Bleeds

Worked ten hours in the city today. Busy. Started off with a 92 year old lady from an assisted living center who's eyes were deviated to the left and she was seizing. gave her some Ativan. Turns out she had a major bleed.

Later in the day we went to a fall. The woman in her forties went down a few steps hit her head. No loss of conciousness. She was alert when we got there, no amnesia of the event, asked where her pocket book was. No one described an seizure activity. A family member said she had a history of recent falls, including one last night down some stairs. The family member said she panicked on stairs and often went limp. There was some phycsh history there.

We boarded and collared her, and went to the hospital BLS, although I teched the call. I was asking her questions on the way. She said sometimes she got the shakes, and she thinks that was what happened on the stairs. Just as we pulled into the ER drive, she had a violent gran mal seizure, biting her tongue so hard she bled from both sides of the mouth. I popped in a quick IV, but stopped seizing before I could open the Ativan. She was out cold for a couple minutes, then woke up as I tried to put a nasal trumpet in her nostril. We talked for a little bit. I asked her if she knew what happened. She was still postictal. I checked her pupils again. Equal and reactive.

We get her in to triage. Bam! She starts seizing again. Even more violently. Lasts about forty-five seconds then she's out cold. They cat scan her and it turns out she has a subdural hemotoma. Whether that was from this fall or the one last night or something going on in the last couple days, they don't know.

***

We did a patient who had been vomiting and with fever at one of the physciatric hospitals. This one place -- well, in my experience many of the pscyh hospitals, it is hard to tell the patients from the staff members. Its like owners who look like their dogs or dogs who look like their owners after awhile. We go in the door, a staff member/inmate lets us in the locked entrance. Then once in the entrance, I heard someone banging on the outside door. I open it thinking its a staff member. In walks this big guy. He stares at me, looks at the oxygen tank on the stretcher demands? "Is that an Oxygen tank?"

I nodd.

"Take it off!" he shouts.

I just stand there.

He starts down the hall, gets maybe forty yards down the long hall, then turns and shouts, "You want to get it on punk ass bitch. You want to get it on?"

I'm still just standing there, thinking how bizzare this is.

"I didn't think so," he says, then turns and continues away.

Another staff member/inmate takes us up the elevator. He has a cigarette behind his ear.

The nurse in the locked unit, tells us our patient is orthostatic, dizzy on standing with no blood pressure or palpable pulse. He is so pale, you can almost see through him, she says.

"Where is he?"

"He's getting dressed," she says.

He comes walking down the hall. He is as pale as she says.

"Let's lay you down," I say.

I can't feel a pulse or hear a blood pressure either. On the monitor, his pressure is 80/50. His heart rate is 160. And they had him walking around.

Also did a chest pain, a couple transfers and a motor vehicle.