The best bradycardia calls are for the patient passed out in the bathroom. You find them on the floor, cold and clammy, no pressure, pulse in the 20’s. We used to give a full amp of Atropine, now we give 0.5, and if that doesn’t work another 0.5 mg, etc. A couple times I have given the full 1 mg by mistake. Old dogs. Still the drug works well, the pulse picks up, the patient wakes up, the skin colors up and drys out and all is well in paramedic land. “You fixed them,” the doctor says to me in the ED. Music to my ears.
I can’t say that Zofran is a life-saving drug, but it is truly an excellent comfort drug. It is rare that I am ever nauseous, but the few times I have been, it is a awful experience. It makes you feel subhuman, pathetic, and puny. Zofran gives patients their dignity back, in addition to keeping the floor of my ambulance clean.
I was at an EMS conference shortly after the guidelines came out and was able to ask a doctor who had participated in writing this section of the guidelines what the AHA meant by the “expert consultation” line, and he basically said, it meant if the patient was stable, medics should leave them alone until a doctor can examine the patient.
The person gets a weird expression on their face, while your audience – partner, bystanders gasp as the monitor goes asystole, and then weird funky beat, weird funky beat and then a few more weird beats and the person is back in a regular rhythm at 80, and they feel so much better and you feel so much better and you print out the strips and show the printout to the patient and say this was your heart going 220 and then here’s what happened when I gave you the medicine and you felt all weird, see that flat line — that was you — and then here’s you now, good as new, and you — the paramedic — are everybody’s hero.
My secret EMS pride has always been my IV skills. I like to think of myself as a Zen master of IVs. And so I know I am hexing myself when I write this — I know somewhere out there right now a diabetic with no veins is slipping into unconciousness, and I will be summoned to perform, and then empty catheter wrappers all around me, I will despair to the heavens that I have lost my IV karma and at last reach into my kit for the Glucagon.