The bad boy chair

     It's not a real weekend shift on the rescue truck if you aren't dispatched to someone with waaaay too much ETOH on board. It was a very busy day too. I think in 24 hours we did 10 calls. It was all a blur at the end of the shift. So much in fact that I forgot to punch out. Needless to say, I was very tired. But I digress...
     So it's oh dark thirty and we get a call for a young woman at PD HQ having a seizure. We get there and there is a woman in her late 20's on the floor not responding to the ALELS or advance law enforcement life support. Which consists of making fun of the drunk person on the floor and then telling inappropriate jokes. Very effective, btw. The AHA should take heed. Anyway, this young lady did not respond much to verbal or painful stimuli. I was basically standing on her chest doing the sternal rub and didn't get much of a response. The fire officer that was on scene was a bit...um...excited. His exact words were "you need to load and go!". Pump the breaks there high speed. Lucky for us she was all of 100 lbs and was starting to come around. Apparently she went out with some friends and by the end of the night there was a big emotional explosion that I could only imagine that resulted in a pile of ripped out hair, broken containers of lip gloss, and a brush or two. Oh and when she finally came to, she told my partner that she was not going to talk to him or give him any information. I love it when people think Paramedics are figures of authority. I guess it's the uniforms (don't get me started...), the lights and sirens, and the fact that we can drive as fast as we want and park anywhere without getting in trouble.
    This "load and go" situation turns into a battle royale with PD and the 80 lbs of crazy that is in cell one. This person just so happens to be the aggressor to our other pt and probably the reason why they were there in the first place. She was not cooperating and was screaming and was struggling with PD. They had enough of her and put her in what we have affectionately dubbed the "bad boy chair". It's basically a chair that you can put a handcuffed individual in and then further strap down their torso and legs. Little miss club scene was not happy about his. In my 28 years on this planet I have heard some bad things come out of peoples mouths, but this "lady" had a few new ones. She was a class act. I have to say I find it funny that once people are either painted into a corner or in this case strapped to a chair, they try and bluff and threaten their way out. She was threatening to sue everyone and was trying to give orders. Just because you are loud does not mean you are going to call the shots or get your way. Oh and little miss sanity then asked/told the cops to "!@#$'n taze" her. Whiskey, Tango, Foxtrot?
     Once she was put in "time out", I called for a second unit because it was probably not safe to transport them in the same truck at the same time. My poor partner would not have known what hit him. But it probably would have consisted of the contents of a purse or two. We transport our less crazy pt to the local ER without further incident. Alcohol makes people do strange things. But most of the time it just makes you a hot mess.

A block and a "blocker"

     The last shift that I worked was a pretty easy shift if you only look at the sheer number of calls that we did. In 12 hours we only did 2 calls, but both of them were ALS calls. I told my partner that we are actually working real EMS today. I know that is not reality, but it was nice to only have to do rescue and ALS while on an ALS rescue truck. Just saying...
     Anyway, our first call of the day was for acute mental status changes at a doctors office. We get there and find our pt who just looks like "one of those patients". They are lying on an exam table/bed in the doctors office and are awake but are not what you would call alert. This pt was unable to tell us where they where, what time of the day it was, the date, the president, who was recently shot in the face in Pakistan, or anything else. There was also talk of the pt possibly having menengitis because of neck and head pain with a fever. So we had to rely on bystanders, medical staff, and physical exam to get some answers. This pt had surgical scars everywhere, so I assumed that the medical history was extensive. But again the pt could not tell me anything other than "I dunnooo". At least there was a good looking family member there. Should have asked for her phone number, but that's another story in and of it's self.
    Anyway, as I digress, the pt had fluctuating vitals signs but I am assuming that it was from them not being the most cooperative with the BP cuff and not sitting still. First it was low then it was high. They had a radial pulse the whole time so I wasn't too worried about hypotension. We had a new medic on scene with us from the local fire department and my partner and I decided to allow him to utilize some of his newly acquired ALS skills. So he started looking for an IV. I don't know if I was being impatient or he was taking too long, but I decided to look in the other arm. I was at the head of the stretcher in the truck and ended up finding one in the pt's hand. They were a bit of a vascular challenge but we got a line. Nothing big, but it did the job. Fluid and med access. We also did the stroke scale, which was inconclusive, and checked her pupils. As it turns out she had small pupils that were slow to react. This prompted me to look at the pt's medication list. This ended up showing a number of pain medications and also showed that the pt has a hx of medication abuse because she was prescribed Suboxone.
     For those of you that don't know, Suboxone is a combination drug that is used to help people with their addiction to narcotics. It is a mix of Narcan, an opioid blocker (more on that drug later) and a narcotic, buprenorphin. The idea is that the mix of the blocker and the narc will help the pt ween off the meds and help them control their addiction. I personally think that it is a load of crap and this medicine is used as a crutch rather than a therapeutic modality. From what I have seen, it is an enabler in pill form.
      Now then, back to the story. So our pt that is presenting with altered mentation, small pupils, and just not acting right is given some Narcan IVP. If we were wrong about the possibility of a narcotic overdose, there would be no effect from the medicine and would be benign otherwise. But the pt responded to the medicine well. They became a bit more coherent and not slurring their speech as much. I have to give props to my partner that day for doing a good assessment and immediately asking for the med bag to give some diagnostic/therapeutic Narcan. Way to go man.
     Our second call of the day was for a fall. The gravity must be different in the area we run ALS because everyone falls down. It wouldn't be a normal shift if we were not dispatched to a fall once a day. So we get our call and get there to find a very old but talkative WWII vet. As it turns out, he had a bout of syncope or near syncope that brought him to the ground. CBG, ECG, V/S, and stroke scale are all completed along with a head to toe assessment. Everything checks out fine with the exception of his ECG/Heart rate. Via the pulse ox, it was 38-45. So we as we get him on the monitor we see an irregular rhythm that was not A-fib. We do a 12 lead and as it turns out this gentleman has a 2nd degree type one heart block. Also known as wenckebach. Hemodynamically, he was stable enough. So IV, O2, and constant monitoring and a trip to the ER was in order. No real change in status and the pt tolerated very well. The point here is that what the call comes in for and what you end  up finding can be two very different things.
     All and all a good shift on the rescue truck. Hopefully it will be my new full time position. We will know soon enough. By for now.