No posts for a week. I'm off.
I'm tired. Fortunately, it's been another slow day. 1 call in thirteen and a half hours. An old man with dementia feeling weak. Another hour and a half to go. Watched both World Cup games today.
Took a nurse from a nursing home to the hospital for an infected dog bite. She was feeling a little woozy, so her boss ordered her to go to the hospital by ambulance. She had a little banadage on her arm. The bite occured two weeks ago, and she had been taking antibiotics, but the arm still seemed infected. She was embarassed to go by ambulance. My general attitude is you want to go to the hospital, I'll take you to the hospital. Fly the friendly skies. Then she pulled off the bandage and showed me the bite. It was nasty. Big punture wound, all white and red and ulcerous. She was afraid she might have gotten some nursing home germs in it. Like MRSA.
Walked in the door and the buzzer went off. 100 year old lady tripped in the dark during the night and broker her arm. She said her pain wasn't bad as long as she wasn't moving her arm. I asked her if she wanted any morphine and she said no. She was a very proper old woman who had spent her life at an upper class country club and who had quite high social standing.
Eleven hours fifty-five minutes and no calls, and then the buzzer rings.
Old lady with Alzheimer's fell and sliced the back of her head on a door. She denied she had fallen. Her husband told her she had to go to the hospital. You're not coming with me? she asked. No, I think I'll go to a tag sale by myself, he said. What? And leave me? No, he said, of course I'm going. He smiled at me and shook his head.
Began the first of what will be six days in a row in the suburbs. Started the day with the same woman from the group home I brought in on Tuesday with the abdominal pain/knee pain complaint. The people at the group home were angry tht the hospital hadn't given them a diagnosis. She was sitting in her chair, feigning unresponsiveness when we got there. On Tuesday she and I had sung "Country Roads" together, so I sat next to her and started whispering in her ear the lyrics to the song, and wouldn't you know, she starts singing: "Country roads, take me home, West Virginia!" and then she ad libbed "Who Let the dogs out!"
Seven calls in 12 hours in the city.
Back at work. Slow day. A woman at a group home claiming first abdominal pain, and then knee pain. A nursing home call for an old fall with a questionable xray. Could be an old fracture of the shoulder, could be a new one. Patient not in much distress. Then a motor vehicle with no injuries.
The Institute of Medicine has just released a series of reports about the nation's EMS system, including one prehospital care. I am still away, and have only glanced at it, but plan on reading it in detail. Here's a summary:
Eight hours. Four calls.
Worked 12 hours in the city. Six calls. Six emergencies.
We didn't have a quorum at the Regional meetings today, but we still talked about the agenda items. There was some contention about my proposals for spinal clearance for basics and morphine for undifferentiated abdominal pain, but more support than opposition.
Two calls -- an MVA for neck pain and a nursing home fall with no apparent injury. I've been watching World Cup Soccer and was hoping to be able to see the USA-Check game. The Checks were up 2-0 and in full control when we were called out, so that was okay. They lost 3-0.
Checked another prisoner. Took a kid with some scrapes from falling off his bike to the hospital. Mom insisted on the ambulance.
I worked a 16 in the suburb. A 16 can be great on a Saturday, but today we were busy at least early on. Started off with an MVA where we took a mother and a daughter to the hospital with neck and back pain. They were struck from behind at a low speed and did not appear to be too injured.
1:30 in the morning, the buzzer goes off. Call for a person at a nursing home who the nurse says is faking it and just wants to go to the hospital, but is complaining of chest pain. Great. I sleep walk out to the ambulance. We drive there without lights and sirens simply because we will get there in the same amount of time either way because no one else is on the road. The nurse meets us at the door. We wheel the stretcher in and ask which way. "Out of the way," she says, "I need to lock the door." Okay.
Working a sixteen hour overnight. I taught skill sessions this morning, and then came to work. Did one call -- a woman with a possible infection. I get off at six in the morning, I don't like overnights so I am hoping it will be quit. Being up all night can wreck the rest of my week. Its so always a gamble. getting paid to sleep or getting paid to be sleep-deprived.
I could be an expert in a lot of things I suppose. I could be like this super hedge fund guy -- a guru who knows the ins and outs of the market. I could be a lawyer specializing in the intracacies of the tax code or maybe a wilderness guide who knows the forest like a feral animal. Instead, like many of my peers in this profession we call EMS, I am an expert in picking people up off the floor. Today we used one of my favorite moves to get a huge person up. Lay them on a board, strap them in, then with a person on each side and me at the head, I lift the board up to a standing position while they balance the patient, and a family member gets the walker or wheel chair, then we unclip the patient, they thank us, we get a refusal, and put our board and clips away. Another job well done.
In the suburban town where I work several days a week there are four full-time medics, three ambulances and two sets of ALS bags, one LifePack 12. Each medic is assigned an ambulance. I share an ambulance with the other day medic, as well as the same set of ALS gear. I come in in the morning, check my gear, and then don't have to worry about it for the rest of my week as I am the only medic using it. What I do do each morning is switch the narcatics into my ambulance along with the Life Pac 12, the pedibox and the spare drug box. This week, the mechanics came early in the morning, woke us up and said they needed to take one of the ambulances. I took the gear out of the ambulance, but by mistake I left the other medic's ALS bag in the ambulance they took down to the garage so when he came in that night, he had to use my bag. This morning they brought the other ambulance back. I switched the narcs, the Life pack 12, the pedi box and the spare drug kit.
Just two calls today -- a three year old who swallowed a dumdum lollypop and then told his mom his throat hurt and a 77 year old man with a TIA that resolved as we were arriving.
We were sent to a group home for a fall only to find an apparently uninjured 50 year old woman with Down's laying on the floor, saying her back hurt and to call her mother with the bad news. The aide was on the phone telling her supervisor they had called the ambulance to cover themselves. The physical survey was unremarkable. The aide told me the woman had hit her while they were arguing over a napkin, then the woman had pulled at the napkin, then let go, hit against the wall, then fallen slowly to the floor.
35 year old male sudden onset of difficulty speaking and extreme right-sided weakness -- unable to move right arm, facial droop. 3 out of 3 on the Cincinnati Stroke Scale. No prior history of CVA. Mother calls 911. We are there within ten minutes of onset. Quick stair-chair down to the ambulance. We do everything en route -- Vitals, 02 by cannula, IV, Blood sugar check, 12 lead ECG -- notify the hospital of a stroke alert. We are at the hospital within 25 minutes of onset. We are talking to the doctor within 30 minutes. The patient is whisked right off to CAT scan. He comes back with a clean head CT -- no bleeding. The doctor tells the nurse to get the TPA ready. When we come back two hours later, the patient can move his right arm, shake my hand, and while his speech isn't perfect, he can now say his name.
Two days off. I did some EMS project work. I put together three proposed protocol changes along with the backing science. One involves asthma -- making SoluMedrol a standing order and adding Magnesium for severe asthma, also on standing order. The other two both involved Morphine, and are an excellent example of how research is changing the way we practice (although I am not certain the committee will go along with my suggestion). I am proposing to make morphine for undifferentiated abdominal pain a standing order at a "judicious" dose of .05mg/kg before having to call medical control. The dose for fractures and burns is .1/mg/kg. I am also proposing that morphine for chest pain be taken off standing order and returned to a medical control option because of recent research suggesting that not only may morphine may not help patients with Acute Coronary Syndrome, it may contribute to their deaths.