Drug Box Awesomeness

The greatest call of the day/week/month came out as chest pain. We arrived to find our patient who only spoke Spanish with no translator in sight. Oh yeah, what made it a pretty hilarious call as well was the fact that I had a paramedic student with me.

So, the student started to attempt doing his thing, although none of us spoke comprehensible Spanish, while the firefighters went to get the stair chair. When they returned, one of them for some reason inquired “Why is she on a nasal cannula?”
Although I’m sure that some of my colleagues would point to the paramedic patch on their left shoulder and say “That’s why!”
I, however merely attempted to explain that I believe a nasal cannula has more uses than for tying things together. Where a mask can feel constricting, a nasal cannula can deliver oxygen without raising the anxiety of the patient, the patient can still get a relatively high concentration of oxygen, and although you think she appears to be ‘gasping for breath,’ I think she is doing alright, also her pulse ox is 99% and why am I still explaining this to you? We need to get out of here.

After stairing her down three flights of ridiculously steep stairs, we got her safely outside and in the ambo. Vitals, monitor, IV. I follow my partners gaze to the screen of the lifepack 12 to discover SVT, which is basically when you’re heart is beating uncontrollably and abnormally fast. She was going at a rate of 186 at one point, about three times faster than my resting heart rate.
Luckily, an English and Spanish speaking neighbor materialized out of nowhere and knocked on the ambo doors. She didn’t mind translating for a minute for us. The student, bless him, tried to explain vagal maneuvers to the translator, which I think the patient understood, but they did not help her. (If you stimulate a particular cranial nerve, sometimes tachycardia can be ‘broken,’ this is what we were attempting)
When that didn’t work and the translator unfortunately left, I decided to break out the adenosine. This is a drug best described as a chemical defibrillator. It essentially can stop the heart, and cause it to (ideally) reset to a more normal rhythm. I had never pushed it before, so I was a little nervous, plus it was difficult to explain to the patient that she was about to feel more than a little weird. (‘Muy mal’ was all I could come up with, but she already felt bad.)

So I drew it up and handed it to the student who, I later learned, couldn’t believe we were carrying out a textbook case like this. I prepped a flush, and we pushed. It’s an exciting drug because you have to push it really fast and then flush it immediately so that it goes through the blood stream very quickly. Then we all stopped and waited. Seconds ticked by, then suddenly, just as we had almost given up, the heart rate went from 180s, 160s, 120s and then ended up hovering around 110. I could barely contain my excitement. “Esta bien?” I asked, and she shook her head yes, looking relieved and quite a lot better.

Now, I love all the drugs in the drug box, but it seems that every time I use a new one, it becomes the reigning favorite. Although we didn’t get the characteristic period of asystole that can sometimes happen with the drug, it was still amazing.
Every once in a while this paramedic thing really comes in handy.

Are my pupils equal?

When I got to work, I stepped up into the back of the ambulance and rammed the top of my head right into the doorway. I wasn’t sure which hurt worse, the top of my head, or my neck where it got hyperextended. Oh, it was throbbing. I stood there in the truck, blinded by my trauma, and thinking I had broken my neck. I wondered if my ear was leaking fluids, if my pupils were equal, and if I was bleeding. In a few minutes I could clear my own c-spine, but I continued to damn the tones, sirens, peoples voices, and any movement that caused me to feel my pulse in the growing goose egg on my head.
It’s better now, although I had to comb my hair very gingerly today.

Our first call was to assist the police with an unknown problem. They were trying to serve a warrant and the arrestee was claiming that her doctor told her not to leave the house. So, they called us to check it out. We walked in and a spry looking woman was sitting there, smoking a cigarette and yelling about going. She kindly showed me her most recent discharge papers which did say ‘no strenuous activity’, but nothing about leaving the house. I suggested that we call her doctor to confirm, and she immediately jumped up and became perfectly willing to go with the cops. Well, that was easy.

We later went to the same street to assist the police with the aftermath of a bat and pipe fight. Everyone involved was refusing care, so we left it as police business. A few hours later we had a call to the police department. Turns out one of those involved learned that after the beers wear off, it really hurts to get beat with a bat.

Another call led me to several fruitless conversations including this one:
me: what’s going on
firefighter: He’s got MRSA.
me: Okay, but what’s wrong with him?
firefighter: Oh, I don’t know, but he has MRSA.
me: (checks gloves and goes in search of answers)

It turned out that there wasn’t really anything wrong with the patient, but his wife insisted that he go. I got about as much information out of the home care nurse as I would have out of a stranger on the street.

We also had a chest pain, back pain, and I’m sure some other stuff mixed in there. It was a good day, we were only on station for about 30 min total. One of the most exciting calls of my career to be posted shortly (I hope.)

Holy Cow, it’s the Fire Department!

After a long dry spell of interesting things to blog, it seems that in one day I’ve had at least a months worth of excitement. I can barely handle it! So. I’m going to start from the beginning (of my day that is).

Around 130 am today, Andy woke me up, and said “There’s smoke in the house.” What! I am not the easiest person to wake up, but I think I am getting better and faster at going from zero to competent, thanks to work.
I threw on a coat and opened the door to the hall and was met with this horrid, acrid smell of some sort of burning substance. Hey, I’m no firefighter. So, Andy was sniffing around the house trying to find the source of it. He was already up because he is a responsible volunteer type and was going to go to a real call that had come out a few minutes before he stepped into the hallway and smelled this smell. Instead of going to the original call, he decided to have some more firefighter types come over and check it out. So as the emergency apparatus came up the driveway, it was crazy, I felt like that kid from A Christmas Story, looking out the window excitedly shouting “Holy cow, It’s the fire department…geeze, it’s the cops!”

So, some fine citizens of our one stop light town came with a fire camera and Andy finally followed his nose correctly, right to a melted measuring cup on the heating element of the dishwasher.
I immediately stopped packing the truck with all of my prized possessions, and went outside to find Lou who, like the teacher she is, was at a safe distance from the house with the dog.

Then we opened up all the windows and tried to air out the dishwasher. I think it’s fixed now, but we’ll never measure 1/4th cup again. Oh well.

The rest of my totally exciting day tomorrow, I hope.

Hometown Madness

Last week after a day at work, I got up early and flew home, amazingly cheaper and much faster than driving. It only took me about an hour of flying time to get to the Baltimore area. From there, the parents found me and we went directly to the fair in my hometown. We are crazy about the fair in my family. Relatives come from even farther away than NH to enjoy it. There’s something about it that entices us back; the food, the entertainment, the nostalgia.
Because the fair has such a draw, I saw a great many of my family members, almost as many as Christmas time brings.
The fair is never complete without corn dogs, laughing hysterically during a wild ride on the tilt-a-whirl, getting heckled by carnies, running into about 50 people you know, petting some cows, posing with a tractor, and doing some serious people watching.

We also got to enjoy the annual demolition derby. Hilarious and awesome as usual and hopefully next year my cousin will get a few more hits in before his car dies.

I got back and went to work that night. I was uber tired, and luckily nothing overly taxing happened. We had a back pain, a nose bleed, a chest pain, and something else I can’t remember now. The chest pain was kind of annoying.
Me: "Is you chest pain sharp or more dull?"
Patient: "Um, it’s really, um, it’s just this pain..."
Me: "Uh...Does it change when you breath in or move around?"
Patient: "I'm, uh, I'm not sure, just a pain..."
My brain: "I'm going to freak out now."

Pretty much every exchange with this patient went like this, earning her the title of ‘poor historian.’ Basically we just worked it up and went to the hospital.
So far today we’ve done 4 BLS transfers, that’s about as entertaining as it gets!

I’ve learned that it’s really weird to go on vacation to your hometown. Coming home from college, I was living out of a suitcase in my own room. Coming home from, um, what can also be described as home, I was living out of a suitcase in a room that somehow resembled my room. But I didn’t feel sad, it was just bizarre. I was happy to realize that I could still navigate around town, and felt entitled to complain about the changes that have occurred in my absence.
Is it everyone who is unwittingly and forever tied to their hometowns?

No place like home

A proper update very soon, until then, a nutshell. Smashed up cars, whiny patients, the family, life long friends, air travel is brilliant, great food (corn dogs, hot turkey, funnel cakes, cotton candy, and pretzels), and being on vacation in my own house is straight up weird.

90 days, memory gone.

Since last we met: Um, a 10 month old w/febrile seizures, an increasingly crazy lady, a car accident with 3 refusals, one girl in big trouble, a guy who put his hand though a window (unfortunately a window that had glass in it), a lady who needed to be picked up off the floor at 4am, and some other calls which I totally don’t remember.
Also, I got my 90 day review (so now, they can’t fire me on a whim.) I can hardly believe it’s already been that long!

I’m off to Maryland tomorrow to enjoy family, friends, cars smashing into each other, piglets, and delicious hometown fair foods. Woot!

Socks and Saws

Patient complaint of the day: “My feet are cold.” We found her sitting on the floor outside of her apartment. How she got there was a bit of a mystery. Apparently she fell down in her apartment, and found it to be a good idea to crawl outside with a blanket, her purse, and her shoes. She ‘needed’ to go to the hospital so she could get her medical records. And her feet were cold. When she started moving she writhed in pain and exclaimed “My leg’s asleep!” Between us picking her up and putting her on a chair she made the greatest decision in the history of decisions and said she’d call a cab.

Then we had a call for cardiac problems. When we arrived, we found a lady looking totally fine sitting in a clinic. The doc took a 12 lead as part of a pre-op check up and found some changes indicative of a heart attack. They hadn’t done anything for her, and why? She was completely fine. Asymptomatic from the time she walked into the clinic to when we left her in the ER.

The best call of the day was for a laceration in the meat department of a local grocery store. As the patient put it, he had a fight with a saw, and the saw won. We had the tip of one finger in a bag (or was it a piece of pork?) and the others were down to the bone.

Also, a sick lady and two fender benders without injury.

Long Enough?

Five years.
Is that long enough for television specials, dramas and documentaries, two theatrical release movies? One, “Flight 93” which made almost 31.5 million dollars in the US alone. More recently, “World Trade Center” has made 55.6 million dollars so far. 87 million dollars, for who? Were these movies made in case we forgot? To remind us of what humans are capable of? As scare tactics?

I still see faded "United We Stand" stickers on cars. I think we’ve forgotten what we’re standing for. It is a day of national mourning, and five years later, those responsible still roam free. Because the president puts a wreath on ground zero we're supposed to feel safe, comforted, of one mind?

I read an article in JEMS about EMS providers who are literally dying from materials they inhaled during the clean up. People who are left with 33% of their lung capacity, bills they can’t pay, rare types of lung cancer, having to quit the job they loved because of debilitating long term effects, lost in debt, and suffering daily with respiratory distress. Maybe they could use some of that 87 million.

PS. Don't forget to vote tomorrow.

The miracle drug

We’ve had a whole mess of calls where ice cream could have been realized as a powerhouse drug in the prehospital environment. Amiodarone is to cardiac problems as ice cream is to everything else.

We had a call for a fall. We found an 80+ year old lady who fell from standing and broke her wrist, her pelvis, was knocked out for about a minute and ended up with a concussion as well. Osteoporosis is a harsh reality, so keep eating that ice cream!

Guy having pain from his sciatic nerve. Treatment: Ice cream topped with morphine.

Chest pain with sinus arrhythmia 100-160. Treatment: Ice cream with bits of nitro in it. Worked like a charm.

We had a lady with more complaints that all of my previous patients put together ever. "I can't feel my legs, and my arms hurt, and I have heartburn, and yeah, now that you mention it, I am having trouble breathing. Also, my back hurts, I can't stand up, I feel tired. I'm thirsty." I said: "Here's a quart of breyers, call me in the morning."

A woman who got pushed into a wall by her crazy mother. "You're sure you want to go to the hospital, because I think this ice cream will change your mind."
Crazy guy who wanted a cigarette, how about a bowl of cookies and cream instead?

In addition: hypoglycemia, hyperthermia, headaches, and crankiness in general. Forget ice packs, just rest that bowl of mint chocolate chip on your bumps and bruises, amazing.
I’m ordering my in-ambulance freezer right now!

*not suitable for patients with lactose intolerance.

All we could do?

It was supposed to be easy, but these things never are. When I entered the house, from downstairs I could hear the fluid in her lungs. The patient was dying. The family, initially prepared for this event, had been enduring her tortured breathing for an hour now, unsure of what to do.
The daughter, who could legally decide, didn't want her transported, and only really wanted her to be comfortable, nothing invasive. I was at a bit of a loss as to what to do. Lasix would only delay the inevitable and what she really needed was intubation, among other things. With a pulse in the 40s I tried to explain to the family that it was quite serious. I realized we were treating them more so than the patient, they only wanted to know that she wasn't in pain. So, we gave her oxygen and I attempted a line, but the lighting was terrible and she had no veins. I found myself able to think about nothing other than how horrible the situation was. Midway though my IV attempt, my partner leaned over to me and said "I think she stopped breathing." I felt sad relief come over me as I realized just how quiet the room had become and felt for a pulse, there was none. Like me, the family had not yet realized what had happened, and I had to tell them.
I was glad that the patient got what any of us would have wanted. To die at home, surrounded by family and friends. I just wish I hadn’t been there too.

The spice of life

We had a patient who had been huffing. ”Huffing?!” I thought, “who does that these days?” But indeed the patient had been doing it, and the mother produced the can to prove it.
a. you are much older than 16, the age where I thought huffing, if it were to happen, would happen.
b. it is not 1995, which is when I think the last reported case of huffing occurred.

A lady found a bump in the sidewalk that caused her to crash her motorized wheelchair. The second motor wheelchair wreck in my career, and in this one, the chair came off worse than the patient. She was refusing before we were over the threshold of the store she had stopped in. I wanted to slip the card of my favorite lawyer in her purse, but alas, he works out of state.

I think I had my first ‘sick person’ who actually turned out to be a sick person. Lots of calls come out as ‘sick person.’ It’s like the default category for calls where dispatch may or may not know what’s going on. Usually these calls turn out to be things like ‘fell in the bathroom’ ‘fainted’ or even ‘cardiac arrest’ but for some reason or another, the call is categorized as ‘sick person’ usually due to on the phone confusion.
But this guy was actually what I envision when I think of ‘sick.’ He’d been not feeling well in the tummy and threw up. That’s it. He didn’t seem into it, but his wife was insisting that he go to the hospital via ambulance while she’d follow us in the car. What?! It was like these people never lived life. I felt like saying “We are ambulance people, we come in peace. You are in a state which we call ‘sick’ which usually does not require any immediate medical attention. I prescribe…” looks at watch, “12 hours time, and you’ll feel much better.”
But instead we helped him to the ambulance and to the hospital where I’m afraid he spend most of those prescribed 12 hours being bored to tears in the ER.

At about 4am we had a chest pain call. I hate this general time of the day. I always feel disoriented if I’ve been sleeping. We arrived to find a guy sitting in his living room clutching his chest, sweating, and generally looking like crap (yes, that’s a technical term.) We got him in the ambulance and gave him the full ALS work up. His pain went from a 10 out of 10 to a three with a couple nitros, and the 12 lead was completely unremarkable. Whew! We set out toward the hospital and arrived without incident.

In addition: A teenager acting totally weird. Psych? Drugs? Simply being a teen? Who knows? A leg pain call that took less than 30 minutes start to finish, and a fainting that we couldn’t figure out so we did what we do best; went to the hospital.

Bloggie Benchmarks

A work in progress is celebrating 150+ posts and 7100+ hits! Yay. Certainly there are blogs that get that many hits in one day, or even one hour, but hey, it took me a year and a half!

I'm going to celebrate by going to bed early and working the entire weekend! Woot!

(if you want to buy me gifts, I'm sure we could arrange something, for the good of the blog, of course!)

I’d been gettin' a vibe…

We headed to a call for seizures. We figured something else was going on when two police cars showed up too. The relatives on scene said they were worried that the patient had a seizure and was refusing to let them in the apartment. The patient had a history of being combative when postictal (the state someone is in after having a seizure, typically they are confused and out of it, occasionally to the point of being violent.) So, we headed up to the apartment which turned out to be about 400 degrees, with the patient lounging in a chair looking totally fine. The relative insisted that she go to the hospital to be checked out and the patient jumped up and appeared to ready herself for a trip to the ER.
On some calls, okay, on most calls you get a vibe of some sort. Sometimes it’s nothing, or that something doesn’t add up with the patient and their situation, or my favorite, when the vibe you feel is that of crazy. Just as this particular vibe was washing over me, the patient rushed forward and grabbed a bag so full of trash that things were spilling out of it, shouting “I’m not leaving without this!” and ran out the door. One of the cops went after her, and we all followed down the hall, down the stairs, and out the door. I thought that she had bolted, but had actually been putting the trash bag in the trash room in the basement. The patient then said, “I’m not going to say anything else.” stepped into the ambulance and laid down on the cot. My partner and I looked at each other, shrugged and stepped in behind her. From here on in, the patient did indeed not say anything else and refused to do anything but sit there.
I buckled her in and drove to the hospital. Just as I was pulling into the driveway and heard my partner saying things like “don’t unbuckle those seatbelts” “were almost there” and “don’t do that!” I looked in the rearview mirror and saw that their faces were inches apart, so I threw it into park, ran around and opened the back door. I had absolutely no plan as to what to say or do after that, but the patient looked at me, released my partner and jumped out of the ambulance before I could even shout “Hey!” My care level for her was at it’s absolute lowest at this point, and I didn’t even care that my supervisor watched as my partner and I threw up our hands and watched her walk into the ER. My partner was unharmed, although her radio mic was broken. We were both happy to be rid of this patient.