The altered, hypotensive high lighter

     I know it has been a bit since my last post. There just has not been much to write about. I could write about how certain drugs work or a new/better way of assessing pts, but that's not as much fun as sharing war stories.
     Recently I worked the second worst shift in the company. For the sake of anonymity I will keep the partners name and the shift we were working to myself. At any rate,  It was just "one of those days". We did a few non-emergent BLS transfers and then the truck died. And just for the record, you can't use a defibrillator to jump start your car. The silver lining in that situation was that it gave us a hour or so of mandatory down time to do nothing. The rest of the day was pretty uneventful until the inevitable laws of EMS struck. I'm going to refer to this one as time to acuity ratio. This means that the smaller the amount of time you have left on your shift, the greater the acuity of the call you will receive. And of course this law applied itself to our truck about 30 minutes before we are set to clear. At least it was a priority one.
     As we start rolling in glitter ball mode we get our update from dispatch for a 50ish year old female with AMS that has not been out of bed for the last few days. Could be nothing or it could be interesting. However, we won't know until we get there. It was in one of the local mobile estate parks that we frequent quite a bit. So we mentally prepare ourselves for heavy lifting, bad smells, smoke, and low ceilings.
     Upon arrival we discover that our mental preparation was 100% accurate. We find our pt lying in bed with the local BLS FD on scene providing O2 and getting a scattered history. Apparently this pt has a history of everything and was prescribed pain med for every disease she was diagnosed with. It was a pretty messy place and a side from all of the pill bottles with various levels of controlled substances, there were ash trays, beer cans, and other substances that I did not care to find the origins of. It was a bit gross to say the least.
      So our pt does have a patent airway but is in and out of consciousness. She is cool to the touch despite being in bed for days and has an extremely weak radial pulse. And in case you could not guess, she was a very poor historian. She did say she didn't feel good. I would imagine so, her skin was highlighter yellow (LIVER FAILURE) and she just looked ill. Her vital signs agreed with my assessment. She was a bit hypotensive, SBP in the 70s but she was not tachycardic.
     After some creative, out of the box thinking we get her out of her bed and on to our stretcher and into the ambulance. IV, O2, and monitor were initiated. However, she was a bit of a vascular challenge. Both my partner and I stuck her multiple times. I even tried for an EJ and that didn't work. My partner was a bit persistent in that we should go after the first stick. I told him I would try enroute. I did eventually get an IV in her. A small 22 in the wrist. I was hoping to try my awesome IV trick but I didn't have time or the luxury of smooth roads. But hey, a line is a line. Mean while "Mrs. Sharpee" is talking to people that are not in the truck, is a/o x toaster and keeps telling me that she is going to go smoke. Right...gotta love this job sometimes. So once vascular access has been achieved, I had my rider set up a make shift pressure bag which boils down to a BP cuff on a liter of NACL. I also had him try some Narcan to see if anything would have changed. It was more diagnostic than therapeutic since it didn't have an effect. But it was a good teaching moment. Just FYI, her pupils were dilated, not constricted. I am aware that narcs will constrict pupils, but with the amount and types of meds that were scattered around on scene, it was worth a shot.
      The pt remained in the state that we found her in while enroute and upon arrival to the ER. I asked if they wanted to go to resus but apparently 70/30 is still acceptable for a regular room. After all, she was awake. However, she did get a central line later on. It was an interesting call. And it held us over for about an hour. I try to find the silver lining in things, so out of all of that we got an hour of over time thanks to the highlighter.

A whole lot of strenght in a very small package

     The other day I was "blessed" with the opportunity to work with one of our sister companies. This was thanks to my partner who called off that day. It was actually a good day. I ended up working about 45 minutes from where I am usually stationed, so it was a bit of a change. The calls for the day were nothing super exciting or very complicated. However, one pt encounter stuck with me.
     We were called to do an inter-facility transfer from local hospital to super hospital for a young lady. I will try and keep this vague enough so I can tell the story and still get my point across. I don't want to break any HIPPA laws. Anyway, this little girl was in 2nd or 3rd grade and was at the hospital for a chronic medical condition complicated by pneumonia. She was one of those little girls that in the face of all the treatments, illness, and overall complications of life landing her behind the 8 ball; she was happy, bubbly, and very outgoing. She was also no stranger to medicine, ambulances, and hospitals. It was funny when she asked if we could go lights and sirens just because she thought it would be cool. Most of my regular partners would have probably done it for her, but mine that day stuck to the rules. She also had a few comments about the people driving behind us while we were enroute.
     The transport was uneventful and when we got her to the super hospital, she asked us to sign a note book. She has all the nurses, docs, medics, and everyone else that takes care of her sign it and leave a little note. I put "I hope you feel better soon. Keep smiling and good Luck. Signed Paramedic Mike". It was the most routine of calls, but her infectious positivity and happy demeanor made it a bittersweet encounter. Unfortunately she still has along road ahead of her but who knows what will happen. Only time will tell.