30 May 2008

May 30th


3rd Degree AVHB.

29 May 2008

May 29th




Kitty is lonely.


My windows need paint. Not my problem.

28 May 2008

May 28th




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





27 May 2008

May 27th


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

It's not my emergency

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 again and blah, blah, blah. When people raise their voice to me, that's what I start hearing. His wife butted in, "They won't see him with all this bleeding?!" I said, "It's not that they don't want to see him, but patients with life threatening emergencies are seen first." "But...but he's bleeding!" she blurted. I looked at him and asked him if it was still bleeding. He removed his paper towel and angily said, "I don't know! ...well, it looks like it's stopped for now. But I can't wait, I'm going to another hospital." "Which one?" I asked, "Because I know that they are all busy tonight." I was legitimately trying to be helpful, but he wasn't hearing it.
He stormed out without being seen.

We had a young guy come in who had chest pain. It didn't fit the bill for anything cardiac and, andas with the last guy I informed him that it would be a long wait. I just don't want people expecting to be seen anytime soon when there is just no chance. His wife butted in too. "But he has chest pain!"

At this point I was getting good at saying "Yes, I understand, but patients with life threatening emergencies are seen first."

I think they only would have been happy if I leaped through the triage window, put the patient on my back and ran him into the ER.

So they waited and kept giving us the stink eye, as if my inactivity proved that they should be getting seen. I don't actually do the triaging, I basically give people bracelets and look pretty. It wouldn't matter anyway, staring me and the triage nurse down won't get you in faster.
Also, it's going to have to pretty spectacular for me to get excited about it. Nose bleeds don't count.

26 May 2008

May 26th


Retrodated post.
Fluids.

Slacker

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.

25 May 2008

May 25th


Retrodated post.
A collection of signs.

24 May 2008

May 24th

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.

23 May 2008

May 23rd




Kitty blends.





22 May 2008

May 22nd




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

21 May 2008

May 21st




Funny idea stolen from Sean.




A late post after a very nice evening.

Sick people

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 our truck back to the hospital. It turned out that the pts. potassium was 7.6. This is very high and at 7.5 the SA node stops working. Thus, the junctional rhythm. The pt. coded shortly in the ER but was resuscitated and apparently will recover.

Two days later at part time work, my partner for the day took the first call. He sent a 12 lead to the hospital and his patient was in a 3rd degree heart block with a ventricular rate of maybe 20. They used the hospitals helipad to fly the paitent to more specialized care. When they arrived to wait, I hopped in to see if I could help. This patient had suddenly felt weak and fainted, and when I got in, my partner was pacing him with success and had given atropine. He paused the pacer to see what the underlying rhythm was. P-wave, P-wave, P-wave, P-wave, okay, turn the pacer back on. The patients ventricles were now not working at all, oops. The helicopter arrived and we sent him on his way.

This morning we were called for a fainting, and we found this youngish guy sitting up, pale, sweaty, feeling lightheaded. He didn't want to go with us so we worked him up hoping to scare him into going. It didn't take much. We stood him up to do orthostatic BPs and he started to do the "duck and weave." We layed him down and he agreed to go with us. Then he fainted again, and started vomiting blood. Somehow I was alone with him at this point and was pulling him onto his side. One of the EMTs helped me, and another ran for suction. I won't lie, what he threw up was really gross. I got a whiff of the acrid blood/vomit smell and almost lost it myself. From here we got him out, started some huge IVs in him and went to the hospital.

I've lucked out, having critical patients without having to write the trip sheet about them.

20 May 2008

May 20th




Electrodes. The nice kind.






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

19 May 2008

May 19th

These boots and I...





...climb.









...stalk.








...calculate.

18 May 2008

May 18th



Awesome double sided cake.


















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

17 May 2008

May 17th





We like to make a mess.










Surprisingly not a whole roll of monitor paper.

16 May 2008

May 16th



My new neighbors. Ah, semi rural living.

15 May 2008

May 15th



I have finally put theory into practice and driven my first manual.









My parents bought it.

14 May 2008

May 14th



Kitty contemplates a world she's never known.

A mixed bag

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't. I did harass her about her smoking, ie; "You really need to stop smoking. Next time you could die." and she couldn't have hurt me if she tried. Come and get me. Case in point.

13 May 2008

May 13th

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.

Intrusion

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.'

I turned back to the sleeping patient and the meddling relative interrupted me again.

relative: "Are you putting her on life support?"

me wondering: Does a nasal cannula look like life support? I haven't even touched the patient.

me: "No, she's fine, but we need to get going now." To the EMT: "Let's just go."

Long pause. I look between the friend/relative standing in my office, the EMT, and the patient who is fine.

relative: "Oh! You need me to leave. I am holding you up."

EMT: "Uh, yeah."

I am sure that I am not alone in hating it when people inexplicably open the doors of my ambulance. It is my safe space, and my work space and they have just compromised both. It's okay to be concerned for the patient, but no knock?
I love this almost as much I love the relatives who tailgate the ambulance the whole way to the hospital with their flashers on running red lights like they are somehow exempt at that moment. That's a recipe for disaster.

12 May 2008

May 12th Update

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!

May 12th

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.

11 May 2008

May 11th




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.

Economic Stimulus

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 forget us in November)



In the end, yes, of course I'm happy to have 600 'extra' dollars in my bank account. That will just about cover what I owed in taxes this year, so I don't exactly see it as free money.
I'm not sure this is what it's going to take to stimulate the economy, but I guess we'll find out. It will stimulate my economy by staying safely in my bank account. Or I'll use it to purchase things overseas. Not exactly what they had in mind for me to do with it.

haha. I'll stimulate your economy. I'm allowed a far reaching sexual joke once in a while, aren't I?

Lost

"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 distance between us, it took me ages to get there. They could have taken the patient to the hospital and had her registered by the time I got to the scene, but they dutifully waited for me.
The patient wasn't too bad off and the call was uneventful.

After all this, I have decided that it would be funny to have a voice recorder in the truck. Maybe I am the only one that talks to myslef, but I doubt it. There would have some nice recordings of me muttering about roads that aren't on maps, faulty directions, curvy country roads, and the insanity of responding alone.

10 May 2008

May 10th















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.

09 May 2008

May 9th


Still fragrant, although the bloom is dying.

Why I love the LAS.
















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'll be honest

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 continued to wonder aloud about how she got here, how her chocolate bar got all over her pants and shirt, and the suddenly asked: "Hey, where's my hat?!" Uh, how should we know, we were a little more concerned with you being unconscious than what was on your head. She seemed not to believe that she had been unconscious and mused about where she could have left her hat. "Do you think I would leave the house without a hat?!" she asked, reaching toward her disheveled hair. Well, you left the house after smoking a lot of crack, your pants are falling down, your shirt is stained and now you can't remember how you got here, or where you left from, so I guess it's believable that you would leave without a hat. Thankfully while driving aimlessly in a drug induced high she managed not to drive into a school yard or a bus full of old people.
She refused to go to the hospital, and went to jail instead.

While I was in London we got on a call for a guy who was unconscious on the street. It was easy to see once we arrived that he was totally drunk, took a short nap on the pavement and a kind citizen had called 999, thinking that he needed help. That kind citizen though, couldn't manage to stick around long enough for the ambulance to arrive. Not an uncommon job. He couldn't even stand up he was so drunk, and of course, like everyone on Earth, had only had two beers. Several minutes later, after many attempts to simply get him to go on his way, he said: "Okay, I'll be honest." Ooh, thanks. "I'mmmm Pissssed!!" Tell us something that's not painfully obvious.

08 May 2008

May 8th





We have a lot of buttons.

07 May 2008

May 7th






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.

06 May 2008

May 6th




Groundhog day.

Saws All

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 job at holding on the dressings. We found the saw, and the blade was completely covered in blood, so there was no telling how far it went in.
He was surprisingly calm through all this, and we had an uneventful ride to the hospital.

05 May 2008

You've got no clue!

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 reason not to do a full assessment and work up on patients.
I think the best thing about it was that he had probably given this lecture a hundred times, and he was very enthusiastic, dynamic, and you can tell that his only motivation is the saving of lives.
At the end, I thanked him for an excellent class and in truth, I can't wait for another chest pain call when last week I gave them all a big sigh.
I can't wait to rig our zoll at part time work to give me CO2 monitoring on the awake patient.
In conclusion, if Bob Page comes to your town, run, do not walk to his class. It is excellent. It will make you a better clinician, and it will saves lives.

May 5th

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.

04 May 2008

May 4th


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

Elevation

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 to a break in issue more than a year ago. Don't even get me started!) Her chest pain was terrible, I gave her more nitro. That didn't work. Basically the call became a minor cluster, which I enjoyed very much. (seriously)
Luckily, through all this her pressure was good, and her oxygen sats were good, so at least I didn't make her worse! Always a good thing.
It seemed to take us ages to get to the hospital. Why do these calls always go down during rush hour?!
I was happy to see everyone ready to receive us at the hospital and that they had believed my radio report. She was sent straight to the cath lab, where I will assume she had "a little work done" and will recover. Until I know otherwise, that's what I will believe.

03 May 2008

May 3rd




A nice local nursery is in full bloom.






FWB

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 parenthesis.

potential date: honestly probably fwb and see where it leads
me: fwb? (asked in my infinite wisdom)
total ass: friends with benefits
me: oh (WTF?!)
ta: yea
me: thats very honest of you
ta: i m honest person (oh, well that changes everything!)
me: so are you saying friends with benefits w/o a relationship
big jerk: yea i guess and see where it leads (which would be nowhere)
me:
how would you get that without a relationship (my sad naivete shining through)
me: I guess i'm curious b/c I've never had "friends with benefits"
me:
and to be honest with you, not much interest in it
big jerk: not much interst in what
me: (are you some kind of retard?) fwb (duh)
moron: too bad (too bad?!!)
moron: they can be fun and make good friends (so can hookers)
me: so you want a friend you have sex with, just be clear
huge jerk: for the time being and see where it develops
me: to me, it's usually the other way around
me: you have a friend and then see what develops
ass: basically thats what it is just throwing fun in there
me: and fun can only be found in the form of sex?
ass: no friends have the regular fun benefits throw in the sex fun (what? that doesn't even make sense)
no longer potential date: its not that bad as u make it out to be (yes it is)
captain obvious: guess i scared u (I wouldn't say scared exactly)
me: I probably would have found out sooner or later
me: but why (this dating site) isn't everyone on there looking for a real relationship?
delusional: as am i (um...no you're not)
bad boyfriend: but i dont rush into them (do you even buy them dinner?)
huge ass: but i just dont want friends..i like fun to much (right. so do pedophiles)
me: that's interesting (actually, no it's not)
jerk: yep
you're not cute: oh well its me i guess
still trying: not interested? (have you and I been in the same conversation?!)
me: in fwb w/o a relationship?
huge jerk: yea
me: no
still a jerk: k (okay, yeah, bye)

02 May 2008

Meme

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.

May 2nd

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.