Listening to Lung Sounds

17 May

A 53 year old male sits in his family room with firefighters and EMTs buzzing around him.  He hasn’t been feeling right lately but tonight’s the worst.  He’s cold but can’t stop sweating.  He’s tired and it hurts to take a deep breath. 

His wife is panicked as he’s always been healthy.  Even as the EMTs were walking in, a neighbor stopped them and said that if the wife was too nervous to go to to the hospital via ambulance  that they would take her. 

The patient is loaded onto the stretcher, packaged and rolled out to the waiting ambulance.

Once in the ambulance, electrodes are attached from the 12-lead monitor to the patient.  The patient is sweating so much that tape has to be used to get the electrodes to stick.

There’s a paramedic off the Engine and a paramedic from a chase car in attendance.  The paramedic from the engine reads the EKG and interprets “narrow complex” tachycardia.  He recommends to the other paramedic – the one that is going to stay with the patient – that two large bore IVs get started.  He doesn’t start them, but he passes on this wisdom as he climbs out of the rig. 

The patient is pale – that unfortunate grey-pallor that people get when things ‘just aren’t right’.  He’s sweating and breathing shallowly.  When asked why he says ‘because it hurts to get a deep breath in’.  The EMT-B in the ambulance asks if anyone has listened to his lungs yet. 

The paramedic looks at her and says ‘a nice easy ride to Memorial Hospital, please’.  She looks at her partner and both of them get out of the ambulance.  One to drive the ambulance and the other to drive the chase car. 

10 minutes later the ambulance pulls into the ambulance bay and the patient has sweat pouring out of him.  One IV is established and there is an errant IV catheter just hanging out of the crook of the patient’s arm.  Placed there but not removed by the paramedic in an attempt to get IV access via the left AC. 

The patient is unable to move himself over from the stretcher to the bed.  He has a couple of syncopel episodes while sitting on the stretcher. ER RNs, a tech and the ambulance crew sheet the patient over from the stretcher to the ER bed.  The paramedic looks on from the door. 

The patient is now on the ER bed and the ambulance crew move away to get supplies and leave the hospital. 

*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*

A return to the hospital about ninety minutes later means an opportunity to check-in on the patient.  The patient is no longer at the ER.  The patient has been transferred to Big City OR via private transport group running lights-and-sirens because the patient has a hemothorax.  The paramedic wrote on the patient care report that he listened to lung sounds and determined them to be clear bi-laterally. 

A look at the CT scan shows a completely occluded right lung and the diaphragm had been pushed down into to the stomach.  The patient was in the Big City OR 10-minutes after arrival…Memorial Hospital attempted to fly him out but the weather was uncooperative. 

There’s a reason that there is an axiom “BLS before ALS”….and don’t document something you didn’t do. 

There’s a reason that brand-new EMTs are told ‘listen to lung sounds on every patient’.  Not because we’re trying to make the process of becoming an EMT harder – but so when you do listen, you can tell the difference immediately between ‘clear bilaterally’ and ‘absent’. 

Every patient that I touch, I listen to.  Regardless of chief complaint.  But now I will listen to every patient, regardless of who’s the ranking person on-scene.  I didn’t and I wish I did for this patient and for that – I’m culpable.

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