Wednesday, July 19, 2006

A Good Partner

12 hours in the city. I got to work today with a woman I used to work with regularly on overtime many years ago. Her regular partner was on extended leave so I worked with her most everyday as she worked on my days off, so it was great overtime for me. What I like about working with her is she is so pleasant. She never rags about the company or about any other employee. She is nice to the patients and when we aren't on a call, she parks the ambulance in a quiet location, turns the engine off and reads a book. What a difference it makes in stress levels.

Day started off with a chest pain that turned out to be a ten year old boy who's chest hurt when he moved his arms. His mother was crying. "You hear about these young children having heart attacks." We reassured her and then transported him to the hospital where he was sent to the waiting room.

We then did a mild chest pain in a 91 and 1/2 year old who did nothing but crack jokes the whole time. He was Jewish and I asked him where he was born, thinking there might be a story about fleeing Eastern Europe(its amazing the number of patients you get in a year who are holocaust survivors), his answer was "I don't quite remember, but I believe I was born in a bed." He was hard to actually get a history from because he turned everything into a joke. My partner drove the long way to the hospital -- I asked her why later and she said it was because she was so enjoying listening to our conversation.

We were sent on a "sick call" in the city and when we got there there was no fire engine outside. The fire are selective first responders. They go to what sounds like a good call. They probably have protocols they follow. They usually don't go to the sick call. It was the top floor of a three story triple decked with a narrow stairwell. The husband showed up his wife in bed. She was in her late fourties. Her skin was like ice and very clammy. I couldn't feel a pulse or hear a BP. I had to use the automatic cuff and that said 90/50 with a heart rate of 92. Her husband said she had had a near syncopal episode and complained of not being able to see. We stood her up and did orthostatics. 80/40 with heart rate of 104. Again, she had trouble seeing. I was interviwewing her and she admitted sever bleeding from her fibroid. Then she puked all over the place. My partner went to get the stair chair. I told her to leave the equipment with me. I had a bad feeling. I have in the past had a partner bring the equipment back to the ambulance when they went to get the stair chair, only to have the patient suddenly code while we were getting them on the stair chair. Anyway, she didn't code. But in the ambulance, the machine said her BP was 64/38. Again, I could get on myself, and the machine is not very reliable. I gave her 500 cc of saline by the time we hit the hospital and she was looking and feeling much better although the machine was still reading a low pressure. The people were I believe Iranian, and were very reluctant to give me her social security number so I hadn't pushed it. She hadn't seen a doctor even though she had been having periodic spotting.

We were sent to intercept with a basic car on a cardiac arrest and got there as they were loading the patient. She was a cancer patient with a DNR but no paperwork. She wasn't in arrest, but she was out of it. En route she went apneic several times. I had her on the capnography and it caputured it. All we had to do was arouse her. My plan was to just deliver her to the hospital alive so they could call her doctor and verify the DNR. That's what happened. Turned out she didn't die, but they got all the paperwork together, transported her home and called in hospice care to help the family.

We did an 80 year old with kidney stones. I gave her 2 of morphine and it made the pain go away. I also used the capnography to monitor her ventilation. When I was in Ohio a medic from Texas showed me their pain protocol where they were required to do a pre and post sedation capnography strip. Her respirations stayed the same.

It was a good day. Some medic calls and no transfers. A good partner.