Preception of perfection

Only two dialysis transports do far. The A/C in the cab of the truck
was not working well, the 85 degree atmosphere was heavy. My partner was edgy, waiting to get results from the NREMT-P (National Registry of Emergency Medical Technicians) written test. She was waiting for an email, I told her to just check the website. Her eyes, widened, and she read aloud the statement of passing the test. She even made me read the results, just to be sure that she had not misinterpreted what she read.

Dispatch: "Medic 42 copy priority 1 to Farthest Nursing & Rehab for respiratory distress"

I have seen more respiratory distress patients in the months I have been working than any other kind of ALS patient. We head over to Farthest, code 3. The pager stated that the patient was to be transported to St. Other end of the County Hospital. This is mostly the patients family making these decisions in written form for the nursing home. I always keep the option to transport to Closest ER when necessary.

The patient's room was filled with staff members (and they even had their crash cart out), they had the patient on oxygen 8 liters per minute via a non rebreather mask (I didn't know nursing homes had these things, they always give nasal cannula). I could hear the fluid in the patients lungs from down the hall. LPN reports the patient has an axillary temperature of 103.4F bilateral Rhonchi SpO2 77%. The patient looks pale and moist. I'm told that he has become this way within a few hours. He's definitely hot to the touch and not looking well. We scoop him up, get the paperwork and head out to the truck. I like to do my work in the ambulance when I can. His pressure was 118/60 heart rate 110 (ventricular pacemaker) restorations 34 shallow lungs bilateral rales (NOT Rhonchi). First thought, I need to breath for this guy, my partner gets the BVM (bag valve mask) and begins assisting restorations. I prepare to nasally intubate the patient. I have already decided we are going to Closest Hospital, will have my dispatch notify the patients family. First attempt, sounded good, looked promising, not good (damnit). Bag the patient for a little bit, get new tube and try again. Second attempt, no good, screw it, let go I'll just bag him (we are 3 miles from ER).

We roll into the ER, give report, the nurses do their work up, get IVs, respiratory arrives. The Doc takes one look and says Aspiration Pneumonia. Patient has a PEG tube (and a foley cath that looked like mud, a PICC line that had not been flushed in days). Doc orders Etomidade, Succinylcholine and intubates the patient. Sure would be easy if I could have done that. RT suctions out the ET tube, and the contents look a lot like feeding tube goo.