Empty Tray

I wasn't on the schedule but when I saw there were a lot of open shifts I called in and told them I could work, but then would have to let me go to the regional EMS meetings from noon to four, drop me off, pick me up, and they said fine, they needed people.

At the meeting we discussed intubations. We've been requiring all medics to complete a form documenting all intubation attempts, and we discussed early results and whether or not we were getting an adequate sampling. For instance, if you missed an intubation would you fill out a form? The guy reporting said while we obviously haven't been getting every form, some people have been honest. We even had one medic who wrote down, he tried three times. I'm remembering I just filled out my form, recording how I'd put the first attempt in the esophagas and didn't get it until the third attempt. I had to create my own box for the third attempt.

Intubations were easy for me in the OR. I nailed my first nine attempts, then missed like four in a row, badly shaking my confidence. I struggled my first year as a medic, then didn't have a problem for the next ten years until lately. I'm intubating less now even though I work more. I just don't feel comfortable. Maybe I've just had some tougher airways. It hasn't been -- in open up, see the chords, slide it in. Wham Bam done. I feel like a hitter in a slump. I'm getting the tubes, just not easily. I feel like I'm looking around, okay, let's see how do I do this? There's the epiglottis, lift up, no, the head positioning is wrong, how about some cric pressure, I think I see them, no, hold on, let's bag some more and I'll try again. Maybe I need some manniquin practice, or maybe just a couple people with easy airways to get back in the flow.

***

Did transfers most of the day.

We go into this room in the hospital, and the guy in the first bed is like 300 pounds and he has a tray piled high with food, and he is chowing down with a big smile on his face. "You're coming for him," he says. He points to the next bed, where there is a rather emacitated man with vacant eyes. His food tray is empty.

We get sent to a locked down unit for a transfer. We find a tiny blind old lady with no legs -- not even stumps -- sitting in the middle of a bed. She is so small, I could fit her in a backpack. We go through four security doors to get back out to the ambulance.

***

Right before we are set to get off, we get an emergency call for a difficulty breathing about two blocks from where we are posted, which is only about five minutes from the hospital. My partner is upset to be hit with the late call, but I say don't worry, we'll bang this call out quick, and still get off on time.

The house is cluttered with furniture and cabinets blocking doors, all of which will have to be moved if we are to get the stretcher in. I'm hoping this will be a very walkable respiratory infection. In the house are nine obese women. No men, no kids, just nine obese women, not one under two eighty. The biggest maybe three sixty. I ask what is going on, and am told the woman in the bed room has had pneumonia, but I can't go in the room because she isn't dressed yet.

"You called 911," I say. "We came lights and sirens, is this a medical emergency?"

"Yes, yes it is," one of the women says.

"Okay," I say then, "I'm going in."

"Okay, then, go on in. It's okay, its okay. He's a paramedic, he done seen naked ladies before."

I get a sudden horrible vision that inside the door will be the queen bee of obese ladies -- a naked Lady Jabba the Hut on her throne of matresses, surrounded by empty buckets of fried chicken and McDonald's wrappers, but it is just an ordinary regular sized obese lady -- maybe two sixty, and she is mostly dressed -- she has a bra on, and just needs a top. She feels hot, and her lungs are decreased. I ask her if she will be able to walk out to the living room, and she says, yes, but she keeps delaying getting up. She needs her cell phone. She needs her fan turned off, she needs someone to bring her someone's number. When I finally get her to stand, she seems already out of breath, so I have my partner bring the stretcher even closer, which requires more furniture moving. We finally get her in the ambulance, and I put her on the oximeter before I put her on the oxygen to get a room air SAT. It's 72. Her heart rate is 168. I try a cannual at 5, but that only gets her up to 90%. A nonrebreather brings her up to 98%. I do a twelve lead and it shows an SVT. I think the tachycardia is caused by the pneumonia, but it could be an SVT. It is an chicken or the egg question. I have her bear down, and the rate drops into the 140's with clear p waves. (When my scanner gets hooked up, I will put the strip in). I give her fluid and we head into the hospital.

We punch out forty-five minutes late.