Shaky Hands, Part 1

"Medic 4, code 3, Sandy Beaches Retirement for a fall."

Damn it, I'm thinking. I was deeply involved with Guitar Hero: On Tour at this point and did not want to be disturbed. This had better be important. It was my second fall patient at a care home this shift. I pull my ballcap on, slide on my eye protection and head out to the unit. My partner is waiting and puts us in route, "medic 4 responding."

We're two minutes away, not even worth the code 3 trip. We pull into the round-about drive at the front door and let the ambulance idle as we grab our equipment. I stuff the narcs pouch into my vest pocket, thinking I'd rather have it with me than to have to send my partner back out for it. We grag the house bag, toss it on the cot and roll inside.

A staff member meets us, one of the med-aids. "She's been on the bathroom floor for maybe a half hour. She was calling for help up until we found her."

I nod, then enter the apartment. From the door, I can hear the patient's raspy, quick breathing. Well, that's doesn't sound good. I introduce myself to the patient as I carefully step around her, kneeling by her side. She tells me her name is Wendy and that she fell when she got up off the toilet. Her breathing is fast and shallow. She's writhing in pain, and winces every time she moves. There's no blood, no visible trauma, which I'm thinking is a good thing.

I ask her if she's having a hard time breathing. "Yes." I ask her about her pain, and she points to her left flank, locating just below the rib cage. "10/10," she rates it without hesitation. I lift up her sweater and exam: no paradoxical movement, no crepitus, no subcutaneous emphysema, but her lung sounds are diminished on the left.

A lot of things are running through my head at this point: how to package her, how to medicate her, the possibility of a pulmonary contusion, a developing pneumothorax, the need to needle decompress or intubate. I want to relieve her pain before we begin to move her and I need to balance my scene time with the amount of care I need to do.

I have no working room, the bathroom is cramped and I'm squeezed between the toilet and trash can. We have to get her into the living room and on our cot to work on her properly. She denies neck or back pain, or a loss of consciousness so we forgo immobilizing her. I send my partner down to the rig for our megamover, then quickly start an IV and give her 1mg dilaudid. She's talking less now, in shorter sentences, and now I'm thinking I should enter her into the trauma system.

My partner arrives with the megamover and we roll her onto her right side to position it. While she's up, I feel her back and note subcutaneous emphysema along her entire left back. Her lung sounds on her left are so distant they're non-existent. I must have had an oh shit look on my face, but I calmly inform my partner that she has sub-q emphysema and that it's time to go. We roll her onto the megamover and she doesn't even wince at the pain. Her eyes are drooping, she's not talking anymore, and her respirations are 40 plus.

Oh shit has turned into oh fuck.

to be continued...