Had an interesting call this shift. Got dispatch Class 1 for an ill person (gotta love those!) Pt wife states pt was sitting in the recliner after dinner and was fine she went outside for a little bit and came back in and found him "sleeping" in the chair and then she tried to wake him and was unable to do so, so she called 911, stating he was unconscious for 5-10 min before we got there. Upon our arrival pt was awake and sitting in chair, pt appeared to be aware of what was going on but was unable to talk. Pt had a pituitary tumor 5 yrs ago and recently the doctors found another mass this time to his left frontal lobe, took a biopsy last week, pt still has sutures in from biopsy procedure, suture site looks healthy. Pt VS are all WNL and I worked out communications with pt by asking yes/no questions and having him squeeze my hand once for yes and twice for no and again he seemed like he was aware of what was going on but just couldnt talk! Blood sugar was 143, no facial droop or arm drift, pt could stand and pivot to stairchair and then again to stretcher with a steady gait. So I took the pt 50 miles (telling my driver I wanted an easy ride, but not to fiddle faddle around either, to use lights and sirens if needed) to the hospital where his biopsy was done instead of the local hospital.
I dont know if I didnt sound sure of myself or what but the triage nurse seemed to focus on the fact that he couldnt speak and the onset time of that and immediately jumped to stroke, and she completely ignored the fact that they had drilled into this mans brain a week ago...so she called a stroke team member in who performed the same tests I had done in the field (looking for facial droop, arm drift, or weakness in extremities and checked his pupils/gaze) and stated "this is not a brain attack". Seriously? If I had compelling evidence this was a CVA I would have flown him instead of taking him an hour by ground considering he was almost an hour and half into the episode. Maybe Im in the wrong here, maybe I was being egotistical, but I did comeplete my assessment, several times, in the field and assumed this was an issue with the mass/tumor they had found recently. Upon arrival of the hospital the pt could answer "yeah" and "no" to questions but was still unable to even state his name.
What would you all have done? Taken him an hour by ground or flew him?
Showing posts with label work. Show all posts
Showing posts with label work. Show all posts
Wednesday, June 30, 2010
Monday, May 17, 2010
oxygen, harmful or not?
Im pretty sure oxygen is a good thing, in the majority of cases anyways. In the last 24 hours I have had 2 encounters where I thought a bit more O2 would definitely be a good thing, but was contradicted by providers with more schooling than me.
event #1: severe asthmatic comes in to the ER and we take them straight to a bed, I pull out a duoneb treatment (cause it takes respiratory a few min to get downstairs after someone calls them) and give the pt a neb via mask on oxygen when the RN tells me "no, use the medical air"...what?? When she sees my confused look she says they normally use medical air, and I inform her we (the medics) use oxygen, pt got the neb via oxygen in the end....
event #2: 20 something y/o male, intoxicated, took a swan dive head first 6-7 feet into a cement trench. Pt unconscious and unresponsive, lac to right temporal, no active bleeding, pupils round, equal, but non reactive to light, pt breathing 12 times a min but shallow with snoring resps, lung sounds clear and equal, O2 sats at 02%, pt resps assisted via BVM, when OPA was attempted pt clenched down. 2 large bore IVs established, 24 min from on scene time to completing extrication of pt from the trench via stokes basket. Upon arrival of flight crew I asked if they wanted to RSI and they replied "no, he's breathing on his own".
I dont know if they were concerned with increasing the ICP, but found it interesting they opted not to intubate. Follow up of the pt was pt had an open fx to right temporal area, several closed fx, an epidural bleed to right temporal lobe and a parenchymal hemorrhage. Pt was intubated at trauma center upon arrival. Pt was extubated approx 8-10 hrs later and is now alert and oriented but still in ICU at trauma center.
What do you all think?
event #1: severe asthmatic comes in to the ER and we take them straight to a bed, I pull out a duoneb treatment (cause it takes respiratory a few min to get downstairs after someone calls them) and give the pt a neb via mask on oxygen when the RN tells me "no, use the medical air"...what?? When she sees my confused look she says they normally use medical air, and I inform her we (the medics) use oxygen, pt got the neb via oxygen in the end....
event #2: 20 something y/o male, intoxicated, took a swan dive head first 6-7 feet into a cement trench. Pt unconscious and unresponsive, lac to right temporal, no active bleeding, pupils round, equal, but non reactive to light, pt breathing 12 times a min but shallow with snoring resps, lung sounds clear and equal, O2 sats at 02%, pt resps assisted via BVM, when OPA was attempted pt clenched down. 2 large bore IVs established, 24 min from on scene time to completing extrication of pt from the trench via stokes basket. Upon arrival of flight crew I asked if they wanted to RSI and they replied "no, he's breathing on his own".
I dont know if they were concerned with increasing the ICP, but found it interesting they opted not to intubate. Follow up of the pt was pt had an open fx to right temporal area, several closed fx, an epidural bleed to right temporal lobe and a parenchymal hemorrhage. Pt was intubated at trauma center upon arrival. Pt was extubated approx 8-10 hrs later and is now alert and oriented but still in ICU at trauma center.
What do you all think?
Wednesday, March 24, 2010
little work rant followed w/ needing your EMS advice...
I have always been a believer of "God doesn't give you anything you can't handle", "what doesn't kill you only makes you stronger", and "everything happens for a reason". For whatever reason I have continued to carry these beliefs through all phases in my life, from growing up to college, to my professional life. I know there are going to be times when I don't have a clue as to what I am supposed to do about a pt, but I am sure that most of the time I will fall back on my basic instincts. Tonight I had another one of those "oh sh*t" calls that when I look back on and talk with my co-workers (medics and doctors) that I know I did what I could with what I had in the amount of time I had. I just get really frustrated when I meet up with a BLS unit and they have nothing done for a critical pt, no history, no oxygen, no vitals. Oh wait, they had a grocery bag full of pill bottles for me. They were so concerned with this pts condition that they walked hin to the ambulance start towards the hospital that is opposit the direction I am coming from then realize Im 5 blocks behind them and cant catch up, so they stop and wait and then have none of the above mentioned done. But when you are called for a SOB and your pt is cyanotic from the nipples to the top of his head, i think any oxygen will help and walking him to the unit won't. Just saying...
I try not to get frustrated on these kind of calls. I try to use calls as teachings for these kind of EMTs who are new or just don't know what to do. During the critical calls I direct and after I try and teach, by explaining why I did or didnt do something or explaining why I did a 12-lead or why I didnt/did run lights and sirens to the hospital,, etc. I also take the time to answer any questions the EMTs may have which usually include "Did I do what i could/should have?" "or is there anything else I could/should have done?" and I answer them truthfully but without sounding like an egotistical jerk. I find that the next time I run a call with those EMTs they tend to be a little more comfortable with me and they have the things we talked about done, they have the pt on O2, they have a BP for me, or pt history for me.
I am sure Im not the only provider who runs into this. Any tips on how I can better this where I run? It happens with a lot of EMTs. Maybe some kind of "asisting the medic" class or something?
I try not to get frustrated on these kind of calls. I try to use calls as teachings for these kind of EMTs who are new or just don't know what to do. During the critical calls I direct and after I try and teach, by explaining why I did or didnt do something or explaining why I did a 12-lead or why I didnt/did run lights and sirens to the hospital,, etc. I also take the time to answer any questions the EMTs may have which usually include "Did I do what i could/should have?" "or is there anything else I could/should have done?" and I answer them truthfully but without sounding like an egotistical jerk. I find that the next time I run a call with those EMTs they tend to be a little more comfortable with me and they have the things we talked about done, they have the pt on O2, they have a BP for me, or pt history for me.
I am sure Im not the only provider who runs into this. Any tips on how I can better this where I run? It happens with a lot of EMTs. Maybe some kind of "asisting the medic" class or something?
Monday, February 22, 2010
my worst EMS nightmare
I mentioned a few posts back that my worst EMS nightmare to date had happened, but at the time I was unable to talk about it. At this point everyone in the local EMS community knows about it, so I suppose it's ok now.
I often do ALS tranports out of the emergency room that I work in. We typically either call one of our own medics in or one of the 3 of us on shift will go, but only for the ALS transports out of our own ER. This was the case the night of "the incident". I took a very stable trauma pt with a head bleed to a trauma center about an hour away. The local BLS transport company sent 2 people on their ambulance. They and I loaded my gear on their truck and we got the patient situated and off we went. The call went without any complications. Upon leaving the trauma center, one of BLS employees offered me to ride shotgun, and I happily accepted. We had an uneventful trip back, put my gear back and finished the rest of my shift, no problems yet again. I got home the next morning and got ready for bed. I had no sooner got situated in my PJs in my comfy bed when my cell rings and I looked at caller ID to see the bossman calling me (this is a rarity, especially using his own phone). He began questioning me about the transport I took, which gear set I used and any procedures or tratments I may have performed during said transport. I explained I only monitored the pt on the cardiac monitor and vital signs, no other treatment or procedures were needed. I was then advised that there were narcotics missing from the gear I had used, and thatthey had been accounted for at the begining of my shift but when day shift was doing their rig check it was discovered that 3 vials of narcs were missing. I immediately got out of bed, got dressed and headed back into work. I eded up spending about 4 hours with my boss, police and simply just waiting. I gave a written statement to my boss, one to police and was interviewed by local police, video tapes were reviewed of both facilities to ensure the theft didnt happen while the ambulance was unattended.
The end line of the story is that while suspicion was high, it couldnt be proven. I was never considered the culprit, and my boss had my back 100%.
Since then the way we store, count, and track our narcs has changed and I have become even more anal retentive about my narcotics.
I often do ALS tranports out of the emergency room that I work in. We typically either call one of our own medics in or one of the 3 of us on shift will go, but only for the ALS transports out of our own ER. This was the case the night of "the incident". I took a very stable trauma pt with a head bleed to a trauma center about an hour away. The local BLS transport company sent 2 people on their ambulance. They and I loaded my gear on their truck and we got the patient situated and off we went. The call went without any complications. Upon leaving the trauma center, one of BLS employees offered me to ride shotgun, and I happily accepted. We had an uneventful trip back, put my gear back and finished the rest of my shift, no problems yet again. I got home the next morning and got ready for bed. I had no sooner got situated in my PJs in my comfy bed when my cell rings and I looked at caller ID to see the bossman calling me (this is a rarity, especially using his own phone). He began questioning me about the transport I took, which gear set I used and any procedures or tratments I may have performed during said transport. I explained I only monitored the pt on the cardiac monitor and vital signs, no other treatment or procedures were needed. I was then advised that there were narcotics missing from the gear I had used, and thatthey had been accounted for at the begining of my shift but when day shift was doing their rig check it was discovered that 3 vials of narcs were missing. I immediately got out of bed, got dressed and headed back into work. I eded up spending about 4 hours with my boss, police and simply just waiting. I gave a written statement to my boss, one to police and was interviewed by local police, video tapes were reviewed of both facilities to ensure the theft didnt happen while the ambulance was unattended.
The end line of the story is that while suspicion was high, it couldnt be proven. I was never considered the culprit, and my boss had my back 100%.
Since then the way we store, count, and track our narcs has changed and I have become even more anal retentive about my narcotics.
Tuesday, February 9, 2010
I'll admit it, I'm a cardiac chicken...
McDreamy Partner goes out for a chest pain in the middle of nowhere in the middle of a blizzard, you guessed it, guy was having an inferior MI. McDP brings pt to the local hospital due to road conditions, we can at least stabalize and get thrombolytics on board, pt found to be having an inferior as well as a RVI...the docs originally decide to admit to CCU here until they can get him transferred to Big City Hospital for a cath. Third Partner says he has connections and can arrange for state DOT plow trucks to lead the way all the way to Big City for the ambulance, so everything gets arranged and the question is asked, which of us wants to go with the local FD ambulance with this guy. There are 3 of us, we all have the same education, 2 of us with less experience, I admit, I was chicken, I didnt want to take this unstable pt in a major snowstorm, partner 2 says the last AMI he had in the last snow storm coded on him in the town square and he is still shell shocked (I DID transport that one in the midst of the last snowstorm) and so we talked partner 3 into going, after all, he has more experience....
I would have taken it if no other choice....but I guess my thought was it was in the patient's best interest for the most experienced medic to go, right??
I still tend to get a little gun shy with cardiac patients, even after 2 1/2 years of being a paramedic.....it doesn't seem to matter how many ACLS or 12-lead classes I sit through....Any helpful advice is welcome.....
I would have taken it if no other choice....but I guess my thought was it was in the patient's best interest for the most experienced medic to go, right??
I still tend to get a little gun shy with cardiac patients, even after 2 1/2 years of being a paramedic.....it doesn't seem to matter how many ACLS or 12-lead classes I sit through....Any helpful advice is welcome.....
Monday, January 25, 2010
want to pull my hair out!
well, last week I had my "worst EMS nightmare" happen to me. I can't really say anymore than that right now, but I can say it resulted in us having a few policy changes and hopefully some bigger, better changes for us, the hospital I work for and for our patients. I am also happy to say that I am glad to have the boss that I do. He probably doesnt realize just how much he is respected. Heck, I look up to him as not only a boss, but a great paramedic. And I am very appreciative for the co-workers who, although can give a hard time, helped me through the last week.
ILYGM!!
ILYGM!!
Monday, December 14, 2009
Whats your EMS opinion?
Well, work has been pretty calm. I had a few days to think about my last few serious calls. I am constantly reminded that I do know what I am doing, although I don't always feel like it. I had an interesting OD call the other day that I wasn't really sure if I did the appropriate thing. Although I have been working in PA for over a year I still sometime revert to the protocols that were engrained in my mind originally (which would be WV...which limit a provider). I was dispatched for a male in his 30s who took an unknown amount of Seroquel. Upon my assessment my pt states he took several different kind of pills, at least 3 different colored pills. The EMTs had gathered pill bottles for me before rendevousing with me and all the bottle they had were Seroquel, all stating the pills were either white or yellow. The pt reported taking several large pink pills as well, the wife stated maybe some Lamictal.
Pt was initially A&Ox4 and stated he felt high, loopy, and nauseated. He attempted to induce vomiting before calling 911, no luck. In PA ALS providers do not carry or administer charcoal, some BLS units do and can give it with approval of medical command. BLS put pt on oxygen and called for ALS. Throughout tx pt became slower to respond to questions and began to get sleepy. Pt could be aroused by a gantle shake to the shoulder but was unable to stay awake for long periods of time and when he talked his speech became more and more slurred, his oxygen saturations also began to decrease as did his respirations. I ended up giving 1 mg Narcan, just to see if it might help, his oxygen saturations came up but he still remained with slurre speech and sleepiness.
When I got back I talked to one of my medic partners who has been a round for a while and she said she wouldnt have even given the 1 mg in case he became violent...
What do you all think?
Pt was initially A&Ox4 and stated he felt high, loopy, and nauseated. He attempted to induce vomiting before calling 911, no luck. In PA ALS providers do not carry or administer charcoal, some BLS units do and can give it with approval of medical command. BLS put pt on oxygen and called for ALS. Throughout tx pt became slower to respond to questions and began to get sleepy. Pt could be aroused by a gantle shake to the shoulder but was unable to stay awake for long periods of time and when he talked his speech became more and more slurred, his oxygen saturations also began to decrease as did his respirations. I ended up giving 1 mg Narcan, just to see if it might help, his oxygen saturations came up but he still remained with slurre speech and sleepiness.
When I got back I talked to one of my medic partners who has been a round for a while and she said she wouldnt have even given the 1 mg in case he became violent...
What do you all think?
Wednesday, December 2, 2009
off day...
So I have to say Im officially having an "off" day. My shift tonight started out BUSY. We as the medics didnt have any calls, but the ER was swamped, and on divert for at least 6 hours. Things eventually calmed down and I was really getting into the game I was playing onmy laptop when the tones sound for an unconscious male, and it was my turn to take a call. As I am enroute further from dispatch is possible cardiac arrest. I keep waiting for the ambulance to mark up, and I wait, and I wait, and I wait. I request PD while Im enroute to the scene (fearing I will be left attempting a code by myself, I assume they can at least provide some man power). I arrive to find a rather large man in his 30s in cardiac arrest with 2 obviously distraught female bystanders.
Long story short: I get a bystander to help me with CPR for 5-7 min until another medic and PD and BLS crews show up. Pt is DRT, in asystole. I attempted an intubation, get no breath sounds but get gurgling, and then stomach distention. So I try a King, no distention this time but only gurgling and no air movement in lungs, so I try the fix all of airway devices, the S.A.L.T.....and still NOTHING, only copious amounts of vomit! My medic partner takes a look and sinks a tube....WTH?!?!?
We get to the ED and of course the doc calls it within 2 min. Then they start examining the body and they find track marks that I would never have seen in a house lit by one 30 watt bulb lamp and they find ice, yes ice cubes, down this guys pants (I had heard of this but never experienced it for myself....) So who knows??
It really affected me that I was unable to get the airway on this pt. I have no idea what, if anything, I was doing improperly and would it have made a difference? Oh, and of course it didnt cross my mind to give narcan a shot....I have been a medic for 29 months now and I still feel so insecure at times....
Long story short: I get a bystander to help me with CPR for 5-7 min until another medic and PD and BLS crews show up. Pt is DRT, in asystole. I attempted an intubation, get no breath sounds but get gurgling, and then stomach distention. So I try a King, no distention this time but only gurgling and no air movement in lungs, so I try the fix all of airway devices, the S.A.L.T.....and still NOTHING, only copious amounts of vomit! My medic partner takes a look and sinks a tube....WTH?!?!?
We get to the ED and of course the doc calls it within 2 min. Then they start examining the body and they find track marks that I would never have seen in a house lit by one 30 watt bulb lamp and they find ice, yes ice cubes, down this guys pants (I had heard of this but never experienced it for myself....) So who knows??
It really affected me that I was unable to get the airway on this pt. I have no idea what, if anything, I was doing improperly and would it have made a difference? Oh, and of course it didnt cross my mind to give narcan a shot....I have been a medic for 29 months now and I still feel so insecure at times....
Monday, November 23, 2009
Conversation in triage tonight
Conversation in triage tonight:
me: (lookint at todays paper) I cant believe Imissed the guys in kilts atthe parade this weekend, all because I slept in...(sarcastically)
Triage nurse: what? you think its sexy or something? men in skirts?
me: oh yea, very sexy...
TN: at least you know they dont have sweaty balls...
me: (sing-song) do your balls hang low do they wobble to and fro...(laughing)
TN: you know theirs do!
(both laughing, me crying from laughing...)
Guess you had to be there.... ;)
me: (lookint at todays paper) I cant believe Imissed the guys in kilts atthe parade this weekend, all because I slept in...(sarcastically)
Triage nurse: what? you think its sexy or something? men in skirts?
me: oh yea, very sexy...
TN: at least you know they dont have sweaty balls...
me: (sing-song) do your balls hang low do they wobble to and fro...(laughing)
TN: you know theirs do!
(both laughing, me crying from laughing...)
Guess you had to be there.... ;)
never gets easier
I have been a part of the EMS world for over 6 years now, and today I realized some things just never get easier. I currently work in a hospital based system, which means we get the opportunity rotate though triage for 4 hours every 12 hour shift. Today I am working a 16 and somehow wrangled 8 hours in triage. (It's really not too bad some days) Well, my fellow paramedic brought in a cardiac arrest who was a rather young pt, in their 30s. The call came in as a seizure but upon BLS arrival it was a cardiac arrest. The crews did their best but was unable to resuscitate. His buddy rode in on the ambulance with him, but family was completely unaware of what was going on. About 30 min after he was called in the ER family showed up, were shown to the consult room and the doctor went to talk to them, you could here the cries and screams of grief clear out in the waiting room. It never gets any easier at the point. I can handle a pt not making it, I have done it several times, but when the family can't handle it or handles it badly it is like daggars to my heart...
Tuesday, November 17, 2009
love notes from the nurses
If you can't read it, it says:
"Tiny insects brains can solve big problems"
then handwritten below says:
"See? Even the medics can accomplish something!"
This was a love note from one of my favorite RNs here at work that I came back to after a call tonight.
It's such a shame that she will soon be leaving the dark side of the ER for dayshift. I am definitly going to miss her love notes and her humor!! Thanks Sue!!!
Sunday, November 15, 2009
compliments
I am not the kind of person who receives a lot of compliments, or if I do I don't realize it...but today I received what I feel was a major compliment, not just me as a person, but me as a paramedic.
I was working tonight, a shift I normally don't work, but switched shifts for a fellow medic, and we were sitting at the nurses' station, just chit chatting, when one of the nurses (well she is a nurse practitioner now) mentioned they were hiring a medical assistant at her office, I was getting the info for a friend that I thought would be interested. She mentioned the pay "isn't that great", when I asked how much she said it was $12.00/hr. I was astonished folks, thats almost as much as I make as a medic at the hospital. She couldn't believe me, and gave the compliment that we, as medics should be making much more than $14-15/hr.
For now, I'm just going to have sweet dreams about that and continue working my 2 lower paying jobs...
I was working tonight, a shift I normally don't work, but switched shifts for a fellow medic, and we were sitting at the nurses' station, just chit chatting, when one of the nurses (well she is a nurse practitioner now) mentioned they were hiring a medical assistant at her office, I was getting the info for a friend that I thought would be interested. She mentioned the pay "isn't that great", when I asked how much she said it was $12.00/hr. I was astonished folks, thats almost as much as I make as a medic at the hospital. She couldn't believe me, and gave the compliment that we, as medics should be making much more than $14-15/hr.
For now, I'm just going to have sweet dreams about that and continue working my 2 lower paying jobs...
Monday, November 9, 2009
When do you know you have had too much to drink?
When your friends have to literally drag you home, your teacher from school sees this, calls 911, the fire department and paramedic shows up to carry your unconscious body down a flight of stairs to the ambulance, takes you to the hosiptal where you end up intubated....thats right, intubated because you didn't know when to stop.
And since you are only 17 they have called the helicopter to come get you to transfer you to a facility who can care for a "pediatric" pt on a vent....
UPDATE:
11/11/2009
This guy walkd into the ER today looking for his clothes from last week, he turned out alright....hopefully he learned his lesson!
And since you are only 17 they have called the helicopter to come get you to transfer you to a facility who can care for a "pediatric" pt on a vent....
UPDATE:
11/11/2009
This guy walkd into the ER today looking for his clothes from last week, he turned out alright....hopefully he learned his lesson!
Tuesday, November 3, 2009
short rant
Working as a paramedic out of an ER has its pros and cons. Im not here to list them right now, just to rant about one con....
They put us here to "help out" in between calls, but when you go into a room to help with a hyperventilating teenage girl and get glared at by the brand spanking new RN its a bit frustrating.She and I were helping another nurse who was trying to talk to the pt. She had just untangled the cords when I told her if she would hand me a gown I could help the pt change she snottily (yes i just made that up)looked at me and said "I will as soon as I am done" then gave me the "I am holier than thou lowly paramedic" look....I have never had a problem with this person until today....I guess we all have bad days, but don't take it out on the people who are trying to help you.
They put us here to "help out" in between calls, but when you go into a room to help with a hyperventilating teenage girl and get glared at by the brand spanking new RN its a bit frustrating.She and I were helping another nurse who was trying to talk to the pt. She had just untangled the cords when I told her if she would hand me a gown I could help the pt change she snottily (yes i just made that up)looked at me and said "I will as soon as I am done" then gave me the "I am holier than thou lowly paramedic" look....I have never had a problem with this person until today....I guess we all have bad days, but don't take it out on the people who are trying to help you.
Sunday, October 25, 2009
Wednesday, October 7, 2009
S.A.L.T. (the newest addition to our intubation kit)
Where I work fulltime I have the priledge of having a boss who is willing to give any of the new products a once over at least. We have had the opportunity to "play" with quite a few different items that he got a free sample of or that one of my fellow medics picked up at the last conference they went to. If something is introduced and it seems to catch more than only a few eyes, particulary those of our older medics, then we usually end up purchasing, if budget allows. (The only exception is out Zoll monitors....most of the medics I work with here aren't huge fans, yet we have 6 Zoll monitors....)
Anywho, these new SALT airway devices were introduced to us a few months ago and I guess there was enough interest piqued that we now officially have these in our airway kits and in stock. They are pretty nifty...we used them on "fred" in several positions....laying, seated, taped to the bottom of a table....and the results were amazing, even our medical director suggested we purchase these after he got his hands on one. We now keep them as a "backup" airway. So anyways, here is just one link to look at, trust me its worth the few minutes it may take!
Let me know what you think!
Anywho, these new SALT airway devices were introduced to us a few months ago and I guess there was enough interest piqued that we now officially have these in our airway kits and in stock. They are pretty nifty...we used them on "fred" in several positions....laying, seated, taped to the bottom of a table....and the results were amazing, even our medical director suggested we purchase these after he got his hands on one. We now keep them as a "backup" airway. So anyways, here is just one link to look at, trust me its worth the few minutes it may take!
Let me know what you think!
Tuesday, October 6, 2009
just another night at the looney bin...
Its been a while since I have written and for that I apologize. I have not been seeing a lot of calls thanks due to night shift, but most of what I do get are legit ALS calls, car wrecks with drunks and people not bothering the 2 seconds and minor inconvience of a seatbelt and now with the weather turning getting some more respiratory pt. I did have an interesting call last night.
Dispatched priority one for a female c/o neck pain and slurred speech, possible ETOH on board, PD being dispatched.
I arrive right behind the BLS ambulance. EMT1 (a new medic student) and his partner EMT2 get out and #1 starts walking towards the apartment complex empty handed...no bag, no stretcher, nada but #2 and I decided to at least take the cot in...I look at #1 with a quizzical look, he says, "Its Joan*, trust me just leave your bag in your truck, she is staying here now instead of xyz street" (I have never had an encounter with Joan, but I later learned Im one of the few fortunate) We stand outside in the cold ringing the buzzer for the apt she is staying in with no answer. After a few minutes we radio dispatch who call back to the apt and we finally get buzzed in. We walk up to the apartment and Joan answers the door, looks at #1 and says, "I didnt ask for no damn stretcher, I just wanted to someone to check out my neck, I'm glad its you at least" and has this look in her eye.... Long story short, Joan was burnt a long time ago and has a scar on her neck and it had gotten dry from the dry air and it had started cracking and bleeding a little. She had no desire to go to the hospital, especially after asking who the doctor was, and when told who it was her response was "then HELL NO I definitly dont want to go"....meanwhile PD finally showed up and #2 and I had to hold our girly giggles as Joan crooned over #1 and then the young policeman who showed up. Did I mention this was all at 4AM???
I swear I love my job!!
*name changed for obvious reasons....
Dispatched priority one for a female c/o neck pain and slurred speech, possible ETOH on board, PD being dispatched.
I arrive right behind the BLS ambulance. EMT1 (a new medic student) and his partner EMT2 get out and #1 starts walking towards the apartment complex empty handed...no bag, no stretcher, nada but #2 and I decided to at least take the cot in...I look at #1 with a quizzical look, he says, "Its Joan*, trust me just leave your bag in your truck, she is staying here now instead of xyz street" (I have never had an encounter with Joan, but I later learned Im one of the few fortunate) We stand outside in the cold ringing the buzzer for the apt she is staying in with no answer. After a few minutes we radio dispatch who call back to the apt and we finally get buzzed in. We walk up to the apartment and Joan answers the door, looks at #1 and says, "I didnt ask for no damn stretcher, I just wanted to someone to check out my neck, I'm glad its you at least" and has this look in her eye.... Long story short, Joan was burnt a long time ago and has a scar on her neck and it had gotten dry from the dry air and it had started cracking and bleeding a little. She had no desire to go to the hospital, especially after asking who the doctor was, and when told who it was her response was "then HELL NO I definitly dont want to go"....meanwhile PD finally showed up and #2 and I had to hold our girly giggles as Joan crooned over #1 and then the young policeman who showed up. Did I mention this was all at 4AM???
I swear I love my job!!
*name changed for obvious reasons....
Sunday, September 13, 2009
pain in the...
Night shift seems to be working well for me again so far. Last week I managed to tweek my back stepping out of the back of an ambulance only an hour into my 12 hour shift and spent the last 11 hours in pain, not even able to stand up straight, thank goodness we have "triage" time, I managed to get onr of the other guys to have his time so that I spent the last 8 hours of my shift trying to find the least painful way to sit in a chair. I sucked u p my pride and had the ER doc check me out after my shift and after some x rays was told it appears to be a pulled muscle and sciatica. I figured I didnt have to work again for 5 days, should be better by then. I was wrong. Its been 5 days and I am back at work, sitting my whole 12 hours in triage because I still can not stand up straight. I spent my days off taking pain pills and laying flat on my back on a heating pad sleeping on and off. I dont know what to do next....
Monday, August 31, 2009
pediatrics
I had an interesting call the other day involving a pediatric.
Was dispatched for a 4 1/2 month old with breathing difficulty. The call was in the northern part of the county and I knew it would take me close to 15 or 20 minutes to get there but that the ambulance would get there much sooner. As dispatch kept updating me, it seemed the pt was getting worse. I pre-alrted and engaged a medevac prior to reaching the pt. Once arriving on scene I found a very sick, 9lb, 4 1/2 month old baby boy who had seen better days (I had hoped anywyas...). He had experienced quite a few problems in his short life span, to include some trachea and esophagus defects as well as some heart defects. (I learned a few new ten-dollar-words that day) Today he was having trouble simply breathing. Mom told me he had stopped breathing and she had to give him a few breaths to get him started again prior to calling 911. I can not even tell you the worries and thoughts racing through my mind. After assesing the baby I knew I had made the right decision calling for the medevac. It seemed like an eternity waiting for them about a mile from the pt house, although it was only about 12 minutes. While waiting the only thing I could do for this little guy was give him some oxygen and a couple breathing treatments to help him out a bit. I set out my infant BVM and intubation kit to ward of the evil spirits, which, thank goodness, worked.
Looking back I just had this feeling that maybe there was something more I could have or should have done, or that I should have donemore, faster. Im confident now I did all I could for him. The most disturbing thoughts are 1) This family lived so far away from the hospital with such a sick baby, and 2) I called to check on him the next day and they had not been able to figure out what caused him to stop breathing, all the tests had come back normal so far....
Was dispatched for a 4 1/2 month old with breathing difficulty. The call was in the northern part of the county and I knew it would take me close to 15 or 20 minutes to get there but that the ambulance would get there much sooner. As dispatch kept updating me, it seemed the pt was getting worse. I pre-alrted and engaged a medevac prior to reaching the pt. Once arriving on scene I found a very sick, 9lb, 4 1/2 month old baby boy who had seen better days (I had hoped anywyas...). He had experienced quite a few problems in his short life span, to include some trachea and esophagus defects as well as some heart defects. (I learned a few new ten-dollar-words that day) Today he was having trouble simply breathing. Mom told me he had stopped breathing and she had to give him a few breaths to get him started again prior to calling 911. I can not even tell you the worries and thoughts racing through my mind. After assesing the baby I knew I had made the right decision calling for the medevac. It seemed like an eternity waiting for them about a mile from the pt house, although it was only about 12 minutes. While waiting the only thing I could do for this little guy was give him some oxygen and a couple breathing treatments to help him out a bit. I set out my infant BVM and intubation kit to ward of the evil spirits, which, thank goodness, worked.
Looking back I just had this feeling that maybe there was something more I could have or should have done, or that I should have donemore, faster. Im confident now I did all I could for him. The most disturbing thoughts are 1) This family lived so far away from the hospital with such a sick baby, and 2) I called to check on him the next day and they had not been able to figure out what caused him to stop breathing, all the tests had come back normal so far....
back to the bat cave...
ok so its not exactly the bat cave...
Im back to working night shift. Im 7 hours into a 12 hour shift. We have only been dispatched to one call for a car into a utility pole, sounded pretty promising, sadly I was stuck sitting at the triage desk watching both my partners head out for the call. (someone has to hold things down back here I suppose)
I am grateful to be back on nights, or I think so for now. I am going to miss some of the daytime nurses that I seemed to have formed a relationship with. I initially thought I would absolutely hate day shift, but loking back, I actually enjoyed it. I got to run more calls, and have some learning experiences. I got to work with some nurses, doctors and paramedics I had not worked with before. I actually had enough time and energy after a shift to get things done at home, like mowing the lawn, or simply having dinner with my roommate and friends. On night shift I usually go straight home and crash, to get up and do it again, at least fr the 3 nights I usually work in a row. Guess we will have to see how things go. I have only had 3 cups of coffee thus far tonight and am doing better at 0200 than I thought I would be. I was pretty sure by time midnight rolled around I'd be dragging my feet.
On a personal note, I have been ill lately, not really sure whats going on, lots of interesting symptoms the strangest to me is that over the last 8-10 months I have noticed my body temp being low, around 96.4-96.8 on a regular basis. The doc initially thought it was my thyroid, everything came back normal (as it always has, even though I have had several docs think I have a thyroid problem). Guess we will just wait and see what the next step is.
Anywyas, you all stay safe out there, I'll keep you updated on how night shift is treating me
Im back to working night shift. Im 7 hours into a 12 hour shift. We have only been dispatched to one call for a car into a utility pole, sounded pretty promising, sadly I was stuck sitting at the triage desk watching both my partners head out for the call. (someone has to hold things down back here I suppose)
I am grateful to be back on nights, or I think so for now. I am going to miss some of the daytime nurses that I seemed to have formed a relationship with. I initially thought I would absolutely hate day shift, but loking back, I actually enjoyed it. I got to run more calls, and have some learning experiences. I got to work with some nurses, doctors and paramedics I had not worked with before. I actually had enough time and energy after a shift to get things done at home, like mowing the lawn, or simply having dinner with my roommate and friends. On night shift I usually go straight home and crash, to get up and do it again, at least fr the 3 nights I usually work in a row. Guess we will have to see how things go. I have only had 3 cups of coffee thus far tonight and am doing better at 0200 than I thought I would be. I was pretty sure by time midnight rolled around I'd be dragging my feet.
On a personal note, I have been ill lately, not really sure whats going on, lots of interesting symptoms the strangest to me is that over the last 8-10 months I have noticed my body temp being low, around 96.4-96.8 on a regular basis. The doc initially thought it was my thyroid, everything came back normal (as it always has, even though I have had several docs think I have a thyroid problem). Guess we will just wait and see what the next step is.
Anywyas, you all stay safe out there, I'll keep you updated on how night shift is treating me
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