Paramedic Journal : A Year on the Streets

Notice

2006-08-16T20:10:00.000-04:00

I am suspending this blog indefinately as I am becomming burned out from trying to keep it up everyday in addition to all my other projects.

I direct readers to the following blog, where I will try to post once or twice a week on the life of a paramedic and topics of interest.

Street Watch: Notes of a Paramedic

Thanks you all for reading.

Cold

2006-08-14T21:16:00.000-04:00

Driving into work I had my portable on. The medic I switch with at the beginning of the week always comes in a little early in the evening so I don't get slammed with a last minute call so I try to return the favor for him. I'm crossing the town line when I hear them paged out for a mother who's son is cold. Okay, I'm thinking code, but I'm also thinking presumption. I start that way -- it is on the other side of town. They get updated that CPR is in progress. They are already out when I arrive. I find them in the bedroom doing CPR on a middle-aged man. He is in asystole. The night medic is going for the line while the cops do CPR, compressions and bagging. I go to the head and put in the tube. His jaw is not limber -- there is a slight amount of stiffness there, but I am able to get the tube in. We work him for twenty minutes, and then call the hospital to gert permission to presume. We don't have to call, but since he is in his forties, we do. The night medic tells the mother that her soon is gone, and she starts crying, and comes over to the body and gets down on her knees and throws her arms over him and starts crying out to Jesus. (Often I give the family a chance to say good bye before we stop CPR, telling them that while we are breathing for them and pumping their heart, they might be able to carry their family's voices off with them when we let them go. I didn't even think of it this morning. Maybe because I wasn't the one running the code or maybe it was still so early in the morning. I wish that I had.) It was a very emotional scene. The night medic's partner was in tears. It was sad, but it was also one of those times when you feel good about the world because you see so clearly the love that people have for each other. The guy died young, but he was surely loved by his mother.

Later in the day we were sent for a seizure possibly not breathing. It was out a house I hadn't been too for several years, but I remembered as a psych's place. We found a semi-naked fourty year old woman in the back seizing, well, she was shaking. I wasn't convinced it was a seizure. She was hot and diaphoretic. I put her on the capnography and saw she was breathing fine and had good cardiac out. In the ambulance she admitted she had been drinking and hadn't had a drink for three years. Then she started shaking again, her whole body. On the capnography she was apneic while she shook, but it never lasted more than thirty seconds. I thought maybe she was holding her breath. My preceptee tried to line and she jerked it out. When she stopped seizing, we tried a sternal rub, but she didn't respond, but then she was awake with no postictal period. The ride in was a bit of a fiasco with us yelling at her to knock it off, her alternately seizing and swearing at us. When I told her I had to stick her to get a line, she said it had hurt the last time. My preceptee had stuck her when she was suppossedly unresponsive. We ended up giving her 1 mg of Ativan just to chill her out some. At the hospital she did her seizure routine for them, and ended up getting strapped down after she started screaming she wanted oxycodone.

Then we got sent priority one for a "severe hemmorage" at the diaylsis center on a commercial pass -- it turned out to be guy walking around with a clamp on his arm. The place was closing and after two hours he still hadn't stopped bleeding whenever they removed the clamp, so because they had to go they couldn't observe him anymore so we had to take him to the hospital.

Sammy

2006-08-13T21:14:00.000-04:00

Three calls: 1) the old lady from last week with dementia who was disorientated. Today her problem was she couldn't sleep -- she needed sleep. She slept only an hour. She had to sleep. We hoped when we brought her in might finally get some social service help, but they said she couldn't get her on Medicaid because she still owned her house. Her daughters live far away and she is losing her mind. The neighbor said she called her 22 times the day before. They put her in the waiting room.

The other two calls were for a nursing home man with sepsis and man with abdominal pain.

We spent the afternoon doing mock codes with my preceptee, using an airway maniquin and a CPR manequin. I taped a sponge in a plastic baggy to the manequin's neck to serve as a jugular vein so he could inject drugs. We used our expired epi, atropine, etc. I played "Sammy's friend," and succeeded in pulling the tube out while assaulting the crew. I had them load the mannequins and drive around the block doing CPR. Good times.

My Birthday

2006-08-12T21:06:00.000-04:00

Day off.

Beam

2006-08-11T21:44:00.000-04:00

Precepting again today. 12 hours in the city. Again, it was nice all 911s.

We did a seizure, a dsypnea, a patinet who was peppersprayed by police, an emaciated patient who we had to talk into going to the hospital, and another call I don't remember.

We were in the apartment of this old man with dreadlocks, emaciated as a Biafrin. he did not want to go to the hospital. Two big guys from some social organization had called us. My preceptee was doing a really good job talking to the guy, convincing him to go to the hospital, to get a meal, get cleaned up, and have the doctor check him out, and then helping dress him and manuever him into the stair chair, all the while the guy is going slow because I sense he worries he won't be coming back to his clutterd little apartment, where I notice two books a paperback -- "The Keys to Success" and a hardcover library book by the same author "How to make a Million Dollars.'

"Too bad, you can't just beam him to the hospital," one of the big guys said. "Just hit a button and he's there."

"Well that would be nice," my partner says, "But that would sort of put us out of business."

"No, no, it wouldn't. You'd still need someone to come and check the person out -- someone to make the decision to beam them -- someone to push the button on the beamer. They couldn't have just anybody do it."

"Well, I guess if you put it that way," my partner said.

Fast

2006-08-10T20:11:00.000-04:00

12 hours precepting. We were busy, but only one ALS call for a chest pain. The other calls were for an OD/psych, a back pain, two falls, hip, and a psych. At least the day went by fast.

Cleaned Out

2006-08-09T21:15:00.000-04:00

First patient today was a woman who I've taken care of several times over the years. She has a history of seizures. She's had them ever since she was born. Her mother had gone to, in her words, "have her womb cleaned out," and the doctor somehow missed the fetus. The fetus was wacked in the head repeatedly with the vaccum, and surprise of surprises lived through the episode, and has seizures as a result. Talk about a survivor. Poor girl works for an insurance company and has for almost a decade, but gets no benefits because she is actually employed by a temp agency.

Last call was an asthmatic, who got two treatments and was still working a little hard.

Tomorrow I am in the city to precept another medic for a few days.

Great Interest

2006-08-08T23:46:00.000-04:00

I had a vicious headache today. I don't normally eat Burger King, but I have always found it to be great anti-headache food, so on the way to work this afternoon, I stopped and got a combo whopper meal, and just as I was pulling into work, just as I opened the door to get out, my radio went off -- a call. I hate that. I had to eat my hamburger going down a bumpy road with the lights and sirens on. That takes away all anti-headache properties. The call was for an old woman and increasing regular customer, who lives alone, and whose complaint today was she just felt "all disorientated." On the drive in she told me several times about how she'd had a big supper. Meal and wheels had brought her meatballs. We had the same conversation five times. My guess was she had some dementia coming on.

Later we did a two patient MVA and a morbidly obese woman who was spitting up blood. We went to the same hospital. The disorientated woman was sitting in the hallway reading the HIPPA form I'd left her. She'd pick it up, read it with great interest for a minute, set it down, and then pick up again and read it with great interest again. She was the only person in the hallway who didn't seemed agonized about the wait.

Congested

2006-08-07T21:31:00.000-04:00

An unresponsive at a nursing home, who on inspection seemed only to be feigning. Then we were called out for an MVA only because the uninjured driver was pregnant. Just before crew change we got a call for baby not breathing, but it turned out to be either a febrile seizure or the two year old with a fever who choked temporarily on a mucus plug. He was fine, just a little congested.

Steri-Strip

2006-08-06T11:00:00.000-04:00

One thirty in the morning, patient in a nursing home threw up some coffee grounds emesis. Patient has a big psychiatric history and has some gender issues. He tries to engage me in a conversation about gender, but I chose to focus on the emesis issue.

Four twenty in the morning, patient with ABD pain and dsypnea with a COPD history. Her lungs are clear and the capnography shows a good wave form. Touch her side and it hurts.

I get back at five and sleep until nine when we get a call for a man in a nursing home who has fallen and has a cut on the bridge of his nose. The nurse has put a steri-strip there and thinks he needs a stitch. Dial 911.

A daughter finds her diabetic mother asleep on a bench in the lobby of her retirement community home while she waits for a ride. She is a diabetic. Her sugar is 343. The mother has no complaints. She says she just fell asleep. The daughter calls 911. We get there and inspect the patient's blood sugar log. Not a day goes by that she isn't up in the 300 or 400's. I have taken care of her before when it was in the 20s. I suggest we call her doctor. We sit there for almost an hour waiting for the doctor to call back. The mother is walking around the apartment telling jokes. Finally its time for her to take her insulin. the daughter is finally convinced to just make an appointment with the doctor's office for tomorrow and to call us if anything changes.

Then its three more nursing home calls -- a seizure, a CHF, and a chest pain. Nitro takes care of both patient's problems.

And now I'm home finally.

A Supplement

2006-08-05T23:49:00.000-04:00

Three-forty in the morning. Man with Alzheimer's can't pee. We take the man to the most distant hospital. History of urinary retention, can't pee, I say in my radio patch. The man is a bit of a kick. He talks about the place where he is staying: "A good place, you get three squares a day and they look after you when you are under the weather. Breakfast, scrambled, eggs, toast, some sausage, orange juice. I have major medical. People think you can rely on Social Security. You can't its only meant to be a supplement. I have a good pension."

I ask him if I could get into this place with just Social Security. "No, its only meant to be a supplement. Its a good place here. Three squares a day and they look after you when you are under the weather. Breakfast, scrambled, eggs, toast, some sausage, orange juice. I have major medical. People think you can rely on Social Security. You can't its only meant to be a supplement."

We have the same pleasant conversation about five times before we reach the hospital. I finally ask, "Well ,what do I do if I only have Social Security."

"Maybe find a dice game," he says. "Social Security is only meant to be a supplement. I'm lucky. Its a good place here. Three squares a day and they look after you when you are under the weather. Breakfast, scrambled, eggs, toast, some sausage, orange juice. I have major medical. People think you can rely on Social Security. You can't its only meant to be a supplement."

Depressed for lack of a good dice game, I don't get back to sleep until 5:15. My shift is over at six. I get up, give the narc keys to my relief, punch out, and then get back in bed and sleep until 8:30, before heading home.

This afternoon I am going to a reunion picnic for my Dominican trip, and then back to work at two for eight more hours.

***

Quiet afternoon and evening. Only did one call -- at a nursing home for high white blood count.

They were extremely short people this weekend, so since I slept most of the afternoon, I am doing the overnight again.

No Way

2006-08-04T23:59:00.000-04:00

Working the overnight in the suburbs -- always a calculated risk -- will I be able to sleep or will I do calls and be sleep-deprived for a week after? I've done three calls on the first leg -- a medical alarm, a man having cluster headaches, and an apparent miscarriage. The miscarriage came in as vaginal bleeding a couple days before the woman's period is due, no possibility that she is pregnant. We get there there is blood all over the floor, and a clotty sack that looks like it might be the beginnings of a fetus. She claims she has been having regular periods and that she isn't pregnant. I explain to her in the ambulance that from everything I have seen she is having a miscarriage. She nodds and seems to understand. At the hospital, her mother is there and the nurse tells me she keeps claiming there is no way she is pregnant.

The eleven o'clock crew comes in and not two minutes later we get called for a fall with hip pain. Its in the alzheimer's unit of a retirement community. The leg appears slightly shortened and rotated, but the man has no pain when I palpate his hips. We lift him up and gently and give him an easy ride in.

I get back just before midnight.

Now if only I can sleep the rest of the shift.

Hot Dog Eating Contest

2006-08-03T23:35:00.000-04:00

Went in for a rare six hour evening shift in the city. I was with another medic, and he said they wanted us to sign on as soon as we could because we were going to be posted down at the city park to do some kind of a standby at a hot dog eating contest. As soon as we signed on, they sent us instead on a transfer, but then a couple minutes later they took us off the transfer and assigned us to the park for hot dog eating contest. The larger event was a Battle of the Bands contest, but before that got underway there was the hot dog eating contest, and when we got there, they explained they couldn't start until we showed up. They needed us standing by in case someone choked. They wanted us on stage with our gear at the ready. I made certain we had our crick kit with us. My partner and I joked about marking everyone's crickothyroid membrane in advance and measuring them all for tube sizes.

It turned out they only had four contestants, and the contest was only going to be for 12 minutes. The champion ate all 16 on his tray and stopped with minutes to spare, although he did get a brief scare when someone told him the old guy on the end was on his second tray of hot dogs. The old guy on the end I think was in fact a homeless man who had either volunteered or been recruited to fill out the table. He only ate three hot dogs and ate them rather leisurely. We were supposed to stay around for a half hour afterwards in case any of them got sick, but all of the entrants left. We ended up staying until the end of our shift just doing a routine standbye for the concert. We sat in the air conditioned ambulance behind the stage -- the AC up so loud you couldn't even tell there was a concert going on -- reading magazines, talking about how screwed up EMS was and how we should distribute money in our 401Ks, and then at the end of the night this incredibly beautiful girl comes up and knocks on the window and asks for some band-aids. I point to my partner ans say, "Here's the band-aid man, right here. He'll take care of you," and then she asks me if we caught her set. And I said,"Yeah, you guys were smoking!" She seemed pleased with that, and my partner got her some band-aids, and I went back to reading my magazine.

Hot Again

2006-08-02T23:12:00.000-04:00

Worked from two in the afternoon until ten at night in the suburbs. It was over 100 degrees with high humidity. Only went out once -- for a child punched in the eye. Why the recreation people called an ambulance, I don't know. We couldn't tell which eye he'd been punched in. We had to wait around for forty-five minutes to get hold of a family member. He didn't want to leave his house to get the boy so we took a refusal over the phone. The cops gave the boy a ride home.

8

2006-08-01T23:03:00.000-04:00

Another hot humid energy sucking day. Started off with four straight calls.

A nursing home DNR, dialysis renal failure, MI, CHF, COPD, IDDM, etc, 80 something year old female who they found this morning with facial drop, slurred speech and a BP of 63/30.

Then a 84 year old woman who slipped in the bathroom and broke her hip. You didn't need an x-ray machine know. Unable to move leg, leg shortened and rotated, extremely painful at rest and more so on palpation of the hip. I gave her seven of morphine -- she weighed 70 kg -- before I even moved her in small increments - 2, 3, and 2, then I waited about five more minutes. We put her on the scoop stetcher with about five pillows for padding. She was still in a fair amount of pain so I called in to get permission to give her 3 more mg. I got permission for 5 more. Hooray for the doctor. She was almost pain-free when we came through the door. I was monitoring her on capnography. Her respirations which were almost 30 a minute were now to down to 8. She was still alert. She and her son, who had questioned me rather rudely when I first said my plan was to medicate her, were both very happy and thankful to us, which was nice.

Did a 24 year old pregant girl with vomiting and "seizure" activity. I had her friend describe the seizure and it didn't sound like a seizure. We got out in the ambulance and all of a sudden she started this arms and legs out straight, shaking like she was at a zombie dance party. I told her to cut it out and she stopped cold. No postictal state, no incontinence, no tongue biting. She said she was aware of the shaking, didn't know why she did it, and she thought it was strange because she was shaking, but she wasn't cold. I have a small digital camera I keep in my pocket to sometimes take pictures of accidents to be able to show the trauma team the mechanism of injury. It has a motion camera feature on it. I thought about getting it out to be ready in case she had another one of her fits -- I thought her doctors would like to see it seeing as they have been unable to make a diagnosis -- but I wasn't certain about how they fit into the privacy laws. It is an interesting question. I suppose it you had a blank disc and left it at the hospital with the patient as part of their record it would be okay.

The other calls were all at nursing homes -- some sick, some not so sick. Falls, pneumonia, etc. Total of seven calls today. Now I am home, sticky hot, sucking down a Corona and about to shower before getting in bed and turning the fan directly on me. It is supposed to be worse tomorrow. I don't go into work until two.

hot

2006-07-31T16:44:00.000-04:00

Started the day off with three calls -- a man with abdominal pain, a man in DTs, and a woman with a headache since a fall a week ago who a scan done today that showed a subdural bleed. Then we got a little bit of a break, and then responded to the town pool for a little girl with head and neck pain after someone jumped into the water on her.

It is hot out.

DVT

2006-07-30T17:49:00.000-04:00

12 hours. One call at a nursing home for a possible DVT. Spent the rest of the shift working on projects. No complaints.

Standing By the Car

2006-07-29T21:19:00.000-04:00

Worked eight hours with another medic. I thought maybe that would get me out of the transfer runaround -- that and it being a Saturday. Still ended up with three transfers, although one was ALS. I don't understand the posting and assigning of calls sometimes. We're a double medic car in an area covering two 911 towns, a car gets sent from the city to our post and we're sent into the city to do a dialysis transfer.

The other three calls were decent. A 23 year old with kidney disease, HTN and IDDM, feeling weak. She had a BP of 220/110 and a blood glucose of 390. She got admitted.

We had another diabetic not taking her meds with a high blood sugar.

The last call was for a rollover in the north end of the city. We were quite aways away when they gave it to us because we were the only car free. I have probably done 10 rollovers in this park of town. I told my partner it was probably a stolen car and there would be no patients. That's how it always is. But I was partially wrong this time. The fire department was reporting downed wires and a patient under them. Another car cleared up and was sent because they were reporting multiple patients. We got there just after they did. I went to the EMT and asked for a report as he was helping board a patient -- an older woman who was bleeding from the mouth. He said she was the worst -- the other two were minor. I said I'd take her then. I came back with the strethcer and got her on it, only then did I realize the EMT was a medic. He was wearing his baseball cap backwards like another guy at the company and when I was talking to him, I'd hadn't seen his face clearly. I apologized then for stealing his patient. He was cool about it.

The story I got at the scene showed I was partially right in my impression. The car that rolled was a new car and its occupants had fled the scene. Same as always -- they steal a car in one town, then come barrelling down a residential street into the city, roll it, and then flee. The fire fighters told me the woman was standing by the car. I thought it meant she had been standing by her car that was hit by the other car when they got there, but as we were en route to the hospital and I was interviewing her, I finally figured out she was standing by her car when she saw the car speeding down the street out of control, and the car had struck her car and rolled over it, striking her. She had a smashed up face, broken teeth, and was somewhat confused. She ended up in the trauma room.

I got off an hour late.

Two Minutes

2006-07-28T23:20:00.000-04:00

Did a bunch of transfers to start the day including a wait and return at a doctor's office. The poor woman we brought in barely fit on our stretcher. Her right side was flaccid from a stroke and we had a hard toime keeping her straight. At the doctor's office, a nurse took her BP and her pulse and listened to her heart. Fifteen minutes later the doctor came in and talked to her for about two minutes. he asked her is she had any chest pain or any trouble breathing, and then he listened to her lungs in two places while she lay on the stretcher. I offered to help him sit her up, but he said that was allright, and then he left. He wrote some notes for her, and then we left.

Other calls included a chest pain that was just hyperventilation, a motor vehicle accident and a drunk who fell down.

Tomorrow I'm only working eight.

Expired 2000

2006-07-27T19:41:00.000-04:00

Hot, sticky day. Started off with a long transfer. We drove about forty minutes to pick up a lady at a distant nursing home to take her another thirty miles to a dialysis center. I guess they closed down the dialysis center near her. I was a little annoyed when I heard a basic car calling for a medic shortly after we got the call, but I didn't mind the air-conditioned drive. My car had just been filled with freon the day before.

On the way back we were sent to a chest pain. The pain came on at work for a fifty- four year old man unrelieved by his nitro. I gave him two nitro and the pain cleared up. I looked at his nitro -- it had expired six years ago.

Later did another dialysis transfer and an old woman with a UTI.

Back tomorrow for 12.

No Complaints

2006-07-26T21:14:00.000-04:00

Worked 12 in the city. Only had to take one call -- a woman who had a syncopal episode. She was undergoing radiation and hadn't been eating. She was way orthostatic. Her pulse went from 76 supine to 92 sitting to 120 standing. I gave her some fluid and she felt better.

Other calls were for a psych off his meds with suicidal ideations, an MVA refusal, a couple transfers, a difficulty breathing that turned out to be a homeless man sleeping.

We started the day off with three hours of sitting in a suburban town. I read quite a lot of my book today.

No complaints.

Back tomorrow for 8.

Code

2006-07-25T13:14:00.000-04:00

6:03. Person not breathing. The night medic hasn't left yet so he offers to come along. I'm thinking its going to be a stiff. We get updated. "The person has a pulse, we're about to use the AED." Okay. We enter the house walk through a narrow hallway,and then down a narrow staircase, and then around some big furniture to a basement bedroom where they are doing CPR.

We enter the room at 6:10. Man in his late fifties with a diaylsis port hanging out of his chest. He's warm. Family says he was talking to them shortly beforehand. A witnessed address. He's asystole now. I intubate him. End Tidal CO2 shows a good wave form with a reading between 17 and 23. We work him hard. Doing the new CPR. I get an EJ and in go the drugs. Epi and Atropine. (Later the night medic asked me why I didn't use Vasopressin. Vasopressin! Do'oh. I never remember we carry it now. It is zipped up in a small pouch. Over a decade of this, I am programmed -- epi, atropine. I give him some Calcium. Next thing I know the ET CO2 is up to 35. We stop compressions. He's got an organized rythmn and a pulse. BP is 124/80. It is now 6:30 -- a half hour into the call. We have to package him. Fortunately we can go out through a backdoor, but there will be a hill to push him up. As soon as we get him outside, the capnography drops down to 18. Back to CPR. More epi/atropine. Capnography gets him back up. We lose him again as we push up the hill, but regain ROSC as we near the hospital at 7:00.

Going down the hall, he starts to fade out again, and even though his ETCO2 is 32, we start CPR. The rythmn looks idioventricular. They work him awhile longer at the hospital, but he doesn't make it.

The capnography was very instructive. It did the following:

1) Confirmed placement of the tube.
2) Alerted us to ROSC three times.
3) Whenever we were doing CPR and the number started to fall, we switched compressors and the number came back up. At one point, I told my partner if he could get the ETCO2 up from 16 to 20, I'd buy at Dunk'n Doughnuts. He started pounding the CPR and the number slowly climbed all the way up to 28. Stopped compressions, the number fell off the cliff almost right away.
4) Confirmed continuously placement of tube. Pulling him out of the ambulance, the wheels didn't drop properly and we almost lost him. There was a lot of jarring, but when I looked at the monitor, the wave form was textbook. Tube still in place.

Here's the capnography trend summary showing Return of Spontaneous Circulation (ROSC).

***

Just when I start to feel like a paramedic again, my next two calls are for blood oozing from a catheter in a nursing home patient and a direct admit from an endoscopy center, both of whom called 911 instead of the commercial ambulance.

Later I did a dsypnea/chest pain with an MI/COPD history that felt better with a breathing treatment and two nitro.

No Bone Scans Today

2006-07-24T21:41:00.000-04:00

Three calls. All old patients, a tough old man with chest pain and two old women who were drama queens. One complained of weakness and did a phony vertigo slow motion spin with knees buckling, all while maintaining her balance when we tried to do orthostatics. The other lady grimaced in pain when we said we were going to move her even though we hadn't moved her. She had fallen three days before and still had hip pain. The portable x-ray at the nursing home was negative, so the doctor wanted a bone scan, so they called 911 and sent us to the farthest hospital, which told us they didn't do bone scans.

Back for more tomorrow.

Cleaning

2006-07-23T19:02:00.000-04:00

The internet was down at work and the computer I use was down, leaving only one older computer with not too much on it. So I spent the day cleaning out the storeroom, cleaning the ambulance, neating the quarters. Only did one call - a man with a fever coughing up blood.

Rotten Meat

2006-07-22T18:29:00.000-04:00

First call was for a rotten smell. I was thinking dead body, but as we go there the police and fire were walking out saying it was just rotten meat, no body.

We did three calls -- a man in a nursing home with rib pain, a man status post shoulder surgery with an infection and a nursing home dementia patient who hadn't peed in 24 hours.

A rainy, drizzly day.