So it was just "one of those days" where we seemed to be stuck in BLS priority 3 purgatory. Nothing exciting was happening and the day was dragging along. Then our pagers go off! Is it a rescue? A trauma? Should we launch the bird? No. It's another priority 3 nursing home call. Ugh! So after putting our "happy to be here, proud to serve" faces, we turn our bus (because that is what it is today) and head to the facility.
When we get there the staff doesn't seem excited, but the patient appears to look kind of sick. However, sometimes with this patient population, that could very well be their baseline. So we get our pt packaged up and collect the necessary documentation and get a set of vitals once we start rolling. No sooner as we put the vehicle in drive, things took a turn for the unexpected.
Our patient is hypotensive, tachycardic and septic. This drastically changes our approach to this situation. So I inform our LOL who is no longer considered to be in NAD and is probably not too far off from CTD. Look up the acronyms on Google or urban dictionary, two out of the three are not exactly "official". I tell my partner the situation and he asks if I want to divert to another facility. Not at the moment, as of right now I can still treat this. I put my patient on some oxygen and an IV gets started and then my patient informs me that they have a PICC line. Well, that could have saved me some time, but thank you, LOL who is now in acute distress.
And the fluid resuscitation begins! First bolus goes in kind of slow and there was no real change to the pt's status. So in true ghetto medic fashion, I slap a BP cuff on the IV bag to create a pressure bag to get some fluid in a bit faster. I have to admit, I always love doing that. Mainly because the hospital looks at you like you are crazy when you walk through the door with that hanging. So my Mcgyver set up is getting the job done. However, bolus number two is not. Pt was reassessed and still found to be hypotensive and very tachycardic. I poke my head through the "doorway" up to the cab of the truck and tell my partner to "step it up". I called ahead to the receiving hospital and gave them a quick run down on the situation. At this point we were about 10 minutes out from our destination.
So boluses three and four do not touch the heart rate but bring up the BP slightly. Still hypotensive but higher than what it was. As we roll into the super hospital, the staff looks at my BP cuff pressure bag with a look of "you can't do that" mixed with "I wish I thought of that". I give report and they take over pt care.
Point of all of this is tow fold. One is to always be on your toes , because you never know when you are going to be sucked out of priority 3 purgatory. And two, you have to make the most of your equipment to do the best job you can. After all, as they say in the USAF "flexibility is the key to air power".
Monday, May 28, 2012
Saturday, May 26, 2012
Oh btw...
I passed my FP-C!!! For those of you that do not know what that is, it is the Flight Paramedic - Certification. I am that much closer to obtaining my dream job. It was not an easy journey. I studied just about everyday for a year. I ended up passing with a 90%. I was so nervous when I was waiting on my results. When I was handed the paper with my fate printed on it, I almost forgot how to read. Ha! At first I thought I failed it because I read the wrong numbers. After a minute or two I realized I actually passed with a great score! I almost kissed the old lady that gave me the paper. That was a great feeling. Now on to the next challenge.
Saturday, May 12, 2012
Complicated NSTEMI is medical terminology for a lot of work!
So in true MICU fashion, we went for a while with nothing exciting to getting a few interesting calls in a row recently. As the title of this post suggests, we took care of a complicated NSTEMI. It is not too often that we take people out of the ICU at our base hospital. Especially on beautiful days with almost no clouds in the sky and minimal wind. Basically this patient should have received a scenic tour to the downtown super hospital via an EC145 or whatever the airframe of the aeromedical provider is utilizing that day. However, we made it happen.
Our patient decided to start having extreme difficulty breathing up there in ICU land and actually had to be intubated. He also decided to say "screw you guys, I'm going into cardiogenic shock"! I'm sure a few of you read that in Cartman's voice. lol. At any rate, this patient who had received a PVC challenge with out paralytics was fighting the tube and required both chemical and physical restraints. Good times.
As it turns out, this pt was having a rather large and complicated cardiac event that required pressors, vasodialators, sedation, pain management, continuous bladder irrigation (CBI), and ultimately a cardiac cath. It was a bit of an ordeal just getting this pt transferred to our equipment and gurney. So much in fact that we had to call for an extra set of hands to drive us priority one to the super hospital where the cath team was waiting.
As my partner starts swapping things over to our equipment, I start asking the friendly neighborhood RN what the story was with this pt. I get a jumbled and some what inadequate report and had to piece the rest together from the chart and the Doc. Oh and we are still trying to get everything swapped.
Just as we are finishing up getting pumps and vents set up and swapped over, our back up arrives. Oh good, we can go now! As we are getting the pt over to the gurney and swapping vents, our "Frankenstein vent" as my partner likes to call it, dies. Great. Not to worry though, the crew that showed up for man power also happened to be a MICU crew that had a vent. So we just borrowed theirs.
Now that we are out of the ICU and what felt like transfer purgatory, we still had a 35-40 minute drive to the cath lab at the super hospital. It's ok. It will just be a bit bumpy until we hit the interstate. Vitals q 5 min and watching the vent should be an easy task. After all, the transfer from the bed to the gurney was the hard part...right? Well I guess we were wrong on that one.
Remember how I said it was a complicated NSTEMI? Well the pt decides to dump their pressure enroute and brady down a bit. Not cool, intubated sick guy! The bradycardia was probably due to the A1 drug we had running but the hypotension wasn't. However, a fluid bolus did help get the pt back on track.Simple solutions for what seems like a complicated problem. Side note ***next time you listen to heart tones, try doing so with either a radio playing or someone yelling in your ear. Just to make it challenging. Because we had lights, sirens, horns, and bumping equipment to contend with. Should be interesting.*** At least no one was shooting at us.
So after our little bout of hypotension, we notice our pt needed the CBI bag changed. Doing so without getting fruit punch colored urine on your clothing is one thing. Doing the same thing down a highway that is in need of repair was nothing short of a miracle. Thankfully I will be able to wear that uniform again for another day. lol.
As we approach our destination, my partner calls report while trying to adjust a problem pump. He ended up putting the lab on speaker phone. I was monitoring the vent and the monitor at this point when suddenly under the chaos of traffic and the notice that is being put out by our ambulance, I hear crappy elevator hold music. The first thing that comes through my mind is "really?". I look at my partner and go "Are we really on hold right now?", to which he just rolls his eyes and hits end call. He gets the pump issue resolved and ends up calling report about 5 minutes out.
Upon our arrival to the facility, we move through the ER dodging IV poles, linen hampers, and the nursing staff. All that was said by all parties was "CATH LAB"! Once we get to the lab, my partner and I give report and get everything all transferred and swapped. Then I get the task of playing ventilator while we wait for respiratory to arrive. It only took about 10 minuets. It was probably a good thing. It gave me time to let my endogenous catecholamines wear off so I could return to my normal sinus brady.
Is it odd that I would rather have complicated MICU calls all day and loath boring (but easy) priority 3 transfers? The jury is still out on that one. lol.
Our patient decided to start having extreme difficulty breathing up there in ICU land and actually had to be intubated. He also decided to say "screw you guys, I'm going into cardiogenic shock"! I'm sure a few of you read that in Cartman's voice. lol. At any rate, this patient who had received a PVC challenge with out paralytics was fighting the tube and required both chemical and physical restraints. Good times.
As it turns out, this pt was having a rather large and complicated cardiac event that required pressors, vasodialators, sedation, pain management, continuous bladder irrigation (CBI), and ultimately a cardiac cath. It was a bit of an ordeal just getting this pt transferred to our equipment and gurney. So much in fact that we had to call for an extra set of hands to drive us priority one to the super hospital where the cath team was waiting.
As my partner starts swapping things over to our equipment, I start asking the friendly neighborhood RN what the story was with this pt. I get a jumbled and some what inadequate report and had to piece the rest together from the chart and the Doc. Oh and we are still trying to get everything swapped.
Just as we are finishing up getting pumps and vents set up and swapped over, our back up arrives. Oh good, we can go now! As we are getting the pt over to the gurney and swapping vents, our "Frankenstein vent" as my partner likes to call it, dies. Great. Not to worry though, the crew that showed up for man power also happened to be a MICU crew that had a vent. So we just borrowed theirs.
Now that we are out of the ICU and what felt like transfer purgatory, we still had a 35-40 minute drive to the cath lab at the super hospital. It's ok. It will just be a bit bumpy until we hit the interstate. Vitals q 5 min and watching the vent should be an easy task. After all, the transfer from the bed to the gurney was the hard part...right? Well I guess we were wrong on that one.
Remember how I said it was a complicated NSTEMI? Well the pt decides to dump their pressure enroute and brady down a bit. Not cool, intubated sick guy! The bradycardia was probably due to the A1 drug we had running but the hypotension wasn't. However, a fluid bolus did help get the pt back on track.Simple solutions for what seems like a complicated problem. Side note ***next time you listen to heart tones, try doing so with either a radio playing or someone yelling in your ear. Just to make it challenging. Because we had lights, sirens, horns, and bumping equipment to contend with. Should be interesting.*** At least no one was shooting at us.
So after our little bout of hypotension, we notice our pt needed the CBI bag changed. Doing so without getting fruit punch colored urine on your clothing is one thing. Doing the same thing down a highway that is in need of repair was nothing short of a miracle. Thankfully I will be able to wear that uniform again for another day. lol.
As we approach our destination, my partner calls report while trying to adjust a problem pump. He ended up putting the lab on speaker phone. I was monitoring the vent and the monitor at this point when suddenly under the chaos of traffic and the notice that is being put out by our ambulance, I hear crappy elevator hold music. The first thing that comes through my mind is "really?". I look at my partner and go "Are we really on hold right now?", to which he just rolls his eyes and hits end call. He gets the pump issue resolved and ends up calling report about 5 minutes out.
Upon our arrival to the facility, we move through the ER dodging IV poles, linen hampers, and the nursing staff. All that was said by all parties was "CATH LAB"! Once we get to the lab, my partner and I give report and get everything all transferred and swapped. Then I get the task of playing ventilator while we wait for respiratory to arrive. It only took about 10 minuets. It was probably a good thing. It gave me time to let my endogenous catecholamines wear off so I could return to my normal sinus brady.
Is it odd that I would rather have complicated MICU calls all day and loath boring (but easy) priority 3 transfers? The jury is still out on that one. lol.
Saturday, May 5, 2012
Stars of Life.
The past week has been very busy. However, it wasn't with sick or traumatized patients. It was with meetings and ceremonies. It's a bit out of character for me, I know. However, I was honored in D.C. at the annual AAA "Star's of Life". I will not go into the details of who the AAA is and what they do, but you can follow the link to find out more.
At any rate, it was a great experience. I was able to meet some of the best and brightest in the industry that were from all parts of the country and even the world. While I was there I not only got to tour the Nation's capitol (And run around it. Awesome!), but I was able to get a glimpse of how private EMS operates on the national level and even was part of a bit of lobbying. All in all, it was an interesting and enriching experience. Hopefully I will be able to return to D.C. again soon.
At any rate, it was a great experience. I was able to meet some of the best and brightest in the industry that were from all parts of the country and even the world. While I was there I not only got to tour the Nation's capitol (And run around it. Awesome!), but I was able to get a glimpse of how private EMS operates on the national level and even was part of a bit of lobbying. All in all, it was an interesting and enriching experience. Hopefully I will be able to return to D.C. again soon.
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