A lot to learn....

It's funny how sometimes you think, "Yea, I can do this job", only to find out that you don't have a clue....

Get called out for an elderly lady that is sick, nausea/ vomiting for the past 3 days. When we get there she is just sitting on her chair, her husband fills in all the details for us, because she is stone deaf. The over-sized hearing aids are malfunctioning and a high pitched squeal is coming from one of them. We have her take it out and it makes us feel better, if not her, because she couldn't hear it in the first place.

We get her in the truck and go to work. Vitals, IV, a little O2 via nose-hose and monitor. Hhmmm... Her pressure is like 80 over nothing and she's got a rate of 32. Well, the BP could have been explained by her lack of intake and excessive output for the last 3 days, then again it could be compounded by her rate. She is pale and cool to touch, but dry. Radials are weak and her breathing is OK. History of CHF and a few other things.

We start down the road as I am thinking of exactly how I want to treat this woman. I don't know what her normal vitals are, so I don't know how far off what I am seeing now is. I've always been told error on the side of the patient, and to treat the patient, not the monitor. Another look at her and to me, she's slightly lethargic, or she could just be sleepy. Skin is not so great, and her breathing is a little faster now, but her lungs are clear. I decide on a small fluid bolus and recheck her BP. It is about 72 over nothing. 12-lead shows sinus brady, nothing else. Well, she is obviously deteriorating. I pull out the atropine and push 0.5 mg. while I am thinking I may have to pace this woman.

I take another look at the monitor screen and the little yellow blips are getting more numerous, but wait....those are the dreaded PVC's we've been taught about. OK, I can do this, check a pulse and see if they are perfusing.....nope...they are not. Damn. Change her over to a face mask and pour the O2 to her. I call for orders for Versed because she is not out of it enough to pace her without it. I get it, give it and start to try to pace her. It doesn't work. Shit, what now? The PVC's are continuing and getting worse. I am thinking she is getting ready to code on me any minute. The only other thing I can think of at the moment is R on T. OK, lidocaine first and then maybe dopamine. I pull it out and before I can push it, she goes into v-fib. Fuck me sideways. I shock her. Flatline. Damn. How in the hell can I do this own my own? I do the best I can. Luckily we are just a few minutes out from the ED. We pull in, pumping and pushing and grunting, trying feebly to bring her back. She never recovers.....

None of this ever happened. Well, some of it did, this was a call I ran, the woman did have a rate of 32 and a BP of 80. But I was driving. I am still an Intermediate, I haven't taken my state test yet, so my paramedic partner rode in with her. She is still alive. She never coded. But, if I was the medic I probably would have treated her at the time. And this could all be true instead of something that scares the living hell out of me. After the call, riding back to the station, I asked my partner if I would have been wrong to treat her. He outlined pretty much what I just wrote about. He wasn't an asshole about it, he was just talking and teaching. But in my mind, I could have killed her. I layed awake that night thinking. I realized that the classroom world and the real world are two totally different things. You can be the best in class, ace every test, know all the protocols back to front, be able to recite everything about every drug in your box, and you still don't know shit. I realized that I still have a lot to learn....