I've been busy.
I went to an awesome conference and met the MacMedic.
I've been moving into my new house.
I've done an awesome shift with my new preceptor (15 leads and 2 year olds with implanted pacers!!!).
I've got the flu.
Blah!
More to come, I promise.
--maddog
3.24.2005
3.13.2005
P.E.R.L.
"I'm going to shine a light in your eyes now. I need you to look at one spot over my shoulder....."
"Pupils Equal and Reactive to Light." says the nurse with the bloody scalp wound.
She fell from standing on her bed and hit her head on the way down. She denies losing consciousness but I assume nothing.
"Yes." I say apologetically, "You know I have to check you out."
She sighs and smiles. Together, we go through all of the normal neurological tests for someone who may have a possible brain injury. She calls out their official name, what nerve they test and what it means to the examiner while I perform each test. Her neighbors got a really good education in neurology.
She passes every test. She looks me in the eye.
"I'm not riding in your ambulance."
I look at the blood trail down the stairs to the kitchen where we met her. I raise one eyebrow.
"You know scalp wounds are bleeders. Besides, My friend, Cindy, will be taking me to the urgent care center."
I want to talk to "Cindy."
Quick as a flash and without any confusion, She picks up the phone, dials, explains what has happened and then hands me the phone.
"This is Cindy."
Yes, it's Cindy. Yes, she's on her way. Yes, she knows where she's going. Yes, she's a critical care nurse too.
This is a patient refusal that I don't feel too bad about.
Good thing too. All of the hospitals were on Re-route. With a patient who's vitals were within normal ranges, we would have waited for hours, I'm sure.
"I saw you playing drums at open mic night at the Café last time. You're good, man." says a neighbor to me.
I love hometown EMS.
--maddog.
"Pupils Equal and Reactive to Light." says the nurse with the bloody scalp wound.
She fell from standing on her bed and hit her head on the way down. She denies losing consciousness but I assume nothing.
"Yes." I say apologetically, "You know I have to check you out."
She sighs and smiles. Together, we go through all of the normal neurological tests for someone who may have a possible brain injury. She calls out their official name, what nerve they test and what it means to the examiner while I perform each test. Her neighbors got a really good education in neurology.
She passes every test. She looks me in the eye.
"I'm not riding in your ambulance."
I look at the blood trail down the stairs to the kitchen where we met her. I raise one eyebrow.
"You know scalp wounds are bleeders. Besides, My friend, Cindy, will be taking me to the urgent care center."
I want to talk to "Cindy."
Quick as a flash and without any confusion, She picks up the phone, dials, explains what has happened and then hands me the phone.
"This is Cindy."
Yes, it's Cindy. Yes, she's on her way. Yes, she knows where she's going. Yes, she's a critical care nurse too.
This is a patient refusal that I don't feel too bad about.
Good thing too. All of the hospitals were on Re-route. With a patient who's vitals were within normal ranges, we would have waited for hours, I'm sure.
"I saw you playing drums at open mic night at the Café last time. You're good, man." says a neighbor to me.
I love hometown EMS.
--maddog.
3.11.2005
Watch out!!
I've gotten a new watch. It's a Timex and I like it a lot. I've had a digital Timex running watch and it's been my standby timepiece for quite a while. In fact, I've gotten so good at reading pulses and respirations off a digital watch that I don't even notice it anymore.
My new watch? Yes, yes, it has a sweep second hand but my recent watch purchase was really about aesthetics. First of all, I love the look and function of analog watches. Telling time on an analog watch requires the brain to interpret a picture rather than another set of numbers.
Secondly, I really like that Timex has put the Indiglo (TM) feature in all their analog watches. Now I can illuminate the entire face of my watch in a phosphorescent green/blue that I find comforting.
Thirdly, and most importantly, my watch ticks. It's a snappy and sure tick that reminds me of the insistence of time. I can hear it all the way down there (I've got loooong arms) when I'm in a quiet place.
It cost me $25; less than 4 pints of really good draught.
I am pleased.
--maddog
My new watch? Yes, yes, it has a sweep second hand but my recent watch purchase was really about aesthetics. First of all, I love the look and function of analog watches. Telling time on an analog watch requires the brain to interpret a picture rather than another set of numbers.
Secondly, I really like that Timex has put the Indiglo (TM) feature in all their analog watches. Now I can illuminate the entire face of my watch in a phosphorescent green/blue that I find comforting.
Thirdly, and most importantly, my watch ticks. It's a snappy and sure tick that reminds me of the insistence of time. I can hear it all the way down there (I've got loooong arms) when I'm in a quiet place.
It cost me $25; less than 4 pints of really good draught.
I am pleased.
--maddog
3.10.2005
Changes are afoot....
One of my classmates from last semester's managment class is a preceptor in XXXXXXXX City. Whaddya know!
The CSC has been somewhat helpful, if busy and dismissive ("Send me an email and I'll get it taken care of!") with my problem.
We shall see.... we shall see...
--maddog
3.09.2005
The Death of Compassion?
Rabbit and Rubber Band and I spend the day running calls to people who didn't really need ALS but could have benefitted from it greatly.
The 24 year old male who was retching from food poisoning. Rubber Band didn't want me to put him on the cot because he doesn't like to change the sheets.
The 47 year old male with back spasms, elevated pulse rate and mild chest pain. I asked if I could do a 12 lead and Rubber Band said, "We never do those." I then ask if I can at least do a 3 lead for a rhythm strip. I'm thinking I want to have some kind of look at this guy's heart. He's got a pulse of 94, a blood pressure of 180/98, he's overweight and he's got back pain of 10/10.
"Nope. We'll be at the hospital in 5 minutes."
Which we are and we wait for 10 minutes. I could have had 3-4 sets of serial 12 leads on this guy and seen what kind of response his heart was doing to all this stress but no.
We leave the hospital but don't put ourselves back on serviced for about 30 minutes. Rabbit doesn't like running calls, apparently. Neither does Rubber Band.
Here's the one that really set me off, though.
We get called across town for a 19 year old male with a shoulder injury from playing football. We take a crosstown highway to get there. Apparently, we're not the only unit in the city who's slow to go back in service. This call sends us deep into another Medic's area. On the way, I notice a minivan following very closely behind us. I'm sitting in the back of the ambulance facing out the back so I can see very well. The minivan tailgates us the whole way (about 5-7 minutes of driving) to the reported address and pulls right up to us when we get out.
"What the hell is this lady doing?" says Rabbit
"He's in here! He's in here! We called you a half an hour ago!" says the woman getting out of the minivan.
It seems she chose to follow us for 5 minutes instead of driving 5 minutes to the nearest hospital. Brilliant!
I go to the back of the minivan and am met with a young man who's covered in mud, in obvious pain and presents with one shoulder about 4 inches lower than the other. I help him walk to our ambulance and get a firm shake of the head from Rubber band when I go to put him on the stretcher. I situate him on the bench seat but once we start moving, his shoulder keeps bumping the backrest and he screams each time. I dislocated my shoulder when I was 18 and again at 32. It's no fun.
I finally override Rubber Band's disapproval and move the kid to the cot and strap him in.
Start an IV?
No
Push some Morphine for the pain?
No, we'd have to get medical direction and we're almost to the hospital, according to Rubber Band.
Well "almost to the hospital" is a 5 minute drive at high speed over the worst potholes in the city. Each scream of pain from this kid elicits a more annoyed look from Rubber Band. Rabbit's driving so, I can't see what her reaction is.
At the hospital, we're 4th in line and the kid is screaming and hollering the entire time. Rabbit tells him he needs to be quiet.
We finally get him a room and Rabbit closes the door on his screams and rolls her eyes as she walks away.
I'm ready to kill someone.
Before we leave the hospital, I walk up to the cab, where Rabbit and Rubber Band are sitting.
"Why didn't we push Morphine?" I ask.
"We'd had to call Medical Direction. Besides it's only indicated for fractures of the extremities." Says Rabbit.
"He had an obviously dislocated shoulder." I reply.
"You can't know that without an Xray." Rabbit shoots back.
"Then how do you determine a fracture in the field?" I ask.
"Look, we were almost to the hospital." She says with exasperation in her voice.
Fine. I get into the back and look up our protocols on Morphine Sulfate while we drive back to our station.
"Isolated injuries requiring pain relief " is what I find in the list of indications from our protocols. That means we can administer it without medical direction.
I've got a healthy kid with no contraindications for Morphine, who's also got an isolated injury and pain that's a 10/10. Why didn't we push the morphine?
Is it because I wasn't aggressive enough with my preceptors? Should I have insisted and told them to go to hell? How would that have looked at grading time? My preceptor holds my grade in the palm of her hand.
Is it because Rabbit and Rubber Band didn't want to deal with the hassle and paperwork of dealing with Morphine administration?
Is it because Rabbit and Rubber Band been on this job long enough that they've lost compassion?
Is it because I need a new preceptor?
--maddog
The 24 year old male who was retching from food poisoning. Rubber Band didn't want me to put him on the cot because he doesn't like to change the sheets.
The 47 year old male with back spasms, elevated pulse rate and mild chest pain. I asked if I could do a 12 lead and Rubber Band said, "We never do those." I then ask if I can at least do a 3 lead for a rhythm strip. I'm thinking I want to have some kind of look at this guy's heart. He's got a pulse of 94, a blood pressure of 180/98, he's overweight and he's got back pain of 10/10.
"Nope. We'll be at the hospital in 5 minutes."
Which we are and we wait for 10 minutes. I could have had 3-4 sets of serial 12 leads on this guy and seen what kind of response his heart was doing to all this stress but no.
We leave the hospital but don't put ourselves back on serviced for about 30 minutes. Rabbit doesn't like running calls, apparently. Neither does Rubber Band.
Here's the one that really set me off, though.
We get called across town for a 19 year old male with a shoulder injury from playing football. We take a crosstown highway to get there. Apparently, we're not the only unit in the city who's slow to go back in service. This call sends us deep into another Medic's area. On the way, I notice a minivan following very closely behind us. I'm sitting in the back of the ambulance facing out the back so I can see very well. The minivan tailgates us the whole way (about 5-7 minutes of driving) to the reported address and pulls right up to us when we get out.
"What the hell is this lady doing?" says Rabbit
"He's in here! He's in here! We called you a half an hour ago!" says the woman getting out of the minivan.
It seems she chose to follow us for 5 minutes instead of driving 5 minutes to the nearest hospital. Brilliant!
I go to the back of the minivan and am met with a young man who's covered in mud, in obvious pain and presents with one shoulder about 4 inches lower than the other. I help him walk to our ambulance and get a firm shake of the head from Rubber band when I go to put him on the stretcher. I situate him on the bench seat but once we start moving, his shoulder keeps bumping the backrest and he screams each time. I dislocated my shoulder when I was 18 and again at 32. It's no fun.
I finally override Rubber Band's disapproval and move the kid to the cot and strap him in.
Start an IV?
No
Push some Morphine for the pain?
No, we'd have to get medical direction and we're almost to the hospital, according to Rubber Band.
Well "almost to the hospital" is a 5 minute drive at high speed over the worst potholes in the city. Each scream of pain from this kid elicits a more annoyed look from Rubber Band. Rabbit's driving so, I can't see what her reaction is.
At the hospital, we're 4th in line and the kid is screaming and hollering the entire time. Rabbit tells him he needs to be quiet.
We finally get him a room and Rabbit closes the door on his screams and rolls her eyes as she walks away.
I'm ready to kill someone.
Before we leave the hospital, I walk up to the cab, where Rabbit and Rubber Band are sitting.
"Why didn't we push Morphine?" I ask.
"We'd had to call Medical Direction. Besides it's only indicated for fractures of the extremities." Says Rabbit.
"He had an obviously dislocated shoulder." I reply.
"You can't know that without an Xray." Rabbit shoots back.
"Then how do you determine a fracture in the field?" I ask.
"Look, we were almost to the hospital." She says with exasperation in her voice.
Fine. I get into the back and look up our protocols on Morphine Sulfate while we drive back to our station.
"Isolated injuries requiring pain relief " is what I find in the list of indications from our protocols. That means we can administer it without medical direction.
I've got a healthy kid with no contraindications for Morphine, who's also got an isolated injury and pain that's a 10/10. Why didn't we push the morphine?
Is it because I wasn't aggressive enough with my preceptors? Should I have insisted and told them to go to hell? How would that have looked at grading time? My preceptor holds my grade in the palm of her hand.
Is it because Rabbit and Rubber Band didn't want to deal with the hassle and paperwork of dealing with Morphine administration?
Is it because Rabbit and Rubber Band been on this job long enough that they've lost compassion?
Is it because I need a new preceptor?
--maddog
3.07.2005
Is the honeymoon over?
Well, this post is about my preceptor and her partner. I have to come up with names for them so, here we go:
My preceptor has many qualities that I just can't seem to put into words. There are times when I wonder why she's decided to be a preceptor. I often feel like I'm a pain in the butt to her. Other times, she can be very accommodating. She always tells me I'm in charge of the call but she'll frequently take control to hurry up a junkie who's not going fast enough. I don't know. Because of her physical characteristics and the fact that I see Bugs Bunny smoking a cigar and wearing a bowler hat every time I look at her, I shall call her "Rabbit."
Her partner is a 42 year old father of 4 who looks, acts and speaks as if he just turned 21. He alternately scares and amazes me. I shall call him Rubber Band.
Rabbit and Rubber Band show up to shift this morning only slightly less hung over than they warned me they would be. I knew they were going to a big dinner function the night before and when, at 0530, they stumbled in, signed themselves to the roster and shuffled off to bed, I smiled and turned to my homework.
We only ran a few calls but they, combined with the calls I ran last shift, served to give me a clear picture on their attitude towards patients, transport and what the think a 'medic should do.
I'm far too exhausted to accurately describe my feelings. There are also some technical aspects and drug questions I'd like to ask my more experienced readers. Stay tuned. I will post again tomorrow.
Coming up....
Apathy, Compassion, Tailgating and Morphine Sulfate!
Will the fun never stop?
--maddog
3.06.2005
More to come....I hope.
On my last duty night had no calls. Blah!
School is demanding but not exciting enough to warrant a post. Blah!
Today? I ran 18 miles. Oof!
Tomorrow? Another shift with Medic XX. There's a good post waiting for me, I know it! Whee!
Soon, I'll be doing rotations at an ED in the same area as my Medic unit. I'm SURE I'll get some blogworthy stuff out of that. I found out that next semester (fall 2005) I'll be in the same ED but I'll be shadowing an ED doc instead of cleaning vomit and hoping for a chance to do an IV stick. It made me think of Doc Shazam and her post about Teachable Moments.
More later, I hope.
--maddog
School is demanding but not exciting enough to warrant a post. Blah!
Today? I ran 18 miles. Oof!
Tomorrow? Another shift with Medic XX. There's a good post waiting for me, I know it! Whee!
Soon, I'll be doing rotations at an ED in the same area as my Medic unit. I'm SURE I'll get some blogworthy stuff out of that. I found out that next semester (fall 2005) I'll be in the same ED but I'll be shadowing an ED doc instead of cleaning vomit and hoping for a chance to do an IV stick. It made me think of Doc Shazam and her post about Teachable Moments.
More later, I hope.
--maddog
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