Like a bag of rice krispies

     There I was right, at a hospital that I spend a lot of time at...minding my own business. When out of no where my partner pups up and tells me that "There's an arrest at the back door. Let's go"! So thankful for the break from iPhone Facebooking, I slip on a pair of gloves and prepare myself to pull some poor person out of the back/passenger seat of a car that I assumed was parked in the ambulance bay. Apparently I was mistaken. My partner, who is ever the alarmist failed to mention that the code was coming in via another private EMS service and that they should be here in within the next 2 minutes.
     So now we wait...with our gloves on. We wait by the door for the ambulance to pull up, throw the doors open with a flurry of CPR, epi, and all that other ACLS blood sweat, and tears type stuff. However, when they rolled up to the bay there was not as much commotion as I thought there would be. Apparently they got a pulse back. However, there sense of urgency dictated that the pt be placed in the resus bay ASAP!
     We now have a 60ish year old pt with what appeared to be an extensive medical hx, based solely on the surgical scars that were every where. However, they were kind of breathing but still being hypoperfused thanks to the heart rate of about 30bpm and a BP of 80/badness. Obviously there was more work that needed to be done. Lines need to be placed, ultrasounds/x-rays need to be done, and decisions need to be made. I thought I would be in my element, what with being in the ER again. But I think I now have fully made the transition to prehospital instead of intrahospital clinician. I am used to running the show, not being merely a player in it. However, I did what I could to help out. As did my partner.
     Now the medic that brought this pt in to the ER made mention that there was some swelling around the face and eyes. I recognized this right away. As a matter of fact, this pt was presenting with what I thought my very first cardiac arrest as a Paramedic presented with. Lots and lots of subcutaneous emphysema. It makes you look bloated  and actually feels like rice krispies under the skin. It truly is an odd sight. So what this means is that there is a huge pneumothroax/pneumomediasteinum, or tracheobronchial tear that was due to either a traumatic intubation with right main stem intubation (my guess), a spontaneous pneumo that grew quickly with positive pressure ventilation, or both. Oddly enough the chest x-ray wasn't the most definitive and really wasn't much help.
     So our rice krispied pt is still growing and the heart rate is in the 30s again. Atropine is given and gets it up for a bit. Then it goes back down into a third degree heart block. WTF? I know, that's what we all thought. But as the rate increase, either through drugs or positive thinking it would convert back to NSR. Just another thing to complicate this already "abstract" picture.
     The air is building and building in the subcutaneous spaces and this pt is looking sicker by the second. A second IV was eventually placed and even a central line. The crazy thing about the lines was the fact that there was actually bubbles coming out of them. You would place a line or draw blood and that area would deflate a bit and you would even get an audible hiss. I can honestly say that I have never placed an IV and had the pt deflate before my eyes.
     Shortly after all of this we were called to sit post, or as my partner calls it "hooking" because we are sitting on a street corner. Unfortunately we never were able to find out the end to what was causing the rice krispie phenomenon. An interesting case, none the less.

For your consideration...

For your consideration, new EMS terms and phrases that I have encountered in the past few weeks.

***Disclaimer*** If you are easily offended, lighten up and do not read this post.

You might be a diabetic if...
     You wake up surrounded by at least 2 strange people in matching uniforms.
     You automatically spit out the phrase "I'm not paying for this"
     have uttered the phrase "Not again" after intravenous D50% has been delivered.

Methasaurus Rex - An extremely large, agitated, and ultimately dangerous meth addict that wants to do bodily harm to you and anyone else within arms reach.
     *Note: They can still see you even if you are standing still.

Decaf = blasphemy! - Based on a conversation I had with a friend about the pros and con of going without your cup of Joe for the day or trying to pass the counterfeit as the real thing. The next question is, should it be looked at as blasphemy or for those, much  like myself who are apparently sensitive to the vasoactive effects of caffeine, as cardio protective. You know...the same way a beta block is, but without the decreased libido.


Just a few thoughts for now. Thankfully the summer semester is winding down and I will be able to work on a few more stories.

I know you are high right now, but...

     Recently working a shift on one of the big white boxes that I call my office, we get dispatched to a location for a possible overdose. The neighborhood was not one that you would assume would have very many drug related issues. Even with us currently being in Beaver Cleaver-ville, we still had to wait for PD to secure the scene. It didn't take too long, so we just sat on the street corner waiting for them to make it "safe" for us.
     Well when we finally get inside I notice that the pt is breathing but is being difficult with the FD. I don't mean difficult as in violent, aggressive, or dangerous. I mean difficult in that "I'm gonna act like a 5 year old" kind of way. This pt apparently took 50+ pills of a commonly prescribed flavor of benzodiazapine and an unknown amount of what I am going to describe as "almost a narcotic". So generally, with my experience, if you take 50-70 of anything, you are usually not going to be doing very well. Lucky for this person, that was not the case. They were just being kind of difficult and basically just ridiculous about the situation. Thankfully the police were able to convince our pt to go with us willingly as opposed to in hand cuffs.
     Mean while there are two other people that just so happen to be on scene who were almost no help at all. Even though I think they called 911 in the first place. One was not wearing a shirt (of course) and could barely say anything more than "dude" or "bro". I am certain his particular brand of canniboid was similar to what was offered in the movie "Ted". Mind-rape, "they're coming! They're coming!", or "It's permanent". I think he went with the last one and never looked back. Seriously, all this guy did was smile, giggle from time to time, and scratch his head.
     Anyway, since pt OD may or may not have taken a bunch of pills, we had to play it better safe than sorry. We put in two IVs, hooked them up to the ekg, and got our vitals going. The typical IV, O2, monitor type situation. The pt was pretty cooperative but was still sleepy and voicing the opinion that there was no need to go to the hospital. Sorry, if you take 50-70 of anything that are not M&Ms or skittles, you are going to the hospital. Whether you like it or not. Thankfully our transport was pretty uneventful. Oh, and Narcan had no effect on this pts status at all. I know, it's not for benzos! So don't even start with that. However, people who overdose usually don't tell EMS the complete truth. It's as much diagnostic as therapeutic. Besides, EMS gets the story of "I don't do drugs and I want your badge number!". The RN gets "Well, I tried the pot once. Can I have some Dilaudid?". The doctor gets "I have been an IV drug user for 20 years and I am currently on angel dust, bath salts, and I vote democratic.
     So we finally get to the hospital and I give report to one of the RNs and transfer care to them. And done...right? Not so much. Suddenly the pt feels as though they have had enough and decide to try and leave. Well the 90lbs of RN immediately calls for security. I walk into the room and help restrain what I can only describe as a very lazy attempt at escape. A few other EMS people are helping restrain the pt. The pt keeps trying to tell us that they have had enough and it was time to go home. "I'm leaving. Come on Frank (or whatever the friends name was) get the keys we are out of here". While still holding one of the extremities down I tap the pt on the forehead and say "knock knock". They immediately giggle and give up the fight. Thankfully this was at the same time that security came in with the leathers and we were able to secure the pt to the bed.