Boots: End of an Era

I just retired my third pair of EMS boots in over ten years a medic, and put on my fourth new pair. The left boot ripped from toe to heel on the outside, seperating from the sole. I knew they were weak so I was carrying a new pair in my car. I just couldn't take them off until they had given it their all. Let it be said they died on the job, limping through their last call. Me and them, we walked some miles together.

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Two calls so far today. A 230 lb young woman, stumbled coming down the stairs and hurt both her ankles. One was badly swollen, the other had a smaller hematoma. Her pain was 8 out of 10. After 10 of morphine, given incrementally, she was down to a 1.

The other call was very interesting. An elderly man is found on the sidewalk of a retirement community with a small abrasion on his head and a couple cuts on his elbows. The security guard says he was initially hypotensive, but is now normotensive. He is alert, denies any pain, has equal grips, talks coherently. He says he tripped. His wife arrives just then, says he has some dementia, and a history of both hypotension and falls. She doesn't want him to go to the hospital. I convince her to let me get him in the back of the ambulance, check him out, and if he checks out okay and she still doesn't want him to go, we will take him to their apartment and put him in bed. I am thinking he will probably check out okay. He is falling a lot recently, he probably just fell, and didn't even hurt himself.

She sits in the front and directs my partner to where their apartment is around the backside of the complex. The man is hemodynamically stable. I start asking him some questions, but he won't answer me. I try to open his eyes, and he keeps them closed. He will squeeze my hands, but will not say a word. I get the wife in back and ask her if this is like him. Not at all, she says.

He is now not responding at all. We go to the hospital on a priority. He starts to vomit so we roll him on the board. By the time we are in the hospital room, he is starting to posture. They knock him out and intubate him.

I'm glad we didn't leave him at home.

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Did a cardiac arrest at a local nursing home. 92 year old male. Found not breathing. Staff started CPR. Called 911. The first responders applied the defibrillator. No Shock Advised. We got there. Patient asystole. Continue CPR. Intubated the patient, got the IV. 4 epis, 2 atropines. 20 minutes of ACLS. No response. Presumed the patient. Left.

I will give the nursing home staff credit. They did good CPR, helped bag the patient, were helpful and never got in the way.

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Finished up the day with a decent asthma call -- I gave the patient two treatments and some fluid and probably should have called for solumedrol, and a refusal AMA of a prisoner with chest pain, who was expecting to be released and wanted to wait until the release was processed. She had a legitamete cardiac history and was having chest pain and was very hypertensive, but she wouldn't go.

While I was at the hospital with the asthma patient, I saw the doctor who took care of my earlier patient -- the guy with altered mental status and she said he had a massive subdural bleed.