(pictured: Lopez after the call smiling for the both of us)
LSA Medic 4 w/ EMT S. Lopez-Call No. 3:
Nature of call: Shortness of breath.
Events: home nurse giving antibiotics via IV for UTI when the patient presented with low SPO2% and SOB.
Mental status: COAx4, GCS15.
Chief complaint: shortness of breath.
Signs/ Symptoms: gasping, two word sentences, pale skin.
History/ Allergies: HTN, UTI / NKDA.
Airway: patent and clear.
Breathing: present-rapid and shallow, SPO2 78% room air.
Circulation: present, skin-pale and dry.
Assessment: Lung sounds-congestion present, Vitals-BP 244/114 (MAP 157), heart rate 96 BPM, Respiratory rate-28 BPM, blood glucose 159, Temp: 97.8F, EKG-NSR, 12 lead-no stemi or st depression, Pupils- PERRL, Stroke assessment-negative.
Treatment: O2 NRB, Albuterol, Atrovent, IV access. nitro considered for BP ( labetalol is contraindicated due to beta 2 blocking properties)
Reassess: SPO2 100% w/ 15 LPM and neb treatment, BP- decreased to normal limits (hypoxia increases pulmonary artery pressures increasing BP), Mental status remain normal, Respiratory rate-20 BPM w/ good depth, full speech present, skin condition-pink and dry, SOB subsided-patient reports feeling better.
Rule out: stroke, heart failure, hypertension crisis, fever/sepsis.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs and continue to provide emotional support. Repeat until we arrive at the hospital.
At the hospital, the patient thanked Lopez and me for saving their life. LSA Medic 4: 1, Death: 0
(pictured: our unit at the hospital after transferring care)
LSA Medic 7 w/ EMT D. Michalk-Call No. 5:
Nature of call: Cardiac arrest
Events: patient has been sick with CHF. Nurse staff initiated CPR.
Mental status: COAx0, GCS3.
Chief complaint: N/A
Signs/ Symptoms: pulseless, pale, hypoxic.
Allergies/ History: NKDA/ CHF, HTN.
Airway: patent and clear
Breathing: absent.
Circulation: absent.
Assessment: Pulse check-absent, EKG-asystole, lung sounds-rales, glucose check-WNL.
Treatment: CPR, BVM, OPA, Intubation, O2, CO2 monitoring, IO access, Epi x2, Fluids-200 mls NS, Suction-bloody tinge sputum.
Reassess: EKG-PEA, Pulse-absent.
En-route: Repeat CPR, Pressure ventilation, Epi and EKG assessment until we arrive at the hospital.
At the hospital, ER staff continue CPR until the patient obtain ROSC.
LSA Medic 7: 1 Death: 0
(pictured: Lopez and Paramedic Student CJ assessing the patient)
LSA Medic 4 w/ EMT S. Lopez & Paramedic Student CJ-Call No. 2:
MOI /Nature of call: Fall.
Events: pt attempted to get in their car and fell on concrete floor.
Mental status: COAx4, GCS15.
Chief complaint: head pain and left pelvis pain.
Signs/ Symptoms: left leg- short and rotated outward, left pelvis pain, head- pain/ hematoma present.
Allergies/ History: morphine/ cardiac hx, dm2. No blood thinners.
Airway: patent and clear
Breathing: present, rate and depth-good, spo2%- wnl.
Circulation: present, weak and slow, skin condition-good, no bleeding.
Assessment: trauma assessment, TBI assessment, PMS assessment before and after moving, vitals- BP-wnl, hear rate- 40bpm, respiratory rate-wnl, spo2%- wnl, glucose-wnl, temp-97.8f, EKG-sinus brady, 12 lead- left axis deviation, right bundle branch block, no other abnormalities.
Treatment: c collar, IV access, 250 ml NS bolus, atropine 1mg IV (rate unresponsive to fluids), no pain meds due to low hear rate.
Reassess: heart rate increased to 80 w/ cardiac med, mental status- remain normal, ABC’s normal, vital signs normal. Pt reports feeling better.
En-route: reassess mental status, ABC’s and vital signs. Repeat until we arrive at the hospital.
(pictured: the EKG strip of the arrhythmia)
LSA Medic 4 w/ EMT Willie-Call No. 2:
Nature of call: chest pain.
Events: pt arrested and taken to jail.
Mental status: COAx4, GCS15.
Chief complaint: Non-traumatic chest pain and SOB.
Signs/ Symptoms: pain-left side, 10/10, radiating to the right side, SOB.
Allergies/ History: NKDA/ none.
Airway: patent and clear.
Breathing: present, rate above normal, spo2% wnl at room air.
Circulation: present, rate- 120bpm, quality-strong. Skin condition-good.
Assessment: EKG- a flutter, 12 lead- a flutter, no stemi or st depression, Lung sounds-good. Vitals- BP-wnl, heart rate-120bpm, respiratory rate- above normal, spo2%-wnl, temp: wnl, glucose-wnl.
Treatment: IV access, 200 mls NS, call medical director for cardizem approval.
Reassess: heart rate decreased wnl w/ cardiac med, mental status- remain normal, ABC’s normal, vital signs normal. Pt reports feeling better-pain subsided.
En-route: reassess mental status, ABC’s and vital signs. Repeat until we arrive at the hospital.
(pictured: Paramedic student Marcos assessing the lungs sounds of the patient)
LSA Alpha 2 w/ EMT S. Lopez & Paramedic Student Marcos-Call No.3:
Nature of call: shortness of breath.
Events: Pt's symptoms developed at a middle school, school nurse reports pt’s SPO2 88% room air. Pt has been dealing with a respiratory infection.
Mental status: COAx4, GCS15.
Chief complaint: chest pain, sob, and weakness.
Signs/ Symptoms: tripod position, rapid and labored breathing.
Allergies/ History: none.
Airway: patent and clear.
Breathing: present, rapid and shallowed, SPO2 92% post inhaler.
Circulation: present, rapid and strong. Skin condition good.
Assessment: lungs sounds-wheezing present, vitals- BP wnl, hear rate 108 bpm, respiratory rate 28 bpm, SPO2 92 % room air, glucose 107, temp 98.8f, EKG-sinus tachy, 12 lead-wnl.
Treatments: O2, neb treatment, IV access.
Reassess: SPO2 100%, chest pain, sob and weakness subsided. Pt reports feeling better.
En-route: monitor and reassess mental status/ABCs/vital signs. Repeat till we arrive at the hospital.
LSA A2: 1 Death: 0
(pictured: AEMT A.Pena unloads the patient at the hospital, while I carry the monitor in one hand and the stretcher in the other)
LSA Alpha 2 w/ AEMT A. Pena-Call No. 3:
Nature of call: sick call.
Events: family witness syncope from chair to the ground, pt turning pale. Pt initially refusing assessment/transport.
Mental status: COAx3-event, GCS15.
Chief complaint: none reported.
Signs/ Symptoms: pale and diaphoretic.
History/ Allergies: HTN, DM.
Airway: patent and clear.
Breathing: present-rapid, SPO2 95% room air.
Circulation: present, pulse- strong and regular, skin-pale, cold and diaphoretic, No bleeding.
Assessment: pulse- wnl, heart tones- wnl, Lung sounds-clear, Vitals-BP 79/52 (MAP 61), heart rate 97 BPM, Respiratory rate-26 BPM, blood glucose-166, EKG-NSR, 12 lead- STEMI-V3/V4-anterior MI. Pupils- PERRL, Stroke assessment-negative.
Treatment: supine position, ASA 324mg, IV access-NS bolus, rapid transport nearest cardiac hospital.
Reassess: no c/c or symptoms, skin condition improved, Vitals-BP 111/80 (MAP 90), heart rate 89 BPM, Respiratory rate-26 BPM, SPO2 95% room air.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Provide emotional support. Repeat until we arrive at the hospital.
At the hospital, ER doctor confirms STEMI present. The wife thanked me for convincing and helping her husband, the pt.
LSA Alpha 2: 1, Death: 0
(It was a save that day, but days later, a family member reached out to me, telling me the patient, their dad, passed away. My partner, AEMT A. Pena, and I are honored to be able to give the family more time with him. Our condolences to the family. LSA A2: 0, Death: 1)
(pictured: At the hospital, AEMT Pena is switching O2 tanks on the stretcher to take the patient inside.)
LSA Alpha 2 w/ AEMT A. Pena-Call No. 2:
Nature of call: breathing problems.
Events: nursing home respiratory therapist reports pt is not responding to albuterol, spo2 % is low. Nurse states pt has been having respiratory issues for weeks now, not new.
Mental status: COAx2, GCS14.
Chief complaint: N/A- non verbal.
Signs/ Symptoms: rapid breathing, audible wheezing, pale and cold.
History/ Allergies: HTN, DM, AMS.
Airway: partially blocked-stridor.
Breathing: present-rapid, SPO2 61% w/ nrb 15lpm.
Circulation: present, pulse- weak and regular, skin-pale, cold.
Assessment: Lung sounds-wheezing, Vitals-BP 122/61 (MAP 81), heart rate 34 BPM, Respiratory rate-32 BPM, EKG-sinus brady, 12 lead- wnl, Pupils- PERRL.
Treatment: o2, atrovent, epi IM (spo2 74%), IV access, CPAP( spo2 80%), Solumedrol, rapid transport to hospital.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Consider magnesium drip and RSI. Repeat until we arrive at the hospital.
Reassess: skin condition improved, Vitals-BP 120/75 (MAP 90), heart rate 102 BPM, Respiratory rate-24 BPM, SPO2 90% w/ CPAP.
At the hospital, transferring care-spo2 100%, vitals-wnl, mental status and speech ability improved.
LSA Alpha 2: 1, Death: 0
(pictured: entering the back room of a small house to the patient)
LSA Medic 4 w/ EMT L. Ramirez and Paramedic Student A. Zuniga-Call No. 1:
Nature of call: non traumatic chest pain.
Events: family reports days ago the patient, 81 year old, was diagnosed w/ “ heart problems” at the hospital. ASA given prior to EMS arrival instructed by LSA dispatch.
General impression: obvious discomfort and ill patient.
Mental status: COAx4, GCS15.
Chief complaint: chest pain (10/10, pressure, non radiating and new) and SOB onset 20mins before calling 911.
Signs/ Symptoms: pale, rapid and labored breathing w/ 2 word sentence, audible stridor and rales.
History/ Allergies: HTN, DM.
Airway: partially blocked.
Breathing: present-rapid, SPO2 64% room air.
Circulation: present, pulse- strong and regular, skin-pale and warm.
Assessment: pulse- strong and regular, heart tones- present-wnl, lung sounds-congestion, Vitals-1st BP-196/123(MAP 147), 2nd BP-214/115 (MAP 150), heart rate-108 BPM, Respiratory rate-28 BPM, blood glucose-211, temp: 96.8F temporal, EKG-sinus arrhythmia,12 lead- wnl without STEMI, ST depression, L/RBBB.
Treatment: full fowler position, hi-flow O2, albuterol, IV access, nitro.
Reassess: mental status same, no new c/c or symptoms, skin condition improved-pink, Vitals-BP 176/92 (MAP 120) post nitro, heart rate 97 BPM, Respiratory rate-28 BPM, SPO2 97% w/ nrb.
En-route: Monitor and reassess mental status/ ABC’s/ vitals signs. Repeat until we arrive at the hospital.
LSA Medic 4: 1 Death: 0
(Pictured: on scene waiting for the family to arrive)
LSA Medic 4 w/ EMT L. Ramirez and Paramedic Student A. Zuniga-Call No. 2:
Nature of call: MVC.
Events: As per dispatch notes, truck crashed into a pole and drove away and crashed again. Mcallen PD interviewing patient, 30 year old, on scene.
General impression: patient ambulatory without obvious illness or life threats.
Mental status: COAx2, GCS14. No recall of events.
Chief complaint: none reported.
Signs/ Symptoms: none reported.
History/ Allergies: none reported.
Airway: patent and clear.
Breathing: present-wnl.
Circulation: skin- pink and diaphoretic (weather considered)
Assessment: refused assessment and transport.
Treatment: N/A
Reassess: N/A
Conclusion: prescription note found by PD stating patient is being evaluated for seizures and shouldn’t drive. Family members are called to take responsibility of the patient since the patient is coherent enough to refuse medical attention but not to drive due to possible seizure episode. Family signed as witness patient refusing medical attention.
(pictured: posting at a different location after the call)
LSA Medic 4 w/ EMT L. Ramirez and Paramedic Student A. Zuniga-Call No. 3:
Nature of call: cardiac arrest.
Events: As per dispatch notes, 99 year old patient has DNR and family wishing no medical treatment. On scene, down time 15 mins, no out-of-hospital DNR present and family openly wanting no medical treatment.
General impression: chronically ill patient.
Mental status: COAx0, GCS3.
Chief complaint: N/A
Signs/ Symptoms: unresponsive, pulseless, skin pale/ jaundice.
History/ Allergies: heart failure and sepsis, discharged from hospital yesterday with complications and hospital DNR.
Airway: absent.
Breathing: absent.
Circulation: absent.
Assessment: pulseless, not breathing, hospital DNR bracelet and iv lock present.
Treatment: N/A
Reassess: N/A
Conclusion: medical director contacted and explained the circumstance, calling it a DOS based on down time, age, history and family wishes. Family thanked us for respecting patients and their wishes.
Medic 4: 0 Death: 1
