Last night we had a call that I can't get out of my head. I'll tell you the whole story, not just the part where I came in. [Identifying information has been changed].
So a man drives his 48 year old wife to the hospital because she is having chest pain. The hospital takes chest pain quite seriously, and runs tests looking for signs indicating it is all the worst things chest pain could be. It turns out, she is having a heart attack, and a middle of the night run to another hospital for specialized care in a cath lab is necessary. This is where I enter the story, as the driver of the ambulance to take her to the cath lab, code 3, in the middle of the night. See, the cath lab is closed at night and only opens for very dire emergencies. Like this one. So we arrive and the patient is alert, pink, warm, dry [heart attacks often present and pale, cold, and clammy], talking and joking around. Awesome! This bodes well for her probable outcome. Yesterday, this woman felt well and fit and healthy, and today she is sick.
We drive fast to the other hospital, with a nurse on board just in case the patient needs medications to control her pain, and because some of the meds in her IV are above our scope of practice. At three o'clock in the morning, the cath lab is staffed and waiting for us, they do the surgery, and finish and hand her back to us in under an hour. We load her back up. She is pink, warm, dry, talking, happy it's over, and healthy again. I hop in the front seat and take my time on the drive back. Almost an hour later my partner sticks her head through the window between the front and back of the ambulance and says, "Um, can you go a bit faster? Our patient's blood pressure is 80/35 and she looks pretty grey." Woah! What happened there?! So I step it up, and when we arrive at the original hospital and I go to help unload her, she looks like SHIT! In and out of consciousness, pale as a sheet, sick, sick, sick. WAYYYYY worse off than when we picked her up. Holy crap! And her blood pressure just hit a freefall. Normal blood pressure is around 120/80ish--the top number is more significant than the bottom number for paramedics, though it is still significant with regards to health. Above 150 and there is added stress on your heart, lungs, blood vessels, and kidneys in particular. Below 100 and you feel dizzy a lot, have blackout spells, or difficulty moving quickly from a lying or seated position to standing. Below 80 and you lose your radial pulses and have difficulty staying conscious when sitting up or moving a lot. Below 60 and you lose your carotid pulse and seriously compromise oxygenation of your brain.
This woman's blood pressure is now 47/15. The nurse escort is doing not much. I mean, he dumped fluids in her IV and stuff but he didn't seem to be experiencing any of the "Sphynctor factor" my partner and I were experiencing. You know, where you get anxious and your butt sphincter winds up somewhere near your esophagus? We rushed the woman up to ICU and I kid you not, TEN MINUTES later she died. And they pounded and pumped and blew and shocked, and she came back to life again. The last I heard she was still alive but not expected to live beyond another 24 hours. The surgery in the cath lab is performed by sticking a long, flexible, very narrow, hollow tube in her femoral vein and threading it up to her heart to open the blood vessels in her heart and stop the heart attack. When they pulled the catheter (tube) out, it left a hole in that vessel. It would have been closed, but I'm not sure what technique was used, but it was either not closed enough, or the blood thinners she was on to treat the heart attack prevented her body from making a clot to heal that hole, and all five liters of her blood poured out of the vessel, into her abdomen, under the skin so it was impossible to tell from the outside until her pressure dropped and she went pale, cold, clammy, and whoozy. [Yes, whoozy is an official medical term. Or is it vertigo? Ha ha. And yes, I did just make a joke in the middle of recounting tragic mayhem] She was given multiple blood transfusions and many drugs and liters and liters of fluid, and it looked like a war zone in the ICU afterwards. Crazy.
The part I can't get out of my head was the medical intervention part. Without the surgery, she would likely have died. But it was a complication of the surgery that killed her. And so fast. At such a young age. Crazy. Life is just crazy sometimes. You know, it is funny because I had this niggling intuition that we should watch her closely, you know? Like death was hanging around and somehow I smelled him.
Travelling mercies, Mrs. X, whether you survive the ICU or not.