30 November 2005

EMS: Making Messes and Taking naps

I started out Monday morning so early that sleeping in until 7 the next day sounded awesome. As I was driving along to this far away clinical, the sun was coming up, the road signs became keystone shaped, and all I could think was “why are there so many people driving at this unholy hour?”
It was like a mini road trip except too short to stop and eat, too early or too late to do something impulsive and fun, and I was by myself.
The clinical itself was pretty good. The ‘white cloud’ gods didn’t realize I was there until about 10 am, so I got to run a few calls before they stopped coming in completely. I was on an ALS chase car, hospital based system. Upgrading to ALS is nice as the patient is usually already packaged, and histories, allergies, and med lists are already obtained, sweet!
We had an asthma attack and a guy who ate a whole bottle of vicodin.
The preceptors there are pretty cool as they really do sit back and let you go at it, intervening only if you’re about to kill the patient. (“Time to suck out your vitreous humor…”)

Then, for the last 9 hours of the shift, I did…um...well, I did discover the one downfall of this clinical site: no good places to sleep. Usually, at a firehouse setting, for instance, when I think “I feel a nap coming on.” I can go find a cushy chair in front of the TV and practice my ‘napping on demand’. Here, I was confined to some desk chairs: not conducive for sleep. Oh well.

In contrast, today was a busy day with chest pain, near syncope, crazy, a very lucky motorcyclist, and an overdose.
We had a call for an MVC with an unconscious person. It turned out that their car hadn’t hit anything, but one of its occupants may have taken a hit of something. When we arrived, he was breathing about 6 per minute, and the BLS crew had begun to bag him. We put him in the ambulance, and while I started an IV, my preceptor gave him Narcan (reverses heroin OD) via a nasal mister. Basically, it’s taking Narcan and spraying it up his nose. (yes, it is as funny as it sounds.)
While I was all up in his veins’ business, I realized that when it comes down to it, the awesomeness of EMS is in making a mess. Opening packages up, squirting saline, wielding needles, spiking bags, throwing stuff on the floor, shouting “sharp!” …what bliss.

26 November 2005

In other news

I received my first application for a real job, yikes! This whole real life thing is beginning to freak me out. So far, this is the only company that interests me. To get the job I have to (finish school, get my registry paramedic) apply, take tests etc. Then, if I get it, I have to find a place to live, get reciprocity, probably get a new car, ride 20 shifts before I get cut loose, and oh yeah, this is over 400 miles from home. Don’t tell anyone, but I’m scared.

I got cleared at work, yay! (not a fake job per se, but...)

Last week, I spent 12 hours of clinical time doing BLS calls, (not that they can’t be useful in some way…wait. what am I saying?)
One was a call for a stroke. “Awesome!” says I, anticipating a good ALS call to salvage the day. 5 seconds after we arrived, it became clear that it was not a stroke, heart attack, dismemberment, asthma attack, or fainting; but actually absolutely nothing.

Medic: What’s going on that makes you think you’re having a stroke?
Pt: My grandmother had one.
Me: Uh….right.*
Later the patient wondered to us: “Could you look through my pills and tell me which ones I can stop taking?” “Sure we can.”*

I don’t think I mentioned yet that I received my Maryland CRT(I) certification, and randomly, my Pennsylvania EMT-B.
Also, I had a lovely thanksgiving.
*not exact quote

"Whoa!"

That (with an open mouthed stare) about sums up my emotions concerning the few patients that I saw during my observation rotation at the premier trauma center in the country. I was told that they often inadvertently have ‘theme nights.’ The night I was there, the theme definitely would have been: Faces. I will spare you from the gory details by using medical terms and other big words.
Patient #1: His cerebrum came in contact with a small lead projectile, forcing it to leave the skull permanently.
Patient #2: Patient’s frontal lobe was herniating into the orbits. I’ll leave that one to the imagination.
Patient #3: Prisoner was stabbed with a bucket handle resulting in a tension pneumothorax.
Patient #4: Patient’s face came in contact with a human fist at a high velocity.
Patient #5: Defenestrated herself from the second story of a burning building, resulting in the avulsion of the lower 2/3 of her face.

If all of these patients had actually only been one person; they would probably not have a head at all.

19 November 2005

“I love magic.”

Ah, the Harry Potter franchise. I love it. The latest installment in cinema form came out yesterday. I really liked this ‘cliff notes’ version of the book. Granted, I could go on for days about what was missing or changed. And, I believe that people who have not read the books will be pretty lost by the end, it’s book readers movie.
I do think that the producers underestimate the attention span of Potter fans. We can follow a scene with more than six lines in it. We can be entertained by scenes without extra dragon time. I love the story for the story; the action is just a bonus.
In general: the world cup is short, the challenges have the best effects yet, Rita is hilarious, the acting is better than ever, the Yule Ball is a consummate representation of teen angst, and “He-who-must-not-be-named” is deliciously creepy.

That’s your heart! Awesome!

Wednesday was a work day. I got paid mostly to read Harry Potter and JEMS, sweet! We only ran three calls, and one of those was BLS anyway, requiring more muscles than brain cells. The other two calls were pretty good. I felt slightly less retarded running them today as opposed to my last shift.

Yesterday I ran with a critical care transport team. My first call was a guy who had a lung transplant last month, and it wasn’t going well. We took him from his bed in ICU to get a lung biopsy. That was pretty cool. First and foremost, I got to wear a lead apron; that was pretty hardcore (and heavy!)
Then they used a bronchoscope to go down his ET tube and into his lungs, where we could see the sutures from his lung transplant. After taking some pictures and performing lavage (which consisted of them injecting saline into his lungs and sucking it back out) they stuck a smaller tube in that went deeper than the scope. This tube had a little claw-type thing on it that open up and grabbed some lung tissue. I could see it on the x-ray as it opened and closed deep inside the bronchioles. Later, I looked at what they had retrieved, and it was miniscule! Amazing how they can make use of such little tissue. Like many medical procedures, I couldn’t help but think about who came up with this first. “Hey, I’ve got a good idea. Why don’t we put this little claw thingy into their lung and just snatch some tissue with it.”

The nurse I was with kindly escorted me into the next room, walked over to the patient, pulled back the sheet, and there was one of the coolest and craziest piece of medical equipment ever. The patient had a ventricular assist device. These are machines that do the job of the left ventricle, using gas to either pull the blood to the ventricle or push it from the ventricle. The device itself could fit in my hand and is (aptly) almost heart shaped. Pictured here. One side of it is connected to the aorta and the other side is inserted directly into the left ventricle. So, it’s kind of hard to explain, but this device was acting as one half of this guys heart. It is outside of the body, and I could see the blood rushing in and out of it, as if I were watching an actual heart. So awesome! Ironically, we had a lecture on these devices on Thursday, so I was uber excited to see one in action.
Again, who thought of this?! “Hey, I’ve got a good idea. Why don’t we put tubes directly into the heart, take the blood out, put it in a plastic heart and push it back out into the body?” Brilliant!
I would guess that the patient has this as a temporary fix until a heart transplant becomes available. This particular model can go for 3 months, but some do exist to be internally implanted and taken home as a complete alternative to transplant. I’m boggled by this amazing technology.

After that we took a patient to have an MRI. This was my first trip to an MRI room. I had to take off all of my metals, and credit cards. None of our equipment could go into the room, which meant extra long IV and vent tubing. The IV tube was about 12 feet long and lead out the door to the pump. The room itself is reminiscent of Wonka’s TV room; large, white, sterile, with huge complicated equipment in it. I watched as the brain MRI was done, and unfortunately the patient had a very large tumor.

In the end I discovered that I can eliminate critical care transport from my list of things to do. I don’t really like dealing with critically ill patients all day. Not because they’re uninteresting or challenging, but because I think the situations the patients were in bothered me somehow. For example: While we were cleaning up after returning our first patient safely to his room, I noticed his wife there, diligently donning her isolation gown and gloves to visit him. She clearly had a routine. I couldn’t help but think about her life. Her life and that of the many others who, via a traumatic event or decay of time are in the same position. Putting on a brave face every single day to show their love and dedication to a terminally ill loved one because that is the only thing they know to do. I admire them, doing the familiar, hoping for a change.

14 November 2005

Return to the City

After an uneventful weekend, aside from getting to hang out with my niece and nephews, today I returned to the illustrious city.

If it hadn’t been for said relatives, the weekend may have been a complete loss. Yes, I did have a helicopter shift. We did get to fly to another hangar for maintenance. Other than that, I did some homework, got pretty far into my ‘remind me what happened’ reading of Harry Potter 4, and even watched an entire football game. That should show you how bored I was. A visiting boy scout troop broke up the monotony of the day, a bit.

But, back to today. Because I have been one of the lucky few to not be assigned a city preceptor yet, I’ll be borrowing everyone else’s. I rode today with a supervisor truck which was pretty cool. Basically we rode around and squirreled calls that sounded interesting. I was reminded of how much I enjoyed my city shifts last year.
We had a heroin overdose who ‘got distracted’ on the way to rehab, a fender bender, twins ready to be born, a suicidal 12 year old, an anxious faker, and a wheezy drunk. The best part of the supervisor truck is that you don’t have to take the patients to the hospital. Just wait for the ambo, and it’s ‘bye, see ya!’
Also, I got to go the wrong way down MLK blvd. which was totally fun!

11 November 2005

Just Point

Wednesday I had my first shift in a neighboring Maryland county. It was really nice. We had two chest pains in a row and later in the day we had a cardiac arrest in a nursing home. It wasn’t dispatched as such so we brought in the traditional ‘baggage.’ As we went down the hall, all of the employees simply looked at us and then pointed in the general direction of the room. Every single employee, not excitedly, but quietly pointed. We were almost to the room when I thought to myself, we should have brought the monitor.
We found the patient conveniently placed right behind the room door with CPR in progress. He should have been suctioned probably 10 minutes before we got there, but alas. We took over, I put him on the monitor and my preceptor went for the tube. I was initially jealous of his position (it was merely more convenient in that ridiculous space in which we had to work for him to attempt the tube) but my jealousy quickly dissipated when what looked to be an easy tube became a difficult, wet, and smelly tube. The patient was in asystole the whole time, I pushed the drugs and tried to help with the tube, which soon became a lost cause. We arrived at the hospital in about 2 minutes, and the doc climbed aboard a called it right there.

Tomorrow, I head back home for another MSP helicopter shift, from now until Thanksgiving I have a clinical or work every other day, I can't wait!
Yesterday I had a scary realization when I received an e-mail reminding me to fill out my FAFSA (free application for federal student aid) for the 06-07 year. I did a double-take when I realized that I don’t need to fill that out anymore (not that it’s been much help.) That’s pretty freaky.

05 November 2005

I’m flying, I’m flying!

I had my first helicopter ride-along yesterday. Leading up to yesterday, it looked likely that I would have to be tied to the helicopter in order for me to go, à la “What about Bob?” Luckily for me, I was just settling in when we got our first call around 7:10. This way, I had little time for second thoughts, as before I knew it, I had grabbed my camera, clamored into my seat, adjusted my headset, and became airborne. “Wow!” and “Ahh!” were the words overriding conscious thought. The view was amazing! I figured I might as well enjoy the ride, as I was kind of committed at that point. No one is more surprised than I am that I enjoyed it immensely. Especially as I classify a simple elevator ride as the moment I was most scared in my life.

Before 9:30 we had run two calls. The first was an ejection from a vehicle. The patient was basically okay and extremely lucky.
The second one was a motorcyclist v. deer. This patient had an obvious facial fracture (I may even go as far as calling it a Le Fort II, unconfirmed, of course), but his vitals were stable and he was maintaining his own airway. We were only about 4 minutes from the trauma center anyway, so we decided to just monitor him. Shortly after we arrived at the hospital, they decided to RSI him (rapid sequence intubation, where you knock the person out with drugs, then intubate them). Sounds vicious, but its really not. Unless, as in this case, the tube was missed the first time, further attempts were made, a crash cart was called, a cric kit was opened, and the patient was deprived of oxygen so long that his heart rate was in the 30s and he was throwing bigeminal PVCs. (Don’t worry if you only understood half of that sentence.) They ended up getting the tube in the right place and all was right with the world.

The rest of the day was pretty quiet. I picked up lunch, watched a movie, did homework, and fell asleep for a while; far more mundane than the first half of my day. Around 5:30 we got another call, but we were cancelled halfway there. I was dead excited just to fly at night.
It’s funny, for as much as I thought I would hate it, I couldn’t wait to go on another call.

A few things I learned:
-take-off is interesting
-turning is not always subtle
-150 mph is fast
-talking on headsets is fun!
-car seatbelts are useful when applied
-1000 feet up isn’t so bad
-autumn is the greatest season
-helicopters are extremely photogenic
-landing is interesting
-there is no graceful way to get in and out

Bottom line: helicopters are hot.