Wednesday, March 30, 2011
Just can't get these right....
In EMS there is never a day or even a call that is exactly the same as another. They are like medicare sponsored snowflakes. At any rate, when you you think of combative and angry you usually do not think of a little old lady. However, this lady was pissed! Crazy, but pissed. So angry in fact that she tried to run me over with her walker. Calls like these always give me a funny feeling, and not in a good way. They are the 911 calls where no matter what I do, it seems that I can't ever get them right. Probably because they are no right or wrong answers to the questions at hand and that we do not have the adequate training to properly handle them. On the flip side to that, we do have the capability to give them a ride to the hospital. Now as much as I hate being call an "ambulance driver", it is a large part of what we do. Additionally, that is really all we have to do for this person. Take them to the hospital.
Saturday, March 12, 2011
Double trouble.
Recently I was working a 24 hour rescue shift at one of the company's out stations. At first it was the usual BLS type of calls and a lot of posting. It doesn't make the shift fly by, but you have to appreciate not working very hard and getting paid for it. So other than being bored out of my skull, it wasn't too bad for the first half of the shift. My partner even made dinner for us, but got a call just as she put our meal on the table. Murphy's law, I guess. Then we posted for a while and didn't actually get back to the station for another several hours.
Just when I thought we were finally all done and would be able to catch a few winks, we hear the tones go off for one of our sister stations for a cardiac arrest. My partner HAD to make the comment of "Haha! They have to do CPR". Thanks. Because probably 10 minutes after she said that we were dispatched to a cardiac arrest...and then another one after that. WTF?
To find a silver lining out of the two arrests that we were unable to save (presenting rhythms were both asystole) I was able to place the ET tube on both patients on the first try. The first one I did, I used the capnography cable, along with auscultation of lung sounds to confirm placement. The initial co2 was 28 but quickly dropped to 10-8 and stayed there for the remainder of the resuscitation. I didn't have a second electronic capnography adapter for the second code so we had to go "old school" and go with all the other stuff like watching the tube pass through the cords, lung sounds, chest rise, color change in the colormetric device, and so on. Although we were unable to save these two (unknown down times and advanced age) these type of scenarios always allow you to improve your practice as an ACLS provider and there is always something to take a way from the experience.
The thing I had to do is to talk to the family about termination of resuscitation and getting them to sign the paperwork. I always hate doing that. "Sorry for you loss, and please sign here so we can bill medicare" just doesn't sound very empathetic to me. But you gotta do what you gotta do.
I have to also give props to the fire department that helped us out on both codes. They rock and are truely a professional and competent bunch of fire fighters and medics. I know I write this blog with a bit of ambiguity, but they know who they are and they rock.
Just when I thought we were finally all done and would be able to catch a few winks, we hear the tones go off for one of our sister stations for a cardiac arrest. My partner HAD to make the comment of "Haha! They have to do CPR". Thanks. Because probably 10 minutes after she said that we were dispatched to a cardiac arrest...and then another one after that. WTF?
To find a silver lining out of the two arrests that we were unable to save (presenting rhythms were both asystole) I was able to place the ET tube on both patients on the first try. The first one I did, I used the capnography cable, along with auscultation of lung sounds to confirm placement. The initial co2 was 28 but quickly dropped to 10-8 and stayed there for the remainder of the resuscitation. I didn't have a second electronic capnography adapter for the second code so we had to go "old school" and go with all the other stuff like watching the tube pass through the cords, lung sounds, chest rise, color change in the colormetric device, and so on. Although we were unable to save these two (unknown down times and advanced age) these type of scenarios always allow you to improve your practice as an ACLS provider and there is always something to take a way from the experience.
The thing I had to do is to talk to the family about termination of resuscitation and getting them to sign the paperwork. I always hate doing that. "Sorry for you loss, and please sign here so we can bill medicare" just doesn't sound very empathetic to me. But you gotta do what you gotta do.
I have to also give props to the fire department that helped us out on both codes. They rock and are truely a professional and competent bunch of fire fighters and medics. I know I write this blog with a bit of ambiguity, but they know who they are and they rock.
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