EMS Call: Respiratory Arrest

Dianna is back for her monthly EMS post. I’d like to pass along my congratulations to her for winning in the ACFW Genesis contest this year! This is a much sought after award and will turn the heads of editors her way. I know we will be seeing her books published in the coming years.

Today, she focuses on the aspects of a respiratory call. This will help add those factual details for your scenes.

EMS 18, respiratory distress at 1234 Greene Road, at 1234 Greene Road on TACH channel 7.
As we climb into our ambulance posting (parked) at our station, my partner and I radio in we’re en route to the above scene. Lights and sirens, we rush out of the garage. En route, we’re notified via our computer that the patient is a 24-year-old female and is conscious and breathing.
Once on scene, we find the scene is safe and no dispatched law enforcement. Typically a fire crew arrives on scene first (prior to us) since there are about three times more firehouses thanEMS stations globally, thus they’re closer than we are. However, fire is not always dispatched along with EMS, so for this sample EMS call we’ll say fire wasn’t dispatched.
Upon our arrival at the patient’s side, my general impression of her is she’s SOB (short of breath) and in respiratory distress (dyspnea). She’s sitting in the tripod position (leaning far forward with her palms on her kneecaps) and she’s breathing shallow and fast (tachypnea). She’s not cyanotic (blue lips or fingernail beds), so she’s perfusing fine at the moment and not hypoxic (lack of efficient oxygen), but that can quickly change.
I won’t discuss everything we’d do on a respiratory call like this, but if you need clarification or further explanation for your fictional writing needs, please do not hesitate to ask me.
As my partner whips out a non-rebreather mask and connects it to the oxygen tank at 15 lpm (liters per minute) then slips it over her mouth and nose, I assess her breathing rate and quality and find it definitely out of range, certainly labored and not efficient to sustain life, so I assemble a BVM (Bag Valve Mask), and my partner bags her.
As I continue with my patient assessment, and notice she’s diaphoretic (cold and clammy skin) I consider assembling a nebulizer (I’d squeeze atrovent and albuterol into a tiny circular plastic cup and attach the nebulizer contraption to the NBR (non-rebreather).
I attach her to our cardiac monitor via a 12-lead (ECG patches) to interpret her heart rhythm and heart rate, and I slip a pulse-ox on her finger (pulse-ox is attached to the monitor) to obtain her blood oxygen level.
I won’t go into any detail about heart rhythms, but I’ll simply say she has a dysrhythmia, her heart rate is at 118 (tachycardia = too fast), and her SAT is 87% (blood oxygen saturation), which is too low. Via my stethoscope, I auscultate her lungs and heart. I hear normal heart sounds, but I hear rales in her lungs. We insert a line (IV).
Our patient falls unconscious, and remains unresponsive. Cyanosis (blueness) begins to appear. She still has a pulse, but she’s no longer breathing, so she’s in respiratory arrest (apnea).
Based off my assessment and what information I gained from her roommate on-scene, I believe the diagnosis is pulmonary edema (various causes that I won’t go into). As I assemble the CPAP—Continuous Positive Airway Pressure—and attach it to her face, my partner pushes (inserts into the line) vasotec and fentanyl.
We place her onto our stretcher and load her into our ambulance for transport. En route, I monitor and reassess her constantly, perform any and all interventions as necessary, and retake all vital signs very five minutes.

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