30 March 2008

IV woes

You are mad, you need an IV, and unfortunately you are 9 months old. The nurse asked me to take a look. A tight tourniquet around your arm, and my fingers become my eyes. I feel a tiny vessel in your AC. I can't see it, but I know it's there. Three of us are holding you down. You are angry and crying, and squirming. I take a literal stab at it and amazingly, a flash! You have surprising strength and are wriggling like crazy. It is so crucial that you stay still at this second. You give a few sharp pulls as I attempt to stabilize the catheter. My partner attaches the lock as I hold your arm as firmly and gently as I can. Wriggle, wriggle, wriggle. I push the plunger on the flush and the vein is blown. Damn! The most honest damn I have ever uttered.
Back to square one and you are still mad.
One look in your sad face and my anger is gone.

28 March 2008

The Chicken or the Egg

Oh, what a strange career I've chosen when a 'good day' includes people dying. I will reiterate that it is not that I want people to become sick or injured, but if they are to get sick or injured, I am happy when it happens on my shift.

Our call came out as a fall, which could mean absolutely anything. Further information was they it was down 5 steps, but they weren't sure he was breathing. Hmm, that's certainly when the call took an interesting turn.
We got on scene and a guy ran up to me, shouted, "You've got to hurry!" and ran back into the house. I followed him to the head of the basement stairs. At the bottom of them, was a guy on his back in a pool of blood that was more or less pouring out of his nose, as his wife was doing CPR. Initial thought: "Oh, shit." I head down with my partner right behind me. The wife stood up, said 'Thank God' and ran up the stairs never to be seen again. So we didn't really know the story, but the conclusion was the same.
I put him on the monitor and he was in asystole. I shouted up to one of the EMTs that we needed someone to do CPR, and another to hold c-spine. Of course these calls always happen at the bottom of basement stairs in a three foot wide hallway. We got him CPR'd and bagged and two lines and several rounds of drugs in. An advanced airway would have to wait. I have never suctioned so much blood out of an airway and with every breath we gave him, blood was splattering everywhere. I backboarded him and the FD arrived to help us get him out.
In the ambulance, my only objective was to get a good airway in. With surprising deftness (given how long it's been since I've attempted a real tube) I readied my supplies and peered into the airway with my Mac 4. There was so much blood in his airway it was unbelieveable. I initially thought "What the hell is going on in here?!" but after a lot of suctioning, the most amazing thing happened. I realized that I was looking into his trachea and passed the tube with ease. I inflated the bulb, removed the stylet, attached the BVM, and with bated breath, I squeezed the bag. CHEST RISE! My partner checked for breath sounds, and declared that I was in, woot!! The CO2 was 35, and I took a time out for a happy dance. It was an atraumatic ride to the hospital. I did some deep suctioning, and got copious amounts of blood that seemed to have no end.
They worked him for a little longer in the ER. By then he had racoon eyes that could indicate a skull fracture, and was still in asystole. The question remained unanswered as to if he had cardiac arrest, then fell down the stairs, or if he fell down the stairs and suffered an injury that caused him to go into cardiac arrest.

Either way the outcome was unfortunately the same, but still my first tube success. It is good to subscribe to the theory that this event would have happened whether I had been there or not. Someone would have intubated him, but I'm glad it was me.

27 March 2008

Nice doggie.

I was pedaling along, minding my own business of course. I was thinking about whatever it is I think about when I'm alone on the road. Suddenly, I heard shouting to my right and look over to see a dog running full on toward me. I'm not a dog expert by any means but I can say without trying to be dramatic that this dog was a pit bull. All conscious thought was gone and my instincts told my legs to pedal like crazy. The dog was next to me within seconds, pushing me into the oncoming lane. It was so close that I could have kicked it easily (not a good idea). I believe that it either would have run me off the road completely or run into the bike causing me to crash.
It was keeping up with me, which concerned my instincts so I just started yelling. I think I yelled "GET OUT!!!" and wondered to myself why I said that given that it made little sense. Either way, that, and an aggressive turn toward the dog made it stop. I continued to pedal, increasing the safe distance between the dog and myself. I stopped further on looking back to make sure I was safe. At this point I am sure I shouted more, and my rant was now peppered with more expletives about leashes and fences. My chest hurt and my pulse beat in my ears. I was in short, outraged.
I finished the rest of my ride without incident, but I couldn't help but think of all the things that could have gone wrong. If a car had been coming, if the dog had bitten me or the bike, if I had crashed. What if I had been a child, or an elderly person, or on foot?
All this bothered me. I could only hope that the owners had seen the whole incident and felt so foolish that they would have installed a fence that evening. I didn't know if the dog was being malicious or playful, and I don't really care, I was still scared. So, I called animal control who will check it out and make sure the owners are fully informed of the dog related laws of the county. I don't like to be a meddler but I can't cut this road out of my regular ride, and I don't want to be worried about some dumb dog every time I get in the area.

I have been searching for possible solutions to the dog chasing problem. The general consensus is not to run away, as it is likely that the dog can outrun a bike, especially on rough terrain or up a hill. (as in my case, I subconsciously knew that I would eventually run out of steam on the hill ahead).
Stopping and using the bike as a shield seems a likely option, but I felt I didn't exactly have time for that.
Installing my can of pepper spray somewhere within arms reach seems to be the best option. Since I already have the spray, I'll just have to find a way to secure it to the bike and still be able to grab it quickly. This will, in theory, kill (or blind) two birds with one stone as it will be ready for canine and human threats alike.

That, or I'll start carrying dog biscuits, or, on second thought, raw t-bone steaks.

26 March 2008

A post.

Having spent two candy and crap food filled holidays without actually consuming any candy or crap this lent, I was particularly excited to end my candy and crap fast. But I discovered, increasingly with every Easter, that I'd rather just eat normal food. I can't have just Peeps for breakfast anymore. And, now within a week, I have pretty much completely returned to my pre Easter diet.
Easter was a non holiday holiday for me, as I was at work the entire day. It was pretty easy money as we only transported two patients out of six calls. I got to split from my partner and venture out on my own in the truck which was equal parts frightening and exhilarating. I was only afraid of getting lost, but miraculously, I knew where the call was! It turned out to be a refusal.

Last week at part time work, I got to experience some advantages to working in the ER when we gave adenosine twice in a row. One guy came in with a heartrate of 170 and was fixed with 6mg of adenosine. And about half an hour later a lady came in with a heartrate of 210 and was fixed with 6 mg of adenosine. What a joyous drug!

I am currently dogsitting for my sister. (Dog above shown in actual size.) She's a good dog, and very excited to have a little vacation in the country. I am shamed to admit though, that kitty is afraid of this dog which is half her size. Kitty spends all her time now either in a cave of bedcoverings or skulking around the living room, hissing at nothing in particular. It's sad when cousins can't get along (not that I expected them to.)

Other than that I decided I really need an editor, rode my bike to the boonies, and I discovered that Red Box movie rentals are the greatest invention ever.

24 March 2008

On the Bike

My hands are cold.
My shoulder is cramped.
My cheeks are red and hot with windburn.
My lungs work fast to take in gulps of air.
My heart is beating faster than ever.
My ponytail is in a windswept tangle.
My quads are tired and begging to stop.

I have never felt better.

18 March 2008

Ellie's Guide to Online Dating

Okay, I'm just going to throw it out there, because I am not ashamed to admit that I am lonely. I am now a card carrying, real money paying, t-shirt wearing, annoying commercial making member of everyone's favorite online dating service: eharmony.com. Okay, I am a little shamed. It's mostly the paying money to meet strangers that bothers me. But, I figure that no matter how I meet people, it will cost me money. Online dating costs less than taking a class, going to bars, getting arrested for selling myself on the street, and those shady mail order husbands. Plus, all of the embarrassing rejection takes place in my house and is witnessed only by my cat.

So I am doing a trial run. The basic facts are these. If you don't find anyone at school, work, or through your friends, you won't find anyone. Well, that's my theory anyway. I don't have the time or money right now to begin higher educational pursuits, and everyone at work is older, creepy, or married. The through friends option for me is running out, considering that by the end of this year, all of them will be married, to each other. So my next option is to venture out onto the superhighway of love.

I've figured out that e-harmony is the working person's dating service. They do pretty much all of the leg work for you. They find the "match" send it to you for approval, and then you send them some generic questions. At some point, the match sends some generic questions back to you. In theory, this progresses to reading the rest of their very revealing profile, and eventually actually talking to them. Well, by talking to them, I think I mean e-mail them, but I haven't gotten to that yet. It's very structured and slow for safety's sake. Eventually you can even go on real dates, I am assured of that by that gray haired guy on TV. Then the shroud of the internet can be pulled back, and all pretense lost. We can date like real humans, and hopefully still like eachother in person.
Although, maybe I have it wrong and the whole thing forces you to base your relationship solely on online personas, and not physical people. Your first date is actually your wedding date. Or it's when you tape your commercial while you hold hands and gush about how wonderful you each are and that those 29 dimensions of compatibility are just magic.

Basically there are two majority important aspects to online dating.
1. Your profile.
-Honesty seems to be the key, but don't reveal all of your crazy at once. Use small doses.
-When things seem too good to be true, I worry that they are in fact, too good to be true. For example: “I’m a personal trainer working on my law degree so I can do pro bono cases. I love to cook and play acoustic guitar and write my own love songs. My favorite movie is ‘Notting Hill’, I admit I love the chick flicks! I’m independently wealthy and will worship the ground you walk on, (if you’re the right girl!) In my spare time I buy homeless people clothes and help old ladies across the street." This is more believable/acceptable as long as the accompanying pictures offer some proof and include you climbing a mountain, living it up in exotic locals, or playing your favorite sport without a shirt on (which is fine, by the way).
-Humor is good, but some real answers would be nice too. Yeah, I know that answering questions about yourself feels silly, but there is no way that you should fit the word 'communism' into every answer. It loses something.
-TV should not make it onto the list of five things you can't live without.

2. Your pictures.
-Do not post pictures of yourself where it is obvious that your ex-girlfriend is cut out. We can tell. Unless you are actually missing your arm from the shoulder, or you have no hair on one side of your head, those pictures are no good.
-Do not post pictures where you are drunk or drinking. Again, we can tell. What else could be in that red Solo party cup but a crappy beer, fresh out of a keg? That's right, mixed drinks with an obscene ratio of alcohol to juice/soda.
-When considering a picture to post, submit it to a friend that is a girl and not your mother for approval.(Making sure they have your best interests at heart.) That's the best solution I can come up with to prevent some really bad and possibly misleading pictures from getting out there.
-I will concede that a bad picture is better than no picture at all.

That being said, do you think it is appropriate to post a picture of yourself licking an iceberg? Hypothetical question, of course.

15 March 2008

Screaming like a girl

We had an ATV accident where a kid, guy, whatever, it's up for debate, launched himself off of his four-wheeler and face planted into something (well, the ground, but something put a nice cut on his face too.) Aside from the cut and scratches all up ons, he was basically fine, (we know now) Although at the time he was acting mental, resisting help, screaming like a girl, carrying on and such, so that we couldn't rule out a real head injury.

Possibly the best part about this call, aside from the amazing amount of amusement I got from his screaming like a girl, and the presence of a helicopter which is always fun, was that he was off the road on a farm lane that was an absolute mess. The lane climbed the side of a hill and not only had potholes big enough to knock your teeth out, it had these large humps. I can only believe these were made to guide floodwaters somewhere else so that the lane didn't become a river, but they were so big that I think that if I had driven over one, the medic unit would still be there balanced on its undercarriage. So, to prevent our truck from becoming a see-saw, I was forced to go completely off road and into the corn field. I'm worried I'll get a reputation for taking the medic unit off road into corn fields at this point. Anyway, it was good fun, and I was very happy not to get stuck.

Helicopter was called, kid was backboarded and bandaged, and all was well. I got to kneel in the dirt and give him an IV, which also made him scream like a girl. (Patients like these don't get any less sympathy for me, and I'm not going to deny that he was in pain. But, there is a line between being scared and in pain, and being dramatic.)

Its annoying/vexing to me when I can't tell if patients are being jerks, or have a legitimate problem that makes them not answer questions properly and scream like little girls. It was really my first issue with EMS when I realized that people call 911 and then refuse to answer legitimate questions, people would pretend to have something wrong with them for attention, and some people just might not have anything wrong with them at all and don't even bother pretending. On the other hand, lots of patients have strokes, brain injuries, diabetes, brain tumors, or any number of other legitimate problems.

As it was with this patient. His inability to answer questions and follow commands properly landed him a helicopter ride and a visit to the local trauma center.


Later we went for a guy with chest pain. I did the 12 lead and my partner asked me how it looked. Without giving it away to the patient: "Like crap." He had ST elevation (indicative of a heart attack) in several leads, and reciprocal depression to go along with it. This guy also vomited, his blood sugar was >600 mg/dl, and, well, that was the extent of his problems, which was plenty. We sprayed him with nitro, made a vain attempt at lowering is blood sugar, oxygenated his cells, and gave him some lovely fentanyl. What fun. Seriously. He didn't scream like a girl at all, and he actually had something wrong with him.

13 March 2008

Breathing Treatments

Last week I got to use CPAP for the first time which was fun.
If you looked up emphysema in the dictionary, there would be a picture of our patient.

emphysema:
1. a chronic, irreversible disease of the lungs characterized by abnormal enlargement of air spaces in the lungs accompanied by destruction of the tissue lining the walls of the air spaces. (dictionary.com)

2. Ellie's patient the other day.

He was on 4 liters of oxygen at home all the time and neb treatments every 4 hours around the clock. He was just finishing up a treatment when we arrived and it wasn't doing anything for him. Well, before he took his neb treatment, he just finished the other kind of breathing treatment: a cigarette. (I'm about to give up on understanding people) We got him in the truck, did a duoneb and an albuterol. After those he was wheezing more, which was actually a good thing. He was still struggling quite a bit, so, with about 10 minutes to the hospital we put him on the CPAP, which was awesome.

He got better, and was bumped into the most interesting call of the week slot.

We also had a gross GI bleed (but come to think of it, I've never had a GI bleed that wasn't gross,) some chest pain patients, kid with a concussion after he rolled his car, a lady with nothing wrong with her, and a lady with something wrong with her.

I'm not sure what was wrong with the one lady, but something was. By the time we go there she was conscious, but barely responsive to us. Didn't flinch at the IV, but managed to rip it out of her hand. Needed some oxygen, but managed to rip the cannula out of her nose. She wasn't violent, just didn't appear to know what was going on at all.
My favorite question to the husband was "When did you last see her acting normally" "Well, she hasn't been normal for several years." he answered slowly. "Okay," says I, "then when was she acting normal for now."
That's when I got the sad answer of about four days ago. (Now I have accepted that I will never understand people.)

Later, I had a chest pain patient whom I gave a nitro to, no big deal. My BLS partner at the time reported a normal BP after the nitro, but my LP12 was saying about 79 over something I can't remember. So, I palped one myself, and it was indeed, 80. Well, time for a fluid bolus! And no more nitro for you! I always strive to make my patients stay the same, or get better, not worse. A noble, and occasionally unobtainable goal.

Other than that, I got back out there, stabbed a box with a sword, had a great bike ride, and spent some pounds, (£) that is (but maybe some of the other kind too!)

06 March 2008

Spring

Last week I went with my friend to the Philadelphia Flower show. We went back in high school and decided to go back. It's also a lot of fun, in the nerdiest of nerdy ways. On our bus it was the two of us and about 40 other retired old people which amused me greatly.
I actually bought plants this year, and had my first Philly cheese steak ever. It was good!
Here are some pictures of Flowers

A few weeks ago I got to test drive a Smart car. It is not a car that thinks for itself but a 71 hp, 40 mpg minicar with just 2 seats and about a foot of storage space. It is awesome! Needless to say I need (an absentminded typo that I'm keeping) want one. But alas, not cost effective while I still owe on my truck. Oh well. But think of the gas savings! It would be significant. Think of how hilarious a 16 foot kayak would look on an 8 foot car! That's probably not legal. Think of the turning radius! Head in parking in a parallel spot is also probably not legal. Think of a highway speed accident with only six inches of crumple zone! Okay, but I still want one.

Other than that, I booked flights, made a plan, tracked my national registry papers, and slept in!

04 March 2008

Updates and other stuff

So, apparently it is possible to be shot through the head and survive. I have heard that my patient is still intubated, but is following commands, which lead them to believe that he will eventually not have a terrible neurological deficiency. And by terrible neurological deficiency, I mean be dead. So, yay! Another life saved, almost for real this time.

(Full time) work has been work like, with basically almost no patients that stand out in my mind. The white cloud has officially caught up with me.

We had a two week old with nothing wrong with it, but an overly worried mother, whom I can't blame at all for being worried. Another patient had nothing wrong with him, except that he woke up with a sore throat that had since resolved itself. 911 is no longer an emergency number apparently.

In the interesting call category, today we had a guy with major sepsis, so much that his temperature was 105 and he was literally red hot. Ew.

Yesterday at (part time) work, I had a lady who was having petit mal seizures. She was getting treatment for a brain tumor, and started with seizures in her arms a day earlier. When I got there they were in her face, and she was barely responsive to me. I gave her some Valium, that stopped the seizure, perked her up a little, but unfortunately, didn't get rid of her growing brain tumor.

Then we had a patient who was in a doctors office so close to the hospital that we got our bags and a monitor out of our truck and literally walked to the call. The nurses there, bless them, were a little excited. Our patient was sitting up looking well, complaining only of feeling very hot. One nurse flashed a 12 lead at me, which definitely got my attention. The following pictures are from our own monitor.

She was in a strange tachycardic rhythm that now with the visuals makes describing it superfluous. Every few seconds she would go into a more obvious sinus rhythm, and then back to this wide crap. The patient felt the same either way. We did a 12 lead which looked equally ugly and decided to try some adenosine. I've given it one other time in "Drug Box Awesomeness" with great results.
















I got it ready and pushed it on this lady as we watched the monitor with great interest. Her 150 bpm heart rate went to a sinus-esque 30 bpm. Thankfully, it didn't go any slower than that, instead, the wide wacky rhythm returned. We couldn't justify staying on scene any longer given that we were literally a ten second drive to the ER doors. So off we went with the patient largely unchanged.

Oh well, it was still a lot of fun.

I have fixed a few typos from older entries. I swear I can spell and I'm not too bad at grammar either. (She writes in a sentence of questionable grammatical correctness.)