Lately I have been fortunate enough to pick up a few extra rescue shifts. It was an easy shift the other day. I only did three calls in thirty hours. I covered for a buddy of mine. Anyway, two out of the three shifts where a whole lot of nothing.
Our call of interest involved a vehicle roll over with 3 patients. There was major damage to the vehicle but all three of our pts who where barely old enough to buy a pack of cigarettes were conscious and self extricated themselves prior to EMS arrival. The local FD was providing BLS and getting everyone ready to be collared and boarded. As I walked to the first and most critical pt, the second ALS unit arrived on scene and their crew took care of the other two pts. The two pts that were in the front seats of the vehicle stated that they were only going about 30-45 mph. yeah right. No one rolls a car like that at those speeds.
At any rate, my pt was complaining of back pain, SOB, neck pain, and chest pain. Lets just say that lifting was an issue for the three of us that hauled the back board out of the ditch. Anyway, once we got the pt on the back board and in the truck, our eyes and scissors assessment showed us some minor abrasions and lacerations but not major bleeds. Vitals were relatively stable. HOWEVER, this pt had diminished breath sounds on the right, chest tenderness to palpation, and was unrestrained in the back seat of the vehicle. I got an IV started (I had to start it upside down again due to the way I was sitting) and started the pt on some NACL therapy. I checked lung sounds again and they seemed to be getting worse. We then started towards the local trauma center at a speed close to mach 2. En route, her vitals started to decrease a bit and I felt it was time to make a decision. I decided to needle decompress this poor person. I check breath sounds again after my partner pulled over and verified with me. We both agreed on the pneumo developing on the right side. I opted to do the lateral aspect of the chest to decompress the pt due to the excess amount of tissue that occupied the second intercostal space. I took out my dagger of a 3 1/2 inch needle I was issued in Afghanistan and after taking all the other appropriate precautions and cleaning the site I place the needle, popped the chest, and secured it. Her vitals improved. Her BP increased, pulse decreased, and her speech became easier. Although her anxiety level was still sky high.
I was feeling pretty good at this point, but I still had to deal with the trauma team. And in true teaching facility fashion, there was an overly anxious resident who really doesn't know how to talk to people. I give report to the team and when I mention diminished lung sounds on the right and the fact that I darted the chest this MD in training just went from stressed to pinging. She basically was yelling at everyone that made eye contact. I have to say I always love how we (Paramedics and EMTs) get questioned about why we did things and basically told what we should have done. You know what "capt. awesome'? you were not there. Just bee a good little resident and take care of your new pt.
But I didn't stay annoyed for very long. I was talking with the other crews that brought in the other pts and just decompressing ourselves after the event. Apparently I am gaining a reputation of being "very fast". I wasn't sure exactly how to take that, but the other medic was basically saying that it was in regard to skills and procedures. I guess that is a good thing. They didn't call me stupid, so that was a good thing. Ha!
The rest of the 30 hour shift was a very easy shift with nothing really of interest. I just have to say, I don't wish harm on anyone but I do love a good trauma call. Bye for now.
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