I'm off to a poker tournament. No posts until Monday.
Nothing for eight hours, then we get a call for an unresponsive. When we arrive, a man meets us at the door and he says, “They are not certain if she is breathing.” We enter the house and I see an officer standing in a bedroom doorway. I can hear the mechanical voice, “No shock advised.” I step into the room and see a woman on the bed, who looks like a corpse. I am surprised when I touch her that she is warm. Because of the kifosis of her spine, her head hangs suspended in the air. We get her down on the carpet. She is asystole. My preceptee has trouble with the tube, and after two tries gives me the blade. I look in and can only see the epiglottis. It is a difficult tube, but I have been anticipating this. I have been thinking what I would do when I encountered this situation again. I take a moment and collect myself, then extend my arm more and turn my wrist . The bottom of the chords are in view and I pass the tube. While the preceptee gets a line and start pushing drugs, I am already saying this is going to be twenty minutes and out, but we soon have some activity on the monitor. I am thinking it is just the epi and she will soon brady down, but the rate picks up. Soon she is cranking away at 170. On the capnography, my reading has gone from a 5 up to a 32.
I started precepting a new medic today. He is a nice young man who has already been cut loose in Massachusetts, so I don't expect it will take long. He seems to have a good handle on the job.
We are sent to a nursing home to pick up a dialysis patient. They dispatch another unit to give us a lift assist. It’s a big patient. We get there first. “Let’s go in and do it,” I say. “We don’t need any help.”
My old partner, who I work with regularly on over time has gotten a transfer to Florida. He’s leaving in two weeks. I’m bummed that he is going, particularly since it will leave me with partner de jour for the entire month of October M, T, W, when I would have been working with him. But I’m happy for him. He likes the sunshine. He was telling one of the nurses today he was going to Florida, and I cracked that he’d finally gotten into the Golden Acres Manor. “A Bed, a roof over my head and three squares a day,” he said. I think for a moment the nurse thought he was serious. “I’m only kidding,” he said, disturbed that she thought maybe he was really ready for the Manor.
Slow day fortunately because I was beat down. I had a Diet Coke on the plane coming back and the caffine kept me awake till almost two in the morning. I was up at five to dress for work. I got a good two hour nap after checking my equipment, then spend most the day working on my blog entries and catching up on email.
I awaken shortly after midnight. The high winds of Hurricane Rita have knocked down one of the tents where sixteen EMTs and paramedics were sleeping. We need to push our cots closer together to make room for the temporarily homeless tent people.
I am working with a local girl from Mississippi. I tell her I need a diet coke to start my morning off so she takes me to a place called Sonic, which is an old time drive-up with rollerskaking waitresses. A woman with rather fat legs on roller skates brings me a can of Diet Coke on a tray. That wakes me up.
I have breakfast with one of the guys from another division in our state who came down a day before I did. We talk about how a trip like this can change you. Any time you can get outside your normal life, it can't help but make you different.
I tell myself no surprises today. I get in my ambulance an hour early and check it out from top to bottom, then set it up the way I want it. I am pleased to find this ambulance has Haldol in its jump kit -- a day too late. The ambulances are from many states as is the gear, so each day is an adventure in what you will have to work with. While the Haldol is the good news, the bad news is the intubation kit only has the crappy disposable intubation blades (We tried them a few years back and had several cases of the blades bending) and an old Life Pack 10 lacking even the hands off pads. If I have to shock someone it will be the old fashioned way, lubing up the paddles with gel, and pressing them hard against the chest. BAM! I do confess I liked doing it that way.
I heard someone say the other night that while there are some regional differences, a paramedic is basically a paramedic and the practice is pretty much the same everywhere. I agree, but also part of being a paramedic is being comfortable with your equipment, with your setting, with your routine. A good paramedic can improvise, but it does help to have a certain underpinning like a captain who knows his boat and his area of the sea.
I sleep through the night. In the morning I have a breakfast of sausage, grits, biscuit and fruit.
I sleep well thanks to the foam earplugs that drown out a room of snoring EMSers.
We meet at the office and a chair van driver takes up up to the airport. There are five of us: two medics, two EMTs, and a mechanic. When we go through the ticketing the airline agent puts a red mark on our tickets and says, we're all special. I am thinking, isn't this nice. They are recognizing our efforts and are going to be upgrading us to first class or maybe giving us complimentary access to the VIP lounge while we wait for the flight.
We were supposed to leave today, but just as I was getting ready to go out the door I got a call saying to stand down, the flight had been changed to tomorrow. I spend the day, cleaning the house, making last minute prepartions. We will be going to Gulfport, Mississippi where our company has a base of operations. I don't know exactly what I will be doing. It sounds like just responding to 911 emergencies in the area. I am told to bring a sleeping bag, an extra set of boots, suntan lotion, bug spray, and uniforms. I am going to prepare just like I did for the Dominican Republic, except I will make sure to bring ear plugs this time. I haven't really had a chance to talk at length to anyone who has gone down there. I'll see when I get there, I guess. I am just happy for the opportunity to go.
Started the day off with a couple transfers, including another wait and return with a paraplegic, who had to go to a distant town because he couldn't get an appointment at one of the doctor's nearer sattelite offices. His complaint was he'd been having spasms. We get to the doctor's office, wait, wheel him into to a room, the doctor -- a personable older man -- comes down and talks to the guy for two minutes, tells him, he's going to order some blood work and send him for a scan. He wants to make certain there's not an infection. He writes the stuff up and that's it. he tells the patient a dirty joke. They both laugh, then we take the patient back. It seems like the whole thing could have been handled with a phone call. Total trip time two and a half hours.
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.
Still getting my computer fixed so yesterday's, today's and probably tomorrow's post will be delayed until Thursday most likely.
We’re standing next to our patient on a stretcher in the waiting room of a clinic with 49 other patients. Our patient, paralyzed from a motorcycle accident, has a fist-sized bed sore on his bottom. We wait for forty minutes. There are no magazines to read, there is no TV to watch. I try to entertain myself by listening to the Spanish conversations going on around us. We are in fact twenty minutes early for his appointment, and then we are seen twenty minutes late. We take him down to an exam room where we wait another twenty minutes. A doctor finally comes in, asks us to leave the room while he examines the patient, then a moment later asks us to return so we can help him move the patient on his side so he can get a better look at the sore. We stay and watch him pack it. It looks good he says, no infection. Good? I wouldn't want one on my backside. It is nasty looking. We wait another twenty minutes for the doctor to come back with a pain prescription. He tells the guy that he’ll see him next week. Bt the time we have the guy back at his house – where we have to move a refrigerator a neighbor dropped off at his house, leaving it right in the middle of his handicapped ramp – two and a half hours have passed.
50 year old male insulin diabetic found by staff with blood sugar of 53. Given glucagon, still out of it. He is still cool and clammy when I get there. I know the patient, having transported him many times over the years including this past Thursday. His sugar is 63. I give him an amp of D50. He wakes up, but is still groggy, almost postictal. He does also have seizures so maybe that is also involved, although no one saw him seizing.
We took in a former EMT with chest pain. The man, only in his forties, has a history of multiple MIs, pacemaker, HTN, high cholestrol, IDDM. He stopped taking his meds a couple weeks ago. He has been known for being noncompliant with his treatment plans. I was surprised to see him. There was a rumor a few years ago that he had died.
I just retired my third pair of EMS boots in over ten years a medic, and put on my fourth new pair. The left boot ripped from toe to heel on the outside, seperating from the sole. I knew they were weak so I was carrying a new pair in my car. I just couldn't take them off until they had given it their all. Let it be said they died on the job, limping through their last call. Me and them, we walked some miles together.
Well I'm at work and have a computer so I feel attached to the world again. Tomorrow I am hoping my partner out here will be able to take a look at my computer and fix it -- in addition to saving my files.
I'm posting this from a Kinko's work station for .20 a minute so I'll keep it short. Got my teef fixed yesterday. Good news was I didn't need a root canal and won't have to go to a peridontist, but the bad news is the bill was still huge. Still, if you are going to spend money, I guess your front teeth have to be high on the priority list.
Worked 13 and a half hours at holiday double time and a half pay. Slow day. Spent most of the time covering a suburban town.