29 March 2006

"New Hampshire?!"

One of the greatest parts of the movie, “What about Bob?” is when Bob learns to sail on lake Winnipesaukee in New Hampshire. "I'm sailing! Did you see me? I sailed, I'm a sailor, ahoy!"
Well, tie me to the mast and teach me to sail, ‘cause I’m moving north.
New Hampshire may seem like a random choice, but the rent is so cheap that the equivalent in my hometown would rent me a nice cardboard box. I’ll be living with a couple of friends in the middle of nowhere. We visited the house last week, and the silence there was absolute and glorious.
And what a state! No sales tax, no state income tax, and beer in the grocery store, what more could I ask for? I learned that thanks to NH, the world has Velcro, Tupperware, McDonalds hamburgers, and republicans. Well, the last two are not very useful, but all the same, a pretty cool state. And, although I will be a resident, I will still giggle a bit when I think of the state symbol used on their road signs, quarters, license plates, and commemorative shot glasses, that fell off it’s mountain perch. RIP old man in the mountain (stifled giggle).
And what a service! CPAP, RSI, standing orders, 45 degree angle laryngoscopes, ALS partners, and tons of drugs that I’ll have to look up, what more could I ask for?
I also like when Bob realizes that NH is his destination and everyone tries to spell “whinn…whena, winnapeesawkie” for him. Believe me, I had to look it up.
New England will be as close as I can afford right now to England original.

Google search term of the week: “Oliver Cromwell incendiary device” Why search for that, I couldn’t tell you, especially as I don’t think there were many incendiary devices in Cromwell’s time. Just a hunch.

The call: respiratory distress. Insert new stethoscope into ears, and all other sounds are drowned out, it’s just me and the lungs, wheezing, wheezing, and rales, in stereo. Throw the stethoscope back around my neck, and it’s time for combivent and lasix. Blood pressures on the fly, crystal clear lung sounds…heaven.

22 March 2006

Return to normalcy

Today it appears that my white cloud is back from spring break and hanging over my head once again. 10 hours, 1 call. Woot.

I did get to attend a lecture about tasers to break up the day. It was pretty cool, especially when they asked for a volunteer. I thought, they wouldn't...they couldn’t...they did! They shot that guy with a taser! That was pretty awesome! Very useful tools, I especially like the barbed 'probes' that dig into the assailants’ skin.

I also ordered a pre graduation, graduation gift, a new (desperately needed) stethoscope from my Godfather.
Tomorrow, spring break starts officially for me, I'll be heading up north with the 'rents to check out the place where I’d like to work.

Paramedic Skills? No Way!

Don't tell, but I actually had patients that required care. The 1st call of the day was a rolled over dump truck with entrapment. No, seriously. Somehow the patient managed to roll the truck onto the drivers’ side, leaving him sitting where the drivers’ window should have been and leaning against the roof. The extrication was pretty sweet to watch. Once we got him out with the obligatory board and collar, it was revealed that he basically had nothing wrong with him, aside from a suspiciously low heart rate for someone his size, and for the fact that he was just pinned in a dump truck. So, we took him to (the obvious nearby hospital of choice) where I caught up with my other patient.

After that we had a series of medical patients resulting in a near record three medication administrations. Three! A little lasix for our trouble breathing, some glucagon for our 43 blood glucose diabetic with no access, and a few baby aspirins for our quasi chest pain. Glucose checks, EKGs, 12 leads, and medical consultations abounded. Rock on.

We had two ride-alongs, which I thought would be terrible, but it turned out great. We just ran the calls while the real crew got paid to do very little. Plus, my partner was British! It was like being back in London, only not. We got to talk about tea and curry and all great things English. It was lovely.

Because we had a 4 person crew, I sat in the captains chair behind the patient more often than not. Leading me to the patient quote of the week:
One patient said “Who’s driving...It’s not the girl, is it?” with a little too much concern for his well being.
Every time my partner shut the outside doors in the wrong order he would shout “Bloody Americans!” with a little too much satisfaction.

Discovery of the week: if it weren’t for trees, there wouldn’t be paperwork. Damn you, trees!

Take that, white cloud!

I've had a very interesting last few days, pretty much starting with an asystole arrest in a nursing home notorious for killing its residents. As soon as I realized where we were, I said "Ooh, this place."
When we got to the room, cpr was in progress, 4 rounds of epi 3 rounds of atropine had already been given, and to top it all off, it was a trach patient, so I didn't get my airway! We tried to pace him, unsuccessfully, both my preceptor and I went for EJs, unsuccessfully, but a few minutes later, we had return of spontaneous pulses. Wow. The patient had been down for 20 minutes, and pupils were fixed and dilated. We transported carefully.

Shortly after, we had a patient, that, looking back at my paperwork now, I don't remember at all. I was trying to finish my Fisdap stuff and I couldn't remember a thing about them (do note the use of 'them' as I don't even remember that detail). Apparently, I even started an IV. Freaky.

Then we had my first 'belligerent' drunk. Usually, they'll just get in the ambo, happy to be inside, entertain us with random ramblings, and go to the hospital. Not this guy. As soon as we got on scene he became 'unresponsive.' He passed the sternal rub test, but failed the "you won't hit yourself in the face test." This is when you take the patients hand and hold it over their face and let go. Sounds bad, but a truly unconscious patient will let their hand fall to their face. A not so clever drunks' hand will miraculously fall anywhere but their face. The plain clothes cops on scene were talking to the patients' wife. "He hasn't had anything to drink today." Right.
So, we got him on the cot and strapped in and into the ambulance. Just as we were shutting the doors we caught him peeking, and he knew the jig was up. Longish story short, he became belligerent, cursing at us and what-not, the cop came on board and ended up tackling him onto the cot. Then, he and his partner "carefully guided" the patient out of the ambulance, so to speak. They put him back on the curb, where he made mistake 1,263 by throwing his coat off and putting his fists up to this cop. Longish story short, we bandaged his face before he was "carefully guided" into the paddy wagon. You can't buy this kind of entertainment.

Our last call was for an injury from a fall. Somehow I knew it would be good as soon as I had to walk on a plank to get into the construction site. The patient had fallen 2 stories onto his head and neck. When we got there is was conscious and completely confused. Blood was nearly pouring from one ear, pupils were good but he must have asked "what happened" 60 times before we gave up answering him. We backboarded him and carried him out. A quick assessment, a quick IV, and we were off; I felt there should be no fooling around. As soon as our driver put it in park at the hospital, the patient vomited, postured, and seized simultaneously. My preceptor and I had one of those "Uh....lets get the hell out of here!" moments, and that's what we did. The first time I ever ran a patient into the ER. They RSI'd him pretty quickly and he headed over to CT. Needless to say, a basilar skull fracture, sub arachnoid bleeds, cerebral contusions...a bit of a mess. Yesterday brought me back to (the hospital where I bet you can guess we took this guy) and he was still there. I discovered that in addition to all the head stuff, he has ribs 1-7 broken on the left side (resulting in a pneumothorax and the placement of a chest tube) but is otherwise okay. Awake and oriented, although still with the tube.
It's nice to get an update once in a while.

Treatable Patients?!

I've had a very interesting week, but no time yet to blog it. Sometime in the near future, I'll have stories in full. Here's a preview: quasi cardiac arrest, 2 story fall onto head, cops and belligerent drunks don’t mix, pinned under a dump truck, and some absolute classics: diabetes, trouble breathing, and chest pain.

Pt. quote of the week:
"Who's driving? It's not the girl, is it?"
Partner quote of the week:
"Minorities and bigots...I hate them both." (said just fast enough to throw you off)

18 March 2006

So much to blog, so little time

I’ve had a few days of clinicals, hence the lack of updates, and the length of this one. I started out by hitting a new personal level of ghetto by taping the earpieces onto my stethoscope, classy.

We had a very eclectic day, starting with a burn patient, marking the first time I got to give morphine, sweet! Later we basically had an interfacility GI bleed patient, pungent! The patient had a PICC line in and the sending facility had started a 22g; way to put fluids in, not.
One call was for neck pain. A quick assessment, (looking at the patient) led to the discovery of a large abscess on her neck. Apparently the patient had shot up there and missed the vein, infiltrating heroin. Of course your neck hurts!
Finally we had a, well, technically it’s outside of my scope of practice to diagnose, but we had a seizure faker. Tip to fakers: look up what ‘ails’ you before attempting to portray it. Accuracy helps. For example: seizure patients do not typically stop seizing to say ‘ouch!’ when they get an IV and then continue seizing.

I did discover that the rumors are true, being thanked is nice.

The next morning, I finally got rid of Ewing, yep; I mailed him to Abu Dhabi. I just stuck a whole book of stamps on his forehead, drove him to the airport, and pushed him out of the moving truck. Actually, if you replace “Abu Dhabi” with “Hawaii” and “pushed him out of the moving truck” with “lovingly bade him good-bye” and you’d have a more accurate picture of what happened.

My first night shift in awhile was marked by a 100% IV success rate.
Most of our patients had no complaint. One lady, a DNR who was completely fine aside from a little dementia, (so, an utterly pointless transport) thoroughly enjoyed herself in the back of the unit. At one point amidst all the bumps and jolts she exclaimed: "Whee!" My preceptor and I had a hard time holding back.

I got to visit a nice Baltimorean theatre where a lady had eaten too many high-class foods, then topped them off with a beer. She was in the bathroom, doing one of my forbidden acts.

Also we had a patient with asthma (hurrah for treatable patients!), a pregnant lady (if only she had called 2 hours later!) a face v. fist, and an arrestee claiming to have been bitten in a, you could say, private place.

Yesterday, I had my least boring day at a particular clinical site ever! Since it's a hospital based system, I hung out in the ER and worked as a skill jockey for a while. "Sure I'll do that line, 12 lead? Oh yeah!" And, I got to run some calls too, but nothing over exciting.

Today I got paid to watch people hit each other with sticks while doing standby for a lacrosse game at school. Nobody got hurt and we lost. “UMBC…we play board games."

14 March 2006

By the Numbers

Since last I wrote: EMS wise; 23 hours of work and about 13 calls, and 1 clinical yielding 1 call and 4 cancellations. Also, 2 cadavers for an airway class allowing for 2 intubations, 1 surgical crike and 1 needle decompression.

School wise; 2 tests back, bizarrely with the same grade, and the score of my last bowling game, 97, marking the end of my phys. ed career.

The best number of all: around 75 degrees, the high for the last 4 days.

Needless to say, we’ve been kayaking twice. A few miles of flat water so Ewing can be properly acquainted with the new kayak. Flat water is great for honing our skills, edging, bracing, drawing, and my favorite, perfecting my forward stroke.
Kayaking wise; smelled 1 skunk, spotted 1 fox, and about 20 geese. 0 impromptu swimming lessons.

Today I ordered my cap and gown and the graduation announcements, leading us to the scariest number of all: 72, the number of days until graduation.

Which leads us to the next scariest number, or perhaps the most hopeful, 364, the address of the house where I'll be moving.

05 March 2006

Another life saved...

So, Ewing bought a new boat. Not like we really need an excuse to go out on the water but, new kayaks help. It was a bit of a brisk day, and the water was lower than usual making me wish that kopapa was equipped with a rock-crusher of some sort. Rocks on a shallow river not only get you stuck, sending you into a fit of rage, they also sometimes jump out in front of you. They should know that kayaks have the river right of way, but no. They’ll pop up when you least expect, causing you to be tossed one way or another, scraping the crap out of the hull, or in the case of Ewing and the new kayak, cause you to capsize. A particularly large rock jumped out of the water and grabbed the new kayak, forcing it underwater like a possessed marine animal, or something like that.
After my initial shock, I grabbed his now rogue paddle and made my way to where he had finally emerged from the roughly 38 degree water. I had a towel so he could dry off a bit, and out of the kindness of my heart I gave him my jacket, as he was left in a soaking wet t-shirt. So there we were; him wet with a jacket, me dry in a t-shirt (and fantastic new PFD) with 20 minutes of river ahead of us. Neither of us could feel our fingers or toes, so I decided to book it, and use the cardio workout to warm me up. Needless to say, we both survived, but I’m afraid Ewing has sworn off cold-weather kayaking until he has a suitable dry top. I keep reminding him that I saved his life by sacrificing my jacket and he owes me big.

I’ve had a clinical in the illustrious city of Baltimore. Par for the course, nothing exciting happened, but it was an entertaining day. I got to visit a methadone clinic, where our only potentially serious patient ran away. That was new. Her pressure was in the dumps, she was sweating like crazy, and about coughed up a lung in front of us. But she felt well enough to have a little snack. She may have put me off snack pack pudding cups for life after eating an entire cup using some cookies, and when the cookies ran out, her finger. I knew I should have been keeping silverware in my EMS pants. So much for always being prepared.

After spending 10 minutes convincing her to go (and suffering through her utensil-less eating), and after her social worker gave her bus fare, she said okay. I walked to the ambo to open the door for her and when I looked back, my preceptor was following her up the street. (stop. don’t. police.) It quickly became a futile chase and an unsigned refusal.

Pretty much the rest of our patients just needed a good nap. One after drinking a huge bottle of gin, another after taking a little too much methadone, and the last who learned that having nothing to eat for a few days except for booze, isn’t the greatest idea.

I now realize that I have been tweaking this post, surfing the net for paddling accessories, daydreaming, looking for vacation spots, staring into space, and eating chips for quite some time. I may have reached the bottom of the procrastination barrel for today, and will get started on my history take-home exam. Unless the roomies want to watch a movie...