressure ulcers in lower legs. pt in good spirits during entire EMS contact and pt transported emergency traffic to CFV and taken to the recess room upon arrival where ED staff and ED MD were waiting.
