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He rattled off the patient's vitals and glucose levels as they transferred him onto the cart.
“How much fluid did you give him?” Lindsay asked with a frown.
“Only two-hundred cc’s so far.” He glanced at her trying to gauge why she was asking. “With this cardiac history, I didn't want to risk heart failure, but that is the treatment for DKA.”
“I understand.” She flashed a small smile. “But I don't smell any ketones on his breath so it makes me wonder if he really has DKA or something more serious like hyperosmolar, hyper glycemic non-ketotic coma.”
He stared at her in surprise. That was something he’d never heard about. “What's the difference?”
“Profound dehydration causes HHNK, you said he's a diet controlled diabetic, right?” Austin nodded, impressed with her knowledge. “We'll know more as soon as we get some lab results back.” She took the tube of blood she just drawn and handed it to a lab tech. “In HHNK, the patient usually has enough insulin in their body to prevent ketoacidosis, but not enough to allow the body to use the glucose appropriately. These patients are often much sicker than they look. HHNK is often misdiagnosed. And really, it’s up to the doctor to make that call anyway.”
On cue, a doctor walked into the room. “What do we have?”
Austin stood to the side, listening as Lindsey ran down the patient's history and current vitals. The guy's blood pressure had not improved, even after Jack removed the nitroglycerine patch.
“Run a twelve-lead EKG and then increase his fluids,” Dr. Graff ordered. “Call me as soon as you get those lab results back.”
“I will.” Lindsey called the EKG tech over.
Austin knew there was no reason to stay other than his own personal need to know what exactly this guy's diagnosis was. He'd made an assumption about the DKA and it bothered him to think it may have been the wrong one. “Jack, let's hang out for a few minutes.”
“No problem.” Jack glanced around. “I wouldn't mind a cup of coffee, though.”
“In the break room.” Lindsey jerked her thumb over her shoulder in the general direction of the staff lounge.
Jack ambled off but Austin stayed right where he was. “How long does it take the chemistry results to come back?”
“Should be any minute now—they're usually pretty quick.” She glanced at him. “What's wrong? You look worried.”
He lifted his shoulder. “Maybe we should have treated him differently. The wife did say he hadn't been feeling well for a couple of days.”
“Normally you wouldn't give a sixty-four-year-old a large influx of fluids, especially if he has a cardiac history,” she assured him. “You did the right thing.”
He appreciated her staunch support. This was exactly what he'd always admired about her. She never made the paramedic crew feel like second class citizens.
“Lindsey? Call from the lab on line three.”
She picked up the nearest phone and he watched over her shoulder as she wrote down the various lab results. When she finished, she handed him the slip of paper. “Definitely HHNK. See? Ketones are negative.”
He nodded handing the slip back. “So now what?”
She had already picked up the phone, placing a call to Dr. Graff. He listened as she relayed the information and then took more orders. She hung up the phone. “He's going to be admitted to the intensive care unit. They’ll keep a close eye on him.”
“Good.” He tucked his hands in his pockets, reassured that his and Jack's treatment hadn't been too far off the mark. “Thanks for letting me know.”
“Any time.” She turned her attention back to the patient and he glanced around for Jack. Was the guy still guzzling coffee in the lounge? He went back and found his partner. As they finished the rest of their newly computerized paperwork, he explained what Lindsey had taught him about their patient's illness.
“That’s interesting,” Jack agreed.
They headed toward the ambulance. Austin was about to slide into the driver's seat when he stopped, realizing he'd forgotten to tell Lindsey there was an extra Tai Kwon Do class that evening for Josh. As he was working, she would have to take him. Instead of calling her later, he decided to tell her now.
“Here.” He tossed Jack the keys. “I'll be right back.”
“Sure.” Jack brightened at the chance to drive.
He went back inside, glancing around for Lindsey. Their patient was gone so she must have transported him up to the ICU already.
How long would that take? He glanced at his watch. Curious, he walked to the staff lounge, intending to ask one of Lindsey 's coworkers for an approximate timeframe. He was surprised to find Lindsey chatting with Mary, one of the other nurses.
