Cath Lab

A lot of EMS is bullshit. People using 911 for runny noses, sprained wrists, and stomach aches from eating too much greasy chicken. Then there are the legitimate calls like strokes and traumas, but too often in those calls there is really not much we can do to fix them. They are dead from getting into an accident at 60 MPH or they are stroked out so bad they are just going to stay that way. That calls that make the most difference I believe are the cardiacs — the chest pains. The patient is pale, diaphoretic, with nausea and chest pressure. You take their vitals, do a quick 12-lead. It shows an inferior MI. You put the patient on a non-rebreather, give them some ASA, put in a couple large bore IVs and fly to the hospital. You call ahead, this patient is having an MI. They need to go to the cath lab.

When all goes well at the ER, the doctor meets you at the door, glances at your 12-lead, and then while you are unloading the patient, he is calling the cath lab, and before you have even sat down to write up your run form, they have heparin running and are wheeling the patient out of the ER and up to the cath lab.

The cath lab is where a cardiologist does angioplasty. They run a catheter in through the patients groin and up through his artery into his heart, where they blow up a balloon to clear the blockage in the heart that is causing the MI. Time from door to cath lab is critical. I’ve brought in patients with ST elevations–the hallmark of an acute MI — and had them code on me in the ambulance. I’ve had them code in the ER, and I have heard about them coding in the cath lab. If they can make it there and get the plasty done, they are often up and walking around within days.

Recognizing an MI and getting the hospital to take it seriously is criticial. Sometimes, you have to go and find a doctor and say, Doc, my patient is having an MI. He needs to go to the cath lab. They are busy with other patients and you need to get their attention. No disrespect to the nurses, who are also busy, sometimes you just have to bypass them in the interest of time.

Trauma patients get the trauma room, but its hard to fix them. Cardiac patients can be fixed, but the system isn’t really geared to them yet. Even the ER doc’s have to call a cardiologist to get the cath lab open. In an ideal system, paramedics could call for the cath lab as they do for the trauma room.

Here’s what happened today. We get called to a cardiologist’s office for an Acute MI. I sign on with dispatch to get an EMD update. “They wouldn’t give us a sex or age,” the dispatcher says, “Its a cardiologist’s office, they have an acute MI. Paramedic hot response.”

A nurse meets us at the door. “What’s going on?” I ask.

“He’s having an acute MI. We’re running in saline. He just walked in. The doctors are in with him.”

I find the man in an exam room. He looks to be in his fifties, a healthy male with good complexion. Good color. He is attached to a three lead monitor that is not reading. They have a 250 bag of NS running wide open through a 22 in his right AC. I ask him how he is doing. He says okay.

The cardiologist comes in and briefs me. He tells me the man is having an acute inferiorposterior MI and I’m to take him right to the cath lab where the doctor will meet us. He is leaving for the hospital right now.

Okay, I say. We hurry him onto our stretcher and take off lights and sirens. I put him on a cannula, take a quick BP – 130/80. HR – 100, then notify the hospital. Coming from a cardiologists office going straight to the cath lab, can you have someone there to lead us straight up.

In ten years I’ve never taken anyone straight to the cath lab from a scene. I don’t want to take a wrong turn in the maze of corridors.

I ask the man how he is. He says, fine, maybe a little nervous. I tell him not to worry he is getting the best care possible — going straight to the cath lab. I put in a another IV — a 20 in his hand that runs great. I tried an 16 in his AC, but blew it, my ego got the better of me. It was only an 18 size vein.

I put him on the monitor. It is my first look at his ECG. They never showed me one at the doctor’s office. Normally I would ask, but here I would basically be giving a report back to the guy who gave me the report.

I’m looking at II, III, and AVF. Maybe a tiny slight elevation in III, nothing in II or AVF. I don’t doubt the doctor at all. It just isn’t screaming MI.

I want to do a full 12 lead for my own edification, but the man has a shag carpet on his chest, and I can’t get the leads to stick.

“You can shave me,” he says.

“We’re going over the Delmar Street Bridge,” I say. “That’s not a good idea.” the Delmar Street bridge has been under construction for two years and is nothing but potholes and uneven bumps. “You’ll end up in the trauma room instead of the cath lab. Besides we’re just about out.”

At the hospital, the tech leads us right up to the cath lab, where the doctor meets us, and we bring him right in and get him on the table.

I can’t tell you how many times I have struggled to get patients up to the cath lab. Called ahead, said, this is an acute MI, I’ve got tombstone ST elevations. I’ve run through the ER showing doctors my 12 lead, screaming MI. But they have their procedure they have to go through in the ER, register the patient, assign a room, have the nurse assess the patient, do a 12-lead, get the doctor over, the doctor questions the patient, then he orders heparin, and calls a cardiologist and discusses the case. Sure, sometimes its quick. 20 minutes. Sometimes its an hour.

This guy was lucky to get such service.

You know what the deal was?

He was a golfing buddy.

I’m not saying I don’t help my friends out. If I was the heart doctor and that was my buddy, I would have done the same thing. All I’m saying is if we can get a doctor up there at the snap of the fingers we ought to be able to get other people up there that quick. Cath’s can save lives.

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