The MacMedic

Only one call last night but it was refreshing. We were dispatched to a reported unresponsive person not breathing at a private home near the center of town. The responding ambulance crew was at the intermediate level and I was going as the duty paramedic to meet them on scene.

When we arrived we were directed to the basement apartment of a nondescript house where we found the two intermediates from the FD rescue attending a middle aged woman supine on a bed. The patient presented cyanotic, with agonal respirations, and with her groin and armpits packed with ice cubes. Her pupils were pinpoint and nonreactive and, unsurprisingly, nobody in the house would initially admit to having called 911.

The FD was looking for an IV site when we walked through the door so I directed the ambulance crew to grab a bag mask and an airway and start bagging the patient to bring her oxygen saturation up from the rather dismal 66% that it was at. She was bagged easily for less than a minute with her saturation coming up to the mid 90’s. In the meantime I started a line and was drawing up some Narcan for what I suspected was a narcotic overdose. The EMT that was bagging stopped for a second and tried to insert an oral airway which resulted in a rather dramatic increase in the patients level of consciousness.

She wouldn’t tolerate a non-rebreather so a cannula was applied and her sats maintained in the mid 90’s that way. She vehemently denied taking any medications other than an antibiotic for Lyme Disease and Lasix for “fluid retention problems”. I wasn’t buying it but after a long debate with the police she eventually agreed to being transported to the hospital voluntarily (her other option was going to be handcuffed to the stretcher) but made it clear that she wanted to medications while she was being transported no matter what they were and what they were supposed to do. She continued to deny any drug or alcohol use throughout the transport but when we stopped stimulating her with conversation she would grow sleepier and her respiratory rate would start to decrease.

Fortunately (I think) she continued to stay well stimulated calling us many very colourful names for coming and bothering her and taking her away from her nice quiet evening at home.

About half way to the hospital we got a call on the radio to phone the dispatcher and got the message relayed to us that one of the occupants of the house finally admitted that they had been taking heroin and cocaine and after going out to get more beer her friend came back and found her unresponsive. That fit pretty well with what I had deduced when I arrived.

Ice in the groin has been a sign of a narcotic overdose until proven otherwise for my entire career. The ice doesn’t do anything other than signal EMS that narcotics are involved. Sort of reminds me of the folks when I first started in EMS who would wrap their chest in tin foil and duct tape believing it to stop the bullets, they were both equally effective at what they were supposed to protect from.