Roommates

Met the ambulance on the road on the way into work, and did a swap with the night medic, then headed on to an abd pain -- a woman with a hernia that hurt when she coughed.

***

We get called to a nursing home for dsypnea. We find a patient on a mask at 2 lpm crying that she can't breath -- no nurse anywhere in sight. The woman's lung sounds are decreased and she is wheezing and not completely with it. We put her on a nonrebreather, load her, then wander the hallways calling out for the nurse. A nurse's aide bring us some paperwork. It says the patient has a COPD and pnemonia history. The aide directs us to a room at the end of the hall where she thinks the nurse is. The nurse, who I have never seen before, looks at me blankly when I demand a report and say she should't leave the patient when she calls 911 for someone in distress.

"She's having trouble breathing," she says, holding her hands out like what more is there to say.

"How about a history," I say. "When did it start? Is this her normal mental status?"

"She's short of breath," she says. "That's why we called an ambulance."

"And her mental status?"

"She's a little confused."

She looks like she is the one being put upon to answer questions.

I look over the paperwork. "How about this? What hospital are we going to?" The space is empty on the paperwork.

The nurse looks at the aide and the aide says, "I'll check."

She comes back and tells us which hospital. "She also hands me some more paperwork and says the patient is a DNR, but the paperwork hasn't been signed yet."

"Great." I nodd to my crew to head for the ambulance.

I give her a breathing treatment and put in an IV. To give a radio patch in one of the big box ambulances that I am in today, I have to leave the patient's side and sit in the chair by the front. I tell the hospital the patient has COPD and is still in distress despite the breathing treatment. After I have patched, I come back to her side, and my partner saying she is bleeding all over the place.

"Huh?"

"She has blood all over the place." He points at her wrist where I put the IV. There is no longer an IV there. The IV is on the floor in a puddle of blood. I get a 4x4 and tape it down. The sheet is soaked with blood.

I hate respiratory calls because the patients are so fidgety -- usually because they are hypoxic. It's hard to get them properly positioned on the stretcher. They are anxious and fight everything you do. I can't get a decent strip on the monitor. I should have wrapped kling around the IV site to better secure it. After the call the ambulance looks like a multisystem trauma. I have never seen so much blood from an pulled IV site.

*

We are not even back to the base when we get another call. Same nursing home -- same room -- this time for seizures. At least the nurse is in the room, but she is still unhelpful. The patient an obese insulin dependent diabetic is still seizing. She has no seizure history. I ask if they checked her blood sugar. The nurse says the night nurse did it. I just shake my head. She then leaves the room. I get my IV kit out, and set up to do an IV, but the patient is obese and I can't see a vein. Fortunately the patient stops seizing. As we load the patient the nurse returns and announces the patient's sugar last night was 210.

Out in the ambulance, I put in an IV and check the sugar. It is normal. Just then she starts seizing again. I give her a milligram of Ativan, and then another. She finally stops seizing, only to start back up again at the hospital when we get her into the room. It turns out she has a massive bleed in her brain. While she is a full code, her roommate now a few rooms over has gotten her DNR signed, and is taking her last gasps.

Two hours later we are back at the same nursing home, but this time a different wing and a different nurse. This patient has abdominal pain and is vomitting.

***

We do two refusals. A diabetic -- 80-year old grandmother with a blood sugar of 42 who didn't eat lunch (We give her D50 and leave her at her daughter's kitchen table where her daughter is preparing something for her to eat) and a not breathing, which turns out to be a guy sho had a couple Budweisers, then went to sleep under a tree. A sternal rub wakes him up, and the police give him a ride home.

***

I'm tired.

***

A 40 year old woman with sharp abd pain in the lower right flank. No vomiting or diarhea. No difficulty urinating, no blood in urine. Good vitals, but pain 10 of 10. Skin warm and dry. Hurts like mad when we hit bumps. I'm guessing an ovarian cyst. I am tempted to call for orders for morphine. The old school is no morphine for abd pain unless it is clearly recognized kidney stones because morphine might mask the diagnosis. The new school is that morphine actually helps with the diagnosis by alleviating some of the tension and anxiety caused by pain. If I call there is a good chance the doctor will get really mad at me, but I am willing to try, on behalf of my patient to alleviate her pain, but she says she doesn't want any. She doesn't like drugs she says as she winces with each bump in the road.

My partner knows her so I am hoping to find out at some point what the problem is.

Medline Search: Morphine ABD Pain - Studies

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Last call for a woman with a migrane.