A Work in Progress

3rd Degree AVHB.

Kitty is lonely. My windows need paint. Not my problem.

The helicopter that took my patient away today. He really needed it. Story and EKG pictures to follow.

Retrodated post. Spotted out of my window on the drive home. Yes, I was stopped.

Man, people get mad when they think they have an emergency and you don't react in the way they want you to. At part time work we spend some of our time in triage. Whatever. Four hours a shift I can surf the net uninterrupted and get paid, I'm cool with it, and it certainly isn't worth complaining about, as it's not going to change. It's fun to see what people come into the ER with anyway. People come in with earaches, headaches, fevers, cough, and colds. And we wonder why the system is broken. One guy came in with a nose bleed. He told me it had bled a lot, and he wanted to be seen. As an informative aside, I said, "Just so you know, the wait is quite long this evening." He looked at me like I had lobsters coming out of my ears and I wondered if he had noticed that the entire waiting room was full. He began lecturing me about how he was bleeding and he was just in for the same thing and he was under the impression he was fixed, but now it's bleeding ag...

Retrodated post. Fluids.

Yes, I am now officially two days behind in the picture a day project. Honestly I didn't think it would last 24 days. But I will pick it back up. There are a few factors here. 1. nothing to take a picture of that I haven't already. 2. other things have had a higher priority in recent days. 3. sleep. Sleep is why there isn't one today. I am feeling too tired/lazy to upload a picture. Not that I took anything good today. But, there it is. Will return hopefully tomorrow after a good nights sleep. As an aside, except for the tired, things are great.

Retrodated post. A collection of signs.

So, I'm cheating. I didn't take this today. Today was super busy at work with no time for artsy or interesting photos. I took this a few weeks ago and it just struck me as funny. (best viewed a little larger) Tomorrows activities will yield at least one acceptable picture. I hope. Probably a clue as to why some of our roads are so badly paved.

Kitty blends.

One more reason why I love my job. Driving aimlessly and taking in the world. Dear Hummer owner: 12 mpg? I am afraid you are fooling yourself there. Especially at the speed I had to go to get this pic. And you should probably be shot for driving this alone. I mean can't you fit like 32 people in there? Let's carpool! Also, on the off chance that you find your picture here, and don't like it, just let me know. I'll take it down. That's why this is the alternate picture of the day. -Ellie

Funny idea stolen from Sean. A late post after a very nice evening.

My last shift at full time work we were called for a 'sick person.' Full of skeptism, we headed to the call. The BLS crew checked how far away we were several times, and declared that when we arrived, we would jump into the back of the ambulance and be "Class 1 all the way." Now my interested was piqued. We arrived to find basically a woman who was nearly dead. She was responsive to pain, with no blood pressure or palpable pulses. Probably because he heart was beating 30 times a minute and her blood pressure was less than 80 systolic. I popped her on the monitor (junctional bradycardia) and as I was getting a line, my partner put on the pacer pads and cranked it up. Thankfully we got capture and I gave her some atropine which didn't seem to do anything. The family though that maybe she had taken too much blood pressure medicine. She had literally a grocery bag full of different prescription bottles. It wasn't my call so I left at that point and drove...

Electrodes. The nice kind. PS. Mala sleuthed that a previous picture was a black crowned night heron . Very cool!

These boots and I... ...climb. ...stalk. ...calculate.

Awesome double sided cake. Random bird I found in my yard. Any ideas? Will update when I figure out exactly what it is.

We like to make a mess. Surprisingly not a whole roll of monitor paper.

My new neighbors. Ah, semi rural living.

I have finally put theory into practice and driven my first manual. My parents bought it.

Kitty contemplates a world she's never known.

I was called to an unconscious person who actually had too many fentanyl patches on. Before calling 911, his family decided it might be a good idea to drag his relatively lifeless body to the bathroom, throw him in the tub and spray water on him. Result: a wet unconscious guy. Recently I had a patient with a spontaneous tension pneumo that wasn't far along enough for me to stick a needle in his chest. He got a chest tube instead. He wasn't even short of breath. We had a patient with a PE (pulmonary embolism) who tried to do the right thing and see her general doctor for her chest pain, but was sent home with orders for an x-ray. When the pain worsened, she became worried and called us. A COPD patient was tripoding, pursed lip breathing, using accessory muscles and generally having a bad time of it. On the way out of her house I saw a sign that read: "Harassing me about my smoking may be hazardous to your health." I laughed a little to myself becuse actually, no it won...

The plight of America. Or is it? Will rising gas prices be what it takes for us to go green? With the use of public transport markedly up from last year this time, there is hope. I'd ride my bike to work too, but it would take about four hours. I have a hard enough time getting up, it'd be pretty bad if I had to leave at 0230. I am only afraid of gas because I really couldn't drive any less than I already do. I walk to the grocery store and bike to the bank. And if it keeps raining, I'll kayak to church.

We had a patient who took a few too many sleeping pills. She said she wanted to sleep, and sleep she got. In fact, I think she's still sleeping it off. We met the ambulance on the road (a little rendezvous action), and as I walked toward it, I could see a semi frantic woman who had pulled her car over running across the busy street to join me. I stepped inside the ambo, and she followed me. Apparently she was a relative or something and as I was attempting to get report from the EMT she kept interrupting us. The patient was happily asleep and on some oxygen on at that point. relative: "Are you going to pump her stomach!?" EMT: "Not in here!" me: "Hi, I'm a paramedic, and they've stopped so that I can help out your friend here. Why don't you head to the hospital, we'll be there in a few minutes." This is the nicest way I can think of to say 'I understand your concern, I don't need anything from you, now get out of my ambulance....

So, for the LP12. I just took a NRB mask, took the bag off, and popped the ETCO2 thing on it. Bam! Works. The only problem now is oxygen delivery. I will at some point try putting a nasal cannula under it and see if it still reads CO2 correctly. When your service is too cheap/stubborn to buy you the real thing, improvise!

After rummaging around in the stock room for a while, I stole enough random pieces from respiratory to do some end tidal CO2 monitoring on awake patients with our zoll at part time work. If only they would buy us the real thing. This isn't practical to have the patient breathe through for the whole call, but at least we can get a baseline with it. In theory. I left one set up and labled in our monitor bag. Maybe someone will use it. Hmm. I wonder if that thing would fit on an oxygen mask? Next time, I'll try. And I'll continue to complain to my boss that we need the commercially made masks.

This is a spica cast. This is what they put on three year olds who break their femurs. Now his memoir already has a good beginning. "After spending most of my youth in a body cast...." A future cop? The cast has its uses. Built in reading stand. This one is out of focus, but shows the most appropriate bored/sad face.

Dear Valued Taxpayer: What's going on? We have deemed you poor enough to receive an extra tax rebate this year! Why? I dunno, hopefully so you can use it to buy clothes, cds, or other American made products. Isn't that awesome? You don't even have to claim it on next years tax return. Your government is working for you. What do you need to do? Go out and spend that cold hard cash! It could have been used to feed people, buy troops bullet proof vests, or something like that, but we'd rather you buy something superfluous for yourself. So get out there and get yourself something nice. How we calculated your payment. Here are some words to fill in this space, but does it really matter? In your case we simply figured exactly how much money you needed to cover what you already paid in taxes back in March. That way you could break even, or you could still spend it on something else. Qualifying Children. Well, you don't have any so too bad. Love, Republicans (don't forg...

"Getting there is more than half the battle." Oh so true. I had my first call at full time work that I had to respond alone to the other day at 3am. I am not surprised at all that the call was on a road that simply didn't exist. I started with our GPS unit, it wasn't listed. Okay, to the old fashioned way! Not in the map book. Neither were the cross streets. Great. I was pretty far away from the general area of the call, so I headed in the direction I knew it was in and hoped for the best. And by hoped for the best, I mean prayed and cursed a lot. When I got a little closer, I got clarification from our dispatcher. And by clarification I mean no help at all. Thanks to the ambulance crew, I knew I was on the right track, and they talked me in. It was, of course a brand new development. Not yet on the map. Needless to say, I was a little freaked out. Luckily, when you are lost at 3am, you are lost alone so I didn't have any traffic to deal with. Because of the sheer...

Jack introduces Kate to "Mr. Angry Eyes." Kate is strangely proud of her saltines. Today, my niece and nephew turned six. So, a picture of them is more or less obligatory. Tomorrow, I think I'll cheat a little and put pictures (that I took today) of my other nephew who is currently sporting a spica cast.

Still fragrant, although the bloom is dying.

Because they can get away with this kind of advertising. LOVE it. (no this isn't the picture of the day. that would be cheating.)

I love my job. I love it even if I'm dealing with people who are drunk, high, stoned, or generally out of it thanks to street pharmacology. My favorite time with these patients is when they inevitably start a sentence with "Okay, I'll be honest..." This almost always leads to hilarity. Yesterday we had a patient who had been unconscious in her car. By the time we got there, I was admittedly disappointed that she was out of the car and I wouldn't be breaking any windows. She was also conscious and yet still quite disassociated from reality. She was already on the cot in the ambo, attempting to explain herself. She couldn't remember how she got to where we were, where she came from, or where she was going. So my partner attempted to start at the beginning. "Well, where did you wake up this morning?" When this became difficult to answer she said: "Okay, I'll be honest with you. I smoked a lot of crack today." You did?! No way. She continue...

We have a lot of buttons.

A nice discovery on the bike that I heard before I saw. I'm now officially cleared at full time work so my shift tomorrow should be fun as now the potential exists for me to be running across the county alone, praying that I'm headed in the right direction. In my opinion, just getting to the call is way more than half the battle. Anything from there is gravy. Oh hell, I can foresee regretting that statement.

Groundhog day.

One of my patients recently had an unfortunate run-in with a reciprocating saw. Somehow, while lowering himself down from a short ladder, he slipped off a rung and fell a short distance onto the saw. When we arrived, he was outside, covered in blood from the waist down, laying in the grass with an EMT pushing hard on where his leg meets his torso. Holy crap, I thought, he cut his femoral artery! I started cutting his clothes off and uncovered where the EMT was dutifully holding and found. . .nothing. So I kept looking. There was a heck of a lot of blood, it had to be coming from somewhere. And it was. Lets just say that the saw cut into an important part of his anatomy. (though it was not a 'bobbitt') But, it's probably good news that the patient had already had a vasectomy. After finding the hole, we simply covered it up, and by that time the bleeding had more or less stopped. Although it was a tricky place to bandage. It turned out that his own leg did a good...

In the last two days I have become a believer in all things Bob Page. Like a traveling evangelist in his Ford van, he is spreading the gospel of prehospital cardiology throughout the land. In fact, if he had been an evangelist, I would have thrown down my crutches and danced a jig. If this class had been a rock concert, I would have come home with 10 CDs, a hat, a t-shirt, and a poster. If some of the stuff he showed us had been guitar riffs, our faces would have melted off. That's how awesome it was. For more info, you can head on over to his website . I hope he doesn't mind me linking him here. But I doubt he would, and I doubt he'll ever know. Among other things he brings to the forefront that if we don't do our jobs, sooner or later, paramedics will not be worth what little money they give us and EMS will revert back to the days of throwing the patient in the back of the meat wagon and driving like hell. Being two blocks from the hospital is not sufficient ...

I finished up class today and went for a walk when I got home in preparation for a trip this summer where these boots and I will be spending a lot of time together. I plan more in this series of "These boots and I..." ...watch the sun set. ...find the best footing. ...go off the trail.

Doing some review from an awesome class I had today. More on that to follow. Today 12 leads, tomorrow prehospital CO2 monitoring.

I finally found a use for the PO ativan we carry. This lady was drenched with sweat, and I mean drenched, vomiting, crying, and had chest pain 10 out of 10. I believed it. She was really freaking out and with good reason. We threw all the nitro we had at her, and managed to get some nitro paste to stick to her. Even the diaphoretic EKG patches were falling off, but I finally managed to get a pretty good tracing. (ST segment elevation MI, aka, heart attack on the old 12 lead.) Yeah, pretty cool. When I saw that, I turned to the driver and said "We can get through this traffic a little faster." "Really?" he answered. I looked him in the eye and said. "Yes." She was practically inconsolable so I gave her some PO ativan. That didn't work. She was nauseous and vomiting, so I gave her zofran. That didn't work. She was still freaking out and the pain was bad, so I gave her fentanyl. That didn't work. (We don't carry morphine due t...

A nice local nursery is in full bloom.

So, I moved out of anonymity a bit with the online dating and gave someone my screen name. I'm here to tell you it wasn't a mistake, but instead I am glad I did. Our first and only conversation saved me a lot of time and effort. I probably should get a 'fake' name just to be safe though. If the integrity of my real screen name was breeched, I'd be pretty mad. We started out with the usual niceties, and he asked me what I wanted out of my online dating experience. I simply answered "a date" which is completely true. In fact, maybe too specific, I mean, I'd settle for "drinks." I asked him the same question and he said "probably FWB and then see where it leads". Which left me thinking 'am I so out of touch that I don't know the current aim vernacular?' Well, yeah I am. So, a little clarification was needed. Here is the rest of our conversation from there, the only editing was spelling, and the addition of my thoughts in pa...

I have been charged with the task of writing a "six word meme" by manchmedic . In keeping with the bloggers code, I must comply, lest I be tied to an anchor and thrown overboard. You, like me, are probably wondering, and to nearly directly quote from Manchmedic, just what the heck is a meme ? I've read a couple of 'definitions' for the word meme, and found none to be satisfactory, or even make a lick of sense. Manchmedic described it as a "six word memoir" I can work with that. Six words aren't very many so here are the two that I could think of that I liked. For work: I sit and wait for trouble. A line, semi stolen from a movie: And now, yellow haired warrior, go.

A long day at work that doesn't end until tomorrow morning. Stories to follow: a mishap with a saw and a sweet STEMI. Two pictures are better than one right? A foggy start to the day. Relaxing in the ambulance we affectionately call "nemo" (due to its orange and white stripes.) If only it would get stolen by an Australian scuba diver. That would be nice. No one would go looking for it.