Heart and Head Problems

This post needs a little bit of background that I would normally not give. While I work in a more urban setting now, this took place when I was working in a much more rural area. Its also mid morning.

Dispatch says we are going to the local doctors office. Not the first time I had been there so I knew they meant the building in the center of town, not the hospital on the edge of town with a few doctors offices. Dispatch also says its cardiac related. Could this mean I actually get a code?

Now one thing I still do not understand about this building is that despite the fact that it has doctors offices on the second floor, the elevators will not fit our cot without it having the head raised and the frame dropped at the top end. We wheel into the doctors waiting room and are quickly directed to an exam room with out AED and gear.

I see an older lady in her seventies with a beautiful LifePack12 from the doctors office nearby. But she herself seems to be in only mild distress, not sweating, normal breathing, no visible pain on her face.

Well, guess this means no code, but maybe I can give nitro?

EMT GFP: "So what is going on today?"

Lady: "I came in for my appointment."

Doctor: "She was complaining of chest pain and has a history of heart problems, so we gave her three nitro. She is still in pain so we called 911."

Darn! No nitro today, but the doctors seemed decidedly worried so we got a quick set of vitals and got back into the ambulance as I started asking questions.

EMT GFP: "Have you had a heart attack before?"

Lady: "Yes, last year."

EMT GFP: "Does this feel like the last time you had a heart attack?"

Lady: "Yes."

EMT GFP: "When did the chest pain start?"

Lady: "Last night around 2 AM."

Blink. Blink. You are having chest pain that is identical to your last heart attack and you are just NOW getting to the hospital? Its nearly 10 AM?! Mind you, I did my best not to show my utter confusion and astonishment.

EMT GFP: "So why didn't you call 911 when your chest pain started?"

Lady: "I knew I had a doctors appointment so I just waited for that since I don't live close."

She didn't code on the way to the hospital and I am pretty sure she did not die that day, though I am not sure about her long term outcome. I am still amazed at the denial of her situation or her lack of education on heart attacks. Sure, for you 20-30 minutes might be a "long distance" but in an ambulance that is not far at all when going lights and sirens and we really don't mind being woken up at all hours to help you out. We will take a hit on our sleep if it means you will live to see another day. I hope that maybe this time she well get the education/wake up call that she need to understand 911 is there to help her!

So please people, if you are having cardiac chest pain, whether you have had it before or not, please call 911!

And Fructose 6 Phosphate is converted by PFK 1 to...

I love science, don't get me wrong, but there is something about having to memorize metabolic pathways that I just haven't mastered yet. Ugh. That was a brutal exam. And its sad that I am excited to get back to endocrinology (because endo really doesn't excite me all that much other than I know it fairly well being the ooooh, fourth time I will be doing it now).

However, it has made me realize (yet again) I have some serious study habit issue I need to resolve. This is my last chance into medical school, I had better not waste it. I may be pretty absent for a bit till I get this studying thing down, but I promise the next post will be an EMS one!

The Masses

I started at this school during the summer in hopes I would get into the program that I am in now. The library was quiet, the campus was fairly depopulated and I only had to worry about lunch when there were camps going.

The classes started.

All the med students came back. I was there taking classes with them. And the library was packed. I thought that many people in one place was nuts.

Then the rest of the campus started classes.

Undergrads started/came back. Grad students appeared. The library became packed (though still the best library ever because it lets you take in food and drink).

I miss the summer not because of summer, but because it was quiet on campus!

Seizures: Part One

As all good calls are, it was some hour just after we had all gone to bed. We had three on the ambulance and we knew the engine from a near by station with a medic was headed out to the call too.

Dispatch was for Status Seizures.

I was still not a crew chief at this point in time but I was almost there so I was trying to be more aware of myself and what I would if I was in charge, even if I wasn’t.

We get to the apartment complex and manage to squeeze everything inside the elevator before heading up to the room. Not seeing the engine out front, we were assuming we were first on scene. Large red fire engines are kind of heard to miss.

We get to the apartment to find the engine crew half in, half out of the door, our patient on the floor still actively seizing with the medics trying to get a line. He was elderly, mid-eighties, and somehow still moving air despite the face that there was no sign of these seizures stopping any time soon. The engine had parked at the other apartment entrance and in rare occurrence in my area, had two medics on it.

I promptly get to pin the arm down so my medic can go for the IV stick, as does one of my fellow crew members for his medic. My medic misses. His get the IV. My medic goes for a blood pressure. His medic goes to mix up drugs as my fellow arm holding crew member is making sure the IV stays in place. Our third is setting up O2 for the NRB that he fished out.

Pressure is decent all thinks considered and there is a prompt debate over the proper mixing and dosing of medications (it is after midnight and everyone wanted to get this right). That was about when I realized that the arm I was holding was bleeding. And not just a trickle, really bleeding from where the medic had gone for a stick. Hand is promptly slapped over that as I pin the arm down. Someone passes me a 4 by 4 to help with the holding of pressure.

The meds are pushed and in what I can only describe as a "better living through chemistry" moment, he actually stops seizing. We all breath a small collective sigh of relief before quickly getting him into the cot. Downstairs we go in two elevators and hop in the back of our ambulance.

I help with a EKG (simple four lead, Smoke over Fire, Sky over Grass), other arm holder is driving as fast as safely possible and our third is working the O2 when our patient stops breathing. That leads to a whole new set of flurry, our third bagging, as we find an oral airway just as we pull up to the hospital, no time for an update.

In we go, nurses and doctors promptly taking over to keep this man out of cardiac arrest. I slowly back off, hoping that this man lives. We stopped his seizures, we made it to the hospital, we did what we were trained to do.

I never found out if he lived or died. Never found out if he seized and hit his head or seized because he fell and hit is head or if a third possibility was running around. I will probably never know but we did our best. And I learned blood pressure cuffs really do work well as tourniquets.

Happy Day!

I got in! I got in! I got in! I got in!

No, not to medical school, unfortunately, but to a Master's program that is going to be my next step to medical school!

Haven't had time to post much due to a class I was taking (which, by the way, physiology rocks!) but I do plan to get back into the swing! And still find time to ride the ambulance. We have been having a really slow summer but it does allow us to train!

I got in!

Perceptions

I hear car tires squealing, I flinch and wait for the sound of crushing metal.

I walk into elevators and immediately gauge whether or not I could fit a stretcher in it, with the most common answer being not.

I go past house were the front door is up three flight of steps, half a hill, and looks about as narrow as legally allowed and wonder how on earth would I get a patient down on a backboard, let a long a stretcher.

I glance at people and wonder what their underlying medical conditions are.

I look at buildings and wonder if everyone could get out fast enough in a fire.

I hear sirens and instead of wondering what they belong to, I try to tease out if its police, fire engine, ambulance, or squad and if its heading towards the highway or towards the hospital.

I no longer see the world simply as it is, I see it now as how I need to interact with it, read it and think 'what can I do in this situation?'

Yes, I am geeking out over this...

I started taking classes recently at Local University which happens to have a medical school attached. And a hospital. So I am on my way to lunch, starving, and notice there is an ambulance just chilling on this little hill. Now, I know what this hill is and promptly rush to get the quickest food I can find and get back outside.

So I just missed the first one landing...



but much to my surprise, a second one landed!



Here they are together with the ambulance for the second one. This totally made my day.