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A Smaller Bag of EMS Tricks

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There are certain things we do or have done in EMS that the research tells us don't help but actually hurt. In fact, there are lots and lots of those things: Remember Hyperstat? Calcium chloride? Two amps of BiCarb? Teeth screws? Ipecac? Backboards—oh, wait, we still use those medieval torture devices, just not on every poor patient who stubs a toe anymore.

Don't get me wrong, I'm all for applying evidenced-based medicine (EBM) to EMS. I do realize that illness isn't a result of an imbalance of the humors, the miasmas of the night air or an excess of blood that must be let. Nevertheless, every paramedic who has been around long enough to have forgotten the mysterious art of applying MAST pants without attaching his partner to the patient with Velcro® has been around long enough to have seen something work, maybe many times, that has since been yanked from the EMS armamentarium.

Ms. Pac-Man
Bob and I were working together on Medic 86. In fact, it'd been one heck of a day. I think we'd already run several calls and they had all been ALS. In fact, we were feeling pretty frisky that day.

We were dispatched to an unconscious female at a residence. When we arrived at the single-story house, we were greeted by a very concerned husband. He told us his wife was playing Ms. Pac-Man when she suddenly dropped to the floor. He didn't think she was breathing.

So, we rushed into the house with all our crap and there she was, a middle-aged lady lying supine at the base of a full-size Ms. Pac-Man console. I resisted the urge to play a game while Bob was getting set up, but throughout the call, I had to suppress a chuckle every time the machine would do its "wah-wah-wah" thing.

Bob stretched the lady out, looked, listened and felt, and he said, "I got nothing." Now you have to understand that Bob is a bit of a bear of a man with a seriously large chest. He stretched her out, reached down with those great big paws of his and grasped not only front of the lady's shirt but also the front of the bra underneath as well. With one great yank, shirt, buttons, bra and boobs went flying. Her torso rose up, her eyes opened wide, and she sucked in a great gasp of air. What must she have thought, waking up to have Magilla Gorilla apparently ravishing her in her own basement?

Well, after she regained her composure, and Bob did his best to cover her back up with her sundered blouse, she said she didn't remember what happened, had no medical history and felt fine. Given the fact she had just been dead a few minutes before, she agreed to accompany us to the hospital for a checkup.

The Thump
A couple of years later, I was working in beautiful downtown Lorain, Ohio, when my partner and I were dispatched on a sick call. We entered the well-kept apartment of an elderly lady who had a history of arrhythmia. She told us she felt her heart was jumping around, and she felt weak. She was conscious and alert with warm, dry skin, but her pulse was erratic. Sure enough, the monitor showed a sinus rhythm with a grab-bag of ectopics. Other than feeling weaker than usual, her assessment was normal. So we loaded her up on the cot with oxygen, IV and monitor in place.

The apartment was a bi-level with about four or five steps leading to the lower level. I was at the foot of the cot, facing the patient, and my partner was at the head of the cot. The Lifepack 5 (I told you this was a few years ago!) was lying across her legs, facing me. As we began to negotiate the stairs, her jaw sank back into her face, her eyes glazed over and her color paled. I glanced down at the monitor. I did a double take at the supraventricular tachycardia at 160 beats per minute. Reflexively, I sucked in a gulp of air and raised my fist about a foot off her chest. Her eyes went from glazed to sharp, her pupils constricted, she gasped back at me, and her rhythm changed instantaneously to a normal sinus.

"What were you going to do?" She asked.

"Thump you," I answered.

"Well, whatever you did, I feel much better now," she replied.

"I bet you do," I chuckled.

"Glad you didn't have to hit me."

"Me too," I said.

Since then, they've taken the precordial thump out of our box of tricks. But they never said we couldn't threaten to thump! Sometimes, a little vagal assistance is all you need to set things right.
 

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