Circle of Life

Got sent for a nursing home "dsypnea/unresponsive." Found the patient on a mask at 6 liters, which as anyone in EMS knows is like putting a plastic bag over someone's head. I explain the problem to the nurse and she nodds and thanks me. She says something interesting -- she says in the hospital she always turns it all the way up, but the machine at the nursing home goes only to six. So the problem may not be completely the nurse not knowing, but the doctor ordering a mask on the phone, but not knowing the standard nursing home 02 only goes to 6.

This is a problem that has been around ever since I have been in EMS -- 17 years now, and probably long before that. A paramedic of ours who is going to nursing school was doing a clinical at a nursing home and was told to put the patient on a mask. She refused because the machine only went to 6. The senior nurse told her to stop thinking like a paramedic -- she was a nursing student now. The medic still refused, and then went and found the home's 02 policies and showed it to the nurse that any mask needed at least 10 liters and by a proper oxygen canister. The nurse said really, whose policies are these. The medic said "Yours!"

Anyway the patient was the same patient I transported earlier this month -- the one with "tachysniffles." The facial tic the woman has makes her appear to be having trouble breathing when she really is very stable. As far as the unresponsiveness, she basically isn't much more responsive than having her eyes open and watching you. She doesn't talk and I guess sometimes doesn't follow commands. She has been back and forth between the nursing home and the hospital several times this month. A new nurse comes in, puts her on a plastic bag, her SAT understandably goes down. The ambulance puts her on a cannula, the SAT comes back up. The hospital evaluates her and sends her back.

I don't think this is what's meant by "The Circle of Life."

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Did a refusal on a dog bite.

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A doctor's office for a patient with ECG changes.

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Last call was an OD. Pretty young girl took all her psych meds at the same time because she was depressed. She had a heavy drug history. I noticed some track marks on her arms. I asked her where they got IVs in her.

"Between my toes."

No, she didn't really say that. But she contorted her wrist, and said, if you turn it just this way and wap it a couple times, a little one might pop up. I found a vein I could put a 24 in in her forearm and filled four blood tubes. Maybe she'll invite me to shoot her and her pals up at their next abandoned house party.

But then she told me how her ex-roomate poured boiling water on her one night when she was sleeping, and said, "You're not so pretty now, are you dearie." Not the kind of friends I would want to hang around with. It was amazing she wasn't scared more badly.

Hard life.