We respond to an Alpha level call for an elderly lady who is feeling sick.
The triage program dispatch uses helps to determine the level of response and resources needed to handle the 911 call. The cards go from Omega to Echo with six levels of response, Omega level being someone with no injuries they just need help. Like they slipped and fell but have no injuries they just need help getting up off the floor, an engine company would respond. An Echo level call would be a full cardiac arrest. In our city an engine company with three personnel and an ambulance with two personnel would respond. At least two paramedics would respond with the Echo call.
My partner and I arrive to find an elderly man in the driveway directing us in. He leads us into a back bedroom where is wife is sitting on a chair next to the bed. I notice she is slightly pale and she states she doesn’t feel good. As my partner begins asking her questions I am listening to the answers. Her back began hurting about an hour ago and she did not sustain any trauma. She feels nauseous and weak. My partner is relatively new and we have previously agreed if any call we are on needs to have paramedic level care I will step in and take patient care. This is starting to feel like one of those calls. My partner turns to the patient’s husband and begins asking him about medical history and medications for the patient. I apply the heart monitor, automatic blood pressure cuff along with the pulse oximeter to the patient and assess her vital signs. This confirms in my mind, this will be my patient. Her pulse rate is 40 bpm, blood pressure of 84/40 and saturation is at 92% on room air. I apply oxygen by a nasal cannula and start asking more questions about the back pain, she indicates it to be on her right lower back in the flank area. She states it went up one side of her back and then back down the other side of her back and settled in her right flank area. She describes it as being “sharp”. I ask her questions to rule out a possible kidney or bladder infection. There is a high probability she may have a dissecting abdominal aneurysm, too many indicators to rule it out.
Since there are just two of us on the ambulance and an engine company is at least six to seven minutes away we notch up into fast mode. We load her onto the cot and into the ambulance. As my partner drives us to the emergency room I get an IV established and continue to monitor her vital signs. I continue to reassess her back pain and find it is now in the center of her back. As we arrive in the emergency department I discreetly advise the doctor of my strong suspicion for a triple AAA. We get her moved over to the hospital bed and she vomits. The ED staff ramp up their response to her as well.
An hour latter while we deliver our next patient to the emergency department I follow up on this one and find they are still having trouble getting her blood pressure up and they still have not confirmed a diagnosis. The next day as I leave my shift for home I drop by the hospital to deliver some paperwork and follow up again, this time the expected news. She has passed on to the next life we call death.
An abdominal aortic aneurysm is a localized dilatation (ballooning) of the abdominal aorta exceeding the normal diameter by more than 50 percent. Approximately 90 percent of abdominal aortic aneurysms occur below the kidneys, but they can also occur at the level of the kidneys or above the kidneys. Such aneurysms can extend to include one or both of the iliac arteries in the pelvis. Abdominal aortic aneurysms occur most commonly in individuals between 65 and 75 years old and are more common among men and smokers. They tend to cause no symptoms, although occasionally they cause pain in the abdomen and back (due to pressure on surrounding tissues) or in the legs (due to disturbed blood flow). The major complication of abdominal aortic aneurysms is rupture, which can be life-threatening as large amounts of blood spill into the abdominal cavity, and can lead to death within minutes.
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