26 April 2006

Now there's a good endorsement!

I’ve had a series of clinicals leading to not very interesting stories.

The other day I did have the weirdest reaction to having an ambulance crew showing up at your place of employment. Apparently, the patients’ co-workers had called the ambulance for her, and must have forgotten to tell. When we walked in, she just started laughing hysterically. It was really bizarre, as if she was on candid camera, or we were throwing her a surprise party. “Surprise, you’ve won an ambulance ride to the hospital of your choice!” She kept giggling and guffawing “You guys!” to her co-workers. It was an amusing and interesting way for someone to deal with stress.

The rest of that day turned out to be a day of cancellations. For example, the calls we were sent out on in rapid succession: non-breathing...cancelled, unconscious...cancelled, pedestrian struck...cancelled. I kept getting my hopes up but then, “oh, nevermind.”

Patient quote of the week “I take percocet fo’ my toof!”

I also had entire day of what I like to call “Grade C BS.” We EMSers love to categorize things almost as much as we love acronyms. I’ve developed grades of BS calls. This will prove to you how bored I have been at clinicals. Do not take this list as a list of patients who do not deserve attention or care, they’re just lucky enough to not be dying.
Grade A are patients with minor injuries or maladies that require attention but certainly not that of an ambulance.
Grade B includes patients with problems with taking alcohol or other drugs to excess.
Grade C are those calls to nursing homes, doctor’s offices, or clinics, where the patient is completely fine. For example when a “severe trouble breathing” is really a patient who had an oxygen sat of 92%. Or, the “chest pain” where the patient hadn’t experienced chest pain that day, or perhaps ever in their life.
Grade D includes the patients who have no complaint at all. They cannot come up with anything true and/or good to tell as the reason for phoning 911. These patients are a complete mystery to me.

Yesterday I went to work. You read right, work. It had been a long time, and it didn’t take long to remind me of why I like to stay away. The day wasn’t too trying though, and for the first time I upgraded a BLS call. It came over as a call only requiring basic life support to a local clinic. The patient was probably fine, but as we were an ALS unit, we decided to work it up. It was a good idea as on the monitor the patient had, let me think, as there were so many adjectives for the heart rhythm, a sinus rhythm with bigeminal, multifocal, couplet PVCs. Fortunately for the patient, they were completely asymptomatic. Oh well.
We also transported a patient only 2 years my junior who had come to the ER days prior with a fever that led to a seizure that led to cardiac arrest that led to the discovery of a mysterious and rare heart defect. Yikes.

Today was absolutely gorgeous and Ewing and I finally go out on the river. The area had the rain we desperately needed, leaving us some good class II rapids in the four miles we traveled. The amount and speed of the rapids was surprising and welcome. At several points in our trip the spray splashed over my head leaving me saturated, it was awesome! We portaged 2 dams, saw 2 herons, 3 types of ducks which I can’t name, many fisherman and other people enjoying the park. It was the perfect balance of adrenaline inducing whitewater and relaxing flat water.

25 April 2006

Stocked up posts

It's been a while and I’m having to look at my calendar to remember what’s gone on in the last couple of weeks. Should I be concerned? Here follows a mixed bag of events.

I’ll start with Easter; traditional, family oriented, candy, desserts, and delicious food abound. We had egg hiding for the big kids and egg finding for the little kids. I think the adults in my family have a silent battle over who can hide a plastic egg in the most ridiculous, precarious, and vexing place. We should have an award for the egg hider who made the egg finder play the “hot and cold game” the longest.

Last week some friends and I taught CPR classes at school. It was no doubt the most successful venture in the history of the student EMS organization on campus. We ended up teaching 44 people, more than twice the amount we expected. The money we made counted as Jon and I finally raising the money we ‘borrowed’ from the club to go to London, sweet!
I officially applied for my paramedic national registry exams, which is a bit nerve wracking. A reminder of the huge, annoying, and scary thing looming in the distance for us. I also officially started studying for the exam, which usually helps with the whole ‘passing the most important test of your life thus far’ thing.

Other than that, I paid money for bent silverware, ate a traditional Greek Easter dinner, meditated on the logistics of moving, worked out several WAPs, and vacuumed my room.

The next post will be clinical time and fun time.

11 April 2006

If you don’t know where you are, you’re lost

This weekend I was a staff member/victim for the EHS departments’ search and rescue class. I took the class 2 years ago, where I learned about search management, deployment of resources, and the like. Every year, there is a weekend trip to Shenandoah national park to put into practice what the students learned throughout the semester. The weekend consists of several mock searches with extrication and tabletop exercises. My year, forever known as the ‘year of the snow’ began with 6” of snow on the ground when we got there, and two more after we got to the campsites, crippling a few tents, including mine. On one hand our searches were easy (footprints) and on the other, terribly wet and cold. Shenandoah is notorious for extremely variable weather and, for some crazy reason, I volunteered to return this year.

Thankfully, when we arrived at the park, we were not greeted by snow, rather with lovely warm, sun burn inducing weather. I could hardly believe it was the same place that I saw two years ago, when I wouldn’t have dared to be out in a t-shirt. Well, the weather got progressively worse, by Friday night it was colder and raining.

At 1945 Friday night I found myself being pelted with rain sitting under a tarp in the woods during a lightning and thunder storm. I am the injured hiker who was left behind while my friends went for help. Only, my friends then forgot where they left me, prompting the need for a full-on search. I enjoyed the solitude, the rain, even the lightning (as long as I didn’t die). I tried to get into the survival mentality as if I had actually been lost in that situation. It was a pretty scary feeling of not knowing who would come, or when, in the dark, the increasing cold, and the rain. People have been lost in terrible conditions like that for days, without knowing if anyone would ever come.
Around 2245, I was located, thankfully, as the novelty of being one with nature was wearing off, and the shivering was setting in. They splinted my “injuries”, offered me food and drink, secured me to the stokes basket, blinded me with their halogen head lamps, covered me up, and rolled me out on the stokes wheel. They did a good job, which basically means they didn’t drop me or make me think they were.

When we got back to camp, our tent had blown about 10 feet off course and the stakes were impossible to find so we bungeed it to a couple of trees. It continued to rain for most of the night, and was pretty cold, but survivable.

On Saturday they did a grid search which is where all the searchers get in a big line, and move together through a field or section of forest. It is not fun at all. Sean, who I drove and tented with got to be the lucky victim for that exercise. Later, while the students were being briefed for Sundays search, Sean and I went for a drive down a road that I thought would be fun given all the rain we had. We got a ridiculous amount of entertainment out a mud puddle that threw water all the way over the windshield. Needless to say the truck is currently sporting a lovely layer of mud.

For the night search on Saturday, I was the reporting party as one of three counselors who had taken three mentally challenged campers to hike and camp. For some reason, I fell asleep in the car, and when I woke up, everyone was gone. The rest of the story was that the other counselors got intoxicated and then in a fight over me, while the campers dispersed. Each camper had a different, um, personality, you could say, presenting a different set of difficulties for the searchers and the search managers. Also, the weather had gotten really miserable, and the fog rolled in, limiting visibility to about 10 feet. I was very glad to be inside for this one.

Within the course of 2 hours that evening, the truck was sporting a lovely layer of frost, making it difficult to open the doors, and impossible to open the bed cover. Let me say, I just love camping with frosty condensation in the tent, and having to sleep with my flashlight so that the batteries don’t die. It hit around 17 degrees, forcing me to zip the mummy bag I was in almost all the way up. I love worrying that I’ll get frost nip and shivering myself awake, it’s awesome!

The Sunday search is always the largest and most extensive. In addition to the teams of the class, the managing team had several K-9 and horse teams at their disposal. The scenario was that the reporting party had dropped his three friends off, intending to pick them up at a certain time later that day, and they never showed up. More of the story that the students wouldn’t know until they found one of us is that we decided to hike overland from one thing to another, because “a straight line is shortest.” (Note to hikers: never do this. Well, unless you truly know what you are doing.)

So, I was placed way off any trail, and about half a mile from the closest road. At 1000, I was just lying down for my long winters’ nap. I got better sleep curled up there amongst the rocks and trees than I had on either night of our trip. The weather was absolutely beautiful, clear blue skies, temperature 40ish, a little wind. I was toasty under my blankets and tarp, and aside from the occasional bird, the silence was complete. Perfect conditions for me to meditate on life for a while.
As the rogue hiker in the scenario, I had stopped here because my legs were cramped. I told the others to “go ahead without me.” (Note to hikers: never do this.) As I put myself in the boots of my character, with my legs recovered from rest, I would have had a hard time staying put (Note to hikers: stay put, even when you think it’s stupid to do so.)

I fully expected to be eventually greeted by an energetic search dog, as the dog search teams usually sweep the type of area I was in, and there was no way I’d be found otherwise. It ended up that at 1630, the same people that placed me, came back to retrieve me. I’m not sure why exactly they were trying to wrap things up quickly, but they just told the teams that I had been found by a ranger and walked out safely. I was happy to return to the relative civilization of the fire station, with indoor plumbing and food that was a little better than granola bars. The teams had found one of the other victims around 1330 and the last victim shortly after I returned.
I’m sorry to say I didn’t come back after six hours alone in the woods with any actual spiritual enlightenment. But, I was very relaxed and happy to be part of the world.

Shortly after, Sean and I headed down the mountain, and became tourists for awhile, stopping at several overlooks to take in the beauty of the region. In the end, if I weren’t graduating, I’d do it again next year. I got mud on the truck, enjoyed nature, trusted others, and got an ab workout from shivering so much.

When I got home my new nalgene bottle was waiting for me, hurrah for lifetime warranties!

07 April 2006

Overdue Post

Night Work 2:

We started the second night in with a febrile seizure that was fixed with clothes off and some ice packs. Then we had a cool motorcycle accident where the patient had apparently performed spectacular acrobatics after losing control and accidentally hitting the throttle. He jumped away from the bike right before it became bike parts and just in time to miss the explosion. When we got there, the sad, burnt out shell of a motorcycle was on the ground with the handlebars and front tire about 20 feet away from the rest of it. It was soundly destroyed. The patient walked away with only minor cuts, amazing.

Later I got to experience the consummate Baltimore call. An absolute classic. The call came out as an unconscious person. What I didn’t know at the time was it was at an inner city Baltimore church. As we walked in, the singing, praying, and organ music continued. All of the women had on beautiful dresses topped with intricate hats that very few people could pull off. The men were in no less than three piece suits, and looking sharp. Paper fans were waving in all directions, especially in the direction of our patient. I caught myself enjoying the culture around me and taking in how different people worship the same Lord. I went to listen to breath sounds and all I heard was the base from the organ.
The patient had taken a nitro and dropped her pressure out, which is why she was unconscious. A pressure of 70 palp will do that to you.

We also had a car v. pole resulting in an obvious concussion. The patient asked the same questions over and over so many times that the hospital made a sign for him. “You were in a car accident, your car was totaled, we don’t know how it happened.” They instructed him to read it whenever he had a question.

After a while of hanging out at the hospital and at “DD” aka Dunkin’ Doughnuts (it’s nice to play into stereotypes every once in a while) our last call of the shift was a GI bleed. The patient had lost so much blood that he was decidedly pale and the conjunctiva (red under part of your eyelid) was completely white. IV fluids abound.

As for my last two day shifts, the highlight was administering Narcan via nasal mister, and later discussing the effects of drugs on your life with the receiver of the Narcan. Other than that, nothing entertaining happened.

04 April 2006

You know what? I think she's lying

So, 30+ hours in the city should yield some interesting calls; shootings, stabbings, calls that are generally violent in nature. That is, of course, if you are not a white cloud like I am. I had the formula right: ALS bun, warm weather, the weekend, and I had just sharpened my trauma shears, but I just ended up with a long string of various types of BS calls peppered with the occasional “good one.” I had so many calls, that I literally have to look back in my paperwork to remember what happened.

Day work:
What did happen? CHF, HTN, unknown unconscious (patent airway), etc. A man with a fractured femur secondary to a car backing into his motorized wheelchair and knocking it over.

Then we had a patient who claimed her boyfriend had assaulted her. The cop interviewed her in the ambulance and it soon became clear that the patient was not a very good liar.
“What’s your address? Where can I serve a warrant?”
“Um… [gives address]”
“That’s not your address, that’s a strip club! Don’t play me!”
“Okay, uh…he was choking me, look at my neck!”
“You wanna play games? I’m gonna play you all the way to jail! What is your address?!”
“Uh…4…2…uh, I dunno”
“Okay, what happened?
“I told you, he was choking me, look at my neck!”
“Is that why when we came in, he was asleep?”
“I…I have mental problems! Look at my neck, don’t you see?”
This continued for a while, until the cop said:
“Show of hands, who thinks she’s lying?”
By the time we got to the hospital she was reporting:
“I got choked, I have mental problems, and I have, uh…trouble breathing.”
UH HUH.
Oh, and she had taken a delicious cocktail of illegal drugs. Drugs are bad.

Night work:

“Ellie, it’s a pediatric pedestrian struck and he’s f’d up!”
Okay; backboard, collar, straps, bag. Get out; spidered windshield, dented fender, no less than 300 bystanders, blood on the ground from the patient’s face. I grab c-spine, the patient is bloody, but I’m comforted by the fact that he’s screaming his head off. In the ambo; trauma naked, vitals, a quick IV with fluids running, Mr. Vaccu-Splint on an obvious humerus fracture, and we’re off. En route; oxygen, consult, and the patient never stopped screaming for very long. About 30 minutes, and we’re back in service.

Bag handling 101
We had a call in the creepiest house I had ever seen. It was dark and cavernous, right out of a horror movie. There was a porch and an entryway both dank and unlit. We knocked on the door and hear loud arguing, drowned out by a large dog barking. I was carrying the first-in bag and at that point, I put it on the ground. I don’t need that slowing me down when I run away. In the end the dog got put away, and our belligerent drunk patient went to the hospital with us, marking the first time I raised my voice to a patient. There will be no threatening gestures toward my crew.
Our next call was in a house that you could say had a little more than humans living in it. I had put the first-in bag on the floor. When I realized we weren’t alone, I picked it up. No need to take any creepy crawlies with us.
So, I wanted to make a little rhyme for this story:

“Dog at the door, bag on the floor,
Roach on the floor, bag...on your shoulder?” It’s a work in progress.

Later we had a guy who claimed that paint thinner had been put in his diabetic meds. Schizophrenia, check. A guy with a blood sugar over 600. Diabetes, check. A non-breathing in a car with pupils the size of, for lack of a better term, pinpoints. Heroin, check.

Night shift #2 blogged soon. Now is the time for sleep before another shift tomorrow.