I'm kind of bored with this right now.

     The other day I was working my regular shift with a new partner. It was an uneventful morning of sitting around and just doing a whole lot of nothing. And then the tones drop in the local area for a priority one call. At least I was able to have my coffee before the call.
    Enroute we are updated that we are responding to a young man that has had a seizure at one of the local AMI factories or fast food joints. The FD beats us on scene and didn't report any seizure activity over the radio upon their arrival. Well, that is good.
     When we finally show up and thankfully beat the breakfast/brunch rush and find our pt who is the skinny, suburban gamer type of guy who is stuck in that awkward age between teenager and twenty something. He is alert and oriented but looks kind of sick. Grey actually. Perhaps it was the food. I know BK does that to me. The FD reports that this guy passed out and has been awake for the past 24 hours. Probably playing video games and knocking back monster energy drinks to compensate for the lack of girlfriends.
     So we ask the usual questions and do the usual assessments. His blood pressure is 88/50 and is bradycardic in the 50s but its irregular. He also has a weak radial pulse. Despite all of that, he says he feels fine and doesn't want to go to the hospital. If I were him, I would have just wanted to go to bed. Some one suggests we do a set of orthostatic vitals. Sure...why not.
      We get Nintendo Mclady's man to stand up for our second pressure and we watch the monitor. He still claims to feel fine though. However, his heart rate goes from 50 to 40. To 29. To 20...to 12. This is where our patient utters the words every Paramedic hates hearing, "I don't feel so good" and he passes out. I jump behind him to catch him and lower him to the ground. My partner said I moved like the wind and was basically a ninja. Oh and the monitor showed asystole for about 7-10 seconds. You gotta be kidding me!
     Now that we have him on the ground I notice his pupils are now the size of quarters and that he is breathing about 3 times a minute. I apply a very vigorous sternal rub and check for a pulse. Both efforts did not result in anything. However, just as I was about to put my weight on his chest to start CPR, he takes a huge deep breath and sits up. He looked a little upset. Well, you just bought a trip to the hospital.
     Mr. Personality got an IV, fluid bolus, a 12 lead which didn't show anything other than borderline bradycardia, and some 02. While the typical EMS routine is being applied to this guy, he mentions that he is pretty bored with this situation. He even states that he was really tired of the IV that my partner put in. Every time we ask him a question it basically end with him saying something to the effect of "Yeah...ok" or "I guess. Whatever". It looks like someone has yet to grow out of his teenage angst. He probably hates his parents too. I guess he was bored with his ambulance ride too because other than his bout of being dead at BK, he was asking how long he would be in the ER. Really?

Chainsaw vs. Face

                One of my earliest shifts as a fully fledged, big boy, all grown up paramedic was a day shift in Mississippi. We started off the day with a priority 1 call for a man that was hit in the face with a chain saw! Now I know what you are thinking, and it wasn’t that bad. This poor guy was up with the sun working on his farm and was sawing some branches on a tree when the chain hit a knot in the wood and kicked back and hit this guy in the forehead, bounced from there and clipped the very tip of his nose. It left a gnarly gash and a Owen Wilson-esk nose. However, he was completely awake, lucid, and other than the gash in his forehead, Farmer Joe didn’t have too many complaints. His wife stated that he was always a bit stoic.

                My preceptor, a 20 year medic suggests that we just take him basic to the local ER as opposed to the closest trauma center. I agreed with him because we thought it was just some soft tissue damage and nothing more. So we bandage him up, take his vitals, and get his history. He never lost consciousness or had any type of deterioration with.

                So we drop him off at the ER and I give report to the RN who immediately tells me that the guy is in shock and that I was basically a bad person for not doing more. Thanks lady…I’m going to go finish my paperwork now. They send the patient off to the CT scanner and we clear our call to go sit at post and wait for our next call.

                One hour later we are sent priority 1 to the same hospital for a transfer to the closest trauma center for one needing an urgent neurosurgical consult. The collective thought it the truck was “Please don’t be our patient. Please don’t be our patient”. Upon our arrival there was a silent yet collective “Damn it!” that was probably very noticeable.

                As it turns out, our previous patient who was kissed by his chainsaw has an open skull fracture and is going to require surgery. So I start to gather the paperwork and remove the last of the egg that was on my face while I get report from the same nurse who was oh so very pleasant to me the first time around. Our patient was STILL alert, oriented, and only complained of slight headache. I’m sure the lights and sirens for his trip to the super hospital are going to be super comfortable for him. As we get him loaded up on the gurney, he asks if this is really necessary. Well sir, you have hole in your head that is not supposed to be there, generally that is a big deal for most people.

                Thankfully he did fine though out the transfer and really didn’t have any complaints or anything to say about the event. Well, he might get a new chainsaw when this is all said and done. Note to self, when using a chainsaw, don’t let it touch your face.

A view from the sidelines...

     It was a mostly uneventful day and my partner and I had spent a good majority of it sitting at post waiting to save the people of that particular city from themselves. Thankfully they found their common sense that day and no one had to call 911 or required a mobile intensive care unit. It's nice to get paid to do nothing, but sometimes it can get old and today was one of those days. However, that didn't last too long and we were cleared into our home location to await our next call.
     As I walk through the door of the hospital, I am thinking "this is going to be a pretty cake shift". Then I hear "%$#@" out of one of the rooms where they put their patients that require close observation. This particular 120 lbs pile of ETOH induced crazy was in four point restraints and exercising the first amendment with what I can only describe as loud and colorful language. Then the drunk mess makes a complete 180 and tries to sweet talk the staff. As if they forgot what she did or said 5 seconds ago. Now I have worked in an ER for the better part of a decade, and it actually requires a touch of ADHD to be successful. However, the type of neuro deficit that one would require to forget such expletives would borderline a GCS of 8.
     I mentioned earlier that is person was tied down to protect themselves and those with in the immediate vicinity. We (my partner, the ER staff, and myself) were a bit surprised and/or impressed when the this person stated that they do not want their IV in anymore and that it was going to come out. No one really thought much of it until the odd shuffling sounds started coming from the room. Apparently the hot mess in restraints some how pulled the IV out with their teeth and was almost gloating at the accomplishment. I have to say I was kind of impressed. Bravo Houdini, bravo.
     For those of you that are unfamiliar with the workings of most ERs, such behavior is not tolerated and is dealt with accordingly. It this particular facility it prompted a larger IV, additional sedatives, and unfortunately a longer overall stay in "Hotel de Emergency". Thankfully my shift ended just as that happened and my partner and I did not have to transport ETOH drama queen to a facility that houses and evaluates people that range from suicidal to those that think they are tomatoes. Perhaps tomorrow, but not today. I will be happy knowing that we received some free excitement at the end of the shift.

It starts on Monday.

     So only after almost 2 years of working full time hours on various shifts, I have finally been awarded a full time shift. I start my full time MICU, or mobile intensive care unit shift on Monday. I am looking forward to having a good full time partner and a shift where I can get a mix of rescue, critical care, and the much less exciting priority 3 non-emergent transfers.
     Additionally, there has not been many interesting calls lately. I have started working on putting some of my old war stories down on paper. Some are actually from when I went to "war" and some are from the previous experiences as a medic. Either way, I hope those that read this will enjoy them and maybe even learn something from them.