30 April 2005

Always a party on MTA

Last night was my last city shift and last clinical of the semester. Yay! Our first and only interesting call was for an overdose. The patient was on an MTA bus. She was sitting up, conked out with sporadic snoring respirations. I started the IV (my fastest yet!) and drew up the Narcan. I gave it to her and about a minute later she woke up, good as new, until about a minute after that, she started puking everywhere. Now, everyone that knows me knows that I have strict rules about vomiting. I have my ‘no puke zones’ which basically include every area within, let’s say, a 50 yard radius of me. I just hate it. Well, who doesn’t really? If somebody’s throwing up, no one says: “Ooh, where! Let me see!”
So, we’re in pretty close quarters with this patient as she was puking all over. Then suddenly I thought: “Hey, I’m okay. I feel fine!” I was so proud of my tummy for not letting me down in this most gross situation; no queasiness here!
We finally got rid of her (just one of those patients) when I began to wonder how she even made her way onto the bus in the first place. Then I wondered why she got on the bus. But, I figured that one out. The MTA is the place to be! It’s a party every day on those busses. Have you seen them? All blue inside with the strobe lights, smoke machines, and mirror balls. Who wouldn’t want to get high and hang out there? It should be their motto: “The fun never stops on MTA” “Always a party on MTA.” I foresee a whole new ad campaign, public transit in the city will never be the same (well, after they get the vomit cleaned up).
I’m pretty happy that I got to experience this “classic” Baltimorean call.

I also came full circle with my area. My first patient in the city was also my second to last (see Snow, combs, forks, and bananas.) She was the conveniently accessorized patient. She was not so enhanced this time; what will she do if she needs to comb her hair? Just suffer like the rest of us inefficient people, I guess. She again had no chief complaint, but she must really like the inside of Baltimore hospitals. Personally, I can’t get enough of them, so I’m pretty jealous that she’s in them 3,4, maybe even 5 times a week, lucky!

I'll be back in the city next year. Exciting things are developing that I'll have to detail later (when it's all official). Time now to go visit the fam for a little while.

26 April 2005

IVs, elevators, pelvics, and psych meds.

What a bizarre evening I had yesterday. My last ER shift was anything but forgettable. Let’s see. The highlight of the day could be one of many things:

a. I was successful on all of my IV attempts. This was uber exciting considering my ER record. I hate sticking people twice. Needless to say there was plenty of happy dancing and pleased patients.

b. On my last shift there was a guy in one of the psych rooms who had already been there for a while. He needed a place in a mental hospital and had run out of is schizophrenia meds. Imagine my surprise when he was still there last night. He was not transferred until I left, making his ER stay an extreme 96 hours! A classmate of mine also saw him over the weekend. At that time he was using the butter from his lunch as lotion. Note to self: don’t run out of psych meds.

c. I missed cafeteria dinner, so I went to an alternative food place in the hospital for dinner. My supper of champions consisted of a muffin. Nutritious and delicious! I decided to use the public elevator to get back to the ER. The doors shut and then I realized not only had I not gone anywhere, but the doors weren’t opening. Well, I thought, maybe it’ll go up, so I pressed 3. Nothing. Maybe it’ll go down to a different floor, so I pressed 1 Nothing. Maybe it’ll go down to a different floor, so I pressed 2. Nothing. I pressed every damn button in the thing, avoiding the one with the bell pictured on it. Finally, I decide to press that one. It turned out to be like a buzzer. I pressed a few times….then a few more….and a couple more (all while trying not to think about the fact that I’m alone, stuck in a 4x6 room suspended two stories up by a wire cable). Then I heard a knock. The security guard had heard my annoying little buzzer and tried to open the doors. He got a maintenance guy to help and after about 10 minutes I saw him pulling the doors apart like the incredible Hulk. Yay! “Thank you, thank you, thank you!” I had come up with ridiculous scenarios of being in between floors and having to be pulled out, etc. The security officer was happy to see that I hadn’t freaked out, he seemed pretty surprised about that. I said: “Well, freaking out isn’t very pretty…where are the stairs?”

d. The little things: A kid mixing music with a crayon box like he was scratching a record, cute! A nurse who insisted on putting her name on and pushing around one of the big IV carts wherever she went, wacky! Assisting with two pelvic exams, gross! The fun never ends!

e. all of the above

I’m going to go with choice ‘e’ but it’s up to you, there is no wrong answer! I’ve enjoyed my ER shifts, but they are mercifully over (at least for this semester). My last city shift is on Friday, then it’s on to home to enjoy the calm before the storm. May brings on gorgeous weather, papers, colorful flowers, finals, and NREMT-I exams.

24 April 2005

Best ER shift yet, but don't make me go back there!

Last night was probably the nicest ER shift I’ve had thus far. Fortunately it was my second to last ER shift. That thought alone makes my day better. I was 2 for 2 on my IVs and did a few direct blood draws, fun!

The funniest story started long before I arrived. The patient in question had been seen and discharged twice before my shift started. First he was taken to his ‘home’ by a private ambulance company. Unfortunately for them it was a false address. When no one answered the phone at home the pt. claimed that they didn’t usually pick up. When aforementioned private ambo company discovered the fake address, they brought the patient back to the ED. Said pt. was later discharged again. I must mention here that he was missing an important extremity and had an ugly unhealed abscess in a nasty place. (so yucky that the tech said, “You can come in and help as long as you don’t breathe and don’t laugh.” a worthy challenge) Now, back to the story. At the time of this discharge, he felt it was appropriate to wheel himself into the middle of a busy Baltimore street (apparently waiting to be hit). Genius at work. My good citizen of the month discovered his attention grabbing scheme and kindly escorted him back to the ED complete with police and paramedic escort. This was about the time I arrived for my shift. All the nurses were praying they wouldn’t get this patient. They had already seen him that day, twice. My nurse ended up getting him, she was none too happy. He was cooperative for a while, especially because the doc gave up and admitted him. Later, his colostomy bag “accidentally” broke, gross.

He and another patient who was hopelessly drunk were the comedic highlight of the evening. Drunk guys conversation with every female in the room: “Hi, how are you feeling tonight?” “Better, now that I’m lookin’ at you!” Ah, there is still hope for us single girls!

Last ER shift tomorrow night! (and there is much rejoicing)

22 April 2005

The rest of the night

I never like reading really long entries, so I figured you didn't either.

Later that night we had a call for an unresponsive person. The patient was responsive when we got there. You could tell she was feeling better, especially when she threw a beer bottle at her boyfriend. She was even more awake when she started slapping the crap out of him. That’s when we left and waited for the police outside. We got three regular police cars and a car of plain clothes cops, that was pretty cool.

We were hit out for a hurt foot at a nearby recreation center. We found this big guy lying on the floor crying and yelling “Don’t touch it!” referring to his ankle. As my preceptor put it, the ankle was definitely, probably, for sure, maybe, really, perhaps, undoubtedly, perchance broken. But this guy was acting like his leg got cut off. He had new tattoos all over him and looked like he could take a lot. Now, my mother had a bilateral malleolus a few years ago, and she barely even winced. Shows how tough my mom is!

My last call of the night was for a “not breathing.” On the way there I caught my self staring at the intubation kit, visualizing getting my tube. I envisioned this perfect scenario, and then I realized that I needed to simmer down. I could barely think, I was so excited at the prospect of a tube. Unfortunately and fortunately the patient had been “not breathing” for about 4 hours.
Oh, well.

Lessons of the week: Narcan is fabulous, and ice cream cures all ills.
This weekend I have my last 2 ER shifts and my last city shift next Friday (sadness).

PS: I love my class, they're awesome!

I just cost you 200 bucks!

I was in the city a few nights ago. My preceptor and I are talking, and he rags me for using too many alcohol preps again! He said, “You’re good at IVs, but you take too long, and you use too many alcohol wipes. You’re not gonna get an aseptic field here.” I know, I know, but I can’t help it! You practice how you play, so I’ll probably be using ‘too many preps’ forever. He is right about fast. When you need an IV, you need an IV. But, when I’m a medic, I’m going to use as many alcohol preps as I want.
For the rest of the night, I’m thinking ‘quick and dirty’ IVs.

My first call in the city that required ALS was also my first experience with the wonder drug, Narcan. We pulled up to find this guy sprawled out on the parking lot of a gas station. An engine crew was already there, bagging him. My preceptor said, okay, start a line. Wait a sec, this dude isn’t breathing! I wanna tube him! Then, as soon as I turned over his hand, I realized why he only needs an IV. He had already used his veins today, and it wasn’t to donate blood.
So, there I was kneeling on the pavement beside him. Our jump bag didn’t have a tourniquet, so we used the BP cuff (ghetto, I love it!) I started his IV, my preceptor hands me the naloxone, I pull out 2 mg and push it into the line. He’s awake before I know it…that was awesome! We get him on the cot and into the ambulance. It wasn’t his first time getting Narcan. That burns me up, I wanted to tell him “I just cost you 200 bucks!” instead, my preceptor reminded him that he would be dead if nobody had called 911. It was a pretty exciting call (for me). Later, I told my preceptor that I only used one alcohol prep. True, it was only because I was in a hurry, but his point exactly: When you need an IV, you need an IV.

19 April 2005

A little tinnitus never hurt anybody. Part 2 of 2

Part two of my auditory clinicals. On the IV front, last night was better. Some successes and a few direct blood draws, (I’m happy to report I’m no longer afraid of butterfly needles). Something new was when my nurse and I took bloods from one guy by him sticking a butterfly into his radial artery…that was interesting.

That same patient had a tracheostomy and needed a vent to help him breathe. Unfortunately, something was wrong with the vent and it kept making this God awful noise. Imagine the most annoying noise you ever heard…then double it in annoyingness and intensity. Now play it in you head every five minutes or so for about two minutes...for about an hour. Pleasant, no? That’s what the vent was doing and it was making me crazy, I heard it all the way home. I was sitting at the nurses station while this was going on and a random voice from one of the nearby rooms yells “Turn that effing thing OFF!!” (you can imagine he did not say ‘effing’) but, my sentiment exactly.

One of the residents said we should just unplug it. “Unplug the vent?” I repeated quietly, “We’re going to have right to life people protesting here if you keep talking like that!…I’d rather hit it with a baseball bat.” Ironically enough, the patient was doing better without it. Luckily, my shift was about over, and I got to leave.

Other than this, my shifts this weekend were…uh…....oh, sorry, I fell asleep writing this sentence. Let’s just say it’s mercifully over until, um, Saturday, how great.

Now I’m going to study while enjoying the smell of spring rain out my window…Zen.

"A what in my what?" Part 1 of 2

The last two nights I had shifts in the ED. As a result I’m posting two entries today, yay! The underlying themes of these shifts had to do with hearing, and the borderline loss of my IV mojo.

It’s only slightly reassuring when the local “IV masters” (as I like to call them) tell you “Oh don’t worry, everyone has a bad day.” Funny, they say that even though they just got that ridiculous IV on your last patient after you missed twice in their best veins. It was just so sad, a Sunday night: no happy dances, wasted 20 gauges, and alcohol preps freakin’ everywhere! (one of the days few redeeming features).

Other than that on Sunday we had this guy who was older than dirt and stone deaf. For some reason he came sans hearing aid which allowed for some hilarity. Everytime I went by the room, rather, anytime I was in the vicinity of his room, I could hear someone yelling something at him. There’s not much friendly banter when a patient can’t hear. Questions like “Do you know where you are!?” developed later into “We’re going to put a tube…in your penis!” -short pause- “Your PENIS!” This alone explains why I didn’t jump up to volunteer to do his foley. It also happened to be time for me to leave. I wanted to die laughing as I took full advantage of this “run away!” moment.

16 April 2005

I love the Internet

In a valiant effort to avoid work today I opened a photobucket account and put up some pictures for your viewing pleasure. There are a few of me, and others from my travels.

I do feel it's presumptuous of me to think you have nothing better to do than look at my pictures, but I don't have anything more entertaining to offer you.
There are plenty of fun ways to waste time on the internet, and I consider myself somewhat of an expert in the field. I've written a handbook called: “The Internet and you: Wasting time Efficiently" I was toying with other titles such as-

“The Internet is more effective at wasting your time than TV: a case study.”

“The Internet: differentiating between useless trivia and false facts”

“1 Million and 1 uses for the IMDB”

“A college students guide to the Internet”

“Proficiency at procrastination”

Well, if you're still up for a little time wasting, here's the link to my pics, enjoy! I'm going to try to make my evening more productive than my day.

10 April 2005

Hypochondria

Everyone in the health service industry must experience hypochondria every once in a while, you just know too much. It’s my time. Last week I had a little cold, although I insisted I was not sick. My generic “Dayquil” and copious amounts of vitamin C told that cold where to go. Then, on Thursday I started to feel weird. I felt extremely tired for no reason and just plain beat. I chose to ignore it, but abstained from usual ER night activities, (except for watching ER). On Friday I went out for happy hour, but immediately after the happiness set in, I felt the extreme tiredness again (okay, I’ll throw in a medical term here: malaise. This word perfectly describes how I was feeling.) Oh yeah, I also adopted this lovely healthy sounding and ladylike cough. At this point I definitely had TB. (That one patient I saw last week was coughing…I think, yeah, well, at least when I die I’ll be in good company with Chopin, Thoreau, and Eleanor Roosevelt.)
So right there at happy hour I could have curled up under the table and taken a pleasant nap. I ordered and my friend asked me later if I had touched my dinner. I looked down at my plate and literally touched my food. (that counts right?)
Yesterday was good though, my parents and my brother came down and we went to a fantastic museum which I happily endorse (the Walters) and to a nearby Asian market, which was fun. Later, I felt worse and I even checked my own lung sounds (who hasn’t? admit it! (They were clear, by the way.))
Then this morning I was officially purulent, a.k.a. sick, a.k.a. borderline miserable. (now I believed I had bronchitis, and/or pneumonia) I even cancelled my clinical tonight, which I would never do, but somehow going to a hospital full of sick people while I feel like this didn’t make a lot of sense. (Amazingly, I felt much better after sending the e-mail to my clinical coordinator. related? I doubt it.) I went to the store to get “purulence accessories” i.e. drugs, juice, and tissues, and now I’m back here to finish some homework and revel in my sick day. Maybe I’ll use some of my free time to think of more diseases I could have like measles, anthrax, meningitis, or my personal favorite, bubonic plague. Any suggestions?
Ooh! Almost time for more drugs!

05 April 2005

Ellie: aka "Alcohol Preps"

I think this is what my preceptor may start calling me. I administered my first IV med yesterday and apparently I use excessive alcohol preps. Now, come on. I’m practicing for national registry! I’ve got to do this crap right! I need at least 2 preps for the IV site. Plus, I feel that if there is still ‘dirt’ on the second one, that calls for a third. Then, I need one for the medication bottle, and one for the Y port site. Also, I need a couple for the bench seat, the floor, to develop my OCD, in case someone faints, one to de-funk my pen, and others for miscellaneous scrubbing and cleansing; the uses are endless. Then, what if I drop one? (as I did, and thank God I had an extra!)
I’m not sure how it happened but when I was finished administering 2 doses of Narcan there were alcohol preps strewn all over the ambulance. What can I say? I like them. Maybe it’s the clean feeling I get from using them. Or, maybe it’s a subconscious attempt to override the stank that some patients produce with the pungent, crisp odor of rubbing alcohol. You can never have too many.

Whatever my preceptor calls me, it won’t be, ahem, bad…cough…luck. We actually had calls that required medical help, which was so amazing. I started three IVs (that seriously made up for my ER shift the day before which doesn’t even bear mention). I did various other skills, and I even, wait for it… I learned! Will the wonders never cease?!
The funniest bit of the day stemmed form a call for a pedestrian struck by vehicle (I know what your thinking, but don’t get your hopes up). The patient apparently had their foot run over by said vehicle. The patient had pulled their sock off, I assessed it, and it looked totally fine. When we got to the hospital the triage nurse said: “Your foot got run over? It looks pretty pristine for that.” to which the patient held up the sock feebly saying: “Well, I had a sock on.” Wow, that’s some sock if it can protect you from the weight of a vehicle. I should get a pair of those, what were they made of? Oh, cotton.

Here’s my tip of the day, which I got to use in the city this weekend. I read it in a certain EMS magazine, which will remain nameless (but it starts with a J and ends in EMS). When attempting to assess breath sounds on a child, simply ask them to blow as if they were blowing out birthday candles. It totally works! They’ll take in this big breath, rendering lungs ripe for the listening.

Now, to go obsess over the crease in my freshly washed EMS pants.