Here’s an interesting case to wrap your head around:
EMS is dispatched to a residence code-3 for chest pain. On arrival, the crew finds a distraught young man waving them inside the residence. He stated that he and his 23-year-old girlfriend were arguing when she suddenly started to complain of severe chest pain. The girlfriend is in the fetal position on the ground crying and grabbing her chest. It is difficult to obtain any information out of her as she is hysterical and won’t answer any questions. The paramedic on the ambulance kneels down to try and calm the patient and get her to talk, while the EMT partner questions the boyfriend.
The patient starts to calm down and tells the paramedic that her chest hurts and is interrupted by the EMT who yells from across the room that the patient has an internal defibrillator. The paramedic turns to his partner who explains that the boyfriend just said that the patient was grabbing her chest saying that her defibrillator shocked her. The patient tells the paramedic that her defibrillator shocked her “a bunch of times”. He instructs his partner to place her on oxygen while he places her on the ECG monitor. Before he can get all of the leads on her, she screams in pain and says “it shocked me again”.
The ECG monitor is applied and shows sinus tachycardia a rate of 112. The crew places her on the gurney and obtains a quick set of vitals. NIBP = 142/72, Sp02 = 99%, HR = 112. Just as the crew prepares to leave the house, her internal defibrillator shocks her again while the paramedic was watching the monitor. The paramedic now suspects that the defibrillator is malfunctioning as she still had a narrow complex rhythm when it shocked her. He asks her if she has a magnetic device to disable the defibrillator. She states that she lost it a long time ago.
The crew loads the patient into the ambulance and begins towards the nearest cardiac facility code-3. While en route, the defibrillator shocks the patient again, only now the patient’s rhythm converts to ventricular tachycardia.
Have you ever run into a scenario like this? What would you do for this patient?
Stay tuned for a follow up post.

When I use this format, I fill in all of the pertinent information prior to making my call-in. Any information that I don’t plan to pass along over the radio is skipped over. For example; A patient complaining of chest pain would most likely require every field to be completed while a complaint of general weakness would not require the OPQRST.
So there I was, sitting in the back of the ambulance cleaning up after running a combative patient that was under the influence of meth-amphetamines. My partner and I were wading through the wreckage that this outstanding citizen caused. Kind of like people do when their homes get demolished by tornadoes. I looked at my partner – who happens to be brand new – and told him that he did a good job on the call. He looked up at me with a confused stare and replied, “are you being scarcastic?” I explained to him that he stayed calm and did a great job with getting the restraints placed on the patient in a timely manner. ”Um….thanks, nobody ever gives me feedback so I don’t really know if I’m doing a good job or not”, he replied.
