Bathroom Break

Came in, checked my gear, went to bed. Got woken up with a call for the lady with leg pain. The EMD dispatch on the line with the caller says the patient is on the second floor. I am tempted to say, "Tell her to meet us at the curb."

We get there and find a 50 year old woman sitting on the bedspread of a kingsize bed on top of a bed pan. Her mother says she hasn't gotten out of bed for five days even though there is nothing wrong with her. She has a history of mental illness but has not been on any medications or seen any doctors for over a year. She refuses to get out of bed for us. When we approach, she becomes violent. We have to hold her down to check her blood sugar. Her mother has said she is a diabetic. Her sugar comes out normal.

We are on the second floor and stairwell is narrow. None of our attempts to persuade her to come to the hospital work. The cop starts writing a PEER(Police Evaluation Request) that gives us the power to take her against her will. None of us is looking forward to wrestling with her. I decide to just medicate her. While I am preparing my two syringes I joke that I should have a sedation kit that would include relaxation music like the sound of waves or light rain fall to put on the music player and incense to burn. When I am ready we hold her down and give her ativan and haldol, then sit back and wait.

I suddenly have a terrible stomach ache. I try to ignore it, but it only worsens. I have had stomach aches before on the job, but then I was always caught up in the call and managed to fight through it. But here I am standing waiting -- at least ten minutes for the drugs to take effect. I am about fifteen feet from the patient's bathroom. Finally I can't take it anymore. I ask the patient's mother if I may use the bathroom. (It is the first time I have ever had to use a patient's bathroom.) She says yes, and five minutes later I am feeling much better. We wait another five minutes, and then pick the woman up with minimal resistance, place her on the stair chair, carry her down to the stretcher, and she sleeps all the way to the hospital.

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We do a fall with a head lac.

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Get called to a doctor's office for rapid afib. The man has been feeling a little light-headed with chest tightness and palpitations. When I put him on the monitor his rate is 170. I give him cardizem and then hang a cardizem drip after the rate goes down into the 90's.

When I get back from the call I am reading the new ACLS guidelines for afib, and they are basically saying that medics should "seek expert consultation" instead of treating such a patient. This is a marked change from the 2000 guidelines. Here's the line: "Stable patients may await expert consultation as treatment has the potential for harm." You can argue over what "stable" is. Some might say, well they called 911 so they they can't be stable. They have chest tightness, etc. Someone else might say -- their BP is good, they are mentating and perfusing fine, they are stable. Whatever, the language is new and runs throughout the tachycardia section.

Management of Symptomatic Bradycardia and Tachycardia

While I will post about all the new changes, many are "anti-medic." I don't mean that in neccessarily a bad way because anything that is good for the patient, which I have to assume these guidelines are, must also be "pro-medic." What I mean is the guidelines seem to either restrict our practice or point out that much of what we do has no evidence proving it works and may in fact be harmful. From intubation to fluid rescusitation to drug administration, the emphasis seems to be on less medic intervention as opposed to more.