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Showing posts from June, 2008

A long walk

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In less than a week I am traveling to my favorite empire and going for a little walk. And by little walk, I mean a 73 mile cross country hike which I think still falls into the British definition of "walk."
A few friends and I are literally going coast to coast in the Scottish Highlands. At the very least I hope to figure out the differences between single malt, double malt, and scotch whiskey, but it probably won't matter in the end when I hold a random glass up and say "What was this one again?! Oh, who cares, cheers!" It would also be great to practice throwing telephone poles, play some mournful tunes on the bagpipes, knit a tartan, and to have a chat with Nessie, but we'll see how that works out.

I will be checking out some fantastic paintings, learning about Scottish history, riding a bike on the wrong side of the road, and I hope to sneak in a visit to Kal, aka Traumaqueen. Then I can lust after Scottish ambulances as well as English ambulances.
I was a…

...like a hole in the house

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Yes, this is as awesome as it looks. This is the result of an unfotunate teenager learning that sometimes you can go too fast in a car. The driver lost control, drove through a yard, dodged a tree by some miracle and slammed into an unsuspecting house. The house lost. Well, so did the car.

This was one of those accidents where I was getting nervous going there because they had already called for one helicopter, and when I got on scene, they called for a second one. Oh crap. I was alone on the medic unit at part time work. I pulled up and saw three patients on backboards, all conscious with not a huge amount of blood on them. I was comforted. One EMT told me they had the worst one that they were loading into the ambulance. I took a minute to assess the other two patients and found their injuries unimpressive. They didn't need a helicopter or a paramedic. It was at that point I realized that I hadn't seen any of the car or cars involved. I gave a quick look around, and found the …

Therapeutic Punching

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The call went out for seizures. I made my way there and the ambulance crew was walking out to meet me in the hallway. The patient looked fine. We got in the ambulance and I got the story straight from him. Apparently he had been experiencing "seizures" throughout yesterday and today. The last one was right as they called 911. The patient though, was totally coherent now, felt a little tired, and could suspiciously remember all of theses 'seizures' (which just doesn't happen to seizure patients.) He said that suddenly he would get a really hot feeling and then would have a seizure.

Mere minutes into describing these events to me, as I put him on the monitor he said, "I think I feel one coming on!" He then went stiff and unresponsive, and the monitor showed ventricular tachycardia, basically a lethal heart rhythm. Before I could even change my pants, he converted back to a sinus rhythm. "Are you okay?" I asked. "Yeah, I'm okay." he …

Why Zoll is inferior

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Photographic evidence of the insanity that is telemetry with zoll monitors. Here, in a tangled jumble are the parts required to send a 12 lead using a zoll.
This is what greeted me in the back of the monitor when I checked the truck this morning. I almost took it all out and threw it in the trash. It was literally exploding out of the monior, impeding access to things that are slightly more important including the cord to the defib pads. To send 12 leads with zoll, it is a multi step process requiring the white box shown, and the mini portable radio shown to the left of it. All those wires move between those two items and the monitor. You can also see where some kind soul used IV tape to secure them together. Thanks. Now it's sticky. One has to take the EKG tracing, plug all this stuff in, establish a med patch with the receiving hospital, turn everything on, give your report, have only a little bit of fun saying "Stand by for 12 lead!", then key the mike, and in…

Early morning complaints

It was 3 am we were called for a lady who thought she was having a stroke. She had no signs or symptoms that would indicate that she had anything wrong with her. Except that she called 911 in the middle of the night, which is a disorder that should be in the DSM IV. She certainly didn't have a reasonable answer to my favorite 3am question of "What changed that made you call us now?"
I was riding the actual ambulance, so when my BLS partner took the call, I was super excited to be driving an ambulance again. It's kind of disturbing how long a chase car medic can go without actually driving an ambulance. But I digress.

We dropped her off and the nurse asked her all the same questions that we had. She then asked the patient why she thought she was having a stroke. The patient paused in thought and said, "Well, right now I feel really tired....Like I really want to sleep." I had to leave at that point to stop myself from shouting. "You feel tired becaus…

Wedding Hair

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Another wedding, another seemingly large amount of bobby pins in my hair. For those that care, all maybe one of you, I had 31 pins in the last picture.

This past weekend one of my best friends got married. It was pretty much exhausting, but went really well, and everyone had a good time. Most importantly, they got married. I was surprisingly stressed for a while there, but in the end I had fun. I got to road trip with my college roommate, get my hair done like a southern bell, found a river, and reconnected with friends I hadn't seen in a long time. I am super happy to have done that. And I was generally feeling some huge relief and happiness by the end of the week!
For those that care, all, well potentially more than one of you, there are more pictures here. Yes, we started the week with the bride in a box of packing peanuts and several adult women chasing after an 18 month old to strip him of his ring bearer tux. He really likes to dress up. The week progressed and the same adults…

15 Lead (reprise)

I didn't fully explain, I'm afraid. V4 is used as V4R. V5 is moved and used as V8 and V6 is moved and used as V9. Try it sometime. Impress your friends and colleagues! Don't forget to mark the 12 lead when it's printed out. That is all.

PS Tracy: 80-120 mg/dl is normal. 180ish is generally considered high. My concern is piqued if the patient is over 200 without a reasonable explanation. Sometimes the gloucometer says "HI" which is, of course, very bad (I'm good at pointing out the obvious). On most meters (that I know of) a reading of HI is > 600 mg/dl.
For the brits, if you divide the reading in mg/dl by 18 you get your reading in mmol/L. 600/18 = 33 mmol/L.

Thanks for the questions!

How to worry your colleagues

It's 102 degrees Fahrenheit. It's sunny. You get out of work at 3pm. Anyone normal would run to the nearest swimming pool or ice cream shop. You, on the other hand, decide to hike eight miles. Where you go is basically the same temperature as the surface of the sun. But you march on; pack fully loaded on your back, slathered in suntan lotion, sprayed with bug repellent, three liters of water in tow.
This will worry your colleagues. When I left, my boss asked me what size IV I'd like when I went unconscious and he responded to the call. A modest bilateral 18s would be fine, I replied. It actually would have been a good idea prophylactically, so maybe next time. It will also worry your parents, friends, siblings, and that guy you're dating.

Why would one do this? Training. It is the first time I have trained for a vacation. But more on that later.

Perspectives

It took a while for them to notice something was wrong. He had filled his gas tank and leaned into his car to get something. Nothing unusual there. A few minutes passed and they noticed that he hadn't stood back up. Someone curious approached the car. First off, his exposed hand was blue, this couldn't be right. He shouted for someone to call 911. He edged closer to the man and shook him. Nothing. Someone handed him a phone and he was asked if the man was breathing. He wasn't sure. Help was on the way, he was told. He didn't know what to do and was getting flustered by the dispatchers’ instructions. "No, I don't think I can get him onto the ground. He's in an awkward position." Thankfully, sirens approached. A paramedic arrived and asked what happened. He couldn't answer. She looked at the patient and attempted to pick him up. "Damn, I'm going to drop him." She turned to him and asked, "Can you lift?" He held out the phone …

15 lead

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Sorry Steven, it took me a few days to get your answer. Turns out I couldn't find pictures of a 15 lead, so I had to take a picture of the one out of my book. (credit to Bob Page.)

V4R goes where V4 goes only on the right side. Elevation in this lead alone is diagnostic of a right sided MI. (Occlusion of RCA)




V8 and V9 can show a posterior wall MI.






Ken- thankfully, my patient had a lot going on and his 3rd degree block sort of got better. Here we follow ACLS (advanced cardiac life support) from the American heart association (AHA) Probably the same protocols that you guys follow. Basically the only treatment for symptomatic and unstable 3rd degree block is pacing.

Hypo

The other day I had one of those calls where I was on scene so long, I felt like exchanging Christmas cards with the patient and calling him on his birthday. It started out as a simple diabetic, but when we got there the patient was more or less awake and oriented. He had had a syncopal episode which led to our being called.
We checked his sugar and it was something like 42. Not good. So I looked around the room, and there were some muffins on the kitchen table. We had him eat one of those, and drink some OJ. Wanting to give those enough time to work, we waited a few minutes and checked his sugar again. 41. What?! So, to plan B. We had him eat a tube of glucose. And some more juice too. We waited a while in hopes that his sugar would be more normal. In this time, though, his wife said that he was acting more normally, which is always good. We were having a nice chat, I learned about all their children and grandchildren, what they both used to do for a living, and we all…

The superior inferior

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I would say that the most frightening, cluster inducing type of heart attack is the inferior MI, which is also the most deadly, 80% of patients with this condition die. The tricky part about them that instead of responding well to nitrates (the usual treatment for heart attacks), these patients drop their blood pressure precipitously instead. Potentially to the point of death.
We got called for chest pain and when we arrived we found a guy, laying in bed, so wet with sweat that it looked like he had stepped out of the rain, complaining of severe chest pain. From the start this call had potential. He had been outside mowing the grass, developed this pain and stopped, hoping it would go away. At this point he went upstairs. Why? I couldn't tell you. Then he took three of is prescription nitros. Hence the laying down and the blood pressure of 80 palp.

We immediately put him on the monitor which showed what is called a third degree atrio-ventricular heart block. Basically, this patients…

June 1st

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So, I didn't take a picture yesterday. I had a great day of dress fittings, civil war medicine, and family dinners with families that weren't mine before. Today, one of my best friends got married.



Mad props to whoever can guess how many bobby pins are holding my hair in place.





This marks the official end of the picture a day project, but I don't think this will stop me from trying to take my camera everywhere. A few actual written posts are in the works, and it's just a matter of taking the time to sit down and finish them. These especially include explanation of the 3rd degree block and the fly out of the same patient. And also, I hope a little 'getting fancy' about preserving lives and things that I've convinced myself that I didn't miss.
And oh yeah, that makes 45 posts in the month of May. That's a new record!