We responded to a report of a patient feeling dizzy. See? Sounds ominous and scary already doesn’t it?
There turned out to be a few factors that added to the difficulty level of this call when we arrived. First, there was a bit of a language barrier. The patient spoke broken English but was difficult to understand. Secondly, his wife was of no help and after letting us in she disappeared to the living room which reeked of dog and unkempt living, which was the third problem.
The patient himself was in the family room using a walker to get around when we found him. He said he was feeling dizzy and I told him to have a seat on the couch so we could check him out. He tried to maneuver backwards to the couch but the walker hung up on something and he tumbled backwards, landing (fortunately) on the couch unharmed. Not a great start though.
Our evaluation showed that our patient was pretty warm to the touch although not truly feverish, he was dizzy and stated he had thrown up. While taking vitals and checking his blood sugar he coughed a little bit though otherwise he didn’t seem to be what we call “big sick”. He was not a great historian about his medical history or medications he was taking so the captain went to the kitchen to try and get some info from the wife.
Our ambulance company arrived and one of the medics went to join the captain in the kitchen to help sort out the medication question. At this time the patient said he felt sick and needed something to throw up in. We gave him an emesis bag and he began to vomit and cough into it. It wasn’t a copious amount but it was a decent amount of blood thrown up into the bag.
It was about this time that the ambulance medic came back in from the kitchen holding a pill bottle. He asked the patient what he was taking this medication for. It was a powerful antibiotic. It took a minute to sort it out but we finally determined it was for TB.
Crap.
So we’d been in a smelly house with a patient who was coughing and/or throwing up blood and NOW we find out he has tb? The ambulance crew put a mask on the patient and themselves to load him up for the trip to the hospital. We were already outside and away from the patient now but the medic came back to tell us he would call us from the hospital when they know the patients status so we can figure out what to do.
We rode back to the station in that charged eerie silence of worried people. Back at the station we began looking up the protocol for exposures and whether what we had would be something that would require testing or treatment.
We all went and took showers and shortly after that we heard over the radio that our ambulance was going “out of service - administrative”. Ohhhhhh that can’t be a good sign. We let the captain know what we had heard and after filling out the exposure reports we decided to head over to the hospital to find out where things stood.
The ambulance and crew were still in the parking lot and came to meet us right away. The first thing the medic said was “good news”. What? Really?
The patient was on antibiotics for tb but it was latent tb possibly from an old vaccine. He also had an unrelated GI issue that was causing the coughing and vomiting blood.
This was all incredibly relieving news.
The whole incident had taken place over the course of an hour or hour and a half but it was still harrowing. So many awful thoughts go through your head: health, family, career...where do they all stand? I’ve only had to be treated for a potential exposure once before in my career and that is one time too many.
