That's one way to get out of a car...

     So recently I was working my regular shift with a part time employee. She is a great partner and is always nice. However, all we did that day was putz around in wonderful world of transfers. Not a single priority one. Well, until the very end.
     We were on our way to do a very easy but not exactly stimulating transfer from here to there when my partner and I get stuck in traffic. I wasn't paying attention and didn't notice the obvious wreck about a block or two in front of us. I thought it was just someone putting their boat in the water. As it turns out, we just happened to have rolled up onto an MVA. A head on collision, to be exact. I guess it was a good thing that I was not driving. Ha!
     So there was A LOT of damage to both vehicles. Apparently they were going about 40-50mphs each as they hit one another. There was so much in fact that neither person was able to self extricate themselves. So one was just as simple as "Hey, why don't you crawl out the passenger door". The other pt wasn't exactly as simple. The steering wheel was about 2 inches from their face and actually touching their chest. Oddly enough, this person was pretty lackadaisical about the whole situation. The one problem was the retrograde amnesia that this person was experiencing. At least they were not really in any pain.
     At this point, the fire department showed up as well as the EMS company that normally runs in that area. Fire immediately got into extrication mode and came over to assess the situation. They quickly got suited up and busted out all the tools. It's extrication time! Now, I am currently holding c-spine in the back of this heap of twisted metal and talking with this lady about what was about to happen and asking her questions about the event. Then suddenly we are covered with a blanket. Oh yeah! They kind of have to cut us out of this pile of metal that was once your car. It might get a little noisy for a bit. BOOM/CRASH goes the window! and out come the cutting tools. Which were not as noisy as I remember them to be.
     Meanwhile, under the tarp...we hear and feel broken glass landing on top of us and hear the cutting of metal and plastic by hydraulic tools that I am sure the FD was more than happy to employ. After all, they are firemen. They got us out in really no time at all. However, as it turns out we were stuck in the car for about 20+ minutes. And that is not including the time before the FD got there.
     Once the B post was removed, we get this pt in full spinal precautions and get them into the waiting ambulance to get the ALS part of the call underway. It was a very smooth extrication and allowed us time to get all of our ducks in a row before hand. As we are going to the truck I ask one of the fire guys where is the closest trauma center and he points us in the direction to the closest super hospital.
     So we do the eyes and scissors things, put in a big IV (even though the pt said they were "a hard stick") and got our vitals going. Now it is time to apply some high flow diesel to the situation and start rolling priority one per protocol. The pt was currently stable but chancing it was not the greatest idea. It seemed like most of what was done was with the idea that it was "better safe than sorry". However, I would rather be more aggressive and not have it be that bad than write off a potentially life threatening situation. I don't have a CT scanner or x-ray vision so traveling priority one to the hospital will have to do for now.
     I call report enroute, reassess my pt, and help my partner get us there. My partner did an excellent job. I didn't really need to do anything to help. And when I called report I said that we were about 10 minutes out. As it turns out, that was a gross underestimate. We were more like 20 minutes out. It didn't really make the trauma team all that happy, but it could have been much worse. It's funny. The entire time the pt seemed to have this "I don't know what is such a big deal" kind of attitude about the whole situation. It was kind of funny.
     Upon our arrival, we give report to the trauma team and hand off patient care. I have to say I always love giving a trauma report because you get to yell over everyone and can even put a big piece of tape on their chest and write stuff  on it.
     It wasn't a bad call to end out the shift with. However, it did keep us over for about an extra hour or so. Oh well, I could always use the extra overtime. Gotta love a good trauma call when all the players involved work together as a team.

Can I go home already?

This was an entry that I apparently forgot to click "publish" about a year ago. Hopefully I didn't just double post it. 

So due to chronic workaholism, I signed up for 36 hours of work in a row. That being a 24 hour shift followed by a 12 that following morning. To the non EMS people out there, this seems like a lot of work. Not all the time. Yes, I am at work for 36 hours, but I am normally working rescue. Meaning we have a station or building to stay in with beds, TV, and kitchen. So when we are not running calls, we can relax. Unlike working a truck that posts, meaning you have to sit in the truck for hours until you get a call.
      The first 24 hours was not a big deal. I think we did a total of 5 calls. Nothing super exciting. No big deal. I was able to do a lot of homework and be super productive while getting paid for it. That's cool. It just felt like the first 24 hours took forever and a day.
      The following 12 hour shift on the other side of town was slightly busier for the first half. Then there was a significant lull and I was so very bored. I was tapped out on homework and was just waiting for the shift to end in the final hour. Unfortunately, my relief never showed up. This was due to an error on the part of the scheduler and the system they have in place. It wasn't cool. So Shift change came and went. Then we got a call. And then another call. And another. Gotta love the job sometimes. What added insult to injury was the fact that we had a call to Chili's when I was already starving. Ugh!
     However, the call to Chili's was actually pretty cool. We had a lady in her 40s who "fell" per dispatch. So we get there and she is laying down in a booth and looking a bit out of it. So I ask her to open her eyes and basically wake up. She does, but I don't know why people that feel well loose the ability to speak up. Whatever. Anyway, the local FD that is there is having trouble getting a BP. She has a very weak and thready radial pulse and she feels ill. So we put her on our monitor and get our stuff rolling. Sats are fine, heart rate is 39-42, and her BP is in the toilet (60/30). The monitor is actually showing first a junctional rhythm which shortly changes to a 2nd degree type II and then to sinus brady. Odd. No real hx but at this point we are very happy that she is sinus. BTW, the place is packed. It's a Saturday night and people are out on the town.
     We move out of the very cramped restaurant and bring our pt to the truck. We have a student with us and have an excellent teaching case for her. Low BP+Bradycardia+AMS=IV, O2, monitor, Fluids, Atropine, and TCP. She verbalized that fine, but unfortunately for the student and fortunately for the pt the vitals turned around and we didn't have to go priority one or treat with medicine or Edison. But it was at least an ALS call. I don't mind staying over for those.

Welcome home!

I know it has been a while, but I just want to make mention of the fact that the hardest working trauma/ER RN that I know just got back from her deployment safe and sound! Thank you for your service and what you did for the men and women of the military. You have my deepest thanks and gratitude. Now get some rest and enjoy your time with your loved ones. You earned it. Thank you, Angela.

Volume before thought

     I just love it when I have the opportunity to do things that require me to "think outside of the box". In EMS, this can come up pretty often and the more creative you are the more successful you can be. On the flip side, doing something differently just because you can is not a good enough reason most of the time. Putting an IV in a patient's foot just because you could usually doesn't fly.
     However, speaking of odd IV placement and thinking outside of the box, it reminds me of an interesting situation during my days working in the ER while on active duty. I forgot if it was day shift or night shift, but the relevant details still remain in my head.
     The shift was plugging along with nothing really out of the ordinary, until we get a knocking on the ambulance bay doors. I can see an SUV parked in front of our ambulance with an elderly woman waiting impatiently for us. As I walk towards the doors to see what all the commotion was about, I can see she already has the back doors of this modern day "grocery getter" open and there are feet poking out  the back. The first thing that goes through my head is "I really don't want to do CPR right now". So I rush over to find a breathing, circulating, and perfusing man lying in the back of this gas guzzler with an extensive medical hx. And that was just by looking at all the old surgical scars and the trach and old trach scars. I look at the woman that drove the vehicle for answers as a few of the other medics are bringing out a stretcher to get this patient out of the truck and inside. She then tells me "When he gets dehydrated. he goes into A cardiac arrest". Good to know.
     As we get him inside for a better look/assessment you can already tell that he is sick. Breathing fast, no radial pulse, and just agitated. Oh and he was cold too. Great. So IV, O2, and monitor treatment are started. Well the IV part was not successful as of yet. This poor guy was about as vascular as a potato and can only be described as a miracle of modern medicine. His v/s were not exactly great. BP of 70/40, heart rate of 140, and resps at about 30. So we need to do stuff to this guy and fast.
     The search for the elusive vein was turning up diddly in all the usual spots. No AC, EJ, saphaneous, or hand veins. There was a whole lot of nothing. However, as I was looking for an EJ I notice he has a scalp vein. A decent one at that. So I shrug my shoulders in a very "it's better than nothing" kind of way and stick it. Flash, advance, flush, and secure. BAM! We now have access. Just as I put the IV in the spouse of the patient yells out "What the hell is that"! It is an IV that is desperately needed and a crucial part of the care and resus for this poor patient. Thankfully the MD was right there to explain why it was acceptable practice and not medical blasphemy and she calmed down.
     The 20g in the right forehead allowed us to give a liter or two of fluid tank up our guy enough to get normal vital signs and a significantly more comfortable looking patient. Securing this line in place made the guy look like he was wearing a "foam dome", you know the beer dispensing helmets. Minus the beer. So all's well that ends well, right?
     Well the ICU called down to have a few words with me later on. They used phrases like "you can't do that" and "what are you trying to pull". My answer was it was either that or an I/O. This line can stay in for 3 days, per hospital policy while an I/O can only stay for 24 hours. Additionally, we do scalp lines on kids all the time. What is the difference between doing so on an 8 month old v/s an 80 y/o? The line went quiet and then was quickly hung up on by their end. I guess I made my point. I decided not to call them back to say that before they increase their volume that they should put some thought into the issue at hand.
     The point of this story stresses what I was taught from day one as a medic. You get a line where ever you can. It may not be text book and you damn well sure it is not going to be pretty. As long as it is in a vein and it works, we can address the finer details later. I have to say I was quite proud of that line. Even if it was only a 20g.