Routine. Routine. Routine. Twice in just a couple weeks I have been saved by routine. Here’s what happened this time.
First, a little background. The first responders in one of the towns I work in have decided they will no longer respond to lift assists without injury. It was argued to the high-ups that well, you never really know until you get there, but to no avail. The first responders have other priorities and the ambulance can do the lift assist if no one is injury. I just found out about the policy. I didn’t even know it was in effect. We have such a good relationship with the first responders. It seems they are always there helping us. Anyway, so we get sent to the “lift assist, no injuries,” and are told there will be no first responder. I explain the policy to my partner, who hadn’t heard of either.
The call is at an elderly apartment complex. A neighbor meets us at the door and leads us into a bedroom, where we find an obese sixty-year-old woman laying flat on the bed, unable to sit up. She is alert and oriented. I touch her forehead it is warm and dry. She says she is weak, and while she normally could get up, she can’t. I ask her if she is a diabetic. She says she is. I ask if she checked her sugar. She said she did earlier and it was fine. Her speech is clear, but when I test handgrips, her left side is weaker. I do the arm drift test and she can’t hold her left arm up. She looks like she might have slight facial droop, but I’m not sure of it. She says she was up around four to have breakfast, and was walking fine, and then she went back to bed, and couldn’t get up when she heard her neighbor knocking at seven.
“This may be a priority after all,” I tell my partner. “We may be on the clock.”
The woman is a difficult lift – it would help to have the first responders there, but we don’t have time. She is already close to the three hour prehospital stroke window. With her neighbor’s help – holding the woman’s feet, we are able to spin her around from the far side of the bed to the closer side, and then lift her on the bed sheet onto our stretcher. Out in the ambulance, as we race to the hospital lights and sirens, I ask the woman if she has ever had a stroke or a TIA before.
“Is that what I’m having now?” she asks, “A stroke?” Her eyes tear up.
“It could be. You’re left side is weak. We’ll let the hospital decide.”
I search for a vein. She says they need to use a butterfly on her. I take a stab at the AC, but come up with nothing. When I pull the needle out of her arm, there is just a small dab of blood from the hole I made. I take out the glucometer and do a sugar check off of it. Just to cover all my bases. LO
LO means less than 20. “
This might be good news. You’re sugar is low.”
“That can cause a stroke?”
“Not a stroke, but it can make you look like you are having a stroke. I’m not saying that’s the problem, but I’m going to give you some sugar and we’ll see.”
I’m wondering what she is doing talking to me if her sugar is less than 20. In most people she would be unconscious. I renew my search for a vein, and find a tiny one on her right arm – enough to fit a 24 in. I recheck the sugar again – just to be sure in case my first reading was contaminated. It still reads LO. I then push the sugar – it actually flows quite well.
“Squeeze my hands.” Equal grips.
“Hold your hands up in the air.”
They both stay up.
I unbuckle her strap.
“Can you sit up for me?” She sits bold upright.
“I think you’re fixed.”
To my partner, I say, “Slow it down and cut off the lights.”
**
I check a sugar on just about everyone – and of course it is part of the stroke protocol to check the sugar just in case it is the sugar causing the problem, but the key part is your routine just makes you used to doing it so you don’t forget, so you don’t end up at the hospital with a stroke protocol only to have the doctor say, “ah, did you check the sugar? It’s less than 20.”
**
Maybe that’s why first responders shouldn’t pick and chose calls. Sometimes “unable to get up – not injured” means a stroke or hypoglycemia. Sometimes it means cardiac arrest. I’ve had that happen before. A woman says, “My husband can’t get up…He’s cold.” Sometimes there’s nothing routine about routine.