My Angel has saved me!

My new preceptor is a wonderful person. She's a runner. She is a bottomless font of compassion. She's sharp. She LOVES working in EMS. She's a goofball.

Clearly, it's a match made in heaven.

I shall call her Angel. I'm sure that's what many of her patients think of her. She calls them all "sweetie," even the junkies.

We run an auto accident. Driver of car A is hit by a taxi that runs a red light. Driver A is pissed because she's been a bus driver for 14 years and has never had an accident on the job. She gets hit by a cab while driving her kids to school.

Low speed impact. All minor injuries.

At the emergency room Driver A glares at Taxi Driver while waiting for the solitary triage nurse to get around to them.

We're outta there!

Another car accident.

Only the passenger has complaints. We do a full spinal immobilization and transport. Nothing much worth mentioning here other than the fact that Angel applauds me for remembering to pad the voids of the backboard to make it more comfortable for our patient.

Wow! Compassion, skill and attention to detail! I'm home.

The next patient is "2 year old. Not breathing."

Shitohshitohshitohshitohshit.......

We arrive to find a little girl in the middle of the floor twitching rhythmically. Mom says she's got an implanted pacer/defribrillator. I see it under her skin. it's almost as big as she is.

I position the kid to open her airway and I see her stomach rising and falling in rhythm. I find a pulse. She's out like a light.

"You carry her. We're going." says Angel.

I scoop up the little girl and take her out to my ambulance.

"Hey, Little one! You there, Little One?" I say.

She seems to be rousing from all the activity. In the ambulance we get her on the cot. I remember from the pediatric seminar I attended (the morning after drinking beer and having dinner with the MacMedic), how to position a toddler to maintain the best airway. She's perfusing at 84% at first. A couple blankets under her shoulders elevate her body enough to allow her head to fall back and her airway to open.

One minute later, on 100% Oxygen, her hemoglobin saturation is up to 98%. Right!

I set up a 12 lead EKG on her. This requires me to place 10 electrodes on her body that I'm trained to do on an adult. Fortunately, the landmarks are the same and I find the 4th intracostal space (the space between the 4th and 5th rib) and the mid-clavicular line (the line straight down from the collar bone) with ease.

I crowd the big adult-style electrodes on her little body and press the button marked "12-lead". I get a readout (Sorry, I didn't get a copy) that tells me she's bradycardic (slow heart rate) with no abnormalities except a cardiac pacer spike (the electrical readout of her pacemaker shocking her heart) and a slight left sided hypertophy (the left side of her heart is a bit bigger than normal from working so hard). She's slow and low.

Meanwhile, Angel tries and fails twice to start an IV in the kid's fat little arms. We discuss an Intra-Osseous (that's where you jam a needle through the bone and into the marrow of the lower leg bone in order to administer fluids and medications) but we decide that our ETA of 3 minutes to the pediatric emergency room rules that out.

We can't get a decent blood pressure on her and I'm watching her oxygen saturation closely while trying to decide if I need to start bagging her (providing breathing assistance with a bag and a mask, effectively forcing more air inter her lungs when she inhales). Her activity level is increasing and she's becoming more responsive to pain and stimulus. These are good signs.

So far, we're thinking she's one of the rare kids with cardiac problems. I get three 12-lead EKG readings on her in sequence to give to the doctor when we arrive.

We arrive.

Into the ED. Nurses galore. Lots of consulting. Someone asks me to show them a pacer spike on an EKG readout. Eight people, one medic (Angel), one medic student (me), one nursing student and Mom are in this room.

Chaos.

Or is it?

3 minutes into it, the little girl cries.

"Moooommmmyyyyyyyy"

A collective sigh and everyone relaxes.

"Blood sugar?" asks the doc.

"Too low to read." says the nurse with the glucometer.

Blood Sugar? I look over at Angel.

An exasperated "Dammit!" is written all over her face.

We were so concerned with cardiac that we didn't test her sugar. Dammit!

The nurses couldn't start an IV (intra-venous, or needle-into-your-vein) line either. The doctor ordered an NG (naso-gastric, or a tube that goes into your nose and down to your stomach) tube and they filled her with glucose.

She came around beautifully.

I heard later that she went home the next day.

After the call, Angel was more concerned with figuring out how we could do that better next time than with justifying her actions. She is, truly, a Jedi. She believes in what she does so much that she can set down her pride and learn from her mistakes. I am humble in her presence.

All my worries about not learning or having a bad preceptor have vanished. Angel and I are of the same mind and she doesn't mind giving me the time to do the skills I need to learn.

My next shift with her is on Sunday night.

I can't wait!

More to come!
-an ED rotation with Icky bedsores and cool nurses!
-a guest volunteer shift in another station with an SUV rollover!

I've been sick. I haven't been dead.

--maddog.