I'm Not Saying She Isn't Sick

So, firstly, I want to say something about the "STEMI" we had this weekend. It wasn't an MI. At least me, and my ex-partner, don't think it was. See, I have seen a lot of strips and a lot of EKGs in my short time as an EMT, and I know what a paced rhythm looks like. On this call, it looked an awful lot like a paced rhythm. BUT, I am just an EMT. I am no para. I have had no formal EKG training, so I cannot say for certain. So, here this:

84yom, complaint of ShOB, warm, dry, pink, no obvious signs or symptoms, no pain or trouble breathing, sats good at 98% and BP within normal limits. We do everything but run a 12-lead--which, you know, if we are ruling shit out, we kinda need to do one, but you know, whatev--and see nothing of note. In fact, the only thing I say other than ask the pt if he is comfortable is loudly acknowledge the presence of a pacemaker implanted in his left chest. Huh.

So, we run him in cold. Because it is a new city and my partner mishears my question, I get a little lost but correct it and we move on. When we arrive, partner tells me to hurry up, pt's having a STEMI. I open the doors, look in, and pt is lying there just the same, as A&O as ever and still warm, pink, and dry. No trouble breathing, no change in sats or respirations. No moaning or groaning or complaining of pain. He looks the same. We pull him in and they put us in a room. As I am prepping the cot for the next pt, I ask my partner to see the strip. No 12-lead, just a single lead strip. I look at it and all I see, me the lowly EMT-B, a paced rhythm at 112. I shrug and go back to work. When we are outside, I ask if maybe it was just a paced rhythm and he tells me it couldn't be. Why would it pace him tachy? So, then, I mention how I was told once by a very smart medic that it is unlikely you would see a STEMI with tachycardia. I don't remember if he told me why, but I have some educated guesses and I agree that it is probably unlikely. (At this point, I should mention that another ex-partner of mine, the famous Bonnie, has said the same thing about tachy STEMIs--unlikely.) New partner goes on to explain how it MUST be a STEMI. I cannot remember what he said, but there was math involved, and I remember being skeptical but letting it go. Because, you know, no formal cardio education here. Anyway, I have been skeptical all week. I can guarantee that in my eighteen months at Urban Ambulance Service I have seen WAY more paced rhythms, STEMIs, and pretty much every other kind of dysrhythmia than his four years in rural service. I don't know, maybe I am a know-it-all bitch. And, again, no formal training the likes of paramedic school. But, it looked paced to me.

So, today I have coffee with Miss Bonnie and relay the story to her. She trusts my instinct and knowledge, she has seen me work in the field more than any other medic in this world, so she knows me and knows my thought process. I explain to her what I believe I saw and what he told me and gave her all of the info on the pt that I could remember. Based on what information I gave her, the information above, she is inclined to agree with me. Probably not a STEMI.

So, I dunno, that is where we are, and I kind of want to pose the question, if anyone in the field is reading, what they think. If you think it could have been a STEMI, tell me why. I want to know. If you think it couldn't have been, tell me why. I want to learn from this and be a better medic. I feel like my partner didn't appreciate my questioning of his call, especially since he was very convinced it was a STEMI. I'd like to know what you guys think. So, please, please share your opinion.

Anyway, that was the interesting call of the week. And, even then it was much less interesting than most of the calls I ran with my former service. I am actually starting to miss my former service, but I know it is a desire for the familiar and the comfortable. I have to push myself out of my comfort zone, I know, but I like knowing what is going on, walking into a patient's room and knowing what is wrong, how to treat it, what we need. I like having a partner that, with one look, we know what comes next and what needs to be done. I like knowing where everything is and how to use it and that I am GOOD at it. I like my comfort zone.

I also still feel very burnt out on EMS. I think I am tired of the culture. I think I need to recoup. I think I need to step back. But, I don't know.

UGH, I wish I could just live off of loans and take a million classes. Because I would have to, because I am bored already working 50 hours a week and going to class 24 and then in March taking six hours on top of that. I am hoping soon I don't get bored.

I need to be writing more. Bonnie asked me about that today. Talk about a way to get over boredom, but I feel so in the wrong mindset. I am sure that if I just sat down and worked to put myself in the right mindset, I would get there. I just have to put in the effort.

Remember all that shit I talked about getting my life together? Yeah, it's so much harder than it sounds.

OF COURSE IT IS. Everything worth doing/having/achieving is hard. DUH.

I just want to take a nap. Sigh.

Maybe I just haven't had enough caffeine today.

Anyway, seriously, readers, if you're out there and you have an opinion on that call--or ANY medical statement I make--let's talk. You can email, Facebook, or just comment here. If you have my number, TEXT ME. Let's start a conversation. I want to hear what you have to say. :) Also, you can totally feel free to tell me if you think I am dumb. Seriously, I want to hear what you have to say.

I'm Saying She's Stupid