Zen Zone

I’ve been missing IVs lately. Not all of them, but more than usual. IVs are my secret pride. I’d like to think if anyone could put an IV into a rock I could. I’ve studied the craft for years, missed enough to learn plenty of lessons, and for quite awhile now have considered myself an expert – the man. I think I have been doing so well, that sometimes I expect that no matter where I stick it, I will see the blood flow back into the catheter chamber. I think the problem is that I have gotten so confident that I am just not paying the close concentration I need to. I am falling out of my Zen zone. I stick and I miss and I go hmm, how did that happen? How dare you not succumb to my needle?

This morning the first call was for a nursing home patient with pneumonia. I missed the first time, and then got the second. I was a little annoyed I missed the first time. It was clearly makeable – a thin forearm vein. I didn’t hold traction and it rolled a little, then I went through it. I put the next one in the hand, but couldn’t draw any blood tubes because it was a little vein – thinner than the one I missed.

Second call was for a seizure. 27-year old guy. Extremely posticial. We had to carry him out in a stair chair. He started seizing again, more focal this time than the gran mal they had described. He didn’t have the typical veins of a strong 27-year old. I went for the AC, although I was a little uncomfortable with my angle. No flash, rooted around, got a flash, but couldn’t advance. I couldn’t see any veins, so I went by anatomy and feel. The problem was where anatomy wise there was a vein, it felt like a tendon. I knew there were no tendons where I was considering sticking. I stuck. Nothing. I tried another one and the catheter bent on his skin. I had to give up then because his seizure was getting worse. I gave him some Versed IM, which stopped it. I tried a fourth time for an IV and missed. In the ER, his mother said they had trouble getting IVs in him. I came back later and they were doing a central line so I felt a little better.

It was a rainy day so we did 3 MVAs. The most impressive was on a side street between two SUVs. I’m thinking one was stolen because even though both cars were destroyed. The patient from one of the cars was missing. This is in an area of town where it very common to do rollover and find brand new SUVs rolled, but no patients there – only reports of them running down the street. The two patients from one of the SUVs were walking in circles in the street, one bleeding from the forehead. Their car had no front end – it was completely pushed in. The driver had no idea he had been in an accident. The passenger knew he’d been in one, but didn’t remember how it happened or what happened next. The other car was destroyed to the point there was no front passenger seat. I took both patients, BLSed them on a priority. I hardly had time to do vitals, a full survey, put them on 02, and get their names, dates of birth and social security numbers. They both got the trauma room on mechanism. The cop came in and said he’d never seen a crash like that and had people live. He also said the phantom car had two people in it, according to witnesses who saw them running down the street. I don’t how the passenger lived.

I was very annoyed on scene with a firefighter. I showed up and asked where the patients were. He ignored me while he questioned the guy with the cut forehead about his name and address. The problem with first responders, who are required to do paperwork, is their paperwork needs sometimes come before their doing their job, telling us what the hell is going on. Other times I have had first responders try to delay our rapid transport so they could get the patient’s name and info for their records. Some towns the first responders don’t do any paperwork.

Other calls were for a demented nursing home patient with lung cancer and dehydration, a young man who wanted to kill himself and a transfer from the hospital to a rehab hospital.

I did get the IV on the dehydrated lady, a little 22 in a small forearm vein and while I couldn’t get bloods, the bag of saline flowed. Back in the zone.

I wasn’t going to work tomorrow because I have my monthly EMS regional meetings, but they are short cars so I worked the same deal I did last month. They will drop me at the meetings at 12 and pick me up at 4. I’ll work 930-1200 and 1600-2130.

I hope to get to the gym in the morning. Right now I’m watching the baseball game, hoping the Yankees lose and the game doesn’t go too late.