Closest Most Appropriate 5/7

I carry Josh down the front stairs of the house to my gurney waiting by the gate, get him settled in, switch over the oxygen to my tank and get him loaded into the rig. The fire medic jumps in behind me and starts reassessing a blood pressure while I hook Josh up on my EKG monitor. Meanwhile, John is getting the mother settled in the front passenger seat.

I don’t usually run a 12 lead on an 8 year old but this is cardiac etiology and I really want to see his electrical conduction from the additional points of view just to make sure I’m not missing anything that might change my transport decision. To get a clean tracing I need take the 12 lead before we start moving to avoid any interference from a moving ambulance.

As soon as I start to get a rhythm on the monitor I get my first piece of good news on this call. The fire medic’s monitor is only able to see one heart lead at a time, my monitor is preset to see two leads and one of those leads is showing me an organized complex of electrical conduction, not the even lumps of atrial flutter. I’m staring at an irregular rate from 150-180 but at least it’s organized.

It appears that all of the heart surgeries and the original defect have altered Josh’s electrical axis – his electrical conduction starts in a slightly different place on the heart and takes slightly different paths as it stimulates the contraction of cardiac muscle. As a result, in the default view of Lead 2 it looks just like atrial flutter but in Lead 1 and Lead 3 it looks much better. I’m starting to feel a little better about the drive ahead.

Everything else can be done en route, so with the EKG done, it’s time to go. I look up and see John and Mom looking back at me. “The 12-lead is good, let’s go.” As we start to exit the neighborhood with lights flashing and the siren making its familiar noise I’m almost starting to feel a little confident that this call will have a good outcome.

John says something from the front and I didn’t quite hear it so I move closer to the pass-through. We’re on the freeway in the far left lane. John flicks off the siren as the traffic is clear in front of us. In a slightly concerned voice he leans back so I can hear him. “I’ve never been to University, I don’t know how to get there.” Crap!

My GPS is sitting on the front dash. I can get to most places in the county without it and definitely to every hospital in the county. It’s occasionally good when we are off in the hills or if I have an inexperienced partner. But I didn’t program in the out of county hospitals.

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~ by KC on May 30, 2010.

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