Sometimes you wish hindsight could be a reality. There’s nothing worse than knowing what to do, not doing it, and wishing you would have.
We responded on a stroke call tonight and found a 65-year-old female laying on her bedroom floor, she was responsive, but not appropriate. She lost control of her bowels and was covered in feces. Her daughter informed us her mother was last seen normal at 5pm (never a good sign considering this was 10pm), with a history of strokes and hypertension.
We sheet carried the woman to our cot and transferred her to the ambulance for further assessment and transport. It was determined then she very unstable. She had no IV access and was quickly decompensating. I attempted intravenous access and asked my partner to call in a stroke alert and drive lights and sirens to the hospital. Her blood pressure was low, her heart rate was slow, not good signs. With my limited ability to multitask (I was alone). I needed to prioritize. She needed access, so I looked on the other arm, and no luck was found. I elected to place an intraosseous line via drill. I placed the defib pads first and then started gathering my tools for the drill. I was able to gain access the first time, but without a second pair of hands had to set the bag up alone, which itself can be tasking. Not to mention, we are in a moving ambulance. I got the bag set up, and the fluids began flowing.
After completing these above tasks, I checked for a pulse and, unfortunately, was unable to locate one. I looked over at the monitor and noticed a non-perfusing rhythm. We had arrived at the hospital, and I needed to get everything together to transfer her inside. I checked again for a pulse and nothing. So I started compressions and turned her care over to the emergency department staff shortly after arriving.
All in all, not bad for being alone, but I think I should have acted quicker, noticed the rhythm change, and done something like pace. Did she need to be paced, or at least atropine before I left the scene, should I have asked fire to ride in with me? All the things I could have and should have done. I also am not sure how long her pulse had ceased before I noticed it. I need to better assess my patients.
In the end, it turns out she had a DNR on file. I was never informed of this, but regardless I should have performed better.
Lesson learned: Don’t downplay anything, and if you have access to resources, use them