About two years ago the cops got excited. They discovered something called excited delirium. Rather than us medical geeks putting on training the cops did.
"Tasers don't work!" "Four men can't hold them down" and other comments abounded. The only hope for these patients? Nasal Versed!
WHAT????
How the heck do you expect me to do that? Enter.....the MAD! Mucosa Aerator Device! You connect a syringe to this cone shaped thing and shove it in their nose. Yea.... the delirious, taser-proof, superhuman folks are gonna let me shove this thing in their nose??
Fast forward one month. The cops call us in. They got one! They need us to put her down. I walk in the apartment not sure what to expect. A young woman with flushed cheeks is in a corner, surrounded by cops looking scared. Occasionally she tries to break through them to get away but doesn't. Already I am skeptical. Excited Delirium is supposed to rank up there with PCP. I have dealt with those patients before. Three firefighters, two cops and me sticking them with needles wherever I can find an open patch of skin trying to sedate them to no avail. This just didn't have the same intensity.
My partner and I walk up to her and place our hands on her arms. While talking in a soothing voice we guide her to the gurney. Her face is flushed and dry. Her pupils are HUGE and she is incoherent. But she is not angry. We search her apartment for any signs of drugs. This isn't acting like any drug I have seen. Narcotics make you sleepy and incoherent, but pupils are small and the dry flushed face is abnormal as well.
She isn't tweaking like a mether, with the jerky, picky movements. Nor is her heart about to jump out of her chest. I already described PCP.
We gently push her back onto the gurney and she immediately jumps back up. We go back and forth several times before we let the cops come in and pin her while we restrain her. I always wait as long as I can to do that. It usually just pisses people off. Sure enough the fight is on. She is screaming jibberish and thrashing against her restraints. The cops are jacked up.
"You gotta do the nasal thingy!" one of them yells at me. They are sure this is the real deal. My earlier comments of uncertainty have gone unheeded.
I cave.
I pull out the Versed, a powerful benzodiazepine that is one of the few sedatives that might work, and draw up the dose. I screw on the MAD and now it is game on. The woman has all extremities pinned to the gurney but her head is loose. I try to put the MAD in her nose and she shakes her head violently. One of the firefighters that showed up and I trust completely holds her head and I rest my forearm on her forehead. I fight my conscious with the knowledge that this will calm her down and keep her from dying from a heart attack or overheating. I shove the MAD in and push the plunger. The woman screams and I narrowly miss being spit on. Her words still make no sense as she yells and flails about. I look at my partner. "Just go!"I yell. The excited cops are fighting over who is following us to the hospital as the back doors shut and we take off towards the hospital. The woman fights all the way. The versed had no effect. Her nose is bleeding.
I vowed then never to use that stupid MAD device again. It seemed almost inhumane to me. I would rather stick her with a needle in her arm or butt that do that again. We get to the ER. Two cops and hospital security is waiting for us. She is transferred to the hospital bed and restrained again. The Er doc comes in and looks at her.
"She is having an anticholinergic response," he says matter-of-factly.
Wha???
I nod, tell him what we did for (to) her and leave. I get in the ambulance and look the term up. Almost the exact same signs and symptoms, minus super human strength. One of the most common medications to cause this?? Benadryl. We found an empty bottle at her house. Dangit!!
A Benadryl Overdose? Really? We just practically tortured that woman, accused her of taking drugs, made a scene at her apartments and she took too much Benadryl?
Granted we still would have had to restrain her and get her to the hospital. But the nasal Versed was overkill.
A while later the cops called me to a possible Excited Delirium. I showed up, put the patient on the gurney, told the officer in my face to shove it and drove the man to the hospital. I have never used teh MAD again! And I never will.
http://en.wikipedia.org/wiki/Excited_delerium
http://en.wikipedia.org/wiki/Anticholinergic
- Check out the signs and symptoms for yourself.
Stories of my life as a mom, wife, paramedic, and student.
Wednesday, September 5, 2012
Friday, March 30, 2012
A Comedy of Errors...
Normal shift with a different partner than usual. He is a friend of mine though so we have fun together. I was so happy I happened to have the J-man this day! We get paged for a long distance transport from Southern Oregon to Portland, 4 and a half hours away. Luckily a Portland crew is going to meet us halfway there so we can transfer the patient. We go to the hospital to pick up our patient and find a pleasant lady, dressed in normal clothes and ready to go.
"She is just going up north for some tests" the nurse tells me. She goes to take the patients IV out. I ask if they will use it up there and we decide to leave it in. A decision I will later be extremely glad we made. Our patient stands with some help and walks to our gurney. She has some oxygen on but other than that doesn't need anything. On our way down to the ambulance my partner and I discuss the fact that he can tech this call. As we put our bed into the ambulance we notice she is still breathing hard from her small exertion. We decide I will take it and we start down the road. I give her a breathing treatment but it doesn't seem to help. By the time we are half an hour pout of town she is breathing quite hard. I start another treatment. I put her on CO2 capnography and find her values are quite high. She is starting to panic, not able to breathe well. I know from experience this is a bad sign. At this point its half an hour to the next hospital or forty-five minutes back to mine. I yell at my partner to floor it and light-er-up! She takes that moment to stop breathing.
"Get me a firetruck!" I yell up to him.
"I don't know how to reach them," he yells back.
"Call our dispatch and have them call their dispatch and get a firetruck to meet us at the next exit!" I yell as I try to breathe for my patient. Two exits later a shiny red truck is waiting for us on the side of the road, lights ablaze. As soon as we come to a stop the side doors and back doors fly open and three firefighter pour in.
"How can we help!" one asks and again I am reminded how great a community the emergency services is. I direct one to put her on the heart monitor, my partner to access the luckily retained IV and a third to pull up the drugs needed to RSI (Rapid Sequence Intubation). Basically we paralyze the patient, put a tube down her throat and breathe for them. I notice one firefighter is unusually twitchy. As I am setting up my equipment I he finally gets the courage to tell me he is a paramedic student. Ahhhhh.
I ask if he would like to try the intubation and he nods eagerly. I remember those days! I give him my spot in the airway chair and watch him try to tube. "Got it!" he says. I look at the monitor and my Co2 detector. I pull out my stethoscope and listen over her lungs and stomach. Nope. Its in her stomach.
I wedge my way in and pull the tube. I take a look and place it. Good reading and good breathe sounds. "You know where the Hospital is here?" I ask J-man. Yep he does. The intern and 1 firefighter ride with me as we work on stabilizing the poor woman's vital signs. Finally we arrive at the foreign hospital and deposit our patient. I thank the firemen and start my chart. J-man is out cleaning the ambulance when a nurse comes and finds me. She nicely informs me the doctor thinks she needs to continue to Portland for further care. okay.
Let me point out t few things here. We are not a portable hospital despite what we think. An ambulances job is to stabilize and transport. Not extended critical care. We do not have the equipment needed for that kind of care. I call J-man in and ask him if the Portland crew can come south a little farther and get the patient or if we should meet them at the per-determined site. I continue my chart.
J comes in with an odd look on his face. Apparently our well meaning dispatcher heard us divert to the hospital and took it upon himself to cancel the Portland crew. "Well turn their asses around!" I snip at him. My crabbiness can be explained by the fact I am 5 months pregnant, nauseated and hungry.
In walks J again. He tells me the Portland crew is not equipped to handle an intunated patient. Apparently in big city Portland they have vent cars that transport those. We have a single use port-vent we use. It is very easy and I can teach a monkey to use it in about ten minutes. I tell them I will teach them how. Ten minutes later they call back and say they have a broken windshield wiper and have to turn around. I tell them to stop at any gas station and buy a new one. Better yet, stop where they are and I will give them one of ours if they will just meet us! No go. They are headed back.
A brilliant idea hits me! Fly her! Of course!! Had she been intubated before we left they would have flown her. They would never had sent her by ambulance. Words with my supervisor send J in to see me again. This time he just chuckles and shakes his head. No helo. I take a deep breathe. What can I do?
I go out to see the doctor. "ok" I say. "I will take her to Portland. But I am pregnant and need to eat. Can she wait ten minutes?" The doctor obligingly shows me to the break room where sandwiches greet my rumbling tummy. As I gorge myself on crappy hospital food J walks in again. He looks at me and chuckles again. I stop eating and roll my eyes. It's coming. "What now?" I ask.
"We are out of oxygen." What! We were low but still in acceptable limits when we left. Our patient was not supposed to be needing 100% oxygen for the whole trip so we should have been fine. But the two breathing treatments and then over thirty minutes of highflow oxygen as we breathed for her tapped the tank. My portable ventilator is oxygen dependent. it will not work without it. We are 2 1/2 hours from Portland and have three full pony (small) bottles. Not enough. We explain our dilemma to the hospital and they loan us two more.
Allright! Lets do this. We start out into the torrential downpour that crippled our Portland counterparts. (Trust me. Their supervisor got an earful when we arrived!) An hour into our transport the patient begins to wake up, the sedative the hospital gave had worn off. I have two doses. The first I gave when I intubated her earlier. I give her the second now. We are half an hour away when I put our last pony bottle on. A sudden jerk of the ambulance awakens me to our surroundings. We are getting off the freeway. What? There is no way we are there yet.
"What are you doing?" I yell up to J.
"Gotta get fuel," he yells back. Are you freaking kidding me?????
We get back on the road again and I hear a beep beep beep. I look a the heart monitor which also monitors her breathing, oxygen saturation and Co2. I have been changing batteries the whole trip and they need changing again. One problem. I am all out. Almost to our exit. We can make it.
My oxygen bottle runs dry.
I remove my vent and start to manually ventilate my patient.
Beep Beep Beep! Replace Batteries! The monitor repeats every few minutes. My patient begins to stir.
"Are we there yet?!?!?!?!?" Almost. I am out of oxygen, sedative and batteries. My patients hand is now grabbing for the tube and she is gagging. I hold it down.
"Do you want me back there to help or keep driving?" J yells back at me as he swerves through traffic. We are off the freeway now heading for the hospital on the hill.
"Just drive," I respond. We can do this. And we do. He pulls in the parking lot and throws open the back doors. He has enlisted the help of two medics outside the ER to help us out. This hospital is huge and we have no idea where we are going. They have no idea the condition the patient is in. They are expecting a walking, talking woman. We wind our way through the hospital. I was able to hook back up to one of our first pony bottles that I had changed slightly prematurely and still had a little more to give. On medic is leading the way, my partner is at the patients feet steering and the other medic is dedicated solely to keeping the patient's hands pinned down.Finally we deliver her into the competent nurses hands and head down stairs. Just another day.
As a side note I recently ran this woman again. She survived our ordeal and is back home in Southern Oregon. Her mystery diagnosis was Guillian-Barre Syndrome from a bad flu shot. Her respiratory muscles became paralyzed suddenly. I was excited to see her again and she thanked me profusely for the help we gave her that day. These are one of the calls that make it worth it. Even though everything that could have gone wrong did, it still turned out good. And much thanks to J-man!!
Tonight I am not quite so disgruntled.....
"She is just going up north for some tests" the nurse tells me. She goes to take the patients IV out. I ask if they will use it up there and we decide to leave it in. A decision I will later be extremely glad we made. Our patient stands with some help and walks to our gurney. She has some oxygen on but other than that doesn't need anything. On our way down to the ambulance my partner and I discuss the fact that he can tech this call. As we put our bed into the ambulance we notice she is still breathing hard from her small exertion. We decide I will take it and we start down the road. I give her a breathing treatment but it doesn't seem to help. By the time we are half an hour pout of town she is breathing quite hard. I start another treatment. I put her on CO2 capnography and find her values are quite high. She is starting to panic, not able to breathe well. I know from experience this is a bad sign. At this point its half an hour to the next hospital or forty-five minutes back to mine. I yell at my partner to floor it and light-er-up! She takes that moment to stop breathing.
"Get me a firetruck!" I yell up to him.
"I don't know how to reach them," he yells back.
"Call our dispatch and have them call their dispatch and get a firetruck to meet us at the next exit!" I yell as I try to breathe for my patient. Two exits later a shiny red truck is waiting for us on the side of the road, lights ablaze. As soon as we come to a stop the side doors and back doors fly open and three firefighter pour in.
"How can we help!" one asks and again I am reminded how great a community the emergency services is. I direct one to put her on the heart monitor, my partner to access the luckily retained IV and a third to pull up the drugs needed to RSI (Rapid Sequence Intubation). Basically we paralyze the patient, put a tube down her throat and breathe for them. I notice one firefighter is unusually twitchy. As I am setting up my equipment I he finally gets the courage to tell me he is a paramedic student. Ahhhhh.
I ask if he would like to try the intubation and he nods eagerly. I remember those days! I give him my spot in the airway chair and watch him try to tube. "Got it!" he says. I look at the monitor and my Co2 detector. I pull out my stethoscope and listen over her lungs and stomach. Nope. Its in her stomach.
I wedge my way in and pull the tube. I take a look and place it. Good reading and good breathe sounds. "You know where the Hospital is here?" I ask J-man. Yep he does. The intern and 1 firefighter ride with me as we work on stabilizing the poor woman's vital signs. Finally we arrive at the foreign hospital and deposit our patient. I thank the firemen and start my chart. J-man is out cleaning the ambulance when a nurse comes and finds me. She nicely informs me the doctor thinks she needs to continue to Portland for further care. okay.
Let me point out t few things here. We are not a portable hospital despite what we think. An ambulances job is to stabilize and transport. Not extended critical care. We do not have the equipment needed for that kind of care. I call J-man in and ask him if the Portland crew can come south a little farther and get the patient or if we should meet them at the per-determined site. I continue my chart.
J comes in with an odd look on his face. Apparently our well meaning dispatcher heard us divert to the hospital and took it upon himself to cancel the Portland crew. "Well turn their asses around!" I snip at him. My crabbiness can be explained by the fact I am 5 months pregnant, nauseated and hungry.
In walks J again. He tells me the Portland crew is not equipped to handle an intunated patient. Apparently in big city Portland they have vent cars that transport those. We have a single use port-vent we use. It is very easy and I can teach a monkey to use it in about ten minutes. I tell them I will teach them how. Ten minutes later they call back and say they have a broken windshield wiper and have to turn around. I tell them to stop at any gas station and buy a new one. Better yet, stop where they are and I will give them one of ours if they will just meet us! No go. They are headed back.
A brilliant idea hits me! Fly her! Of course!! Had she been intubated before we left they would have flown her. They would never had sent her by ambulance. Words with my supervisor send J in to see me again. This time he just chuckles and shakes his head. No helo. I take a deep breathe. What can I do?
I go out to see the doctor. "ok" I say. "I will take her to Portland. But I am pregnant and need to eat. Can she wait ten minutes?" The doctor obligingly shows me to the break room where sandwiches greet my rumbling tummy. As I gorge myself on crappy hospital food J walks in again. He looks at me and chuckles again. I stop eating and roll my eyes. It's coming. "What now?" I ask.
"We are out of oxygen." What! We were low but still in acceptable limits when we left. Our patient was not supposed to be needing 100% oxygen for the whole trip so we should have been fine. But the two breathing treatments and then over thirty minutes of highflow oxygen as we breathed for her tapped the tank. My portable ventilator is oxygen dependent. it will not work without it. We are 2 1/2 hours from Portland and have three full pony (small) bottles. Not enough. We explain our dilemma to the hospital and they loan us two more.
Allright! Lets do this. We start out into the torrential downpour that crippled our Portland counterparts. (Trust me. Their supervisor got an earful when we arrived!) An hour into our transport the patient begins to wake up, the sedative the hospital gave had worn off. I have two doses. The first I gave when I intubated her earlier. I give her the second now. We are half an hour away when I put our last pony bottle on. A sudden jerk of the ambulance awakens me to our surroundings. We are getting off the freeway. What? There is no way we are there yet.
"What are you doing?" I yell up to J.
"Gotta get fuel," he yells back. Are you freaking kidding me?????
We get back on the road again and I hear a beep beep beep. I look a the heart monitor which also monitors her breathing, oxygen saturation and Co2. I have been changing batteries the whole trip and they need changing again. One problem. I am all out. Almost to our exit. We can make it.
My oxygen bottle runs dry.
I remove my vent and start to manually ventilate my patient.
Beep Beep Beep! Replace Batteries! The monitor repeats every few minutes. My patient begins to stir.
"Are we there yet?!?!?!?!?" Almost. I am out of oxygen, sedative and batteries. My patients hand is now grabbing for the tube and she is gagging. I hold it down.
"Do you want me back there to help or keep driving?" J yells back at me as he swerves through traffic. We are off the freeway now heading for the hospital on the hill.
"Just drive," I respond. We can do this. And we do. He pulls in the parking lot and throws open the back doors. He has enlisted the help of two medics outside the ER to help us out. This hospital is huge and we have no idea where we are going. They have no idea the condition the patient is in. They are expecting a walking, talking woman. We wind our way through the hospital. I was able to hook back up to one of our first pony bottles that I had changed slightly prematurely and still had a little more to give. On medic is leading the way, my partner is at the patients feet steering and the other medic is dedicated solely to keeping the patient's hands pinned down.Finally we deliver her into the competent nurses hands and head down stairs. Just another day.
As a side note I recently ran this woman again. She survived our ordeal and is back home in Southern Oregon. Her mystery diagnosis was Guillian-Barre Syndrome from a bad flu shot. Her respiratory muscles became paralyzed suddenly. I was excited to see her again and she thanked me profusely for the help we gave her that day. These are one of the calls that make it worth it. Even though everything that could have gone wrong did, it still turned out good. And much thanks to J-man!!
Tonight I am not quite so disgruntled.....
Thursday, March 15, 2012
I couldn't bring myself to save him....
Many of us joke around with the title "paragod" instead of paramedic. Obviously there is no truth to that. Most of the people who call us don't need us. Those who do, there are pretty cut and dry standards and procedures of what to do. The chances we take are when a procedure could cause more harm than good. However we are covered because we were following a protocol. There are a very few patients were we are really truly in charge of if they live or die. I let one die today,
Truth be told he was already dead. For how long I do not know. I walked in the room and recognized him instantly. He was a frail man with more things wrong with him than right, He was wheelchair bound and cried in pain anytime we touched him. Everyone dreaded going on him because you could not treat him without hurting him. His health had been declining for years. His friend was there yelling for us to save him. He had not been seen since the night before. In order to survive CPR needs to be done within minutes of death.
The first thing I do on any possible dead body call is grab their arm. You learn a lot with the simple grabbing of a wrist and raising it above a persons head. Skin temperature. If it's cold, he is dead. Rigor mortis, he is dead. Lividity, (discolored skin where the person is contacting the floor, bed etc.) dead. He had none of these. Many people with this many health problems and a poor quality of life have a DNR or Do Not Resuscitate order. His freind said he didn't and to do anything.
I quickly cut his shirt off and place the defibrillator pads. As the monitor turns on I place my hands on his chest and prepare to start CPR. His ribs are protruding so badly it seems as though they may pop through his skin. I remove my hands and check again for a pulse. I look at his eyes. Fixed, dialated. Dead. I poise my hands again, shuddering inside thinking of the crunches, pops and damage I am about to inflict on his person. I cannot do it. The heart monitor shows Aystole. No heart movement. Flat line. Despite what TV says you cannot shock that. I poise my hands one more time.
"Check his back for lividity," my partner offers, sensing my hesitation and feeling the same way. To do CPR on someone as frail as him seems like cruelty. We roll him to his side and look, strain to see some discoloration. Perhaps it was dents from the fabric he lay on. Perhaps it was the beginning of lividity. Whatever it was, I called it. "I'm sorry," I tell his friend. "We cannot save him."
The truth is, I did not want to.
Truth be told he was already dead. For how long I do not know. I walked in the room and recognized him instantly. He was a frail man with more things wrong with him than right, He was wheelchair bound and cried in pain anytime we touched him. Everyone dreaded going on him because you could not treat him without hurting him. His health had been declining for years. His friend was there yelling for us to save him. He had not been seen since the night before. In order to survive CPR needs to be done within minutes of death.
The first thing I do on any possible dead body call is grab their arm. You learn a lot with the simple grabbing of a wrist and raising it above a persons head. Skin temperature. If it's cold, he is dead. Rigor mortis, he is dead. Lividity, (discolored skin where the person is contacting the floor, bed etc.) dead. He had none of these. Many people with this many health problems and a poor quality of life have a DNR or Do Not Resuscitate order. His freind said he didn't and to do anything.
I quickly cut his shirt off and place the defibrillator pads. As the monitor turns on I place my hands on his chest and prepare to start CPR. His ribs are protruding so badly it seems as though they may pop through his skin. I remove my hands and check again for a pulse. I look at his eyes. Fixed, dialated. Dead. I poise my hands again, shuddering inside thinking of the crunches, pops and damage I am about to inflict on his person. I cannot do it. The heart monitor shows Aystole. No heart movement. Flat line. Despite what TV says you cannot shock that. I poise my hands one more time.
"Check his back for lividity," my partner offers, sensing my hesitation and feeling the same way. To do CPR on someone as frail as him seems like cruelty. We roll him to his side and look, strain to see some discoloration. Perhaps it was dents from the fabric he lay on. Perhaps it was the beginning of lividity. Whatever it was, I called it. "I'm sorry," I tell his friend. "We cannot save him."
The truth is, I did not want to.
Thursday, March 1, 2012
I am not a freaking taxi!!
Nothing pisses me off more than the non emergent patient. People with no insurance are the worst culprits of the taxi ride ambulance. They have no intention of paying their bills so they call for anything. Nauseated? Call 911. Sore throat? Call 911. Sale at the Dollar Store and you live far from town? Call 911. Literally people have told me they know its not an emergency but if they call an ambulance they will not have to wait in the waiting room. Really? We only have 5 ambulances in the entire county and you think its ok to call one of us out because you have the flu and don't want to wait the 3 days the rest of the world does to feel better? I have even had patients literally walkout the front door before I get my chart done. Why do we waste our time and money on these obnoxious people? This sue happy world has made it impossible for us to refuse these requests on the off chance one really is having an emergency. I might get my company sued if I refuse to take the guy with the "killer zit" to the hospital. (I swear I am not making this shit up!) There are days I want to get a magnetic sticker for the side of my ambulance that says TAXI. Because sick people rarely call us. Just assholes.
Thursday, February 16, 2012
Whoops...my patient died
Ok. Every person in the medical field has looked back on their career and thought of a patient that, if they didn't kill, they at least did not help. Not on purpose of course. Well this patient is a little different. I know now that there was no way to save him. But I digress.
Busy days are the worst. Nothing is as exciting as crawling into your lumpy bed and pulling your blanket/sleeping bag/sweater or whatever you have with you over your shoulders and closing your eyes. BEEP BEEP BEEP! Dammit! The stupid radio! "MVA in the middle of Frickin Nowhere!" I honest to goodness slept my way out to the call while my partner drove like a bat outta hell, lights and siren on. We pull up to the scene. A battered and bloody man is sitting on the bumper of the fire truck.
"Can you wake up my buddy so we can go home?" he asks me, his drunken slur unmistakable. I scramble down to where the action is. Four firefighters are piled inside a single cab truck around my patient who is barely breathing. Before I get to the truck, one firefighter is yelling to me, "I'm going with you to the hospital"!! I shrug. I don't give a crap who comes with me. Maybe no one will come with me depending on the patient. This particular firefighter annoys me anyways. When I fail to answer her and begin assessing my patient she taps her bloody fingers on my shoulder and repeats herself.
"Fine!" I answer just to get her to shut up. She drops the c-collar she was putting on the patient and runs to yell at her captain I said she could come with me. The patients head bobbles. Three of us gasp and grab his head. I yell for someone to put the c-collar on and ask the guy breathing for the patient if there is an airway adjunct in (something that keeps the airway open). A quick shake of his head tells me airway is priority. I set my EMT to get an IV and I attempt my first (and so far, last) NASCAR style intubation. I am lying on the hood of the pickup my head and shoulders through the broken windshield attempting to stick a tube down this guys throat. Needless to say, it fails. We forget the airway and haul his but onto a backboard and trek him up the embankment to the ambulance. The one overeager firefighter is waiting in the back of the ambulance. I take one look at her and one look at the patient and ask for another firefighter too. We are at least twenty minutes to town so I tell my partner to go and I will do everything else enroute. Jumpy firefighter is helping the patient breath and competent firefighter is helping me set up medication and equipment to try to intubate again.
I push Jumpy out of my way and attempt another intubation. One breath in and the tube fills with blood. I pull the tube out and bloody vomit follows immediately. All over the patient. All over the ambulance. All over me. Now I am annoyed. I ask Jumpy to suction his airway while I get a new tube. The task seems to be too much for her so Competent jumps in and helps. I kneel in the pool of bloody vomit, cringing as I do so. I attempt an airway again with the same result. I am truly annoyed now. I have failed to get an airway, my #1 priority, and I am covered in nastiness. We are about 10 minutes from the hospital and I pick up the radio to let them know where we are. Just them Competent says, "Hey! look at the monitor. How long has he been dead?" In silence we all three stare at the flatline on the heart monitor. "Shit!"
We start CPR and medications to start the heart with no real gusto. We all know the facts. Trauma codes don't come back. We arrive at the hospital and the doctor calls him dead before we finish transferring him over. Now that we are in a big trauma room with bright lights and no rain I can clearly see a large split down the side of his head. Yeah, he never had a chance. Still, I never want to hear my firefighter say to me again "how long has he been dead?"
Busy days are the worst. Nothing is as exciting as crawling into your lumpy bed and pulling your blanket/sleeping bag/sweater or whatever you have with you over your shoulders and closing your eyes. BEEP BEEP BEEP! Dammit! The stupid radio! "MVA in the middle of Frickin Nowhere!" I honest to goodness slept my way out to the call while my partner drove like a bat outta hell, lights and siren on. We pull up to the scene. A battered and bloody man is sitting on the bumper of the fire truck.
"Can you wake up my buddy so we can go home?" he asks me, his drunken slur unmistakable. I scramble down to where the action is. Four firefighters are piled inside a single cab truck around my patient who is barely breathing. Before I get to the truck, one firefighter is yelling to me, "I'm going with you to the hospital"!! I shrug. I don't give a crap who comes with me. Maybe no one will come with me depending on the patient. This particular firefighter annoys me anyways. When I fail to answer her and begin assessing my patient she taps her bloody fingers on my shoulder and repeats herself.
"Fine!" I answer just to get her to shut up. She drops the c-collar she was putting on the patient and runs to yell at her captain I said she could come with me. The patients head bobbles. Three of us gasp and grab his head. I yell for someone to put the c-collar on and ask the guy breathing for the patient if there is an airway adjunct in (something that keeps the airway open). A quick shake of his head tells me airway is priority. I set my EMT to get an IV and I attempt my first (and so far, last) NASCAR style intubation. I am lying on the hood of the pickup my head and shoulders through the broken windshield attempting to stick a tube down this guys throat. Needless to say, it fails. We forget the airway and haul his but onto a backboard and trek him up the embankment to the ambulance. The one overeager firefighter is waiting in the back of the ambulance. I take one look at her and one look at the patient and ask for another firefighter too. We are at least twenty minutes to town so I tell my partner to go and I will do everything else enroute. Jumpy firefighter is helping the patient breath and competent firefighter is helping me set up medication and equipment to try to intubate again.
I push Jumpy out of my way and attempt another intubation. One breath in and the tube fills with blood. I pull the tube out and bloody vomit follows immediately. All over the patient. All over the ambulance. All over me. Now I am annoyed. I ask Jumpy to suction his airway while I get a new tube. The task seems to be too much for her so Competent jumps in and helps. I kneel in the pool of bloody vomit, cringing as I do so. I attempt an airway again with the same result. I am truly annoyed now. I have failed to get an airway, my #1 priority, and I am covered in nastiness. We are about 10 minutes from the hospital and I pick up the radio to let them know where we are. Just them Competent says, "Hey! look at the monitor. How long has he been dead?" In silence we all three stare at the flatline on the heart monitor. "Shit!"
We start CPR and medications to start the heart with no real gusto. We all know the facts. Trauma codes don't come back. We arrive at the hospital and the doctor calls him dead before we finish transferring him over. Now that we are in a big trauma room with bright lights and no rain I can clearly see a large split down the side of his head. Yeah, he never had a chance. Still, I never want to hear my firefighter say to me again "how long has he been dead?"
Monday, February 13, 2012
Disgusting People
Busy days mean eating what you can, when you can. I had just shoveled in a large meal from Taco Bell when we got a call for a sick person. My stomach rolled as we navigated the streets to a small cul-de-sac on the other end of town. A woman is standing outside smoking as we arrive. Dispatch was busy so we got no info. "Are you my patient?" I ask, hopeful this will be an easy call. She shakes her head no and starts explaining how its not her fault. What is not her fault? I don't really care so I walk past her pretending to listen and in the front door. The smell assaults me as I walk in. The house is dirty. Not 'I haven't folded my laundry' or its been a few days since I vacuumed' dirty but years of filth and neglect dirty. The cobwebs in the corners have dirt hanging off them. There is literally no more room on the kitchen counter for another empty container, dirty dish or half rotten food. It is a scene from the show Hoarders, only with a path wide enough for his electric wheelchair to go through.
Sadly this is not the first house I have seen in this condition. The wheelchair is emitting an odor I know well too. Gangrene. My stomach rolls again. The woman at the door now says it has been two weeks since he has taken his shoes off. Hesitantly my eyes roll down to his feet. Among the misshapen toenails and different colored flesh I see an open wound on the top of his foot that is oozing. I look around the room a little more carefully. Blood and pus have been smeared on surfaces, doors and the TV. Two weeks? The woman replies it may have been more like a month. My stomach is losing the battle. I retreat to outside because I "forgot something" in the ambulance, my partner hot on my heals. We take some deep breathes and grab bandages. I put them on loosely and from as far away as I can. We help him to our bed and vacate the house as soon as possible. I figure his health is generally poor judging from the house and the kitchen. I start an IV and breathe through my mouth. "So two weeks?"I ask the poor old man. "You haven't taken your shoes off that long?" He shakes his head. "So, uh, does that mean you haven't showered in that long too?" He smiles at me, a huge grin.Food particles and who knows what else are caked on his teeth at least halfway up his teeth.
My stomach lost its battle.
Sadly this is not the first house I have seen in this condition. The wheelchair is emitting an odor I know well too. Gangrene. My stomach rolls again. The woman at the door now says it has been two weeks since he has taken his shoes off. Hesitantly my eyes roll down to his feet. Among the misshapen toenails and different colored flesh I see an open wound on the top of his foot that is oozing. I look around the room a little more carefully. Blood and pus have been smeared on surfaces, doors and the TV. Two weeks? The woman replies it may have been more like a month. My stomach is losing the battle. I retreat to outside because I "forgot something" in the ambulance, my partner hot on my heals. We take some deep breathes and grab bandages. I put them on loosely and from as far away as I can. We help him to our bed and vacate the house as soon as possible. I figure his health is generally poor judging from the house and the kitchen. I start an IV and breathe through my mouth. "So two weeks?"I ask the poor old man. "You haven't taken your shoes off that long?" He shakes his head. "So, uh, does that mean you haven't showered in that long too?" He smiles at me, a huge grin.Food particles and who knows what else are caked on his teeth at least halfway up his teeth.
My stomach lost its battle.
Saturday, February 11, 2012
The most exciting job in the world.....
People meet me and ask what I do for a living. "A Paramedic?" they say. "Wow, that must be exciting!" Well, let me tell you about the most exciting job ever. I get to work and say hello to my fellow EMS workers. Hello is often answered with a detailed description of the day and how it sucks. I grab my keys to my ambulance, my box of narcotics that several patients will try to con me out of during the course of the day and my dreaded radio. We climb into the rig to find out what kind of poor condition it was left in by the crew before. Unless there is blood, vomit or a missing heart monitor I keep my mouth shut about anything that might be wrong. After all, tomorrow I will probably not leave it much better for them.
We head to post, usually some street corner where we can pilfer wi-fi and see a good assortment of crazy people. Some times we are there five minutes and sometimes it's two hours. One thing is for sure. My back hurts sitting in these damn ambulances but I am too scared of the psychos outside to get out and stretch.
90% of my calls involve people over the age of 75 and probably 80% of my calls do not need to go to the hospital. Three phrases that will instantly make me hate you are 1. If I go with you I will not have to sit in the lobby, 2. I have an appointment with my doctor tomorrow, and 3. This has been going on for several days (usually this one is at 2am on a weekend).
Fall victims are prevalent in the elderly. We go, help them up and leave. They use their handy lifeline buttons to get us to haul ass to their homes only to find they need to change their oxygen bottles, the battery in their wheelchair is dying, they want their blood pressure checked or they are unsure how many pills they can take.
Most car accidents are fender benders where a person is convinced they will get out of a ticket or get more money if they say they have neck pain. Not to mention the two or three patients a day who have been vomiting for an hour and want us to "make it stop!" You have the flu! Drink some water and go to bed you jack ass!
Then occasionally, not even every shift, it happens. A real call. A call that requires you to use your skills. A call where someone really needs you. You rush in.make command decisions and think, this is why I am here. Then the doctor yells at you for forgetting to bring one of the patients 17 medications or your boss yells at you for forgetting to get a copy of their insurance card. By the end of the day I am tired, grumpy and behind in charts. Some days I can barely remember all the calls if its been busy. I try to replace everything we used in the last twelve hours. A new fresh crew comes in as I am trying to finish up. I give them a detailed report of my day, even though they didn't ask so they know my shift sucked and go home, once more a disgruntled paramedic.
We head to post, usually some street corner where we can pilfer wi-fi and see a good assortment of crazy people. Some times we are there five minutes and sometimes it's two hours. One thing is for sure. My back hurts sitting in these damn ambulances but I am too scared of the psychos outside to get out and stretch.
90% of my calls involve people over the age of 75 and probably 80% of my calls do not need to go to the hospital. Three phrases that will instantly make me hate you are 1. If I go with you I will not have to sit in the lobby, 2. I have an appointment with my doctor tomorrow, and 3. This has been going on for several days (usually this one is at 2am on a weekend).
Fall victims are prevalent in the elderly. We go, help them up and leave. They use their handy lifeline buttons to get us to haul ass to their homes only to find they need to change their oxygen bottles, the battery in their wheelchair is dying, they want their blood pressure checked or they are unsure how many pills they can take.
Most car accidents are fender benders where a person is convinced they will get out of a ticket or get more money if they say they have neck pain. Not to mention the two or three patients a day who have been vomiting for an hour and want us to "make it stop!" You have the flu! Drink some water and go to bed you jack ass!
Then occasionally, not even every shift, it happens. A real call. A call that requires you to use your skills. A call where someone really needs you. You rush in.make command decisions and think, this is why I am here. Then the doctor yells at you for forgetting to bring one of the patients 17 medications or your boss yells at you for forgetting to get a copy of their insurance card. By the end of the day I am tired, grumpy and behind in charts. Some days I can barely remember all the calls if its been busy. I try to replace everything we used in the last twelve hours. A new fresh crew comes in as I am trying to finish up. I give them a detailed report of my day, even though they didn't ask so they know my shift sucked and go home, once more a disgruntled paramedic.
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