Wednesday, June 21, 2006

The City

Seven calls in 12 hours in the city.

Did a lady who fell down three stairs, severely breaking her forearm and twisting her ankle. She was crying in pain. I asked her about allergies, and whether she could take morphine. She said it always made her sick. I convinced her to let me give her some phenergan first, then then I gave some morphine very slowly. I ended up giving her 12.5 of morphine, and it helped a great deal. No nausea.

The most interesting call was for an unresponsive. Obese male in his thirties with IDDM and kidney problems who hadn't been taking his insulin was found incontinent and thrashing about on the ground. His heart rate was 140. Pressure 200/100. Pupils dilated and non-reactive. Altered breathing. Respiratory rate in the 30's. I did a finger stick and only got 375. I did again and got 377. He was feverish and the hospital later said it was 103 degrees. He was a very difficult extrication. We had to use a scoop and at several places stand him up straight. I thought at one point when we were carrying up the steep narrow basement stairs that he had coded.

In the ambulance I put him on the capnography and was surprised to see a good number of 38. With the nonrebreather he was SATTing at 98. I felt a little better about the immediate prospect of him coding. Still we took him in on a priority. The hospital got 666 for a blood sugar. They knocked him out and intubated him.

Other calls were for an MVA, a neighbor hit on the head with a cane by a fellow tenant, a guy with walking pneumonia, an uncooperative nursing home patient, and a woman who fell and scraped her legs.