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Primary Complaint
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The Story Unfolds...

Season Five, Episode Thirty Seven..

ßß  Primary Complaint   ßß

Debut Launch: September 1st, 2006.

Date: Mon, 04 Sep 2006 10:56:25  
Subject: A Beautiful Day

It was 7:00am in the morning when Captain Stanley and his
crew reported in for another forty eight hour tour of duty at Station
51. C-Shift was just getting off duty.

Paramedic Dwyer approached Roy and said. "Well, good luck!
We had another wild one here. Thirteen calls. Would you believe that?"

"I'd believe anything." Roy said. "When the weather's warm and
it's a full moon, things are bound to happen. See you soon."

"See ya next time, Roy, and tell Johnny over there not to worry
about the fifty cents he owes me from the bet he wagered with me
on Brackett." grinned Gil.

"Oh, really?" Johnny exclaimed, making a face of dismay.

"Brackett? What about Brackett?" Roy inquired at them both.

Dwyer began giggling without warning.

"Th-That he and Dr. Carrie Cederstrom would not last a month!"
Johnny said with a snicker. "I bet Dwyer here that they'll be at
each other's wits end before you know it!" Johnny told him. Then
he frowned at Gil. "You mean they aren't?" he fretted.

"Well, I'm sorry to say this. But, I think they're made for each other,
pal. They are both stubborn, arrogant, demanding..."

"Oh, I get it. In other words, they're just perfect for each other." Roy
said as he tapped his partner on the shoulder to show him the fifty
cents he was paying Dwyer on his behalf. "Here you go, Gil. I'm afraid
he's strapped until lunch.." DeSoto said, pointing at Johnny. "He actually
paid me all he had for a couple of shoelaces I gave him yesterday after
he broke his own trying to tie them too fast."

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"Thanks for the pay up. Yeah, those two are just like Archie and Edith on TV."
Dwyer said . "But they honestly love each other. Hmm, I'm outta here. Take it
easy!" waved Dwyer as he walked away to change into his street clothes.

"See ya." Johnny and Roy said to their colleague.

Roy spoke again to Johnny and said. "Well, we'd better get dressed
before the captain starts to think that we don't want to work today."

"I'd rather be on a boat just sailing by Catalina Island all by
myself to get in some peace and utter quiet. What a beautiful
day today!" replied Johnny.

Later, after Johnny and Roy dressed in uniform and went to meet
the rest of the crew, they discovered Henry already sound asleep
in doggy dreamland on the couch. Chet Kelly was having a candid
discussion with Mike Stoker and Marco Lopez about the new 911
emergency number that was to take effect countywide within the next
few months.

"This new number is going to get help to people quicker than the
system that we have now. They'll have only one number to remember
instead of three or four different ones for calling the cops, fire,
or an ambulance in an emergency whenever something happens."
Chet said to Mike. "I think it's a wonderful idea."

"But the main problem is this... The system that needs to be in place's gotta
be one in which the caller's location and phone number is automatically
sent to the dispatcher, so whoever dispatches out a reply response,
they'll have a permanent record of it." Mike said. "That could be years
yet down the line, Chet."

"That leaves just a training issue." Captain Stanley said. "A guy
trained to handle just fire calls at L.A. won't have the know how to
handle police or ambulance calls. So what do you do then?"

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Gage was well versed on the topic already and he jumped right in
as he and Roy entered the kitchen.

"W-well, train all the dispatchers to handle all calls from a
single answering point. Put six people on a shift. Two cops, two
fire guys, and two paramedics. Three people to take over
and prioritize the calls, and then have the second trio dispatch them
into the proper channels. EMS, Fire and Police. That might make
it more efficient." Gage said.

"It sure would." replied Roy.

"But how are WE all going to get used to it ?" Marco wondered.

"Don't you worry about that. We will. We always do whenever
there's a policy change." Johnny told him.

"I think it's a great idea with this,..uh, 911 number. But is it gonna
cut down on false alarms? Is it gonna give people a sense of
security they really need in a crisis? Or are some people gonna
abuse the system?" Roy wondered.

The rest of the gang shook their heads a few seconds later,
not believing Roy's negative angle for even an instant.

"It is possible." Roy insisted.

"That very issue has faced opposition by some people close to the
department already. " Hank Stanley said to all of them.

"Who?" inquired Johnny.

"Chief McConnikee and Dr. Kel Brackett."

"Brackett ?!  I figured he would and probably that new doctor friend
of his in Intensive Care, that Dr. Cederstrom, would, too." Johnny said
with a sarcastic smile on his face. "I wonder what their beef about it

"Johnny, are you in love again?" Chet asked him when Johnny
suddenly rubbed his nose in a telltale fidget.

"No, not with her. She's in love with Dr. Brackett and they may be
just like each other, but I still think that they aren't going to last long."

The whole crew erupted in hearty laughter that woke up even the
sleeping dog.

Mike Stoker was about to make a crude couple comment when the
station's SCUs went off and Sam Lanier's voice rang over the
loud speaker.

##Station 51. Possible heart attack. 6042 Emerson Blvd. Room
120. 6042 Emerson Blvd. Room 120. Cross Street Hazelton.  Meet
the nurse at the nurse's station. Time out : 0718.##

"L.A. Station 51, KMG 365." replied Captain Stanley from the bay

Both units took off with lights flashing and sirens blaring
towards the address which they knew was a nursing home.

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From: Mark Panitz <>
and the Voyagerliveaction Staff Writers
Date: Mon Jul 3, 2006 12:07 am
Subject: Reminiscing  

"Yeah, today feels like the toss of the dice on luck today
and no doubt we'll be seeing that more clearly once more
calls roll in." said Gage as they sped ahead of the engine
on their way.

"Luck, huh? I remember a day like today. It was
about this same time last year..." Roy said.  "Remember
that one, where the child got his head stuck inside a chair?"
he prompted his partner with a head bob as he changed lanes.

"Yes, wasnít that the day where the tenant didnít have a smoke
detector and we noticed it?" Johnny thought back, gesturing
pointedly while he helped Roy watch the road all around them.

"Yep. And soon, it happened that month too, that the county was
GIVING away smoke detectors. How ironic is that?" Roy chuckled,
turning up the dash radio when a cancel came out for a fire station.
"Not for our station."

Johnny blinked but didn't seem to have paid Roy's remark any
attention. "Huh, That was fire prevention week as I recall." Gage
said, glancing down at his address sheet. "Turn a left here."

DeSoto cranked on the steering wheel without even being aware
that he had been directed to do so. He was still very lost in thought.
"Thatís right. Thatís when I got the odd feeling we'd better put one
up for them."

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"You did?" Johnny asked. "I don't remember that."

"I do. And later that day, we returned to her apartment and helped
that mother put up our last smoke detector."

Gage picked up the memory. "Oh, now I recall it. Didn't we do that
just in the nick of time, too?"

"Huh?" Roy blinked.

Johnny elaborated. "That same evening, they had an unexpected house
fire afterwards.."

"Oh, yeah.. That smoke detector ended up saving their lives, so
we didn't have to, that's right. Boy was that a miracle it all
happened that way." DeSoto sighed in amazed reflection. "What
good luck..."

"Luck went bad that day, too." Johnny said, beginning to squirm.

Roy nodded in agreement. "I remember. It was when that work crew
was supposed to be flushing the water line, but fuel got into
the pipeworks instead. Was that it?"

"Yes. How could I forget? Thatís when I tried to put out the fire
with the garden hose and I got a little crisped here on my arm."
Johnny moaned.

DeSoto was liking the turn of conversation. It kept him from
thinking about the way traffic was slowing them down due to an
early rush hour. "Or about that other bad timing,.." Roy stuttered.
"W-what about that time that day when you wrote the chief
about auto drivers refusing to pull over for the squad." he said,
throwing a hand at a truck in front of them who wasn't yielding to
their flashing reds and sirens as he gritted his teeth in barely
veiled irritation.

Gage's voice grew in anger, too, when he noticed the problem
just ahead of them. He poured all of his energy into a glare in the hope
that the driver would catch his fury in the rear view mirror. But Johnny's
voice, all the time, remained in civil conversation as he concentrated on
keeping them on the shortest possible route to their current cardiac call.
"The chief had the sheriff department assign Vince to follow the squad..."
he replied. "And on one run when I wanted to help out a little while
off duty, I got a ticket for it!" replied John.

"You get all the luck.." Roy replied cheekily.

"Very funny. Why don't you just hush up now? We're almost there." grumbled

"It takes two to have a conversation.." Roy prodded defensively.

Johnny just glared right back at Roy, returning his affront without speaking.

Finally, Gage's volcano ran over. He stuck his head out the passenger window
and he hollered at the oblivious truck driver."Hey! You! Yeah, you! What part
of these big, red, flashing emergency lights don't you understand, buddy boy!
Move it out of the way!"

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Startled into motion, the truck veered suddenly to the shoulder, nearly clipping
Roy's front bumper. DeSoto neatly dodged the driver. "Thanks. That worked.
I knew the horn wouldn't've."

"No problem.." Johnny snapped, sinking back into his seat.

Date: Mon, 04 Sep 2006 10:56:25  
Subject: A Beautiful Day

It took them four minutes to get to the scene. Soon, the residents in
their walkers, canes, and wheelchairs were looking on in curiosity
as the firefighters began hauling the squad's gear in.

An elderly lady sitting on a porch chair replied. "Lord, have
mercy!" as the men made their way to the nurse's station.

Johnny and Roy and the engine crew were met by a CNA named
Kathy who told them the situation quickly. "Mr. Osterloh has had a
heart attack. He started feeling short of breath ten minutes ago. Then
about ...oh, a couple of minutes later, he said that his chest was
hurting.  We've put him on oxygen." she said.

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From: "Derrick" <>
Date: Mon Sep 4, 2006 6:07 pm
Subject: Primary Complaint

"Is that his primary complaint?" Roy inquired.

The CNA Kathy replied as they were escorted down the
hallway to Mr. Osterloh's room. "Yes.  He does have a history of
hypertension and he's had several strokes. He takes
Aldomet, Quinapril, Plavix, and Potassium. He is awake, but at
times is unresponsive."  

Two LPNs and an RN were attending to him, keeping him on oxygen
and monitoring his vital signs. "How's he doing?" Johnny asked
the RN name tagged Glenda standing at his head.

"He's on 8 litres of O2." she answered, looking up. "Vitals are now
180/150, he's got a pulse of 120, and his respirations are now
down from 28. They're at 20. His O2 sats have increased from
86 to 90 %."

Johnny and Roy came in closer visual contact with the pale,
gaunt elderly man. Johnny spoke to him. "Mr. Osterloh. My
name is Johnny and this is my partner Roy. We're paramedics
from the fire department. We are here to help you. How are you

Mr . Osterloh's eyes and head rolled back and forth as he took in
breaths of oxygen from the mask and he said. "Help me.
I feel terrible."

"Do you know what's bothering you today?" Roy asked, to
get the story straight from their patient.

"It's my chest. I can't breathe. I think I'm having a heart attack!"
he gasped.

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"Okay Mr. Osterloh? Can you tell me where it hurts right now?
How bad is the pain?" Johnny shouted while he drew out
his stethoscope to use from the I.V. box.

Mr. Osterloh's head went from side to side again as he
kept taking in deep breaths of oxygen without speaking.  

Nurse Glenda replied after a decent interval. "He said
that it started about twelve minutes ago and that the pain began in
the center of his chest and radiated into the middle of his back.
He rated his pain a ten out of ten when we first got in here."

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From: Patti or Jeff or Cassidy <>
Date: Wed Sep 6, 2006 2:20 pm
Subject: Blow Out..

"What was he doing when all this started?" asked
DeSoto to Glenda, the home's head registered nurse.

"He was resting after taking his morning shower.
He bathes from a chair with an orderly helping him."

Roy nodded. "Are there other new status changes that
you've noticed on him, such as any new confusion, lethargy,
agitation, slumping, flaccid limbs, or drooling?"

"No, he's still at the baseline of what's normal for him."
replied Nurse Glenda.

Johnny got her attention after looking at the man's
eyes for a pupillary response with his penlight.
"Is he on Coumadin? Or Aspirin?" he asked. "Roy,
he's PEARL, both sides."

"No. And before you ask it of us, this resident does not have
a DNR order. So please, treat him as you will. He has no
family left to speak for him." replied the RN Glenda, softly.

Gage nodded as he bent over their patient again.


Photos: None.
From: "Derrick" <>
Date: Tue Sep 5, 2006 9:10 pm
Subject: Treatment  

"Roy, I got decreased lung sounds with rales and stridor on the
left side." Johnny paused as he listened carefully to the right side
of Mr. Osterloh's chest and said. "Decreased and clear on the
right." As Marco assisted Roy, Johnny once again asked
Mr. Osterloh a question. "Mr. Osterloh, when did you have your
last stroke?"

Mr. Osterloh turned his head in the direction of Johnny and
said. "It was, I think back in .... in ..... February? March?
I don't remember anymore."

"Mike is contacting Rampart now on the biophone." Marco
said. "Or... do you want to do it?" Lopez wondered.

"That's ok, let him do it." Johnny replied as he began a
probing hands-on search for problems by palpating the
sick man's gaunt abdomen. "I'll take over for him in a second.
I gotta do a quadrants' check here."

Nearby, Mike Stoker spoke into the handset.
"Rampart Base, County 51. How do you read?"


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From: Patti or Jeff or Cassidy <>
Date: Wed Sep 6, 2006 2:20 pm
Subject: Blow Out..

Dr. Kel Brackett picked up the line. ##51, I read you loud
and clear. Go ahead.##

Johnny then took over the biocom from Stoker after they had
established the opening channel. "Rampart, we've a male who's
a partial invalid in the state home. Aged,..uh.."

"Seventy two.." said the CNA Kathy helpfully.

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Johnny smiled at her. "...aged seventy two who's complaining of
a severe sub-xiphoid pressure radiating into his back, accompanied
by some dyspnea. He's on medication for hypertension with
Aldomet, and an ACE inhibiter Quinapril.  Also, he's on Plavix.." added
Johnny as he confirmed the third medication by eyeing up the pink,
round biconvex, debossed, film coated tablets in the last bottle
another nurse was showing him for their dosage information. "His skin's
warm, flushed. Vitals signs at 0722 hours were : BP 180/150, pulse
120, with respirations at 20. His O2 sats are 90 % on six liters of  
unhumidified O2. He has a long history of multiple cerebrovascular
accidents with some resulting mental and physical detriment.
There is partial paralysis on the right side of his body."

##Are there abnormal lung sounds?##

Gage gathered those signs quickly. "Rampart, no bruits heard higher
up, but lung sounds are diminished with rales and stridor on the left
side, and clear but decreased on the right. Negative for hyperpercussion.
Also, note that he already has an IV, Rampart, a saline locked intravenous
access point mid radial...dated today." Gage said, picking up Osterloh's
arm as he peered at the saline lock's transparent tape ink marks. "The
nurses here say he's on potassium therapy. Uh,...currently, this chest
pain's sitting around a ten out of ten, by his reckoning. We believe him.
He's getting slightly agitated and very restless."

##What else have you found?##

Roy took over the phone. "Doc, the abdomen is non-tender on palpation
with no pulsatile masses. Bowel sounds are normal. On his neurological status :
He is physical effort intolerant and somewhat stuperous at irregular intervals.
We suspect he is suffering from long term severe, uncontrolled hypertension
on top of his new problem today." Roy added.

All the nurses in Mr. Osterloh's room winced with guilt at that.

Glenda, the home RN spoke up. "I'm sorry he hasn't been managed better.
We've all been horribly overloaded with residents this week.
We've been trying for three days to get more nurses in from the temp agency,
but no one wants to come here. Not even the student nurses. I guess it's
because of the stigma we have of being a nursing home for the homeless."

Roy nodded, inclining his head politely as he handed the phone receiver
back over to Johnny so he could prepare what he knew Brackett would
order for medications.

Johnny took Roy's current notes from him deftly, and the phone, while DeSoto
moved onto other care duties. "Rampart, County 51. We have current
vitals of BP 170/120, Pulse is now 124, respirations 20 with O2 sats, still at
90 %. We can send you a strip in a minute, Rampart, at your discretion."

##Is there any increase in edema in either his periorbital, upper, or lower
extremities', regions?## Kel asked.

"Negative at this time, Rampart." Gage replied.

Nearby, Nurse Glenda tapped Kathy the CNA on the arm.
"Kathy, bump up his oxygen to fifteen liters on a non-rebreather. The
light Venturi's not doing the job well enough. Do you see
the blue forming around his ears and throat area?"

"But he hates the smaller mask, ma'am. He put up a fight
something awful yesterday.." Kathy whispered to her trainer,
trying not to be overheard by the paramedics.

"Would you please make the change? These nice young paramedics'
primary goal is to reduce Mr. Osterloh's oxygen needs as soon
as possible. Don't fret about Teddy. He's uncomfortable to the point
now where he won't complain much, no matter what we do for
him, Kathy. I promise you that he won't be fighting anyone
today. He hasn't any energy left for it."

Kathy complied and soon, Osterloh's respiratory rate eased
even more to almost a near normal level.

Johnny frowned when his fingers brushed over the sick man's
hot, sweaty skin. "What's this stickiness on his chest? Is it afterbath

"No, sir." Kathy blurted out. "It's NTG ointment, he has an order for
it PRN on his daily chart."

"When did this stuff go on?" Gage asked, being neutral.

"Just as soon as we realized that Mr. Osterloh was in trouble.
About ten minutes ago." replied Kathy's preceptor, Nurse Glenda.

"Ok, wipe it off." Johnny told her without looking up again.

"But, he needs it. He's in a lot of pain.." Kathy insisted.

Roy lifted his head from the drug box he was rifling through.
"Kathy, nitro in topical form takes up to an hour to work.  And where this's been
applied is going to be in the way of our electrocardiogram lead placement.  
Don't worry. He'll get his nitro. We'll be giving it I.V. in a minute or two. The
delivery route's far faster that way." he said with a smile, trying to counter
the gruff order Johnny uttered. He knew his partner only got short with
relatives and witnesses on a scene when he was worried. Tactlessness wasn't
Johnny's intention at all, so Roy felt he always had to explain that to others.

Dr. Brackett's first diagnosis boomed out and made the others hasten
to listen to his words. ##Squad 51, I concur with your finding of suspected
heart ischemia along with hypertension. Go ahead and administer Nitroglycerin
IV 5 mcg/min, with a bolus into that saline lock. Make sure that's patent first before
any injections to avoid the chance of causing chemical necrosis in his arm.  
Increase the NTG dose by 5 mcg/min every five minutes to the desired effect
up to three times total if he's still uncomfortable. Go ahead and establish a
Y-site, too, for other medications, at the lock. I'll be ordering them just as soon
as I know more. Give him aspirin,.. 162mg chewable tablets by mouth if he's
able. Also, draw up an injection of Lidocaine 1mg/kg and have it standing by
for a slow IVP in the event you note signs of ventricular ectopy or a new run
of multifocal PVCs. Especially if there's increasing ectopy."

"Isn't that dangerous for him to take ASA on top of his Plavix?" asked
the nervous, near tearful nursing assistant Kathy.

Roy smiled. "Aspirin should be administered, regardless of whether
the patient is taking anticoagulants. We don't want him developing
a pulmonary embolus. We want to mimimize his ischemia immediately
if this is truly an early heart attack. Having blood a little thinner's ok here
and it's all for his greater good. Sort of like not being afraid of giving a
little more sugar to a stricken diabetic on the off chance that their problem's
hypoglycemia. A little more will never hurt him."

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Kathy nodded, wide-eyed with concentration. This was the first time
she had ever seen paramedics at work in her entire life.

Brackett returned over the speaker system on the biphone.
##Have one of the home's nurses draw laboratory specimens.
Tell her to draw a variety of tubes that will allow our lab to perform
hematology, chemistry, and coagulation studies.  

##Begin your MONA protocol.  Use the nitroglycerin first and then add
morphine to help relieve that chest pain as needed. Use two to four
milligrams MS IV only when and if the nitro doesn't appear to be
working for you anymore. Get another set of vital signs, including
a pulse oximetry. Attach your heart monitor and get me a detailed,
one minute duration, twelve lead electrocardiogram..## said Kel.

##Have one of the nurses on site prepare him for some continuous
respiratory monitoring. We'll be needing a close watch over him
after we give out his cardiac narcotics. If there's no resolvement
of pain after your third dose of NTG, raise him up to a semi fowler's
position to aid his difficulty breathing...## Brackett told his paramedic
crew. ##Support him on ambu if he's fatiguing.##


Kel turned his head and nodded for Nurse McCall to take extensive
notes. "Dix, when he gets here, I'll want a hemogram,
electrolytes, a blood sugar, BUN, creatinine, a full coagulation study
with cardiac markers, an eg,  a myoglobin, and a screen for troponin. Also
tell them to get these: An LDH, LDH isoenzymes, CPK, CPK isoenzymes,
a CBC, and blood differential. And for Hematology, obtain renal function
studies on the blood 51 will be bringing in. Order a room for an emergency
cardiac catheterization, stat. Also, line him up for chest X-rays: a PA, lateral,
an antero.. the works. I want to rule out all possible parenchymal involvement

"Right away, Kel." said Dixie. And then she got on the white phone.


Back at the home, Mr Osterloh began moaning. "I can't.. chew these...
I- I'll choke.." he gagged on the baby aspirin.

"Just relax, sir. Put them under your tongue. They'll dissolve there
in a couple of seconds, ok? You don't have to swallow them if you
don't want to." said Johnny near his ear.

Then he turned his attention to the EKG monitor that Mike Stoker,
Chet and the others had set up. He turned on the unit, studied it
for a couple of seconds, then he picked up the phone, trying not
to frown in dismay.

"Doc, we're transmitting now. I'm reading just initial T-wave inversions,
without significant ST segment elevation..." Gage reported.
"Tachyarrythmias are evident but there's no signs of Wenckebach's
or Mobitz II complexes."

The EKG strip came through on the base station's monitor and Dr .
Brackett meticulously examined it. He then said to Johnny.
##51, how much does the patient weigh?##

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"Approximately 165 pounds or 75 kilograms, doc." Johnny said as
the siren from the Mayfair ambulance stopped in the distance.

The RN beckoned Kathy to her side, handing her a kleenix. "Do you
understand what that paramedic's saying about Ted's EKG?"

Kathy shook her head, no.

"Ok, let me explain a little bit about cardiac strips for you.
A T-wave inversion usually signifies an area of ischemic heart
muscle from decreased blood supply. The cells are not yet actively dying.
Secondly, an ST segment elevation of more than two mm in an affected area
signifies an area of the heart muscle that is infarcting. The cells are actively in
the process of dying..." said the Glenda.

Kathy actively sucked in her breath.

The RN reassured her. "Now he hasn't found anything truly dire yet.
Mr. Osterloh's ST waves are still normal or very near so or he would have
mentioned something about them, ok?"

Kathy sighed quietly and studied her shoes. "This is hard, ma'am."

"I know. Mr. Osterloh's your first crisis call on a resident. You did fine.
The help he needed so badly's here now and they're doing everything that's
physically possible in order to save him. You've been a large part of
of that good care. Be proud of what you've done. It's all any of us can do
when we work for a state run home. Now listen to this last part on an EKG's
tracing.  A Q-wave formation signifies an area of cellular death, an earmark
of a very old or extensive MI. He's clear of Q's, Kathy. That's a very
good sign."

Dr. Brackett was issuing the last of his preliminary guidelines.
##Monitor for arrhythmias, signs of pulmonary edema, and cardiogenic
shock, 51. Let me know the NTG dosings' outcome as soon as you find out.##

Kathy remembered some of her schooling and she began muttering
under her breath.. "Twelve leads. Ok,.. Leads V1, V2, V3 shows anterior
damage. Leads II, III, AVF shows inferior damage. And last of all, Leads
I, V4, V5, V6 shows up any lateral heart damage. Got it.." she told herself.

Then Kathy tried to make herself smile when the frightened Mr.
Osterloh looked straight at her own terrified, staring eyes.  


"Ok, Glenda is it?" Roy smiled quickly as he angled his
head around to look at the tan haired RN.

"Glenda, that's right."

"Could you and Kathy here help me sit him up a little higher
in bed? Doctor's orders."

"Sure.." said the two nurses on the home's staff.

The three of them no sooner had the man's head propped
against the headboard on ample pillows when Mr. Osterloh's
chin suddenly slumped down onto his chest.

"Whoa...." DeSoto muttered, quickly sliding down the bed to
pull his patient flat once more so he could regain an open airway.

Gage startled, too. "Rampart, our victim's just gone unconscious
following a positional change. Stand by. Roy?"

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Primary Complaint
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