Everything you are about to read happened after midnight.
It was a rather cold and rainy night, you know, the ones where you of course get a call in the worst location possible.
First up was a little old man and his wife, cute couple, had just come back from a late dinner with the kids when they realized they needed us. Or rather, he needed us. My partner and I schlepped up several flights before the wife let us in and led us back to the rear bathroom. There, standing over a new very red sink was a little old man with his nose poring blood.
And I mean poring. The white sink was nearly invisible under the blood, a trash can had also been graced with blood, and the towel held to the man's face was swiftly doing nothing. Upon seeing the scene I turned to my partner with that look of 'We are going and we are going now.'
A quick packaging, a set of vitals, and another towel later we are on the road. The poor guy said that something similar had happened two night ago but the bleeding had stopped on its own just as spontaneously as it had started. Unfortunately this time it would require a trip to the hospital. I felt a bit bad as I hung out as far behind his head as the bench seat would allow but whenever he spoke I could see the blood droplets leaving his mouth. Did I mention he was coughing up clots too?
Thankfully a quick trip to the hospital and a combination of cautery and packing, the nosebleed finally stopped. And here I thought the dispatch of 'nosebleed' was going to be bogus.
Sped forward to the wee hours of the morning just before the sun rises. Dispatched for a second nosebleed. As we rolled up to this one I refused to believe we would get two real serious nosebleed calls in one night.
I was wrong. Blood droplets were strewn across the house as another poor man pinched his nose in a desperate attempted to get it to stop bleeding. It had started that evening but seemed to stop enough for him to sleep. Well now there was blood everywhere so clearly that was a false alarm. While not as serious as the first, it was another trip to the hospital to figure things out.
This poor man had the added complication of having face-planted in a parking garage a few days early, breaking his nose and looking like he had been in serious fight. It was unknown if the nosebleed was from the previously broken nose or something new.
I may never dismiss a nosebleed call again.
Showing posts with label ems. Show all posts
Showing posts with label ems. Show all posts
Wednesday, April 25, 2012
Tuesday, March 27, 2012
Death and Dying
Lab has been insane. All I have to say is finding funding is not pleasant in this economy and has created far more stress than necessary. This stress should be directed towards papers, not grants!
Anyways, my crew and I have had a string of patient deaths, though not the we couldn't save them deaths. No more it was the elderly reaching the end of their time deaths. A DNR, a should have been DNR that the family was going to get the paperwork done the next day but relative decided tonight was the night, and elderly (105!!!) just not doing well and probably reaching the end of his time. Now, I could rant all day about hospice and the lack of planning in this country, but I will refrain for that for now.
Instead, and what I found very interesting, was that I had a new probie who was terrified of death and dying. Now maybe this is just something that I processed early on as a child and accepted (and no, I did not have my parents/grandparents die young), maybe its because I always have known I want to go into medicine, in the end it really doesn't matter but death and dying is something I am comfortable with in the field. Yes, I do get a bit nervous making the call, but for BLS, you have to be really dead or have a DNR to call it and thankfully those are the situations I encountered. Nerve wracking sure, but pretty clear cut. And yet this normal process really disturbed by probie. Perhaps I am the odd one finding his reaction odd but perhaps it was also his first dead person.
My crew chief and I asked her if she wanted to talk about it and she staunchly replied with a "no". Well, that makes us helping you deal with it all the harder.
The same thing happened when we had a "code" that was really a "well we were going to hospice tomorrow morning and we know she wants to die but no, we don't have any paperwork. Whats a DNR?" Thankfully the medic go medical clearance to stop the code but again, my probie didn't want to talk about, though we could tell she did not like dealing with the situation at all.
We all deal with death in different ways, but in EMS and medicine it is something that is there every day (sometimes in frequent stretches). We HAVE to deal with it. Its our job. Now if only I can crack the death nut with my probie and at least get her talking instead of bottling it up. If she wants to do this long term, this is something she has to deal with.
Anyways, my crew and I have had a string of patient deaths, though not the we couldn't save them deaths. No more it was the elderly reaching the end of their time deaths. A DNR, a should have been DNR that the family was going to get the paperwork done the next day but relative decided tonight was the night, and elderly (105!!!) just not doing well and probably reaching the end of his time. Now, I could rant all day about hospice and the lack of planning in this country, but I will refrain for that for now.
Instead, and what I found very interesting, was that I had a new probie who was terrified of death and dying. Now maybe this is just something that I processed early on as a child and accepted (and no, I did not have my parents/grandparents die young), maybe its because I always have known I want to go into medicine, in the end it really doesn't matter but death and dying is something I am comfortable with in the field. Yes, I do get a bit nervous making the call, but for BLS, you have to be really dead or have a DNR to call it and thankfully those are the situations I encountered. Nerve wracking sure, but pretty clear cut. And yet this normal process really disturbed by probie. Perhaps I am the odd one finding his reaction odd but perhaps it was also his first dead person.
My crew chief and I asked her if she wanted to talk about it and she staunchly replied with a "no". Well, that makes us helping you deal with it all the harder.
The same thing happened when we had a "code" that was really a "well we were going to hospice tomorrow morning and we know she wants to die but no, we don't have any paperwork. Whats a DNR?" Thankfully the medic go medical clearance to stop the code but again, my probie didn't want to talk about, though we could tell she did not like dealing with the situation at all.
We all deal with death in different ways, but in EMS and medicine it is something that is there every day (sometimes in frequent stretches). We HAVE to deal with it. Its our job. Now if only I can crack the death nut with my probie and at least get her talking instead of bottling it up. If she wants to do this long term, this is something she has to deal with.
Tuesday, February 7, 2012
6 Signs You Have Been at the Firehouse Too Long
1. You expect all vehicles (marked or not) with back up lights to also have back up alarms
2. You think the smell of a diesel engine/exhaust isn't that bad (bonus points if you have started to enjoy it)
3. You wake up in the middle of the night because the overhead radio had a neighboring station's prealert tones go off (just in case you are running a call with them)
4. You can't go to sleep without the hum of the exhaust system in the background
5. You can't wake up unless you hear the screech and chirp of SCBAs being tested at shift change.
6. You know where the secrete stash of the good coffee creamer is kept (bonus points if you don't even like coffee)
2. You think the smell of a diesel engine/exhaust isn't that bad (bonus points if you have started to enjoy it)
3. You wake up in the middle of the night because the overhead radio had a neighboring station's prealert tones go off (just in case you are running a call with them)
4. You can't go to sleep without the hum of the exhaust system in the background
5. You can't wake up unless you hear the screech and chirp of SCBAs being tested at shift change.
6. You know where the secrete stash of the good coffee creamer is kept (bonus points if you don't even like coffee)
Thursday, January 12, 2012
How to procrastinate productively
A) Study for the class that you are taking this semester (because what else do you do when you aren't in medical school yet? take more classes!)
B) Do/study for the classes for EMT-B recert
Yeah, I am putting off the fact that I need to help clean the lab and play with my cells today. And that I need to revamp my lectures for this semester. Just not feeling it yet...
B) Do/study for the classes for EMT-B recert
Yeah, I am putting off the fact that I need to help clean the lab and play with my cells today. And that I need to revamp my lectures for this semester. Just not feeling it yet...
Sunday, January 8, 2012
In the End
She stood waiting for us at the door, quiet and composed though visibly in pain. We had been here once before, for a fall that ended up with a trip to the E.R. thanks to the chemo he was going through. She greeted us and took us to the bedroom, neatly kept just like the rest of the house.
He was lying in the bed, silent and still, on that snowy day. We had of course brought the works into the house but I knew the moment I saw her we wouldn't need any of it. He looked so frail on the bed, blankets piled up to keep him warm, frailer than when we had seen him several months ago for that fall.
The cancer had not been kind to him. He had lost his battle and we were left comforting his wife.
She was stoic, having cared for him at home this entire time, refusing to let him be in the hospital unless absolutely necessary. She had known that it was coming but that didn't lessen the blow.
"I had just closed my eyes. I didn't mean to take that nap."
I thought to myself that her nap was probably exactly why he had chosen that moment to go. You could see the love the two had throughout the house, I had seen it during our call here for the fall. He didn't want to burden his wife with his illness and yet she had refused to let anyone else care for him. He had to have been grateful for that, perhaps wanting to spare her the last pain of watching him die in front of her.
We left only once we were sure she would be okay. Sadly, it would not be a merry Christmas Day for her.
He was lying in the bed, silent and still, on that snowy day. We had of course brought the works into the house but I knew the moment I saw her we wouldn't need any of it. He looked so frail on the bed, blankets piled up to keep him warm, frailer than when we had seen him several months ago for that fall.
The cancer had not been kind to him. He had lost his battle and we were left comforting his wife.
She was stoic, having cared for him at home this entire time, refusing to let him be in the hospital unless absolutely necessary. She had known that it was coming but that didn't lessen the blow.
"I had just closed my eyes. I didn't mean to take that nap."
I thought to myself that her nap was probably exactly why he had chosen that moment to go. You could see the love the two had throughout the house, I had seen it during our call here for the fall. He didn't want to burden his wife with his illness and yet she had refused to let anyone else care for him. He had to have been grateful for that, perhaps wanting to spare her the last pain of watching him die in front of her.
We left only once we were sure she would be okay. Sadly, it would not be a merry Christmas Day for her.
Monday, December 12, 2011
Devotion
The dispatch was for a sick person, but the issue was not a sick person at all. An elderly man, mid-eighties, had called because his wife's feeding tube had come out. I know, not an emergency in the classic sense, but this was a feeding tube that went through her side, not her nose. Stomach acid is not a pleasant thing to having leaking in all the wrong places.
She was mostly paralyzed from a previous stroke and her husband refused to put her in a nursing home again. He said he had done it once but the look in his eyes spoke volumes about the care, or perhaps the lack their of, she had received. He could take care of her daily needs, but this he could not no matter how much he tried.
So we bundled her up and moved her carefully to the cot, with her husband answering all my questions along the way. You could see his devotion to her as he sat in the back with me and his wife, holding her hand for the ride. She couldn't respond much but you could see there was still life in her eyes, still understanding trapped in a body that now refused to move.
I wish it was easier for sir, to take care of your wife, to not worry about her, but let me tell you that you are doing a wonderful job for her. She could not have a better care taker than you.
She was mostly paralyzed from a previous stroke and her husband refused to put her in a nursing home again. He said he had done it once but the look in his eyes spoke volumes about the care, or perhaps the lack their of, she had received. He could take care of her daily needs, but this he could not no matter how much he tried.
So we bundled her up and moved her carefully to the cot, with her husband answering all my questions along the way. You could see his devotion to her as he sat in the back with me and his wife, holding her hand for the ride. She couldn't respond much but you could see there was still life in her eyes, still understanding trapped in a body that now refused to move.
I wish it was easier for sir, to take care of your wife, to not worry about her, but let me tell you that you are doing a wonderful job for her. She could not have a better care taker than you.
Thursday, December 8, 2011
Finals: Its busy on the professors too!
Needless to say, its been a busy post Thanksgiving.
Several nights at the firehouse were we ran call all night (and then I went a taught the next morning. Thank you firehouse pitch black coffee!)
On top of that, I have had several experiments in lab that have lead to late nights frantically analyzing results, making figures, and proofing papers before deadlines.
Lets not even go into my frustrations with my bacteria at the moment. Needless to say, E. coli should not be this hard to grow. Its E. coli for crying out loud! It should be hard to kill these buggers! At least now they are growing on plates, now to just get them going in culture.
And last but not least, my poor students. I love them dearly but I sometimes pity them when this is just half of the review that I gave:
Several nights at the firehouse were we ran call all night (and then I went a taught the next morning. Thank you firehouse pitch black coffee!)
On top of that, I have had several experiments in lab that have lead to late nights frantically analyzing results, making figures, and proofing papers before deadlines.
Lets not even go into my frustrations with my bacteria at the moment. Needless to say, E. coli should not be this hard to grow. Its E. coli for crying out loud! It should be hard to kill these buggers! At least now they are growing on plates, now to just get them going in culture.
And last but not least, my poor students. I love them dearly but I sometimes pity them when this is just half of the review that I gave:
Bonus points for anyone who can tell me what the second pictures is explaining!
Tuesday, November 22, 2011
Why family can sometimes be really helpful
Often times EMS providers can find family more of a hinderance than a help. Sometimes I will tell family members if they can find a medication list or a bag for the patient, in part because it is helpful but more often than not it is so I can talk to the patient without interruption or fear of outside influences.
Now, there are times when having the family around is absolutely essential.
We get dispatched for an altered level of consciousness at the local incredibly frustrating apartment complex (its a nightmare to get anything other than a stair-chair in and out of) and find a worried family with an elderly man lying on the back bed.
First impressions for me where that he was very ill (medically speaking) or that he may have had a stroke. Then the family pipes up. "He fell down a full flight of stairs to the basement and a neighbor brought him back up. He normally is not like this."
Hello red flag! He fell down a flight of stairs?! And he was moved?! Now this is no fault of the family themselves, they were not present during the fall, but one of my biggest pet peeves is possible head/neck injuires that decide moving is a brilliant idea (more on rugby players at a later date).
A quick assessment gets me very little response from the patient, something about chocolate was all that was audible. His vital signs are stable but I do not like the fact that he is so out of it. The ALS that is on the way is not getting canceled at this point.
I get my partners to hold C-spine and go grab the backboard. I start asking the family more questions (including that drug list!) as we start to get him ready to for transport. Beyond his current state, he sounds pretty healthy. The wail of sirens lets me know that ALS is here and I start mentally prepping for the report as the family tells me this lovely detail: "He is typically more lucid than you or I." Red Flag! Red Flag!
I do a quick hand-off to the medic and am getting quizzical looks as to why my partners are now trying to get a C-collar on this poor man. The medic even tries to shoe them away and not call it a trauma, as if I am crazy and don't know my own BLS protocols.
I may be less experienced than you but I do know this, when family says that this is vastly off his normal mental status AND that he fell, I am NOT letting you take off that collar. After a quick re-emphasizing of those two points (especially how off this is for him from his families standpoint), the medic gets it and agrees with me on the board and collar.
We of course help ALS carry him down the stairs (they may not be my favorite medics from that station but I am not one to let personal taste get in the way of professional care) and he is off to the local trauma hospital.
Even when you are out ranked and have less experience, when the family is rattled by his lack of mental awareness, or rather the sudden drop in it, you list to the family hands down. If it were not for them, I would not have been nearly as persistent as I was with the medic. If it were not for the family, I am not sure anyone would have realized he may have been a head trauma until it was too late.
Sometimes, family is your saving grace on a call.
Now, there are times when having the family around is absolutely essential.
We get dispatched for an altered level of consciousness at the local incredibly frustrating apartment complex (its a nightmare to get anything other than a stair-chair in and out of) and find a worried family with an elderly man lying on the back bed.
First impressions for me where that he was very ill (medically speaking) or that he may have had a stroke. Then the family pipes up. "He fell down a full flight of stairs to the basement and a neighbor brought him back up. He normally is not like this."
Hello red flag! He fell down a flight of stairs?! And he was moved?! Now this is no fault of the family themselves, they were not present during the fall, but one of my biggest pet peeves is possible head/neck injuires that decide moving is a brilliant idea (more on rugby players at a later date).
A quick assessment gets me very little response from the patient, something about chocolate was all that was audible. His vital signs are stable but I do not like the fact that he is so out of it. The ALS that is on the way is not getting canceled at this point.
I get my partners to hold C-spine and go grab the backboard. I start asking the family more questions (including that drug list!) as we start to get him ready to for transport. Beyond his current state, he sounds pretty healthy. The wail of sirens lets me know that ALS is here and I start mentally prepping for the report as the family tells me this lovely detail: "He is typically more lucid than you or I." Red Flag! Red Flag!
I do a quick hand-off to the medic and am getting quizzical looks as to why my partners are now trying to get a C-collar on this poor man. The medic even tries to shoe them away and not call it a trauma, as if I am crazy and don't know my own BLS protocols.
I may be less experienced than you but I do know this, when family says that this is vastly off his normal mental status AND that he fell, I am NOT letting you take off that collar. After a quick re-emphasizing of those two points (especially how off this is for him from his families standpoint), the medic gets it and agrees with me on the board and collar.
We of course help ALS carry him down the stairs (they may not be my favorite medics from that station but I am not one to let personal taste get in the way of professional care) and he is off to the local trauma hospital.
Even when you are out ranked and have less experience, when the family is rattled by his lack of mental awareness, or rather the sudden drop in it, you list to the family hands down. If it were not for them, I would not have been nearly as persistent as I was with the medic. If it were not for the family, I am not sure anyone would have realized he may have been a head trauma until it was too late.
Sometimes, family is your saving grace on a call.
Friday, November 11, 2011
Gloves: Its Always Your Size They Are Missing
In my case, it is always the small gloves. And its both the ambulance and the lab.
At one point I was even taking pairs from the hospitals we transported to because we never had any of the good gloves at our station. We had small latex gloves, but they were first off latex and second off so old that as soon as you touched anything with them on they tore, shredded, ripped or otherwise tried to disintegrate on you while you were wearing them. Completely useless darn things.
Thankfully after a few months and some polite asking, new small gloves were ordered and I haven't had much problems at the station since. I did recently run into the lack of gloves problem in my newest lab (they only had large and extra large! Massive problem!) but thanks to some polite asking, I was able to "requisition" some gloves for use.
But what about the gloves themselves? Perhaps I am pickier than most, but I actually do care what kind of gloves I am wearing for what "job". Granted, I care more that I have gloves or not and that they are smalls more than anything else. But if I have a choice, I will exercise it.
Ambulance: Oh the high cuffed glove! How I adore thee! Sometimes you are fairly thick and you do make finding a pulse difficult but you do such a great job at protecting my arms from gunk, particularly in the summer! Touch wise I like the Cerulean blue gloves that seem to have taken up home at my station. They fit reasonably well (as in not super baggy) and they give me great textural input without being too think and breaking.
Lab: This gets broken down into about three categories depending on what I am doing.
For mouse work, give me tight fitting gloves that are fairly thin. I need the grip they provide to hold on to those little buggers when they squirm! Not to mention, tail vain injections with a 27 gauge needle work oh so much better when I have fine dexterity control that the thin gloves provide. Now due to the short cuff, this means I also typically punch holes in the paper gown I have to wear and stick my thumbs through so that the gown stays down on my arms and my gloves stay affixed over the gown. No mouse or mouse parts are making it up my gloves!
For gross organ processing I like those nice thick purple gloves! Great for keeping everything I am doing off my hands, maintain most of my dexterity, and can last for hours on end, a requirement when an experiment takes all day! Sometimes these feel too thick though and can tire out my hands if I need to do fine dexterity work.
For molecular biology work, give me my latest find in gloves! Super thin but incredible textural feedback! Somehow also super durable! I have only ripped maybe two gloves and it was under severe duress! Granted, I will wear the extra small in these gloves because the smalls are a bit to baggy, but it means that I never get my gloves stuck in microcetrofuge tubes or drop anything due to excess glovage! I think these would also make great gloves for the ambulance but I haven't been able to test that yet. Another point for these gloves is that they don't make my hands sweat nearly as much as other, a major bonus when I am in and out of gloves all day!
Anatomy Dissection: Now this is where I am torn. I like a thinner glove because I am not only double gloving but I need some serious dexterity control here. However, I like to stay covered as possible and having my hands not smell like cadaver at the end of the day is great. Sometimes it depends on the dissection, where I will risk thinner gloves for greater dexterity. Either way, these buggers had better be tight fitting! No getting stuck in dissection scissors for me!
Overall, I like a tight fitting glove that has good textural feedback and dexterity. I dislike extra glove floating around my finger tips. But at the end of the day, I they have to hold up and not break so that I can actually get work done!
What are your likes and dislikes about gloves? Ever had a great moment where you didn't have the gloves you wanted?
At one point I was even taking pairs from the hospitals we transported to because we never had any of the good gloves at our station. We had small latex gloves, but they were first off latex and second off so old that as soon as you touched anything with them on they tore, shredded, ripped or otherwise tried to disintegrate on you while you were wearing them. Completely useless darn things.
Thankfully after a few months and some polite asking, new small gloves were ordered and I haven't had much problems at the station since. I did recently run into the lack of gloves problem in my newest lab (they only had large and extra large! Massive problem!) but thanks to some polite asking, I was able to "requisition" some gloves for use.
But what about the gloves themselves? Perhaps I am pickier than most, but I actually do care what kind of gloves I am wearing for what "job". Granted, I care more that I have gloves or not and that they are smalls more than anything else. But if I have a choice, I will exercise it.
Ambulance: Oh the high cuffed glove! How I adore thee! Sometimes you are fairly thick and you do make finding a pulse difficult but you do such a great job at protecting my arms from gunk, particularly in the summer! Touch wise I like the Cerulean blue gloves that seem to have taken up home at my station. They fit reasonably well (as in not super baggy) and they give me great textural input without being too think and breaking.
Lab: This gets broken down into about three categories depending on what I am doing.
For mouse work, give me tight fitting gloves that are fairly thin. I need the grip they provide to hold on to those little buggers when they squirm! Not to mention, tail vain injections with a 27 gauge needle work oh so much better when I have fine dexterity control that the thin gloves provide. Now due to the short cuff, this means I also typically punch holes in the paper gown I have to wear and stick my thumbs through so that the gown stays down on my arms and my gloves stay affixed over the gown. No mouse or mouse parts are making it up my gloves!
For gross organ processing I like those nice thick purple gloves! Great for keeping everything I am doing off my hands, maintain most of my dexterity, and can last for hours on end, a requirement when an experiment takes all day! Sometimes these feel too thick though and can tire out my hands if I need to do fine dexterity work.
For molecular biology work, give me my latest find in gloves! Super thin but incredible textural feedback! Somehow also super durable! I have only ripped maybe two gloves and it was under severe duress! Granted, I will wear the extra small in these gloves because the smalls are a bit to baggy, but it means that I never get my gloves stuck in microcetrofuge tubes or drop anything due to excess glovage! I think these would also make great gloves for the ambulance but I haven't been able to test that yet. Another point for these gloves is that they don't make my hands sweat nearly as much as other, a major bonus when I am in and out of gloves all day!
Anatomy Dissection: Now this is where I am torn. I like a thinner glove because I am not only double gloving but I need some serious dexterity control here. However, I like to stay covered as possible and having my hands not smell like cadaver at the end of the day is great. Sometimes it depends on the dissection, where I will risk thinner gloves for greater dexterity. Either way, these buggers had better be tight fitting! No getting stuck in dissection scissors for me!
Overall, I like a tight fitting glove that has good textural feedback and dexterity. I dislike extra glove floating around my finger tips. But at the end of the day, I they have to hold up and not break so that I can actually get work done!
What are your likes and dislikes about gloves? Ever had a great moment where you didn't have the gloves you wanted?
Wednesday, November 9, 2011
Accomplishments of the Day
Work for grant figure - completed (until we decided what to add for the supplemental)
Downloads box - emptied
Printer connection - established
To do list for lab research - growing to epic proportions
Apparatus - cleaned and detailed
Patients saved - pending...
Lecture presentation - waiting to be worked on
Yes, I live in two/three very different worlds: researcher/student , EMT, and professor :)
I love them all
Downloads box - emptied
Printer connection - established
To do list for lab research - growing to epic proportions
Apparatus - cleaned and detailed
Patients saved - pending...
Lecture presentation - waiting to be worked on
Yes, I live in two/three very different worlds: researcher/student , EMT, and professor :)
I love them all
Thursday, December 9, 2010
Exhaustion
I was doing good, I was working on studying, I was almost on top of things.
And now I a, overwhelmed. I still have secondaries. I have cardiopulmonary lectures that need studying piling up left and right. I got sleep but it feels like it wasn't enough.
I had a busy night on the ambulance. It was good, I got to see things that I had not seen yet and learned a lot. But then something as simple as ice now has me feeling guilty that I couldn't have done more. I feel like a should have warned someone, even if it was 4 in the morning.
I want time to pause. I want break to be here. I just want to make it through this holiday season and not break down.
Time. I just need some time.
And now I a, overwhelmed. I still have secondaries. I have cardiopulmonary lectures that need studying piling up left and right. I got sleep but it feels like it wasn't enough.
I had a busy night on the ambulance. It was good, I got to see things that I had not seen yet and learned a lot. But then something as simple as ice now has me feeling guilty that I couldn't have done more. I feel like a should have warned someone, even if it was 4 in the morning.
I want time to pause. I want break to be here. I just want to make it through this holiday season and not break down.
Time. I just need some time.
Friday, September 24, 2010
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!
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!
Monday, August 9, 2010
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.
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.
Saturday, July 3, 2010
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?'
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?'
Tuesday, June 29, 2010
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.
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.
Monday, June 28, 2010
Thursday, June 24, 2010
Friday, June 4, 2010
Exhausted
Exhausted.
Three calls back to back. It’s only the start of our shift. And there was a pediatric patient. They always drain me emotionally, even if they are okay the entire time in my care.
Exhausted.
0500 cardiac arrest call. I end up bagging the patient till the medic unit arrives on scene. The sun rises as we leave the scene.
Exhausted.
Filling out application after application to master’s programs. I need to go back to school. I realize this. But I hate writing personal statements. And in some ways it is still admitting defeat and having to deal with realities of screwing up in college. At least I am waitlisted, at least there might be a sense of hope.
Exhausted.
There is an ever growing pile of laundry to do. Dirty to wash so I have pants. Clean to fold so I have somewhere to sleep. We are not even going to into how much I need to clean my desk off.
Exhausted.
Treating mice every single day with oral drugs. For two weeks straight. Three weeks straight. Four weeks straight. On weekends too. Measuring tumors. Trying to finish experiments up. Trying to get everything done and leaving every day thinking I should have done more.
Exhausted.
My brain just wants to shut off and zone out to a book or TV. The sofa is at least a horizontal surface. I wake at 0300, all the lights still on, still dressed in what I wore to work, and all I can do is turn off the lights before curling back up on the sofa and sleeping.
Exhausted.
Medical school applications need to be started. Again. Maybe I will have a glimmer of hope this year. Maybe I will finally at least get an interview.
Exhausted.
House fire. No one is hurt. We check vitals signs and make sure no one is over heating. And we pack hose. Lots of hose. Its actually rather fun. But I am also the smallest person on scene and am seriously lacking upper body strength. I’ll but sore but I will have had a good time.
Exhausted.
Four calls, two back to back and the rest close enough together that sleep is questionable. They are all good calls. They all teach me something. The medic that hops on twice teaches me too. But I have to go to work in the morning and the last call gets me back into the station just at shift change.
Exhausted.
Three calls back to back. It’s only the start of our shift. And there was a pediatric patient. They always drain me emotionally, even if they are okay the entire time in my care.
Exhausted.
0500 cardiac arrest call. I end up bagging the patient till the medic unit arrives on scene. The sun rises as we leave the scene.
Exhausted.
Filling out application after application to master’s programs. I need to go back to school. I realize this. But I hate writing personal statements. And in some ways it is still admitting defeat and having to deal with realities of screwing up in college. At least I am waitlisted, at least there might be a sense of hope.
Exhausted.
There is an ever growing pile of laundry to do. Dirty to wash so I have pants. Clean to fold so I have somewhere to sleep. We are not even going to into how much I need to clean my desk off.
Exhausted.
Treating mice every single day with oral drugs. For two weeks straight. Three weeks straight. Four weeks straight. On weekends too. Measuring tumors. Trying to finish experiments up. Trying to get everything done and leaving every day thinking I should have done more.
Exhausted.
My brain just wants to shut off and zone out to a book or TV. The sofa is at least a horizontal surface. I wake at 0300, all the lights still on, still dressed in what I wore to work, and all I can do is turn off the lights before curling back up on the sofa and sleeping.
Exhausted.
Medical school applications need to be started. Again. Maybe I will have a glimmer of hope this year. Maybe I will finally at least get an interview.
Exhausted.
House fire. No one is hurt. We check vitals signs and make sure no one is over heating. And we pack hose. Lots of hose. Its actually rather fun. But I am also the smallest person on scene and am seriously lacking upper body strength. I’ll but sore but I will have had a good time.
Exhausted.
Four calls, two back to back and the rest close enough together that sleep is questionable. They are all good calls. They all teach me something. The medic that hops on twice teaches me too. But I have to go to work in the morning and the last call gets me back into the station just at shift change.
Exhausted.
Tuesday, April 6, 2010
Lessons Learned and Thoughts Provoked
I was rather excited to discover that my area as a whole may have learned a few things after the Blizzard of 2009 for the Blizzard of 2010. For the large part, no one was out. This is in sharp contrast to the 2009 blizzard in which many people were out driving in cars that could not handle snow and on roads that really were not good for cars, ambulances too for that matter, period. Its was eerily quiet on the medical side of the fence where I was. Unfortunately, I know that our engine had to go out numerous times for downed lines and tree limbs despite the weather. Further, I know several other stations in the area around us were running numerous medical and engine calls in drifts of snow that were waist deep almost the whole blizzard.
Now, right at the beginning of the 2010 blizzard, my crew and I did get a call which made me think. It was after dark and the snow was just starting to really come down. There was maybe four inches of snow on the ground, enough for us to take twice as long getting to the house as it would have normally, even with chains on the tires.
When we get there, we find a patient and his wife in the bedroom. He hasn't been feeling well and was throwing up a bit earlier. His vital signs were stable and he had been able to keep some water down earlier. Now, I am no doctor but I was fairly confident that he was not about to code, have serious dehydration, or die on us in the next hour at the very least. In fact, he looked rather good for being sick, maybe a bit warm and a bit weak, but that is expected if someone if fighting off the flu, be it regular or stomach.
Now here comes the sticky part, when we look out the window, its snowing cats, dogs, mice, rabbits, and maybe a few horses thrown in for good measure, significantly heavier than when we had arrived at the house. Now, we had no qualms about transporting the patient to hospital, but we were worried about his ability to get back home after he was discharged. If this was the "nice" end of the storm, the middle was sure to be horrible (and it was, nearly white out conditions by morning. They actually stopped plowing a bit at one point) and driving was going to be nearly impossible.
After some conversation and discussion about what we could and could not do (sorry, we can't treat you, we really only can transport you as an Basic unit and even an ALS unit could not have done much more for you but have your tried calling your doctor or pharmacy?), the patient decided that it was probably best to wait out the night and see if he felt any better in the morning. He would call us if anything got worse, encouraged by us really to call if anything got worse, and call his doctor in the morning. I don't like refusals in general, as I feel that if someone called 911 there probably was a reason, but I did agree with this patient that perhaps the risk of leaving his house was greater than staying in with a currently non-life threatening illness.
This is where I do truly envy the system over in the UK where medics are able to contact other forms of medicine than just the ER to help their patients. As an EMT, I can only encourage people to contact their doctors, not call one for them. It would be great to have other options beyond transport or not transport, particularly when the call is not life threatening and the patient really wants someone to help him figure out what to do or just get a ride to the local ER. Particularly in the middle of snow storm!
Now, right at the beginning of the 2010 blizzard, my crew and I did get a call which made me think. It was after dark and the snow was just starting to really come down. There was maybe four inches of snow on the ground, enough for us to take twice as long getting to the house as it would have normally, even with chains on the tires.
When we get there, we find a patient and his wife in the bedroom. He hasn't been feeling well and was throwing up a bit earlier. His vital signs were stable and he had been able to keep some water down earlier. Now, I am no doctor but I was fairly confident that he was not about to code, have serious dehydration, or die on us in the next hour at the very least. In fact, he looked rather good for being sick, maybe a bit warm and a bit weak, but that is expected if someone if fighting off the flu, be it regular or stomach.
Now here comes the sticky part, when we look out the window, its snowing cats, dogs, mice, rabbits, and maybe a few horses thrown in for good measure, significantly heavier than when we had arrived at the house. Now, we had no qualms about transporting the patient to hospital, but we were worried about his ability to get back home after he was discharged. If this was the "nice" end of the storm, the middle was sure to be horrible (and it was, nearly white out conditions by morning. They actually stopped plowing a bit at one point) and driving was going to be nearly impossible.
After some conversation and discussion about what we could and could not do (sorry, we can't treat you, we really only can transport you as an Basic unit and even an ALS unit could not have done much more for you but have your tried calling your doctor or pharmacy?), the patient decided that it was probably best to wait out the night and see if he felt any better in the morning. He would call us if anything got worse, encouraged by us really to call if anything got worse, and call his doctor in the morning. I don't like refusals in general, as I feel that if someone called 911 there probably was a reason, but I did agree with this patient that perhaps the risk of leaving his house was greater than staying in with a currently non-life threatening illness.
This is where I do truly envy the system over in the UK where medics are able to contact other forms of medicine than just the ER to help their patients. As an EMT, I can only encourage people to contact their doctors, not call one for them. It would be great to have other options beyond transport or not transport, particularly when the call is not life threatening and the patient really wants someone to help him figure out what to do or just get a ride to the local ER. Particularly in the middle of snow storm!
Wednesday, March 31, 2010
The Handover - "Respect" - March 2010 Edition
The Handover "Respect Edition" hosted over at Life Under the Lights
This may have been where I started reading EMS blogs and I love it when it comes out every month. Its a great snapshot of providers from across many a different EMS system.
Go! Read! Enjoy!
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