Thursday, June 09, 2005

John Belushi

Came to work tired because I had worked till midnight the night before, then had to get up at five. The night medic has a preceptee so I figured the ambulance would have been well-checked out, so I just dropped my bag in the front seat, and went right to back to the bedroom and crashed.

Hit the pillow at six-zero-five. The tones go off at six-fifteen. We're sent for a person feeling weak, whose doctor wants him transported to the hospital. No lights or sirens. Cold response.

The guy is lying on the bed. His wife says he has been having diarrhea and is weak, not his usual self. The first responder tells me he can answer questions when he sees I am directing my questions all to the wife. I then ask the patient how he feels, if he is in any pain. He looks me right in the eye and says, no.

On the way to the hospital, I do my routine ALS, )2 IV monitor. I draw labs, and then check his blood sugar. There are only two chemstrips in the glucometer -- and none on the shelf(I'm still in the other ambulance -- the one with the tie-locked cabinents), and I am a little pissed -- pissed at the preceptee for not checking his gear and pissed at myself for assuming he would. I weigh not doing the blood sugar to conserve the strips in case I really need them if I get a call before I can get back to resupply, but then decide I should, just because I should, and the patient is a non-insulin diabetic so they will ask me what his sugar is so I need to know. I put a drop on the strip, wait ten seconds.


I am glad I checked, happy that checking sugar is a part of my routine, but feel like a knucklehead that I did not even think of hypoglycemia, low blood sugar, as part of my differential diagnosis. I find I get lulled into a here's another old sick person, put them on the stretcher, do routine ALS, take them to the hospital. In the clinical impression box, I just want to write "old."

I give him some D50 and he perks up some. At the hospital, his wife says he's definately improved.

Speaking of D50, here's an interesting article that suggests D10 might be better for patient's than D50.

Why Not Use 10% Dextrose Instead of 50% Dextrose in Hypoglycemia?


My next call is for a syncope. I'm not working with usual Thursday crew today, so when I go to put the electrodes on the patient, I open the back of the monitor, and there is only one package of electrodes left. Fortunately, I'm in the back of the ambulance, and I have plenty on the shelf, so I do the twelve lead, do my routine ALS, take the patient to the hospital. I think it is just a vaso-vagal episode.

I do not have an afternoon crew so the commercial ambulance sends us a rig with an EMT as per the town contrcat and I ride on the commercial ambulance, who gets to bill for the calls. First call is for a dsypnea at a nursing home. COPDer, who has a fever and is coughing up green phlegm. In the ambulance, I go to put the patient on the monitor, open up the back of the monitor. No electrodes. My last crew didn't replace them. Again in the classic words of John Belushi in Animal House, "You fucked up, you trusted me." I reach for the shelf where the spare elecrodes are always kept in the commercial ambulance, except there are none. I go through all the cabinets. No electrodes. John Belushi is sitting there in the captain's chair, laughing at me. But I have him fooled. In my briefcase, I carry lots of spare things for emergencies -- spare sissors, a spare stethescope, an attachment to bag a treatment into a patient, spare field guide, eye glass repair kit, nailcutters, tylenol, cough drops, plastic spoon and fork, and spare electrodes. You never know when you might get caught short. I reach through the doghouse window, tell the EMT driving to not mind me, as I dig through the bag and whallaa! come up with my electrodes. I put them on the patient. The machine doesn't read. I reposition the electodes. Nothing. I turn the monitor off, turn it back on. I get something, but it is like all 60 cycle interference. Completely unreadable. The electrodes are after all about five or six years old -- they are a little dried out. I feel stupid. Fortunately, the lady doesn't appear to be having an MI. I'm pretty confident she just has pneumonia. Her pulse is strong and regular. I weigh slapping the defib pads on -- there's one way to get a strip, but at $80 a pop, I think I'll just go in without the monitor on, and just notate too much interferenece to get a good reading. I could write equipment failure as an excuse, but it is really paramedic failure. At the hospital, I grab some extra electrodes and put them in the monitor.

There are two types of medics when it comes to stocking an ambulance -- those who overstock and those who don't. Those who don't get pissed off if you have more than the legal minimims on the shelves. Me, I like to have plenty of stuff. I ALS a lot of calls and I am very busy so I'd rather throw some extra electrodes in in the morning, then have to resupply after each call. I like to be prepared so I have a saftey net when the unexpected happens. I need to remember to put more electrodes -- fresh ones this time -- in my briefcase. I should probably put an extra run form or two in there also. You never know when someone will leave your run box on scene or you will leave it at the hospital.

When you work overtime, you get your routines and you like to keep them regular. I work with so many different people, it is hard to do unless you set yourself up after every call. It is hardest in the suburban town. I like to leave the BP cuff on the bench. Some partners always put it on the shelf. I like to leave the portable 02 on. I like to leave the trash can against the bench seat where I can put the IV trash rather than trashing the bench seat, then having to pick it all up and walk across the ambulance to the trash can. I like to leave my tourniquet on top of my little IV supply kit. People put the trash can against the far wall, and take the tourniquets and tie them to the overhead rail -- not over my head, but way out of reach so I have to stand up and reach over for them. And I like to always have a johnny on the stretcher. I like to always have a johnny to put on the patient so I can access them more closely, and it makes it easier for the nurses at the hospital so they don't have to undress the patients. Some of my partners never remember to get me a johnny. Sometimes other crews toss the johnnies because they are not on their checklists. I think I'm the only medic I know who uses johnnies.

These aren't complaints so much as little small details of my day. It really isn't too much to ask of myself to after every call, set the ambulance up just how I like it, so I will be ready, so I won't be caught without some needed equipment. I always check my car out throroughly when I am in the city, but I have been lazy in the suburbs lately, and if I don't crack the whip on my own back, I am going to pay on some call. I've got to keep Belushi out of my rig.


Four calls total for the day. Diabetic, syncope, pneumonia, and weakness.