So there I was right, working another 24 hour rescue shift. As long as the hours may sound, these shifts can actually be pretty interesting. Sometimes. However, it is very much hit or miss. The first 6 hours or so of the shift seemed to be heading in that direction. Then people started calling 911. So much for having an easy shift. But hey, you gotta earn your money some how.
Now I have to admit I hate it when we get a call for a "fall". I don't know why I hate it. I just do. The funny thing is that some of my better calls have been initially dispatched as "falls". I guess I always associate it with the LOL in otherwise NAD that breaks her hip or pain in the ass drunk people that interrupt an otherwise pleasant Friday or Saturday night at the station.
So we get our call for a, you guessed it! A fall. So my partner and I do the lights and sirens thing to the call. No new information pops up over our super high tech notification devices we in the business refer to as pagers. These little throw backs to the the 90s are prime examples of why some people think EMS is stuck in the past while other say simplicity is a beautiful thing.
Anyway, in a few short minutes we arrive on scene at just about the same time as the local FD. Well all get out of our vehicles with the appropriate equipment and set off to where we thing the pt is. Fire had the right idea and went around to the back. Apparently we missed the memo and decided to enter the house. As I open the door, we are "greeted" by a large, scary looking black dog. SLAM goes the door! Well they are not in there or the scene is not safe. Better double back and reassess the situation. Luckily as we are doubling back we take the road less traveled and discover our pt with the FD on the slope of a small hill.
At first glance it looked as those this patron on of the 911 system had way too much ETOH on board. There was the slurring of speech, the uncooperative nature, and just a general feeling of "WTF" in the air. No matter what the injury pattern or disease process, this pt is getting an IV or two, some O2, and will be wired for sound thanks to Zoll medical. Oh and lets not forget the whole c-spine and assessment deal too.
At this point I "introduce" myself to this pt and discover very quickly that not only do they not want to go to the hospital, but according to what the pt said, it was night time and that our current location was actually a town located across the state. Yup, you're going to the hospital. Sorry but it kind of has to happen.
Now that we have a bit of a better look at this pt, we notice a few things. One, he is unhappy. Two, he is not the most cooperative. Three, he can't move his right side. And to top it all of at four, his eyes are constricted and fixed to the right. However, still alert and oriented times 3. Oh and all of his other vitals check out reasonably well. This pt also didn't know he wasn't moving his left arm. I kind of didn't want to believe that he couldn't move his left arm, but reality slapped me in the face with her right hand, SMACK! Now, I'm no doctor, but sounds to me like this guy has a lot of neuro badness going on at the moment. Not much we can do about this in the field except a diesel bolus. For those of you not familiar with EMS slang, that means going lights and sirens to the closest appropriate hospital.
So c-collar, IVs, monitor, oxygen, v/s, and we are enroute. Lights and sirens. Meanwhile, our pt still thinks they the trip to the ER is totally unnecessary. Really? Ugh! Lucky for me I get to drive this on this call. From what my partner tells me, nothing too much had changed enroute.
Upon our arrival to the ER, we give report to the RN and transfer care over to the clinical staff. No deterioration in the pt's condition while with us and is otherwise stable. However, this pt does require swift intervention. Lucky for all parties involved, there was a known onset time and that there is a good chance for a full recovery.
Monday, September 24, 2012
Sunday, September 16, 2012
That fixed gaze...
No one likes PEDS calls. If anyone tells you that they do, they are a liar. No one likes seeing little kids sick, hurt, or worse. With that being said, everyone (I assume) does like helping kids and making them feel better. Well my partner and I had an opportunity recently in one of the many cities we cover to witness both.
So there we were, sitting at post. Minding our own business. When we hear the tones go off for what we assumed was a seizure. OK, game face. Which also happens to include lights, sirens, and a large amount of diesel fuel. While this is all going down, I am tapping away on my touch screen work laptop trying to save some time and get as much of the documentation done as possible before getting on scene. Just the stuff that will be required for every call. Nature of call, time of call, and so on. Then the call finally gets sent to the pager. I pick it up to glance at it, and the words "blue" and "baby" are present. !@#$! Not good!
Once the string of obscenities my partner and I both let out have been completed, I start to go over dosages in my head for some of the meds we may or may not be giving. OK, got it. Now that I have that preloaded in my skull, hopefully that will help me when we get on scene.
Upon arrival to the call, we find a wide eyed, wide mouthed baby who is not making much noise and has a fixed gaze to left. May not sound all that exciting, but when a little baby is not crying, pooping, sleeping, or eating, there is a problem. So we spring into action and do our ALS thing for this kiddo in acute distress.
Now it is important to point out that when dealing with pediatric patients, math is always required for proper dosing of medications. Parents are usually a good resource for this. Unfortunately, when they are crying and very distraught, it makes it a bit more difficult to get the information you require. Sometimes you just have to guess. Another thing to point out is that it is not always easy to calculate medication doses for kids. Especially if you are under a lot of stress and thinking from your brain stem. Thankfully after a quick weight estimate and some quick math done on the back of a 4X4, we have our dosage. I wasn't super comfortable with it, but it will have to do for now.
I was surprised at how easy of a stick this little one was. Our other option was to give it rectally, but we got the IV in so fast that we were able to give the meds that before we had it drawn up. SCORE! And while all of this is happening in a very stressful and emotionally charged environment the pt also got a set of vitals, an ecg, blood sugar, oxygen, and so on. This all goes down in a matter of minutes
After that is all said and done, the little one stops seizing. Sweet! I then scoop this little bundle of joy up in my arms and get them secured to the gurney for transport and we are off to the local ER for further treatment.
While enroute I can't shake the idea that my math was wrong. People always tend to second guess themselves with pediatric pts and apparently I am no different. But the kiddo is crying, which in my line of work is a great thing. It means that they are alive and breathing. A silent kid is a sick kid. No bueno. The rest of the ride is uneventful and the little one improves. However, I am still doing the math for the medication dosages in my head thinking that I @#$%$ something up.
Once at the hospital and after I give report to the RN, I sit down and do the math for the medication dosage and keep coming up with the same answer. I even have my partner do the math too and he gets the same answer as well. Finally after about what seemed like 20+ times of figuring out the proper dosage, I finally admit to myself that I gave the right dose.
I guess when it comes to kids, most people feel that they have very little room for error. No one wants to hurt a little one. They usually want to do the opposite and help in anyway they can. The lesson here is kids are difficult. No matter what. However, I am glad that little one is doing well today.
So there we were, sitting at post. Minding our own business. When we hear the tones go off for what we assumed was a seizure. OK, game face. Which also happens to include lights, sirens, and a large amount of diesel fuel. While this is all going down, I am tapping away on my touch screen work laptop trying to save some time and get as much of the documentation done as possible before getting on scene. Just the stuff that will be required for every call. Nature of call, time of call, and so on. Then the call finally gets sent to the pager. I pick it up to glance at it, and the words "blue" and "baby" are present. !@#$! Not good!
Once the string of obscenities my partner and I both let out have been completed, I start to go over dosages in my head for some of the meds we may or may not be giving. OK, got it. Now that I have that preloaded in my skull, hopefully that will help me when we get on scene.
Upon arrival to the call, we find a wide eyed, wide mouthed baby who is not making much noise and has a fixed gaze to left. May not sound all that exciting, but when a little baby is not crying, pooping, sleeping, or eating, there is a problem. So we spring into action and do our ALS thing for this kiddo in acute distress.
Now it is important to point out that when dealing with pediatric patients, math is always required for proper dosing of medications. Parents are usually a good resource for this. Unfortunately, when they are crying and very distraught, it makes it a bit more difficult to get the information you require. Sometimes you just have to guess. Another thing to point out is that it is not always easy to calculate medication doses for kids. Especially if you are under a lot of stress and thinking from your brain stem. Thankfully after a quick weight estimate and some quick math done on the back of a 4X4, we have our dosage. I wasn't super comfortable with it, but it will have to do for now.
I was surprised at how easy of a stick this little one was. Our other option was to give it rectally, but we got the IV in so fast that we were able to give the meds that before we had it drawn up. SCORE! And while all of this is happening in a very stressful and emotionally charged environment the pt also got a set of vitals, an ecg, blood sugar, oxygen, and so on. This all goes down in a matter of minutes
After that is all said and done, the little one stops seizing. Sweet! I then scoop this little bundle of joy up in my arms and get them secured to the gurney for transport and we are off to the local ER for further treatment.
While enroute I can't shake the idea that my math was wrong. People always tend to second guess themselves with pediatric pts and apparently I am no different. But the kiddo is crying, which in my line of work is a great thing. It means that they are alive and breathing. A silent kid is a sick kid. No bueno. The rest of the ride is uneventful and the little one improves. However, I am still doing the math for the medication dosages in my head thinking that I @#$%$ something up.
Once at the hospital and after I give report to the RN, I sit down and do the math for the medication dosage and keep coming up with the same answer. I even have my partner do the math too and he gets the same answer as well. Finally after about what seemed like 20+ times of figuring out the proper dosage, I finally admit to myself that I gave the right dose.
I guess when it comes to kids, most people feel that they have very little room for error. No one wants to hurt a little one. They usually want to do the opposite and help in anyway they can. The lesson here is kids are difficult. No matter what. However, I am glad that little one is doing well today.
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