So it has been a few weeks as part of a the flight crew at the new job. It actually wasn't anything super exciting or really critical. Just a lot of policy and procedure. However, I was able to get my first flight! It wasn't a super crazy scene call that involved RSI and landing on the interstate, but it also wasn't a dialysis transfer either. What it was, was an opportunity to break the seal and apply what I have learned thus far. After all, you have to crawl before you can walk and walk before you can run. Oh, I have to admit that it was pretty cool to be able to do so in a brand new aircraft but man did it take forever to get that first flight out of the way.
At any rate, we took a very stable pt from one of our out lying facilities to the "mother ship" for further evaluation of a DVT. Nothing ground shattering or mind blowing. It was an easy call. I have done calls like this dozens of times on the ground but this time I happen to have a much cooler ride. Thankfully the flight went fine without any issues or concerns by anyone involved. It was nice to reach a goal and check it off of my life's list of things to do. Or as some of you would put it, the bucket list.
But now is not the time to get comfortable or cocky. Now is the time for learning, growth, and observation. Onward and upward! Hopefully this particular chapter in the adventure that is my life will allow me to add a few more interesting stories to my collection.
Thursday, August 8, 2013
Wednesday, June 19, 2013
Things that make you go "Huh?"
From time to time in this line of work you mutter the words "really?" or "are you blind?" or simply "huh?". I had one of those situations a while back at one of the super hospitals in the area.
My partner and I were transferring a pt from the hospital we were stationed out of about 30 miles away from this particular super hospital. It was an easy transfer that didn't require lights and sirens. It was a BLS call. The transfer itself went fine. It was when we arrived at the hospital was when we experienced that "huh?" moment.
We park at the hospital and are wheeling in our pt through the ER to their destination when we encounter a rather large and worried looking group of medical professionals near the resus/trauma room. I think we all just stopped and looked at each other for a minute until someone from with in the resus crowd asked "Is that the flight crew?" I have to say, I was a bit taken back by that. I wanted to ask this particular resident/intern/person who should know better "really?" but instead all that came out was a very confused "huh?" Our gray uniforms don't exactly look like flight suits. As the awkwardness of the situation lifted we slowly moved away from the trauma hungry mass to drop our pt off at their room.
After the call, my partner and I just shared a confused looked and muttered "really?" We then shrugged it off and went back in service for our next call. Just another thing that makes you go "huh?"
My partner and I were transferring a pt from the hospital we were stationed out of about 30 miles away from this particular super hospital. It was an easy transfer that didn't require lights and sirens. It was a BLS call. The transfer itself went fine. It was when we arrived at the hospital was when we experienced that "huh?" moment.
We park at the hospital and are wheeling in our pt through the ER to their destination when we encounter a rather large and worried looking group of medical professionals near the resus/trauma room. I think we all just stopped and looked at each other for a minute until someone from with in the resus crowd asked "Is that the flight crew?" I have to say, I was a bit taken back by that. I wanted to ask this particular resident/intern/person who should know better "really?" but instead all that came out was a very confused "huh?" Our gray uniforms don't exactly look like flight suits. As the awkwardness of the situation lifted we slowly moved away from the trauma hungry mass to drop our pt off at their room.
After the call, my partner and I just shared a confused looked and muttered "really?" We then shrugged it off and went back in service for our next call. Just another thing that makes you go "huh?"
Monday, June 17, 2013
Movin' on up!
Recently I completed my first flight as a new crew member for my new job as a flight paramedic! It was not a scene call. It wasn't even a transfer. It was just a training flight. Still, it was pretty sweet. I had to do my check/cert ride to be NVG qualified. That's right, night vision, goggles. How cool is that? We flew around for about an hour and landed at one of the hospitals, did some failure drills, and worked on communications. It was a great training exercise and I look forward to writing more and more about my experiences on this new job/adventure. Stay tuned.
Friday, May 17, 2013
A story from back in the day: First arrest...ever!
A story from way back when...
So I have a paramedic for all of about 3 months and have not had anything too crazy yet. Sure, in the ER I have seen it all and done it all (or that is how I felt at the time) but out on the road as the lone ALS provider, I was still very green around the gills. I'm not sure where that analogy came from, but it is still applicable. At any rate, I am working my second job for the local ambulance company down in Mississippi. We did a few transfers and maybe a rescue or two but the day wasn't super exciting. Until we get the call "Control to 99. Priority 1. Details on the way". OK, so we put the info into our GPS and head on out that way. Since we are covering most of what seems like the southern most portion of the state, it was a bit of a drive to get there. While enroute, dispatch calls to tell us "CPR in progress". Great. This is going to be a lot of work AND it's my first arrest ever as a medic.
This was it. This was a big stepping stone from student, to third rider, to new employee. Getting your first arrest ever as a medic is a big deal and can really be a bit unnerving. You want to do the best job you can, not screw up, and hopefully get a pulse back. Unfortunately, that last part doesn't always happen and new medics tend to take that personally. I don't feel I did, but anyway, back to the story.
As we arrive on scene after what felt like an eternity, my partner and I see one of the local deputies doing CPR in the passenger seat of a parked car. The seat was at about a 45 degree angle and he was pounding away at her chest. Not the greatest position for such maneuvers. So in a very hurried manner, my partner and I pull out all the equipment and place the gurney next to the car where our pt is then promptly placed on gurney, secured, and CPR continued.
Now let me try and paint a slightly better picture of the situation. When we arrived, our pt was in the passenger seat of a four door sedan when she arrested. She was in her early 90s and was about to go to the store with one of her family members when she suddenly collapsed. The family then called 911, started CPR, and when the Sheriff's deputy arrived, took over CPR. Our pt was all of 90 lbs if she was soaking wet with change in her pockets.
Thanks to my endogenous catecholamines that were circulating, I was very much thinking from my brain stem. I thew on the defib pads and immediately forgot how to work the monitor. $#@! Thankfully I had a spasm of lucidity and was able to get to the pads view to see what was going on. And in true mega code fashion, it was course VF. Very course VF. We deliver our first shock. POW! 360J of Mississippi power go coursing through this poor pt and her arms and legs go flailing all over. Actually I was almost hit in the face due to poorly securing her to the gurney. A total rookie maneuver, I know.
And to continue the trend of rookie moves, I hastily attempted to intubate my pt right there in the chaos of this rural MS drive way. So between my blade placement, probably rocking back the blade and just not being an expert on laryngoscopy, I could not see !@#$. So in true protocol driven medicine I reach for the combi tube. They are OK airways when they work, but they do not protect from aspiration and are actually pretty rough on the soft structures of the airway. This is especially true when you have a new guy jamming it in with all of his might. So push, push, push and the tube goes into place. And I am sure we bagged WAY TOO FAST as well. But we load up the pt into the waiting ambulance and I ask who is coming with me, the fire fighter or the deputy? Both look at each other as though they had an unspoken game of "1,2,3 Not it!". Then the good o'l boy fire fighter begrudgingly hoped into the truck and took over CPR. The doors then close and we are off like a shot.
I opted to start an IV enroute since enough time was taken on scene. I tried for an EJ on the right side but it infiltrated. Great! Now what? I can't drop drugs down this monstrosity of an airway that I have in place. Is her face getting bigger? Anyway, I have to get an IV...and bag...and watch the monitor...and not fall on my ass. I thought to myself, are all arrests like this? So I opted to try the other EJ since I would allow me to do the least amount of moving around the cabin and not interrupt CPR. Oh BTW, CLEAR! POW! Shock delivered at 360j the pt has been in course VF this whole time too.
At this point, I am able to calm down ever so slightly and reassessed the situation. I have good compressions going, an airway in place, and an IV. Is her face getting bigger? Anyway, I am glad I had the fire guy with me, because he did CPR for me while we transported priority 1 to the closest hospital. His CPR seemed almost lazy because of the little amount of effort he had to put into it due to how big he was and how tiny the pt was. BTW, this hospital was about 20 minutes away going priority 1. Great.
Now I may be new, but I knew my ACLS protocols inside and out and was doing my best to follow them as closely as possible. I just kept grabbing boxes of drugs every few minutes and pushing them though my one good line. Everything is going well so far on my end...well maybe.
Her face IS getting bigger. One of her eyes is bulging and her face and neck appear swollen. When I reach down to touch it, she feels as though she has rice krispies under her skin. Apparently when I went all KER-SMASH with the combitube and tear went the trachea. No bueno! I can't take out the tube to reattempt intubation, and I don't have an airway alternative. Oh sorry, clear! SHOCK! And CPR continues.
I am sure I repeated myself multiple times when I called report and sounded a bit shaken. Hopefully they cut me some slack. I doubt that they did though. After I hang up the phone and continue to multitask between airway and drug therapy, I look at my jump bag and see that I am running out of just about everything. We better be at the hospital soon! My partner yells back from the front "2 minutes out!" and I am slightly relieved. However, that last 2 minutes felt like an eternity.
When we get there I scream out my report to the staff in this tiny little back country ER. I probably didn't need to do that. Damn adrenalin! My fire fighter rider is drenched in sweat, the staff gives bicarb and calcium, and I have no idea what to do next. They pronounce the pt a few minutes later and disconnect her from the monitor.
Unfortunately for everyone there, another arrest rolls into the ER 5 minutes after we get there. Good it won't me just me that has to do a mountain of paperwork. The arrest that followed mine was an intentional OD that was rearresting and coming back every few minutes. So it was a bit more of a challenging call than my arrest.
Thankfully the staff was good to me and didn't bite my head off for anything. They asked me what I had given for documentation purposes and I realized we gave 8 epi, 3 lido, fluids, and about 8 or 9 defibs. I am surprised that this LOL who CTD didn't just disintegrate.
Everyone remembers their first arrest or first really bad call. They usually don't go as well as planned and even can get screwed up more often than not. It is a right of passage and mine was no different.
So I have a paramedic for all of about 3 months and have not had anything too crazy yet. Sure, in the ER I have seen it all and done it all (or that is how I felt at the time) but out on the road as the lone ALS provider, I was still very green around the gills. I'm not sure where that analogy came from, but it is still applicable. At any rate, I am working my second job for the local ambulance company down in Mississippi. We did a few transfers and maybe a rescue or two but the day wasn't super exciting. Until we get the call "Control to 99. Priority 1. Details on the way". OK, so we put the info into our GPS and head on out that way. Since we are covering most of what seems like the southern most portion of the state, it was a bit of a drive to get there. While enroute, dispatch calls to tell us "CPR in progress". Great. This is going to be a lot of work AND it's my first arrest ever as a medic.
This was it. This was a big stepping stone from student, to third rider, to new employee. Getting your first arrest ever as a medic is a big deal and can really be a bit unnerving. You want to do the best job you can, not screw up, and hopefully get a pulse back. Unfortunately, that last part doesn't always happen and new medics tend to take that personally. I don't feel I did, but anyway, back to the story.
As we arrive on scene after what felt like an eternity, my partner and I see one of the local deputies doing CPR in the passenger seat of a parked car. The seat was at about a 45 degree angle and he was pounding away at her chest. Not the greatest position for such maneuvers. So in a very hurried manner, my partner and I pull out all the equipment and place the gurney next to the car where our pt is then promptly placed on gurney, secured, and CPR continued.
Now let me try and paint a slightly better picture of the situation. When we arrived, our pt was in the passenger seat of a four door sedan when she arrested. She was in her early 90s and was about to go to the store with one of her family members when she suddenly collapsed. The family then called 911, started CPR, and when the Sheriff's deputy arrived, took over CPR. Our pt was all of 90 lbs if she was soaking wet with change in her pockets.
Thanks to my endogenous catecholamines that were circulating, I was very much thinking from my brain stem. I thew on the defib pads and immediately forgot how to work the monitor. $#@! Thankfully I had a spasm of lucidity and was able to get to the pads view to see what was going on. And in true mega code fashion, it was course VF. Very course VF. We deliver our first shock. POW! 360J of Mississippi power go coursing through this poor pt and her arms and legs go flailing all over. Actually I was almost hit in the face due to poorly securing her to the gurney. A total rookie maneuver, I know.
And to continue the trend of rookie moves, I hastily attempted to intubate my pt right there in the chaos of this rural MS drive way. So between my blade placement, probably rocking back the blade and just not being an expert on laryngoscopy, I could not see !@#$. So in true protocol driven medicine I reach for the combi tube. They are OK airways when they work, but they do not protect from aspiration and are actually pretty rough on the soft structures of the airway. This is especially true when you have a new guy jamming it in with all of his might. So push, push, push and the tube goes into place. And I am sure we bagged WAY TOO FAST as well. But we load up the pt into the waiting ambulance and I ask who is coming with me, the fire fighter or the deputy? Both look at each other as though they had an unspoken game of "1,2,3 Not it!". Then the good o'l boy fire fighter begrudgingly hoped into the truck and took over CPR. The doors then close and we are off like a shot.
I opted to start an IV enroute since enough time was taken on scene. I tried for an EJ on the right side but it infiltrated. Great! Now what? I can't drop drugs down this monstrosity of an airway that I have in place. Is her face getting bigger? Anyway, I have to get an IV...and bag...and watch the monitor...and not fall on my ass. I thought to myself, are all arrests like this? So I opted to try the other EJ since I would allow me to do the least amount of moving around the cabin and not interrupt CPR. Oh BTW, CLEAR! POW! Shock delivered at 360j the pt has been in course VF this whole time too.
At this point, I am able to calm down ever so slightly and reassessed the situation. I have good compressions going, an airway in place, and an IV. Is her face getting bigger? Anyway, I am glad I had the fire guy with me, because he did CPR for me while we transported priority 1 to the closest hospital. His CPR seemed almost lazy because of the little amount of effort he had to put into it due to how big he was and how tiny the pt was. BTW, this hospital was about 20 minutes away going priority 1. Great.
Now I may be new, but I knew my ACLS protocols inside and out and was doing my best to follow them as closely as possible. I just kept grabbing boxes of drugs every few minutes and pushing them though my one good line. Everything is going well so far on my end...well maybe.
Her face IS getting bigger. One of her eyes is bulging and her face and neck appear swollen. When I reach down to touch it, she feels as though she has rice krispies under her skin. Apparently when I went all KER-SMASH with the combitube and tear went the trachea. No bueno! I can't take out the tube to reattempt intubation, and I don't have an airway alternative. Oh sorry, clear! SHOCK! And CPR continues.
I am sure I repeated myself multiple times when I called report and sounded a bit shaken. Hopefully they cut me some slack. I doubt that they did though. After I hang up the phone and continue to multitask between airway and drug therapy, I look at my jump bag and see that I am running out of just about everything. We better be at the hospital soon! My partner yells back from the front "2 minutes out!" and I am slightly relieved. However, that last 2 minutes felt like an eternity.
When we get there I scream out my report to the staff in this tiny little back country ER. I probably didn't need to do that. Damn adrenalin! My fire fighter rider is drenched in sweat, the staff gives bicarb and calcium, and I have no idea what to do next. They pronounce the pt a few minutes later and disconnect her from the monitor.
Unfortunately for everyone there, another arrest rolls into the ER 5 minutes after we get there. Good it won't me just me that has to do a mountain of paperwork. The arrest that followed mine was an intentional OD that was rearresting and coming back every few minutes. So it was a bit more of a challenging call than my arrest.
Thankfully the staff was good to me and didn't bite my head off for anything. They asked me what I had given for documentation purposes and I realized we gave 8 epi, 3 lido, fluids, and about 8 or 9 defibs. I am surprised that this LOL who CTD didn't just disintegrate.
Everyone remembers their first arrest or first really bad call. They usually don't go as well as planned and even can get screwed up more often than not. It is a right of passage and mine was no different.
Thursday, May 2, 2013
Soon..
I started the new job and will be on orientation for what seems like forever. I will be doing the ground rotations for the next few weeks then it will be on to the helicopter for a while. It should provide for some interesting stories. Until then I will have to stick to old stories I haven't shared yet.
Tuesday, April 23, 2013
Onward and upward!
Yesterday was my official first day at the new job! For those of you that don't know, I have (finally) secured a position as a flight paramedic! It is a mix of ground and air transport shifts. I would have preferred to fly all the time, but it is a start. I am looking forward to this new chapter in my career and all that I has to teach me. For now I will be stuck in front of a computer trying not to stab myself in the eye with the nearest pencil once my PowerPoint threshold has been reached. I do also have a few stories that I am working on, so bare with me.
Thursday, January 24, 2013
1600 Joules
NO, we didn't super charge/over shock our pt on this call! That just happens to be the total amount of joules we used between all of the defibrillations that were administered. Crazy, huh? Yup. But lets go back to the beginning...
So there we were, right. Working a 24 hour rescue shift in the usual location when we were dispatched to the neighboring city for "one unconscious". As my partner that day said, we "wee-wooed" all the way there. She is a trip and a lot of fun to work with. While enroute we hear that CPR is in progress. Great. It was kind of expected, but you always hope that it doesn't take that turn before you get there.
However, upon our arrival the local FD was there doing their awesome BLS thing. They are always on top of it. They had already shocked this pt twice with the AED and dropped a King LT. If you don't know what that last thing is, google it. So really, half the work is already been done. Plus, the awesome autopulse (CPR machine) was called for and was being delivered shortly. We swap the pads over to our monitor to find very coarse VFIB and give our first shock at 200J. POW! And start more CPR. Things are being yelled out, needles are placed into veins and bones, and the pt is placed on the autopulse. This not only does better CPR, but it also frees up an extra set of hands to get things moving. It sounds funny, but it is a great machine.
And speaking of the placement of needles, there were obviously a lot of people working on this pt and space was at a premium. I had to cut the pts pant leg to be able to place the IO. While doing this, my partner had to catch one of the FD guys from falling back on me. Good catch too! That could have resulted in disaster! I really didn't' feel like explaining to my superiors as to why one of the local FD personnel had an IO sticking in/out of his thigh.
So anyways, we now have good vascular access and can start pharmacologic therapy. "FIRST EPI IN" as the autopulse squeaks away doing compression after compression.This made the act of carrying this pt down the stairs a bit odd. But the job was done. And just as we secured our squeaking life support device, pt, and all to the gurney, it was time for the next EPI. Then slam goes the doors, shock goes the defibrillator, and we are off like a shot! Priority one to the closest ER.
While enroute another IV is started. More specifically, an EJ. This was perfect because it was just in time for some more medication. This time it is the antiarrythimic that is being given. It was easily pushed through the EJ and was flushed by the pressure bag in turnout gear. Shortly there after we not only see a spike in ETCO2 (look it up) but a decent rhythm on the monitor. Tada! We officially have ROSC! And, AND with a good pulse. However, this does not last very long. There ventricular ectopy started pouring into what was once a very pretty sinus tach. Then pulses were lost as the rhythm went from order to chaos or as those with an ACLS background like to call it, VFIB. But it's ok, we have the tools to hopefully correct this. Charging! CLEAR! And shock goes the monitor...NSR immediately with pulses. SWEET! Unfortunately we have to go through this process about 4 times before we get to the hospital. However, by that time we got the second dose of arrhythmic in and the ventricular ectopy calmed down to just an occasional PVC.
Now that we have a pule, a blood pressure, a rhythm, and all that goodness it was time to take a closer look at what just happened and to organize a report that I can shout at the ER staff without them getting mad at me. What was the down time? What was the hx of the pt? Was it witnessed? Is that peridefib ST elevation or is this a true complicated STEMI? Oh btw, CLEAR! POW with another 200j of Detroit Edison that promptly converts VFIB back to ST.
Upon arrival to the ER I shout out the report quick, fast, but not in too much of a hurry so it could be understood. The post arrest 12 lead was accomplished showing NO ST elevation but the pt was still sent up to the cath lab. Hopefully for some worthwhile intervention.
As hectic and chaotic as the call was, it could have been much worse. It was actually one of the better calls where everything went right and all the pieces and players fell into place. Good job to everyone involved. We may never know what happened to this pt, but they certainly received a 150% effort on the part of everyone involved.
*I am sure all the defibs don't add up to 1600 in this little glimps of what is my professional life. However, the total number of defibs did equal that number. For the sake of time and ease of telling the story some details were left out and/or forgotten.*
So there we were, right. Working a 24 hour rescue shift in the usual location when we were dispatched to the neighboring city for "one unconscious". As my partner that day said, we "wee-wooed" all the way there. She is a trip and a lot of fun to work with. While enroute we hear that CPR is in progress. Great. It was kind of expected, but you always hope that it doesn't take that turn before you get there.
However, upon our arrival the local FD was there doing their awesome BLS thing. They are always on top of it. They had already shocked this pt twice with the AED and dropped a King LT. If you don't know what that last thing is, google it. So really, half the work is already been done. Plus, the awesome autopulse (CPR machine) was called for and was being delivered shortly. We swap the pads over to our monitor to find very coarse VFIB and give our first shock at 200J. POW! And start more CPR. Things are being yelled out, needles are placed into veins and bones, and the pt is placed on the autopulse. This not only does better CPR, but it also frees up an extra set of hands to get things moving. It sounds funny, but it is a great machine.
And speaking of the placement of needles, there were obviously a lot of people working on this pt and space was at a premium. I had to cut the pts pant leg to be able to place the IO. While doing this, my partner had to catch one of the FD guys from falling back on me. Good catch too! That could have resulted in disaster! I really didn't' feel like explaining to my superiors as to why one of the local FD personnel had an IO sticking in/out of his thigh.
So anyways, we now have good vascular access and can start pharmacologic therapy. "FIRST EPI IN" as the autopulse squeaks away doing compression after compression.This made the act of carrying this pt down the stairs a bit odd. But the job was done. And just as we secured our squeaking life support device, pt, and all to the gurney, it was time for the next EPI. Then slam goes the doors, shock goes the defibrillator, and we are off like a shot! Priority one to the closest ER.
While enroute another IV is started. More specifically, an EJ. This was perfect because it was just in time for some more medication. This time it is the antiarrythimic that is being given. It was easily pushed through the EJ and was flushed by the pressure bag in turnout gear. Shortly there after we not only see a spike in ETCO2 (look it up) but a decent rhythm on the monitor. Tada! We officially have ROSC! And, AND with a good pulse. However, this does not last very long. There ventricular ectopy started pouring into what was once a very pretty sinus tach. Then pulses were lost as the rhythm went from order to chaos or as those with an ACLS background like to call it, VFIB. But it's ok, we have the tools to hopefully correct this. Charging! CLEAR! And shock goes the monitor...NSR immediately with pulses. SWEET! Unfortunately we have to go through this process about 4 times before we get to the hospital. However, by that time we got the second dose of arrhythmic in and the ventricular ectopy calmed down to just an occasional PVC.
Now that we have a pule, a blood pressure, a rhythm, and all that goodness it was time to take a closer look at what just happened and to organize a report that I can shout at the ER staff without them getting mad at me. What was the down time? What was the hx of the pt? Was it witnessed? Is that peridefib ST elevation or is this a true complicated STEMI? Oh btw, CLEAR! POW with another 200j of Detroit Edison that promptly converts VFIB back to ST.
Upon arrival to the ER I shout out the report quick, fast, but not in too much of a hurry so it could be understood. The post arrest 12 lead was accomplished showing NO ST elevation but the pt was still sent up to the cath lab. Hopefully for some worthwhile intervention.
As hectic and chaotic as the call was, it could have been much worse. It was actually one of the better calls where everything went right and all the pieces and players fell into place. Good job to everyone involved. We may never know what happened to this pt, but they certainly received a 150% effort on the part of everyone involved.
*I am sure all the defibs don't add up to 1600 in this little glimps of what is my professional life. However, the total number of defibs did equal that number. For the sake of time and ease of telling the story some details were left out and/or forgotten.*
Saturday, January 5, 2013
Not just another fall
The thing I love and hate about EMS is that at any given time you may be called upon to utilize a skill or exercise some knowledge that you have not used in a long time or in the case of some people, ever. And these situations can come when you least expect it. That is why you never really know what you are getting until you get there. A call for a "fall" can be anything from fall down go boom from standing height to a cardiac arrest, or someone that fell off of a building after getting electrocuted. The point is, you never really know. This call was no different.
We were dispatched to a local rehab center for one that had fallen. At first thought, most would not think that this would be the most exciting call that probably wouldn't require more than a c-collar and a trip to the hospital. Don't assume anything because the mixture of the EMS brand of chaos coupled with Murphy's law tend to make for obscure and challenging situations. But I digress...
When we get there, we find our LOL in obvious distress. She wasn't looking well and seemed very confused. OK, what could this be? Diabetic, hypotensive, a dementia patient that fell and just hasn't gotten up yet, or something else? Definitely something else.
This pt had that glazed over look but was still breathing. The radial pulse was kind of weak and slow. Really slow! Like 20-24 beats a minute slow (normal is 60-100 a minute)! @#$%! MONITOR, GO! My partner slaps on the monitor leads and pads. The result of this action is a narrow (good) but very slow (not good) cardiac rhythm that is very symptomatic requiring immediate intervention.
Now I am not sure why this phenomenon happens, but it seems as though when people are in dire straits and have super crappy vital signs, they seem to say very simple but very odd things. I once had a pt with a dissecting thoracic aorta with a horrible blood pressure and all she could tell me was "It hurts". This Pt's only request was that she was hot and that we should take her pants off. Really? Really. We didn't take her pants off because it wasn't medically necessary. Anyway, back to the story.
Flip the switch to the left and let's start pacing! Oh and we should probably start working on an IV or two as well. We start at a rate of 80 and are steadily increasing the mA (energy) until we get a good spike or capture. Unfortunately, this doesn't happen as easily as we would like. However, at this point we have an EJ in place and can try some pharm therapy! Since the pacer isn't really working at this point but isn't making things worse, we leave it on. Unfortunately, the pacer pads either got disconnected or someone turned down the energy because the pt went from a slow heart rate to no heart rate! I look at the monitor and am certain that everyone in the room could hear stream of profanities running through my head. Thankfully what came out of my mouth was much more politically correct. Something along the lines of "Crank it back up!" Thankfully we get a better paced rhythm this time. Not the best, but better. As soon as we get our pt on to the gurney and ready for transport, I take a better look at the monitor and decide to up the energy level on the pacer. Boom! Capture! We have a good pulse, a good BP, and now 2 IVs. Let's go!
The ride was bumpy and loud, but we were able to get some fluid into the pt as well as make it to the hospital alive. Our pt would appear to pass out from time to time and just when we think we would have to start CPR and even more invasive with our treatments, she would wake up. We would have to yell her name or do a sternal rub but she was still alive. Oh and the fire department drove for us so we got there lickety split but I question their safe driving record from time to time. Although I always appreciate it when they drive for us.
Once we get there and hand over care, the pt no longer requires TCP treatment and has a better blood pressure. Was this due to our treatments or was she just trying to make us look bad? Just kidding. Per the doc, it was probably a sick sinus syndrome, a heart block from an MI, or a bout of symptomatic bradycardia. Whatever the case may be, she will be getting a permanent pacemaker placed and hopefully will not have to deal with this issue again. Gotta love it when a call goes from blah to "PRIORITY 1" to a probable hospital discharge. Good job everyone!
We were dispatched to a local rehab center for one that had fallen. At first thought, most would not think that this would be the most exciting call that probably wouldn't require more than a c-collar and a trip to the hospital. Don't assume anything because the mixture of the EMS brand of chaos coupled with Murphy's law tend to make for obscure and challenging situations. But I digress...
When we get there, we find our LOL in obvious distress. She wasn't looking well and seemed very confused. OK, what could this be? Diabetic, hypotensive, a dementia patient that fell and just hasn't gotten up yet, or something else? Definitely something else.
This pt had that glazed over look but was still breathing. The radial pulse was kind of weak and slow. Really slow! Like 20-24 beats a minute slow (normal is 60-100 a minute)! @#$%! MONITOR, GO! My partner slaps on the monitor leads and pads. The result of this action is a narrow (good) but very slow (not good) cardiac rhythm that is very symptomatic requiring immediate intervention.
Now I am not sure why this phenomenon happens, but it seems as though when people are in dire straits and have super crappy vital signs, they seem to say very simple but very odd things. I once had a pt with a dissecting thoracic aorta with a horrible blood pressure and all she could tell me was "It hurts". This Pt's only request was that she was hot and that we should take her pants off. Really? Really. We didn't take her pants off because it wasn't medically necessary. Anyway, back to the story.
Flip the switch to the left and let's start pacing! Oh and we should probably start working on an IV or two as well. We start at a rate of 80 and are steadily increasing the mA (energy) until we get a good spike or capture. Unfortunately, this doesn't happen as easily as we would like. However, at this point we have an EJ in place and can try some pharm therapy! Since the pacer isn't really working at this point but isn't making things worse, we leave it on. Unfortunately, the pacer pads either got disconnected or someone turned down the energy because the pt went from a slow heart rate to no heart rate! I look at the monitor and am certain that everyone in the room could hear stream of profanities running through my head. Thankfully what came out of my mouth was much more politically correct. Something along the lines of "Crank it back up!" Thankfully we get a better paced rhythm this time. Not the best, but better. As soon as we get our pt on to the gurney and ready for transport, I take a better look at the monitor and decide to up the energy level on the pacer. Boom! Capture! We have a good pulse, a good BP, and now 2 IVs. Let's go!
The ride was bumpy and loud, but we were able to get some fluid into the pt as well as make it to the hospital alive. Our pt would appear to pass out from time to time and just when we think we would have to start CPR and even more invasive with our treatments, she would wake up. We would have to yell her name or do a sternal rub but she was still alive. Oh and the fire department drove for us so we got there lickety split but I question their safe driving record from time to time. Although I always appreciate it when they drive for us.
Once we get there and hand over care, the pt no longer requires TCP treatment and has a better blood pressure. Was this due to our treatments or was she just trying to make us look bad? Just kidding. Per the doc, it was probably a sick sinus syndrome, a heart block from an MI, or a bout of symptomatic bradycardia. Whatever the case may be, she will be getting a permanent pacemaker placed and hopefully will not have to deal with this issue again. Gotta love it when a call goes from blah to "PRIORITY 1" to a probable hospital discharge. Good job everyone!
Subscribe to:
Posts (Atom)