CPR, Collapsed Lungs & Tour Guides

Well there is plenty to anecdote about yesterdays 24 hours. The usual 911 abusers are always there and when dispatch is rattling off the address my partner and I can always look at each other and know what we're in for.

We respond to our frequent flier who is a 25 yo kid who lives with his mom and sisters. He is a hypochondriac who is always afraid that if we don't rush him to the hospital he's gonna die. We haven't been to his house in a month or so, but the other 2 shifts have. We get there and he's complaining of a cough. Yes, a cough. He's been congested and coughing for 4-5 days. He has no medical hx and has taken nothing OTC. It kills me how some people refuse to go to the giant local Walmart or Kroger and pend the $5-8 for some decongestant and stay at home. Anyways... his ribs hurt. He's called 911 because he's afraid he has a collapsed lung. O2 is at 99% with all vitals w/in normal limits. We educate him a little and we leave. Oh yeah... and tell him if he wants to go to the hospital, the 7 cars in the driveway can take him.

Later in the night we get dispatched for a man w/ diabetic problems. Its an address we got to very often. Very non-compliant diabetic on dialysis. Normally we get there, give him an amp of D50 and leave. We walk in and he's supine on the floor. Still. Calm. Initial assessment... sternal rub... talking to the family to get an update... MM (my partner) says is he diaphoretic? I look up and say Is he breathing? Damn. We call a cardiac arrest as the engine company walks in. It goes as well as any cardiac arrest can. The family has absolutely no clue what is happening and start calling other family members to come over. As we're doing chest compressions I overhear a family say on the phone, "They're trying to wake him up". Well, yeah I guess you could say that. We keep working. Unfortunately, lots... let me rephrase that... a plethora of vomit showers us while getting the tube. Mmmmmmm.... keep working. You force yourself to keep working. His glucose reads HI. He stays in Asystole throughout. We call him. While we have the family's consent to call him, all hell breaks lose when it hits them. PD really is needed to help maintain the scene. Lots of decon, laundry and showers later we're back in service. I can't write yet the rest due to legality issues... maybe another day.

And lastly, our tour guide at the county jail. We respond usually once shift. Our patient is an "A" patient who seems to just want some fresh air time outside the four concrete walls. We always just have to take them. They know the key words that get them transported. Anyways, like I said we're at the jail almost every shift. We walk in and get a detention officer who is like Mr. Rogers and gives us *literally* a play-by-play guide of our trip up to the 3rd floor medical sector. This is the elevator... We'll be getting off here... We'll be curving to the left here... (mind you there are no other options but the turn here or there) MM and I start eyeing each other and giggling. This guy's funny. He totally means well and is just so happy to be at his job. ...And this is the door we'll be going into... LOL. Stay safe out there!

History and Trauma

Wow... what a day... and my tour isn't even over yet. I am emotionally and physically drained but need to get this stuff down before I forget it. That, and my little squirt and I are spending the day together tomorrow and I'll never get it written. First, the good stuff.

Ya know how sometimes you are a part of a moment in time when you just know that you're witnessing a little bit of history? Well today, two of our department's finest have decided to retire. 30+ years they have served the citizens of this area. It just amazes me. I'm so far on the other side of the mountain I can't even fathom it. But these 2 great guys, 2 awesome leaders in our field, 2 excellent senior guys who love the job, who have that bone-deep passion for the job... are leaving. And I'm happy that they get to start a new chapter in their lives.... but also so sad that I've missed out on learning and laughing with these two. One is a moderate acquaintance in another territory and the other is a dear friend who I admire and trust very much. This place just won't be the same without them.

And now the crappy part. We just got back to the house after running an entrapment call. Crazy still how the dispatch rarely matches the scene. Usually it's a "all hell is breaking lose" dispatch, matched with a trash can fire. Well this was a fender bender dispatch, matched with a full entrapment, patient's losing consciousness, multiple (and I MEAN multiple) system trauma, compound fractures, etc.

We were on scene within 3 minutes of dispatch. Our patient had approx 7" from the edge of the steering wheel/dashboard and windshield and the back of the seat. Extrication was extensive and there was miscommunication between the bird I requested and our command. We arrived at the landing site only to find out they were another 14min out and going to land another 3-4 miles in the opposite direction of the ER.... when where we were at had a perfectly set-up LZ. Oh well. It ended up being conducive to just get on the highway and transport ourselves. We did everything we were trained to do, but unfortunately our patient did not make it.

But why is it always the post-adrenaline, post transfer of patient, de-con, re-stock, and paperwork that makes it so exhausting? I'm heading to bed. I'm exhausted.

*** Follow-up *** We found out a couple of shifts later that the original helicopter we requested for our patient had a bird strike while approaching the LZ and had to divert to an immediate drop-down. Just a shout-out to the flight medics, nurses and pilots who have an incredibly dangerous job to save others' lives.

Poo.... lots and lots of poo

We've all read the blogs and "about my job" stories from medics how we've all been vomited on, poo-ed on, spit on, bled on, etc. And everyone also knows... one time is one time too many. We got dispatched to a call for seizures. We get in the truck thinking its most likely either hypoglycemic or epileptic seizures. Enroute the computer updated us that the patient was now combative, running through the house and defecated everywhere. The patient had family there who was trying to help but also stay out of the patients way while they were combative.

Leads me to think hypoglycemic. We arrive on scene and are glad there is a fresh restock of BSI gowns in the cabinet. Its a dark home. The kind of home where there is one shade-less lamp in the corner of each room. The patient is supine and postictal on the bed (thank goodness) in a back bedroom. A bedroom where the headboard is wedged behind the door so that we only have a 12-15" clearance to get in... and get him out. Quickly find he is not hypoglycemic so we throw on some O2 and cocoon him in some sheets to get him out. He becomes very combative so that the only way to get him out is to grab ankles and wrists and drag. Not a pretty situation, but one with little to no alternatives. I administer some Versed to stop the new seizure activity and restrain him to the stretcher. Poo is still everywhere and growing. We get him into the rescue and head off to the ER. He has stopped seizing but is still very combative. Finally we get the pearl of information we've been needing. He is in stage 5 kidney failure. Ding. Ding. Ding. At least we have a most probable cause. He is so acidotic that his system is not compensating at all. After turning him over to the ER, they run his blood and get him stabilized. I see a long dialysis future for him.

It was a long and *very* detailed decon of our rescue, our equipment,... and ourselves. I don't think our rescue has been cleaner since it was delivered to us. Probably cleaner. After a good shower and some dinner (although I wasn't really hungry by now)... we were back in service to wait for the next one..... Stay safe out there.

Turkey-neckers

Crazy, I know? 2 posts in one day? Say it isn't so. I'm on way home from the grocery store this afternoon and pull up on an MVC that literally just happened. At an intersection, its a cross between a t-bone hit and side swipe. One female driver not hurt but cant get out (and is on the non-hit side) and a male trying to crawl out of the passenger side. Both of his airbags deployed and has light to moderate smoke and liquids coming from the engine compartment. There are also 3-4 other vehicles that have stopped to.... not render assistance... but stand around and holler to seemingly no one, "I'm going to call the police" or just making a broad announcement like a crowded restaurant "Is anyone hurt?" Jeez folks!

So I walk up to the crawling man and introduce myself. Ya know, when someone is able to crawl out of a vehicle, walk 10-15' and sit down, that already tells some of the picture. I assess him and ask the lady who is hollering about calling the police (because she still hasn't done it yet) to please relax, call 911 and tell them we have one injured and just need a basic rescue, etc, etc.

So I'm assessing the guy who is A/O x2 and a little wobbly still, and behind me I hear this engine just scream and make an awful racket! I turn to find some well-meaning but not-so-bright older woman who had crawled into this guy's SUV and try to crank the engine and revved it all the way!!! WTH!!! I holler for her to shut the engine off and get out of the vehicle! What the hell are you doing lady? "I was gonna try and move it out of the way" Move it where?? Why? It's wedged into another vehicle and its draining a ton of fluid underneath.... ugh! Then she comes and stands over my back so much so that she leans onto me for balance. OK, I've had enough. Yes, I'm not on duty. Yes, I'm not in a uniform. I've clearly identified myself to her as well as to the gentleman I'm assessing.... walk away lady. Walk away.

As soon as the rescue gets on scene, I give the basics and get out of there. They're on duty today. Not me. Now I'm home and the milk and eggs are in the fridge. Hhmmmmmm.....

Flood of 2009

Unless you've banned watching the news for the past couple of weeks, you've seen the devastating flooding that has hit the Southeast. Atlanta is under water in many hard hit areas. Thankfully where I live has not been flooded, we've just have copious amounts of rain... therefore... mud. But the West side of the ATL metro area has been ravaged. So much so that major interstate arteries have been completely shut down after being submerged in raging waters. It was been quite a sight. So what happens when crazy weather mixes with no so bright citizens? Tragedy and Ignorant comments made on TV. I'm not saying that the people who lost their lives deserved it, I would never wish that on anyone.... but when public safety agencies and every news outlet is telling you to stay home and *not* drive into standing water.... WTH are you thinking?

And when the sound-bite hungry news reporter is sticking a microphone in everyone's face asking "How does all this make you feel?".... well.... opportunities are endless. One genius who was speaking about how he was trying to get home and every road he tried was blocked off, continued saying... "I just don't know what is going on." Did you just fly in this morning from Egypt? Its been raining for 40 days and 40 nights silly! And others who expressed frustration at fire & police for closing roads. That's our job, to protect you from yourself. And when people are told to *get out* of their homes cause its gonna flood and they refuse. They flat out refuse.... then want a big rescue when they decide... nnooowwwwww I want out. Now I want out after there is 3' of water in their living rooms. This frustrates me. A lot. Text on a screen can only convey so much emotion.

I've been off work for a bit recovering from the bug. Don't go back for another week. I'm accomplishing a lot of fall cleaning in this time off. When I get back it'll be back to the 24hr tour on our new mama-jama rescues. Our new ambulance is about as big as our engine. There are some kinks that *really* need to be worked out but I am getting a little acclimated to it. We'll see how it goes. Stay safe.

I'm sorry what? I can't hear you!!!

We ran the wheels off our engine yesterday. 8 calls before 12N. We decided to splurge and get crab legs for dinner. Figures. I cooked up a decent meal of some gigantic crab legs, roasted potatoes, corn on the cob and broccoli. Cooked for a good hour and half. The rescue ran a call but was back before we put dinner on the table. And as sure as it usually does... the 5 of us sat down and the bell went off. Medical call for the engine, was easily helped into the rescue and we were on our way back when.... "respond to a gas leak at Memorial and X St." Well, so much for the crab leg dinner. A construction crew hit both a gas main and a water line. Loud. Very Loud.

So we evacuated everyone in the proximity and stood by til the Gas Dept could get there. And we waited. Some more gas dept supervisors showed up and said it be a little bit longer. And we waited. The whole time copious amounts of natural gas blasting in the air. It was quite a spectacle. Gas breaks aren't hard calls. Potentially dangerous, but generally we stand by to make sure no one lights themselves off.

Ignorant citizens never cease to amaze me. Hundreds of feet of yellow "do not cross" tape is stretched all over the place and people walk under them, cars drive through them, etc. And these folks get mad at us for inconveniencing them. Oh gee... sorry... and whose fault will it be when you blow up?

But the good guys on the HazMat truck got us some drinks. After 2.5 hours, the Bat. Chief called another engine to relief us for a bit. By this time it was 2230, I wasn't hungry... just wanted to shower and go to bed. Face was burning from the gas in the air and a shower sounded heavenly. Oh, I'm sorry, did I say sounded? I couldn't hear a thing. We ran another couple of calls through the night. It was one busy day.

Ready yet?

Damned if you do, damned if you don't. Sometimes you get patients who are waiting for you at the front door, keys in hand, suitcase packed with their favorite pillow, their face pressed against the screen for fear of missing you drive by. And before you've even put the truck in park and put your gloves on, they're bolting the front door and walking down the driveway. Whoa, whoa, wait a minute Ms. Sweet Elderly Lady... lets check you out first. This kind of presentation, if you will, by our patient usually leads me to believe that this is in fact NOT a life threatening call. And because we have the option to call for a basic rescue to come transport and/or refuse transport at all if deemed appropriate.... I'm usually headed down that path. I've run a plethora of these... usually constipation or trying to get to a surgery appointment on time. Frustrating to say the least, but I have an affinity for older folks and don't mind taking the time to check em out, give them the "next time..." speech and help them lock their house up.

Then you have the calls where either the patient or the family calls and while from initial presentation its not a load and go.... after you hook them to the monitor, a few flags raise.... then the 12-lead... more flags... and you're like, "OK, lets get going, we'll do everything else enroute." That's when your patient keeps finding just one more thing that they just HAVE to have. Be it insurance card, meds, ... their favorite pillow.... and you're approaching the line of either snapping that, "Look, we can't stay here any longer, we really need to get going, now." vs. getting that one more thing that will help relax them and not cause any undue distress. Its that affinity for older folks that keeps me tottering on that line. Sometimes I just have to be the bad guy. But its only for their health and well-being.

Then there was the call at 0800 this morning for a 20-yr male with a cramp in his foot. Really son,.... really? The cabulance is here...

Stereotyping

How many times are you getting dispatched and before the address is complete you already know the patient you're responding to. You can already picture their face, their living room (or street corner), their presentation and even their vitals. You get tunnel-vision.

Other times you get dispatched for the chest pain or difficulty breathing and on arrival you greeted with someone who appears to be having an emotional breakdown. A para-suicide-threatening moment. A psychosomatic anxiety attack. And again... you get tunnel vision.

A dangerous place to be indeed.

So we get called for a 40-yr old woman with chest pain. She's sitting in a chair at the county courthouse after standing in line to pay a ticket, hiding her face behind her large mane of hair. She looks like a model. Tall, thin, dressed to the nines with 3" stilettos. Not saying much of anything, rather letting the first responders answer after long pauses to our questions. I'm getting some tunnel vision. I ask about history. She is as vague as she can be. She thinks she had an MI in the past but doesn't remember. She can't remember anything else she might have. She says she takes meds but can't remember a one. My suspicion of anything serious is diminishing.

I put her on the monitor. Whoa!!!!! Quadrigeminal PVC’s on a NSR with runs of V-Tach. Well darlin, lets get going. We secured a line enroute and was on the apron in just a few minutes. All her other vitals were normal. Come to find another tidbit of information that, I at least, never learned in medic class. Hyperthyroidism causes tachycardia. I had known about hypothyroidism causing bradycardia.... why a=b therefore -a=(-b) didn't connect with me I don't know. I do know. Tunnel vision!!! She had hyperthyroidism and was not taking her meds!

So watch your tunnel vision. From those patients that we'd love to just buy a bus pass for to the atypical presentation. Full assessments folks. It's patient care. You just may be the only person on this world that gives a flying flip enough to respond to their need. Whether it be just some human interaction, a friendly face in their world of despair, or a true call during a life-threatening emergency. Trust me... I need to be reminded of my own advice everyday. Stay safe out there.

Catching up

Well I haven't written in quite some time, but think its time to once again share my tales. I should have blogged several shifts over the last few months as some calls just defied the imagination. I so wish I could invest in a lapel camera on my radio strap as some things I just have no words for.

But for now the first thing that comes to mind to get on soapbox about is the upcoming changes to ACLS and what is in the pipeline. Just to state the obvious, no, I am NOT a doctor. But these changes just don't make sense to me. We go to these ACLS recert classes and they hand down what are the new guidelines and there is nothing to back up these new guidelines. Reminds me of the saying, "There's a reason they call it practicing medicine." For anyone in EMS longer than 1 year, think about how many things are different that when you first started. Heck, the new medics coming out now are reciting things that are 180 degrees from what I learned.

Granted, we're all doing the best we can for the patient at any given time, its just so frustrating when "powers that be" make changes that just dont always make sense.

1st of 2009

Hope you and your had a very Merry Christmas and a Happy New Year! I had a great one. It was nice, relatively quiet and mellow. Spent with family and friends and celebrating the reason the for the season. I'm excited about what 2009 will bring me.



With the holidays and filling in at other stations and then my Kelly Day, it feels like I haven't been at my station in forever. So I have a bit of a renewed sense of "lets get it done". Our first call of the day slams me head-first into reality and the bread-n-butter calls we get everyday. Its a difficulty breathing call for a woman who I ran on just last week. She hates using her CPAP machine and is really wanting some attention from her family so she feigns, and hums and hoos. We get there and its really her belly. She says she has a hernia for the past few years but now its hurting when she moves. She wants an ambulance because she thinks she'll get seen faster. When the basic unit arrives she feigns some more and cries for her family to not leave her. We try and get her to the door to the stretcher. After a good 10-15min of trying to get her outside she says she has to pee. But in a not urgent kind of way. I say, "Ma'm, we need to get you to the hospital, do you think you can hold it, or do you need to go back inside?" Nope.... no answer.... just all of the sudden hear a drip, drip, dribble.... and yes... she is urinating on herself in the front yard. Of course we maintain our professional composure, but I am just perplexed at her non-chalant attitude as if of course thats what you do when you have to pee. Hhmmmmmmmm.



We ran a pediatric arrest on a 5-week old. It went textbook but did not end well. I need to call my hubby and check in on my own infant for a little reassurance. I say a prayer, one of many, for the family.