Labs

In one of the towns we cover, the following people respond to an emergency. 1)The ambulance(usually with a paramedic. In today's case -- me), 2) a paramedic fly car, 3)two police cars, and 4) a fire engine with at least five firefighters. We get sent to a doctor's office and arrive after fire and police are already there. The paramedic fly car medic arrives at the same time as us as we were parked together talking when the call came in. We have a difficult time getting in the doctor's office with all the people standing about. As it is there are three firefighters with the patient in the tiny room. The nurses and doctor's have fled the commotion. I get a quick report from fire. Chest pain, chest tightness for a couple days, hurts when he breathes. A police officer hands me the demographics. I just nodd and get him on the stretcher. I figure I will get him outside in the ambulance, and then assess him from the start. He is alert and oriented and only forty.

When we get in the ambulance, I talk to him on the way in, while I take his vitals, do a 12 lead and put in an IV. Well, it turns out the concern in not "chest pain" but the fact he might have a PE. He became short of breath on a plane a couple days ago, and has been having pain on breathing, and difficulty catching his breath since. According to the doctor's notes he had a SAT of 89 when he walked in.

The point to all of this is sometimes too many responders is too many. If just the ambulance responded, I could have actually gotten to talk to the doctor in the prescence of the patient, and been clued in a little quicker. It is hard for the doctor to figure out who has to give the report too, when various responders keep showing up.

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Took a prisoner from a hospital to another hospital where they have a lock down unit. He was in severe hyperglycemia. The nurses was rattling off all his labs, his Sodium, White blood cells, BUN, creatine, etc. I was just nodding. I didn't know what the numbers meant. I looked them up in the ambulance. They meant he had an infection and was dehydrated. I gave him some more fluid. I guess I was pleased that she respected me enough to think I knew what all the lab numbers meant. I took a class in it along time ago, but since we don't use them every day, its hard to remember what all the numbers mean.

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Ate pork and tostones for lunch.

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Took a 500 plus pound intubated lady to a rehab hospital on a portable vent. I don't care for long distance critical care transports. I don't mind arriving when the bad stuff is happening, but a complicated patient, who has been in an ICU, and is deemed stable enough to transport, but who requires constant monitoring, I am a little uneasy. Rarely does anything happen. I watch all the monitors, and gages as well as eyeballing the patient, and every little gag and flutter spooks me.

It was a 40 mile trip, but everything went okay.

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Had a guy with an unexplained swollen cheek who lived .4 miles from the hospital, call the ambulance. He walked out and meet us at the curb.

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A nursing home dementia patient with a history of falls, slipped and bruised her cheek. the nurse was concerned because on pupil looked different than the other, although she admitted she didn't know the patient's baseline. The patient seemed fine and did not want to go to the hospital. I looked at the patient's pupils. She had a cataract in one eye.