Saturday, October 23, 2010
Pager: "Seeing Jesus"
Yesterday/Last night was a fairly easy shift. I got to work with a cool partner and got paid to watch Eddie Izzard for a few hours. Most of the calls that night were pretty easy and straight forward with the exception of one. We got the call for a psych/commital call. I will spare you the details of the call, mainly because it wan't all that exciting. However, the page that we recieved stated that the patient was "Seeing Jesus". I hope that was not a standard canned message that dispatch sends out for all psych calls. Just goes to show you that you never know what is going to happen or come across your pager. Ha! Now to rest up for tomorrow's mandatory paid training. Should be interesting. Probably not, more like filled with bad jokes and making the day last way longer than it should. Oh well. 8 hours of pay is 8 hours of pay.
Monday, October 18, 2010
48 hours of fun, a 26.2 mile race, and a few lives saved.
This weekend I worked 48 hours. Two 12 hour shifts and a 24 hour rescue shift. Shift number one was the most eventful and exciting. The rest of the weekend was pretty "run of the mill" as far as EMS goes.
My partner and I had two very good and very successful calls this weekend. The first one where he was the lead medic, was a LoL (Little old lady) in CHF. She was confused, not talking well, had a very low sat of 74%, and her lungs sounded like a washing machine. We started treatment right away. As my partner put her on the monitor and looked for a line, I put this LoL on high flow o2 and got the drugs ready. She responded well to initial treatments but would de-sat once you turn the o2 down. I asked about CPAP, but since I was driving it wasn't my call. We did prepare her for it though, explained to her what was going to happen once we got her to the hospital.
The second call of that successful day was initially dispatched out as a cardiac arrest in one of the worst places ever. Lets just say that the unofficial acronym for the area suits it and that the location was 10+ stories tall. So we get there and take all of our gear up to the "Penthouse" and were met by PD who told us that it was "obvious death". When we walked in, the smell was overpowering. Now I have smelled some pretty bad odors doing this job. This place was top three. I can see how PD thought the guy was dead. However, if you looked at him for more than 0.5 seconds, you could see that he was breathing. Luck for us he was all of 90 lbs and was an easy extrication. So his vitals were as follows BP (per monitor) 40/20, Pulse 41, resps 8, and CBG (that's blood sugar) read "low". You almost could not feel a central pulse on this person. So treatment consisted of the typical IV, 02, monitor, D50%, atropine, and a multiple fluid boluses. We also warmed him up with blankets and turning the heat up in the truck.
The funny thing about this call was that with someone like this with a BP in the toilet, I was able to get a 16g IV in the AC. However, I was unable to get a second line in the other arm. This got me thinking, I could have attempted the saline push against at TQ technique. This is a fairly simple procedure to put a bigger line in a pt where you can only get smaller lines (22-24g) in. What you do is you place the smaller line in the pt and leave the TQ in place. Then using that smaller line, you push 50-60cc of NACL with the TQ in place. This causes the viens lumen to expand from the pressure and allows you to put a bigger line in. 18 or bigger. This is a great technique for pts that are hypovolemic for any number of reason. I wish I knew about this when I was deployed.
Finally, my friend Stephanie did an excellent job on an arrest that occurred during the Detroit Free Press Marathon. She not only acted quickly and professionally but her actions resulted in an honest to god save! The pt she treated was not only extubated recently, but is completely neurologically intact. Way to go girl! Great job.
My partner and I had two very good and very successful calls this weekend. The first one where he was the lead medic, was a LoL (Little old lady) in CHF. She was confused, not talking well, had a very low sat of 74%, and her lungs sounded like a washing machine. We started treatment right away. As my partner put her on the monitor and looked for a line, I put this LoL on high flow o2 and got the drugs ready. She responded well to initial treatments but would de-sat once you turn the o2 down. I asked about CPAP, but since I was driving it wasn't my call. We did prepare her for it though, explained to her what was going to happen once we got her to the hospital.
The second call of that successful day was initially dispatched out as a cardiac arrest in one of the worst places ever. Lets just say that the unofficial acronym for the area suits it and that the location was 10+ stories tall. So we get there and take all of our gear up to the "Penthouse" and were met by PD who told us that it was "obvious death". When we walked in, the smell was overpowering. Now I have smelled some pretty bad odors doing this job. This place was top three. I can see how PD thought the guy was dead. However, if you looked at him for more than 0.5 seconds, you could see that he was breathing. Luck for us he was all of 90 lbs and was an easy extrication. So his vitals were as follows BP (per monitor) 40/20, Pulse 41, resps 8, and CBG (that's blood sugar) read "low". You almost could not feel a central pulse on this person. So treatment consisted of the typical IV, 02, monitor, D50%, atropine, and a multiple fluid boluses. We also warmed him up with blankets and turning the heat up in the truck.
The funny thing about this call was that with someone like this with a BP in the toilet, I was able to get a 16g IV in the AC. However, I was unable to get a second line in the other arm. This got me thinking, I could have attempted the saline push against at TQ technique. This is a fairly simple procedure to put a bigger line in a pt where you can only get smaller lines (22-24g) in. What you do is you place the smaller line in the pt and leave the TQ in place. Then using that smaller line, you push 50-60cc of NACL with the TQ in place. This causes the viens lumen to expand from the pressure and allows you to put a bigger line in. 18 or bigger. This is a great technique for pts that are hypovolemic for any number of reason. I wish I knew about this when I was deployed.
Finally, my friend Stephanie did an excellent job on an arrest that occurred during the Detroit Free Press Marathon. She not only acted quickly and professionally but her actions resulted in an honest to god save! The pt she treated was not only extubated recently, but is completely neurologically intact. Way to go girl! Great job.
Wednesday, October 13, 2010
EMS expo
Over the past few days I have attended the EMS expo here in Novi, MI. It was a nice event with plenty of great classes that covered a variety of topics. It was fun to get out there and mingle with some of the other EMS providers with out people bleeding, crying, or complaining of chest pain. This weekend it will be another marathon three days with 48 hours of work. I can't really say that the money is good, but the job has its moments.
Saturday, October 9, 2010
22 hours of BLS, nursing homes, and a "rescue" shift.
Hours lately have become more and more scarce. Well, shifts that I would like to work. There are shifts open every day for those willing to work them. I worked two shifts in one day yesterday. I did a 10 hour MICU shift and a 12 hours rescue shift. I can't complain too much about the shift yesterday. It was a fairly easy shift.
With that being said, I did have a patient deteriorate on me. ***NOTE TO ALL: I will try to keep patients fairly ambigeous to protect their right and privacy.*** We took this patient from an outlying facility to one of the urban super hospitals with all the services under the sun. This patient required Neurosurgery and had a brain bleed. I should have known it was going to be "one of those transfers" because as soon as we put the patient in the ambulance, he decided he need to put his dinner he had last night on the floor and part of the wall. We all vomit from time to time. No big deal. The issue was that as we got closer and closer to the super hospital, the patient became less and less conscious and more and more obtunded. However, looking at the vital signs, one would think that everything was fine. As my friend Kelley the RN would say "...not so much...".
As we arrive to the super hospital, someone decided to call a trauma arrest/alert. Not sure why? So all the students, residents, interns, fellows, and the rest of the staff and trainees show up "asking questions". So after all the confusion of the who, what, when, where, and why was cleared up the patient was intubated and placed on the ventilator. Gotta love it when the patient decides to crump on you while in transport.
Luckily the rest of the day, all the people I came into contact with didn't require anything more than a ride from point A to point B. This job is not all cardiac arrests and trauma. If it were, I think the burn out rate would be that much higher.
With that being said, I did have a patient deteriorate on me. ***NOTE TO ALL: I will try to keep patients fairly ambigeous to protect their right and privacy.*** We took this patient from an outlying facility to one of the urban super hospitals with all the services under the sun. This patient required Neurosurgery and had a brain bleed. I should have known it was going to be "one of those transfers" because as soon as we put the patient in the ambulance, he decided he need to put his dinner he had last night on the floor and part of the wall. We all vomit from time to time. No big deal. The issue was that as we got closer and closer to the super hospital, the patient became less and less conscious and more and more obtunded. However, looking at the vital signs, one would think that everything was fine. As my friend Kelley the RN would say "...not so much...".
As we arrive to the super hospital, someone decided to call a trauma arrest/alert. Not sure why? So all the students, residents, interns, fellows, and the rest of the staff and trainees show up "asking questions". So after all the confusion of the who, what, when, where, and why was cleared up the patient was intubated and placed on the ventilator. Gotta love it when the patient decides to crump on you while in transport.
Luckily the rest of the day, all the people I came into contact with didn't require anything more than a ride from point A to point B. This job is not all cardiac arrests and trauma. If it were, I think the burn out rate would be that much higher.
Wednesday, October 6, 2010
Explaination of the picture at the top of the page.
That unit patch you see at the top of my page was designed by yours truly. It was a moral booster and a way for me to say thanks to the other medics, corpsman, and providers I had the pleasure of serving with while I was deployed to Afghanistan. Even had the chance to save a life or two while wearing it. It scary at times, but I have to say it was one of the best experiences of my life. Well, other than all the convoys. I thought I went to Paramedic school so I didn't have to drive any more? Ha!
A blog in transition
Hello all,
And by all I mean no one yet, since no one has subscribed to it. This blog is going to be at best, accidentally educational. More than likely, it will be a way for me to get some of my "war stories" out there and to have a little fun. So if you are a Paramedic (Like me), EMT, Fire Fighter, Police officer, or in any other way involved in EMS, this blog is for you. Post comments, pictures, stories, and what not.
And by all I mean no one yet, since no one has subscribed to it. This blog is going to be at best, accidentally educational. More than likely, it will be a way for me to get some of my "war stories" out there and to have a little fun. So if you are a Paramedic (Like me), EMT, Fire Fighter, Police officer, or in any other way involved in EMS, this blog is for you. Post comments, pictures, stories, and what not.
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