Only one, but it was a head-scratcher

I rode overnight the other night, with one of my favorite crews.  I was lucky enough to have a BLS crew in house all night, so I could ride 3rd on the medic.  This is something I do as often as possible since I am not operating as a medic right now and most of the medics I ride with allow me to do assessments and ask me my treatment plans and such.  It's good practice for me for when I am the 'lucky' one.  In the meantime, I don't have to do paperwork.

So anyway...We got a call to a residence for an elderly patient complaining of 9/10 abdominal pain.  Had abdominal pain all day, woke up feeling poorly, and had gone about daily duties until the pain just got too bad.  History of strokes, IBS, vertigo, and an appendectomy as a child.  Vitals on scene were stable; in fact the first BP we got was better than mine.  The patient was a poor historian, and family members filled in the blanks, but the history of the current problem was slightly sketchy.  Abdomen was soft, no masses, with some slight tenderness over the LRQ.  We were considering constipation, but the patient had even written down what time he took care of that particular problem this morning.  The thought of a AAA crossed both our minds, but the patient just didn't look right for it.  No sudden onset of pain, the pain was cramping rather than stabbing in nature; it just seemed like an issue of IBS or constipation.

However, the patient looked like crap.  Pale, slightly diaphoretic, with that clammy nature I've learned over the past 16 years is the hallmark of the truly sick.  The BLS crew had chased us, and the EMT (who has been an EMT for over 20 years) seemed surprised that ALS would transport (both the medic and I had that "feeling" that this one was not quite right).

The patient insisted on walking down the stairs to the stretcher outside and did so without incident.  We had a nice quiet ride to the hospital, non-emergency.  No 12-lead changes, no EKG changes, vitals remained stable, pain didn't move, and we talked with the patient a good bit en route.  As we were pulling up to the ambulance bay, the patient suddenly grimaced and said "Wow, the pain just got worse."

This particular hospital we went to is not really known for moving fast when we arrive.  For a moment, I half expected them to shunt our patient out to triage.  The charge nurse took one look at our friend, and hustled into action.  The patient was transferred, blood drawn, 12-lead done, and doctor hurried in.  The patient's color looked slightly better, but now BP was somewhere around 80/50, rather than the nice 116-120 systolic it had been for us.  The patient was also now telling the doctor that the pain had been around for 2 days, and the abdomen was now tender.  I'm not sure what all they did, but by the time we cleaned up and were leaving, the patient was alone in the room again.

The hospital thought AAA as well, and I know they were working up the patient for that.  The chief is going to call down and see if he can get an update on what exactly was wrong.

So yeah, lesson of the night was to listen to your instincts, children.

Of course, as par for my expectations, that was the only call we had.  I don't get many chances to ride with ALS at my volunteer house, and it seems that when I do, we barely turn a wheel.