Recently I worked a very long 24 hour shift. We were pretty much awake the whole time. The odd about the shift though was that we only did 2 transports out of 8 or so 911 calls. Now I know what you're thinking, that's a pretty high sign off to transport ratio for the day. It would be if most of these calls resulted in contact with an actual patient. We were cancelled on two calls before we got there, signed off some guy that ended up being transported with PD (I will elaborate in a bit), and got cancelled off the scene of an MVA where the driver wrecked his car pretty bad and took off on foot. Good times. The transports we did do were an LoL NAD with a possible broken hip, and an acute methadone OD which was actually related to the guy that was carted away with PD.
So now let me paint you a better picture of the more interesting call(s) of this 24 hour shift. So we get a call to come "check out" two individuals at a location in a wonderful school district that is known for things like meth, heroin, and all around red neckery. No meth lab explosions...yet. At any rate we show up and there is half the paid on call FD for the area and 3 cops with the K-9 unit on the way. This is going to be "fun". As I walk through the door I am hit with the all too familiar smell of menthol cigarettes, stale beer, and old pizza boxes. One of the "patients" has been put in time out by PD but still feels the need to call the shots.
To digress a bit, I love how the more subdued (hand cuffs, tazers, zip ties, police cell) the more verbal they are about what people should do and what needs to be done. I believe it is an attempt to salvage a little bit of control that they have lost. Usually these people are already manipulative and controlling anyways. So this is new territory for them. Well perhaps not new, but uncomfortable territory. So our guy who just so happens to be wearing a "tapout" shirt is yelling at his family and calling people names and is overall not very cooperative. But he does admit to drug use that day.
Ok back to the scene, his girlfriend, baby momma, boo, or whatever red neck ghetto hood rats call their significant other looks about as strung out as strung out can be. She is confused and says she really needs a cigarette. However, she eventually tells us that she has an extensive medical history, has taken some benzos, smoke some pot...excuse me, "medical marijuana" which she has a prescription for...just not here, and that she rode her bike here. And as she is giving us all this useful information, the cops pile up a bunch of what I can describe as make shift gas station fodder. In other words, drug paraphernalia. She grabs her "prescription meds and her boyfriends legitimately prescribed methadone and leaves with a friend. And right about this time her hand cuffed lover (not in the fun way that requires a safety word) starts to get irate and is dragged off with the cops.Good our episode of cops is over and we can have dinner. Or so I thought.
So about an hour or so later, we get a priority one call for a young lady with abnormal breathing and is semi conscious. We sigh as we jump into our trusty ALS unit and respond priority one. Once we get there, the first words out of my mouth are "Hey I know her!" in stealthily sarcastic pseudo professional tone. Our pt who probably is a GCS of about 5 is picked up and placed on our gurney and we start the process to administer 2mg of IV sobriety, AKA Narcan. Oh and btw, her pupils were almost non existant. So we push the meds and 3,2,1 to quote Eminem "Snap back to reality"! And off to the hospital we went. To the same hospital that her lover boy was at. I'm sure that made for some controversy later in the ER and a few colorful words were yelled at one another for her stealing his methadone.
I know I have written a few of these short stories about overdoses, but they are just so entertaining. However, it boils down to just another day in the life of this particular paramedic.
Monday, October 31, 2011
Monday, October 24, 2011
Just in time...
I was working my pseudo regular shift the other day with a new partner. I don't know if it is Michigan, the county, the company, me, or EMS in general, but I have worked with a handful of people that just don't talk for 12-24 hours. If it is not related to the call we are on at the moment, I am lucky to get 5 words out of some of these people. Oh well, I guess awkward silence is better than hostile "conversation".
At any rate, we get a call for a choking in progress that has gone unresponsive in one of the neighboring cities, so off we go priority 1. On the way there we are thinking we are going to be walking into a situation where CPR is in progress or the family has DNR/DNI papers present. However, that was not the case.
When we walk in, we find three PSOs around the pt providing o2 therapy, have an AED placed, and getting a baseline set of vitals on their pt that is currently lying in the "recovery position". The pt is an elderly female that is probably a GCS of 9-10 at the moment. But with each passing minute, she is increasing her GCS and will eventually be at 15 and a/o x3ish. All the hard work was done by the PSOs on scene. And they did a fantastic job. They saved this woman's life. Now let me paint you a better picture of what happened before we arrived on scene.
The PSOs received a call for one choking. When they arrived there was a family member that was attempting to do the Heimlich but was not ever successful. The officers tried and the pt became unresponsive. After laying the pt on to the ground they were able to yank out a large wad of pizza and start ventilating the pt with the BVM and some high flow oxygen. They said they bagged her for about a minute or two before she started coming around and breathing on her own. This is a great example of how simple BLS maneuvers can save a life. This "young lady" was very fortunate to have survived such a traumatic ordeal. Kudos to the PSOs and the fantastic job they did in saving this woman's life.
As I said earlier, they did all the hard work and saved her life. All we did was take her to the hospital. But it was nice to be part of the team. The family was very appreciative and I am happy that they have their "grandma"around for a while longer. We[EMS] always strive to be the hero, unfortunately we usually end up having to be the bearer of bad news. However, this was certainly one we can put in the win column between us and the reaper. The score on the other side is always higher, but it doesn't mean we will ever stop trying. Now on to the next adventure in public safety. Bye for now.
At any rate, we get a call for a choking in progress that has gone unresponsive in one of the neighboring cities, so off we go priority 1. On the way there we are thinking we are going to be walking into a situation where CPR is in progress or the family has DNR/DNI papers present. However, that was not the case.
When we walk in, we find three PSOs around the pt providing o2 therapy, have an AED placed, and getting a baseline set of vitals on their pt that is currently lying in the "recovery position". The pt is an elderly female that is probably a GCS of 9-10 at the moment. But with each passing minute, she is increasing her GCS and will eventually be at 15 and a/o x3ish. All the hard work was done by the PSOs on scene. And they did a fantastic job. They saved this woman's life. Now let me paint you a better picture of what happened before we arrived on scene.
The PSOs received a call for one choking. When they arrived there was a family member that was attempting to do the Heimlich but was not ever successful. The officers tried and the pt became unresponsive. After laying the pt on to the ground they were able to yank out a large wad of pizza and start ventilating the pt with the BVM and some high flow oxygen. They said they bagged her for about a minute or two before she started coming around and breathing on her own. This is a great example of how simple BLS maneuvers can save a life. This "young lady" was very fortunate to have survived such a traumatic ordeal. Kudos to the PSOs and the fantastic job they did in saving this woman's life.
As I said earlier, they did all the hard work and saved her life. All we did was take her to the hospital. But it was nice to be part of the team. The family was very appreciative and I am happy that they have their "grandma"around for a while longer. We[EMS] always strive to be the hero, unfortunately we usually end up having to be the bearer of bad news. However, this was certainly one we can put in the win column between us and the reaper. The score on the other side is always higher, but it doesn't mean we will ever stop trying. Now on to the next adventure in public safety. Bye for now.
Monday, October 10, 2011
And it just kept coming...
So recently, I have been working a steady schedule of rescue and it seems as though my partner and I will work an arrest every shift. Good practice, I guess. This call was a bit of a mess though. Mainly because of the thick viscous and sometimes chunky (gravy-ish consistency) fluid that was pouring out of his airway that never really stopped. I mean it looked as though there was a good liter of it next to his head when all was said and done.Gross! Now let me paint you a better picture of the situation.
My partner and I first get the call for someone bleeding. No specific reason why this person is hemorrhaging or where the blood is coming from. So we get there just as the local FD is applying the AED pads. "NO SHOCK ADVISED. BEGIN CPR" is heard through the doorway. As we walking we see a middle aged pt with black-ish fluid/stuff on his face and in his mouth. So we quickly switch the AED pads over to our monitor thinking that this will be an easy pronouncement, and the monitor says...PEA. Great. So we start CPR in this very cluttered and cramped bed room and start the process of ACLS care.
Now I am at the head of the pt and start to work on managing the airway. This putrid black liquid just keeps coming out of his mouth. It clogs up the suction machine several times and I even had to pull off the yaunkauer off and just use the tubing from time to time. Bagging is basically impossible right now. Repositioning, suctioning, and BLS maneuvers were not giving us good chest rise. As I said earlier, this fluid just keeps coming. So while I am continuing to stain the carpet with this horrible death gravy, my partner is getting a line, a CBG, and pushing drugs. The pt is still in PEA so mostly just epi after epi. We did find out that the pt had a CBG of 60mg/dL. We corrected that with no change in status.
Great CPR is being done right now and the airway is still not clear. So I guess better now then never, I attempt to find what might possibly be chords in the sea of black that is still coming out of this persons mouth. Nothing. Try to bag again with basic airway adjuncts and more suctioning. Still nothing. I try one more time as the FD is getting a combi tube ready. Again nothing. Better drop the humility airway (hate to admit it, but medics sometimes have to put their ego aside to place the most appropriate airway. Me included). So the airway is placed and immediately black garbage pops out of the top of both tubes. Again, gross! So suction and more suction to both tubes just to be able to use the damn thing. Finally we get the tubes clear and the correct one receiving positive pressure ventilation. Which still needs a bit more suction. Ugh!
ACLS protocol is still being followed and we are reaching a point where we should terminate resuscitation. We call the local hospital and don't get any crazy orders this time before calling the code. Time of death, right meow. Now we have to break the news to the family.
Don't ask me why I said I would do it, but I did and I feel I did an especially bad job at it. Now I have done these many times and have had to break the news to family. But for some reason, I think I just F'd this one up. I was to the point and didn't use euphemisms but it just didn't go well. I will spare the details, but I need to look at this as a learning experience.
So we finally clear and clean our truck and get a new drug box. Just to reiterate, messiest code ever. Ugh!
My partner and I first get the call for someone bleeding. No specific reason why this person is hemorrhaging or where the blood is coming from. So we get there just as the local FD is applying the AED pads. "NO SHOCK ADVISED. BEGIN CPR" is heard through the doorway. As we walking we see a middle aged pt with black-ish fluid/stuff on his face and in his mouth. So we quickly switch the AED pads over to our monitor thinking that this will be an easy pronouncement, and the monitor says...PEA. Great. So we start CPR in this very cluttered and cramped bed room and start the process of ACLS care.
Now I am at the head of the pt and start to work on managing the airway. This putrid black liquid just keeps coming out of his mouth. It clogs up the suction machine several times and I even had to pull off the yaunkauer off and just use the tubing from time to time. Bagging is basically impossible right now. Repositioning, suctioning, and BLS maneuvers were not giving us good chest rise. As I said earlier, this fluid just keeps coming. So while I am continuing to stain the carpet with this horrible death gravy, my partner is getting a line, a CBG, and pushing drugs. The pt is still in PEA so mostly just epi after epi. We did find out that the pt had a CBG of 60mg/dL. We corrected that with no change in status.
Great CPR is being done right now and the airway is still not clear. So I guess better now then never, I attempt to find what might possibly be chords in the sea of black that is still coming out of this persons mouth. Nothing. Try to bag again with basic airway adjuncts and more suctioning. Still nothing. I try one more time as the FD is getting a combi tube ready. Again nothing. Better drop the humility airway (hate to admit it, but medics sometimes have to put their ego aside to place the most appropriate airway. Me included). So the airway is placed and immediately black garbage pops out of the top of both tubes. Again, gross! So suction and more suction to both tubes just to be able to use the damn thing. Finally we get the tubes clear and the correct one receiving positive pressure ventilation. Which still needs a bit more suction. Ugh!
ACLS protocol is still being followed and we are reaching a point where we should terminate resuscitation. We call the local hospital and don't get any crazy orders this time before calling the code. Time of death, right meow. Now we have to break the news to the family.
Don't ask me why I said I would do it, but I did and I feel I did an especially bad job at it. Now I have done these many times and have had to break the news to family. But for some reason, I think I just F'd this one up. I was to the point and didn't use euphemisms but it just didn't go well. I will spare the details, but I need to look at this as a learning experience.
So we finally clear and clean our truck and get a new drug box. Just to reiterate, messiest code ever. Ugh!
Monday, October 3, 2011
48 hour shift....why did I think this was a good idea again?
When I was in the military, I was always busy. I worked in the ER, was a preceptor for the medic students, ACLS/BLS/EMT instructor, etc, etc, etc. I thought I would be less busy when I got out of the military and only had to work and go to school. Turns out I was wrong. My need to be constantly busy has made me a glutton for over time. Hence why I just worked 60 hour this past weekend. I did a 12 on Friday and then a 48 from Saturday to Monday morning.
So I was a bit tired at the half way mark with my 48. We didn't get a lot of sleep but we didn't have that many calls. I guess that is the silver lining right there. The back half of my 48 however, was a different story. I think we ran 8 or 9 calls and most of them were a bit of a challenge for some reason. We had the diabetic with a sugar of "low" that was a bit of a vascular challenge that ended up getting a 24g in his thumb to get the wake up juice, a chest painer with a serious case of denial, and to top it all off, a cardiac arrest.
The arrest was a bit of a mess. Well, more so normal. It was a witnessed arrest with a short downtime. However, the presenting rhythm was asystole. We work the code per protocol. I had trouble getting the tube and had to stop, bag, suction, and try again. I got it on the second try but I was having a bit of trouble getting the tube past the chords, but we made it happen. The initial EtC02 was not too bad for an arrest (25mmHg) but there was a lot of fluid in the lungs and it compromised the detector. We had good chest rise and fall, colormetric changes (go for the gold), and no sounds over the epigastric area. The tube was in, but there was just a lot of stuff that needed to be either in the suction container or on the floor.
Oh and this pt was another vascular nightmare. No EJs, my partner bent the I/O needle (probably is own endogenous catacholamine circulation), and so on. One of our friendly neighborhood fire fighters got the line. Thanks man, we always appreciate the help. So 6 rounds of drugs later the pt is in a sinus PEA at a rate of 75. We have exhausted all of our options and made the call to medical direct if they want us to transport the pt or not. The result of that conversation was "time of death 0'dark-30". Surprised this MD didn't have me do bilateral needle decompressions again.
It was now time for the worst part of my job, breaking bad news. I would much rather work arrests and transport them just to avoid such difficult situation. However, that would not be safe for the crew, beneficial to the pt, or the family most of the time. However, in order to be a true professional, one must step outside of his or her comfort zone and do the appropriate thing. In this situation you have to be blunt and not use terms like "passed away", "no longer with us", or "is in a better place". You need to be clear and say "your loved one is dead". Then we have the horrible task of having to get signatures and insurance information. I hate that part of the job. Ugh!
After all of that, the second worst part of working an arrest is the paperwork involved and the clean up. Usually the clean up is faster than documentation. Our new e-pcr software can be very time consuming with involved calls like this. Usually putting all the drugs/interventions in chronological order is the most time consuming. I did use my full code IPhone app for this code and it really helped out. It helped us to swap out CPR providers and kept good track of our ALS interventions. So it helped cut down on documentation time.
Overall, I am (probably) not going to work a 48 again anytime soon. Oh well, clean the truck, write the report, and get 10-8 as soon as possible. Off to the next adventure.
So I was a bit tired at the half way mark with my 48. We didn't get a lot of sleep but we didn't have that many calls. I guess that is the silver lining right there. The back half of my 48 however, was a different story. I think we ran 8 or 9 calls and most of them were a bit of a challenge for some reason. We had the diabetic with a sugar of "low" that was a bit of a vascular challenge that ended up getting a 24g in his thumb to get the wake up juice, a chest painer with a serious case of denial, and to top it all off, a cardiac arrest.
The arrest was a bit of a mess. Well, more so normal. It was a witnessed arrest with a short downtime. However, the presenting rhythm was asystole. We work the code per protocol. I had trouble getting the tube and had to stop, bag, suction, and try again. I got it on the second try but I was having a bit of trouble getting the tube past the chords, but we made it happen. The initial EtC02 was not too bad for an arrest (25mmHg) but there was a lot of fluid in the lungs and it compromised the detector. We had good chest rise and fall, colormetric changes (go for the gold), and no sounds over the epigastric area. The tube was in, but there was just a lot of stuff that needed to be either in the suction container or on the floor.
Oh and this pt was another vascular nightmare. No EJs, my partner bent the I/O needle (probably is own endogenous catacholamine circulation), and so on. One of our friendly neighborhood fire fighters got the line. Thanks man, we always appreciate the help. So 6 rounds of drugs later the pt is in a sinus PEA at a rate of 75. We have exhausted all of our options and made the call to medical direct if they want us to transport the pt or not. The result of that conversation was "time of death 0'dark-30". Surprised this MD didn't have me do bilateral needle decompressions again.
It was now time for the worst part of my job, breaking bad news. I would much rather work arrests and transport them just to avoid such difficult situation. However, that would not be safe for the crew, beneficial to the pt, or the family most of the time. However, in order to be a true professional, one must step outside of his or her comfort zone and do the appropriate thing. In this situation you have to be blunt and not use terms like "passed away", "no longer with us", or "is in a better place". You need to be clear and say "your loved one is dead". Then we have the horrible task of having to get signatures and insurance information. I hate that part of the job. Ugh!
After all of that, the second worst part of working an arrest is the paperwork involved and the clean up. Usually the clean up is faster than documentation. Our new e-pcr software can be very time consuming with involved calls like this. Usually putting all the drugs/interventions in chronological order is the most time consuming. I did use my full code IPhone app for this code and it really helped out. It helped us to swap out CPR providers and kept good track of our ALS interventions. So it helped cut down on documentation time.
Overall, I am (probably) not going to work a 48 again anytime soon. Oh well, clean the truck, write the report, and get 10-8 as soon as possible. Off to the next adventure.
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