World Champion or Flamming Idiot?

Called for a possible stroke. Find a middle aged woman lethargic, skin very warm, blood sugar reads HI, which means over 600. Delayed capillary refill. Pressure 76/40. Heart rate on the monitor - 120. Respiratory rate in the low 30's. Can't get a SAT. History of IDDM and a kidney transplant, with subsequent infection problems.

I put her on a non-rebreather and tell the family I will be doing an IV in the ambulance and giving her some fluid. "You won't get an IV," the daughter says. "She has no veins."

I like a challenge. Patients or their family members often say they have no veins, then when you get one, they are very impressed, but when you miss after they have told you they have no veins, well, you're an idiot. I've been the stud and I've been the idiot.

When I check her out in the ambulance as we head lights and sirens to the hospital, I spot a tiny blue vein on her bicept. Can't feel or see anything else. It is a vein that will only take our tiniest catheter -- a 24, and I manage to pop one in and get a good flash. I hook up a bag of Saline, and by the time we are at the hospital I have run in 250 ccs. Not as much fluid as she needs, but better than nothing, and she has access for the IV insulin she needs.

I have patched ahead, and we are quickly hustled to a critical care room, where we are greeted by doctors and staff. Someone says they need to try to get another IV.

"Let a paramedic do it," a flight medic says. "Get me a 18 or a 16."

I am standing there watching as I write my report. This I have to see to believe. Either this guy is the world champion IV master or he is not just an idiot, but a flamming idiot.

He puts a tourniquet around the woman's forearm, and then getting the 16 needle from a nurse, pats the woman's wrist, then plunges the huge needle in. He digs around. Nothing.

"I'm going to put a central line in," the doctor says.

The medic takes the needle out, then to my surprise plunges it back in -- the same needle. He roots around some more.

"I'm concerned she's really not reacting to your poking," the doctor says.

The medic pulls the needle out, and announces, "She's completely shut down."

I guess he was the latter of the two.

On her healthiest day, you couldn't put a 16 into her wrist.

The woman goes up to the ICU in DKA, diabetic ketoacidosis.

***

Called to a Doctor's office for anaphalactic reaction. Find a woman with a swollen face, an itchy rash and difficulty swallowing. They have given her bendryl and a steroid called kenolog. She had IV dye three days ago, but can't think of anything else that might be affecting her. The rash started two nights ago and got suddenly worse this morning. The nurse says the woman had stridor when she came in and a face more swollen than it is now. When she gets anxious and says she feels her throat tightening and can't swallow, I give her .3mg epi SQ.

She says she feels a little better. Her vitals are all good and she is moving air.

Strange case. I can't believe the IV dye from three days ago is causing the reaction.

***

Do a seizure -- a guy I have taken care of before. He has had epilepsy since he was a baby and has 10-14 seizures a month. They have given up trying to regulate his meds. He normally doesn't go to the hospital after a seizure, but today he hit his head and has a lac that needs some stitches.

He tells me he thinks the epilepsy came from a doctor's error when he was in the womb. They thought his mother had had a miscarriage so when they went to vaccum her out, they bonked him in the head. At least he didn't get sucked out. A bad news/good news story.