1.31.2006
School starts!
Classes start tomorrow! I've bought all my books! I bought a new pen! I've filled my notebook with fresh, crisp loose leaf paper!
I'm excited!
(What a dork!)
--maddog
1.26.2006
Night of Insanity: Final Chapter.
I hop in the ambulance, gobbling chili as I go. The call is to an address I know pretty well. The fire engine is already out on another call and as we climb the hill to our destination, we see it. There's a fire right across the street from where we're going. A friend of mine lives in that set of townhouses and I think, "Gee, I hope he's ok." I find out later that he is ok but it was his house burning.
Poster Girl, Sky Captain and I enter the house of my patient. I know this woman. Her son taught me to ice skate when I was 8 years old. She has a bunch of medical conditions including, diabetes, high blood pressure an amputated leg, extremely brittle and breakable bones. According to all her doctors, she should have died a few years ago but she's still going. She's persistent, energetic involved in the community and irrepressibly cheerful. She's one of my favorite people.
Not cheerful tonight. She's got abdominal pain 10/10 with nausea and vomiting. Hasn't been able to keep anything down for the past 18 hours. I greet her and her husband. She even manages a smile when she sees it's me. She's in a lot of pain but her mental state is good and she answers all my questions appropriately. She's got a blood pressure of 238/180. She hasn't been able to keep her blood pressure pills down. The call was dispatched as an ALS (Advanced Life Support) call and the Medic unit arrives soon after I do.
I give my report to one medic while the other seems to be doing his best to find a reason to downgrade the patient to BLS (Basic Life Support, i.e. me) so they won't have to transport her. They're giving each other the look I've seen before.
"I was going to palpate her abdomen to rule out a AAA when you got here." I say. A "triple A" is an Abdominal Aortic Aneurysm. That's where the main aorta going down the abdomen gets a tear in it and hurts like crazy. The real danger is if it bursts then the patient will quickly bleed to death. Not much I, as a basic provider can do for that.
Both medics look at me. Then at each other.
"If I'm going to take her, I'd really prefer one of you to come with me. With her pressure and abdominal pain, I'm a little nervous. There's not much I can do if she bonks." says I.
Both medics sigh, nod their heads in resignation and one tells me to get their cot. I'm getting a reputation, I suppose, of not letting the local medics get away with anything!
Back at the station, it's midnight. Blessed sleep.
At 4:30 the bell rings again. I stagger out of the bunkroom and think I'm still asleep. "14 year old female, Chest pains, trouble breathing." Squawks the radio.
14? Chest pains? Great, I'm surely still asleep. I look at the printout. Sure enough: 14 years old.
I put my bunker pants on over my flannel pajamas and hop in the ambulance. Poster Girl is driving, Sky Captain has found his sleepy way into the back.
In the apartment, I find a worried mom, a pair of sleepy siblings and a 14 year old girl sitting on a couch. She's crying and rocking back and forth while clutching her chest.
I get her to calm down a bit and get her to describe the pain. She says it's a burning that work her up about 4am (20 minutes before). Poster Girl interviews mom to get medical history, medications and allergies. I hear the mom say, "She takes Prevacid."
"Does she have acid reflux disorder or GERD?" I ask.
"Oh yeah." says mom.
"Has this happened to you before?" I ask the daughter. Still crying, she nods. Her vitals are all good for a 14 year old kid but she's in a lot of pain. We walk her out to the ambulance and I sit her in the cot as upright as it will go. I hook up some oxygen and get her strapped in. As we drive to the hospital her pain decreases to almost nothing.
We have to wait a bit in the ER for a bed. Mom is there with the two little siblings. The boy is about 6 and has a look of constant skeptical distrust. I lean over as if to tell him a secret.
"I'm wearing pajamas." I say in a stage whisper. He looks even more skeptical. I hike up the cuff of my bunker pants over the top of my boot, revealing a plaid flannel pajama leg. I wink at him. A couple minutes later, I hear him whisper to his sister.
"He's wearing pajamas!" Giggles ensue.
--maddog
Poster Girl, Sky Captain and I enter the house of my patient. I know this woman. Her son taught me to ice skate when I was 8 years old. She has a bunch of medical conditions including, diabetes, high blood pressure an amputated leg, extremely brittle and breakable bones. According to all her doctors, she should have died a few years ago but she's still going. She's persistent, energetic involved in the community and irrepressibly cheerful. She's one of my favorite people.
Not cheerful tonight. She's got abdominal pain 10/10 with nausea and vomiting. Hasn't been able to keep anything down for the past 18 hours. I greet her and her husband. She even manages a smile when she sees it's me. She's in a lot of pain but her mental state is good and she answers all my questions appropriately. She's got a blood pressure of 238/180. She hasn't been able to keep her blood pressure pills down. The call was dispatched as an ALS (Advanced Life Support) call and the Medic unit arrives soon after I do.
I give my report to one medic while the other seems to be doing his best to find a reason to downgrade the patient to BLS (Basic Life Support, i.e. me) so they won't have to transport her. They're giving each other the look I've seen before.
"I was going to palpate her abdomen to rule out a AAA when you got here." I say. A "triple A" is an Abdominal Aortic Aneurysm. That's where the main aorta going down the abdomen gets a tear in it and hurts like crazy. The real danger is if it bursts then the patient will quickly bleed to death. Not much I, as a basic provider can do for that.
Both medics look at me. Then at each other.
"If I'm going to take her, I'd really prefer one of you to come with me. With her pressure and abdominal pain, I'm a little nervous. There's not much I can do if she bonks." says I.
Both medics sigh, nod their heads in resignation and one tells me to get their cot. I'm getting a reputation, I suppose, of not letting the local medics get away with anything!
Back at the station, it's midnight. Blessed sleep.
At 4:30 the bell rings again. I stagger out of the bunkroom and think I'm still asleep. "14 year old female, Chest pains, trouble breathing." Squawks the radio.
14? Chest pains? Great, I'm surely still asleep. I look at the printout. Sure enough: 14 years old.
I put my bunker pants on over my flannel pajamas and hop in the ambulance. Poster Girl is driving, Sky Captain has found his sleepy way into the back.
In the apartment, I find a worried mom, a pair of sleepy siblings and a 14 year old girl sitting on a couch. She's crying and rocking back and forth while clutching her chest.
I get her to calm down a bit and get her to describe the pain. She says it's a burning that work her up about 4am (20 minutes before). Poster Girl interviews mom to get medical history, medications and allergies. I hear the mom say, "She takes Prevacid."
"Does she have acid reflux disorder or GERD?" I ask.
"Oh yeah." says mom.
"Has this happened to you before?" I ask the daughter. Still crying, she nods. Her vitals are all good for a 14 year old kid but she's in a lot of pain. We walk her out to the ambulance and I sit her in the cot as upright as it will go. I hook up some oxygen and get her strapped in. As we drive to the hospital her pain decreases to almost nothing.
We have to wait a bit in the ER for a bed. Mom is there with the two little siblings. The boy is about 6 and has a look of constant skeptical distrust. I lean over as if to tell him a secret.
"I'm wearing pajamas." I say in a stage whisper. He looks even more skeptical. I hike up the cuff of my bunker pants over the top of my boot, revealing a plaid flannel pajama leg. I wink at him. A couple minutes later, I hear him whisper to his sister.
"He's wearing pajamas!" Giggles ensue.
--maddog
The Night of Insanity, Part Two!
I return from the previous call to a firehouse full of people. This includes a couple who live in town who are interested in volunteering. I have invited them down to check the place out. All they see is a chaos of people, fire trucks and ambulances rushing in and out. Herself is serving out chili to any takers and spirits are high.
I dash out my paperwork from the last call and go into the kitchen. The ladle is poised over the bowl, ready to deploy a spoonful of chili deliciousness when the bell rings again.
ARGH!
27 year old male with chest pains. 27? with chest pains? Whatever, off we go. I've got Poster Girl driving and Sky Captain in the back as my trainee.
Oh, yeah, and all the medics in the area are busy. I'm on my own. Great!
The guy was driving his tow truck when he began to feel funny, we respond back to the same Major Interstate about 200 yards away from the previous accident of the night and pull in front of a flatbed tow truck. I get my gear on and get out. As I do so, there is an EMS supervisor walking my patient to the ambulance. Okeydoke. In you go!
I'm interviewing the guy and he's actually complaining of a strange feeling in his chest like his heart is skipping a beat. I feel his pulse and, sure enough, he's got an extra beat in there every now and then. I turn to the EMS supervisor,
"You got a Lifepak 12 in your truck?"
He looks at me surprised, "Um, yeah."
"Thanks!" I say. He looks at me again and then heads off to his truck.
Back with the Lifepak, I pull out leads, hook up my patient and print out a strip. (don't have a copy, sorry.) Sure enough! He's got some early ectopic (unusual) heart complexes on the readout. I call them Perfusing Premature Junctional Contractions. The QRS complex is a bit too narrow for me to call them ventricular. All the same, my patient is hemodynamically stable (has and maintains good blood pressure and is heart is adequately moving blood and O2 around his body), has a good mental status (knows where he is, who he is and what day it is) and is mostly just scared.
"You coming?" I ask the supervisor.
"No, and you can't take that either." He replies, indicating the Lifepak. He gives me a smile. We introduce ourselves to each other and shake hands.
Off I go to the hospital. My patient is nervous and chatty. I tell him everything that I'm doing and why. He seems really interested and I go a bit deeper into the science. He's eating it up. My lecture on the functions and dysfunctions of the heart carry us all the way to the hospital. We ended up going to another one further away than the last but it had the attractive feature of being open to receive patients.
My patient takes no meds, has no allergies and has no history of cardiac problems. His father, however, has high blood pressure, a 4 way bypass and takes lots of meds for his ticker. Okeydoke. My patient's blood pressure is also 222/118. That's pretty high for 27 years old.
At the ER entrance there's a man waiting who looks a bit like my patient. He's wearing a guardedly anxious look on his face.
"Are you Dad?" I ask. He nods.
"C'mon." I say, indicating him to follow us into the ER.
In the ER, the charge nurse asks for and expects a full report. She listens carefully to my entire report and even asks a few questions for clarification. It's nice to be appreciated! We transfer my patient to a bed, make a few jokes, pat him on the back and get ready to leave. On my way out, Dad stops me and shakes my hand.
"Thank you very much." he says, solemnly.
"Thank you, Sir. I trust you won't take offense if I say I hope I never see you like this again."
This seems to relax Dad and he gives me a smile.
Back at the firehouse by 10:20pm. Paperwork done by 10:25. Bowl in hand, chili on ladle at 10:26. Bell rings at 10:27. I'm running to the ambulance, eating really tasty chili. Poster Girl gives me a look when I get into the ambulance, shoveling chili and rice down my gullet.
"I'm hungry!"
Coming up:
I respond to the house of one friend while the house of another burns across the street! 14 year old with chest pain!
Hometown EMS, Yoikes!
Stay tuned!
--maddog
1.23.2006
The night of insanity, Part One!
What a night!
I arrived about 45 minutes early to the Firehouse to get dinner set up. I have a gallon and a half of venison chili in a pot on the front seat of my car and all the fixin's in the trunk. I'm opening the trunk of my car when the bell for the ambulance goes off.
Out the door I go! Rear-end collision on the Major Interstate. I arrive as the rescue squad from my old station is preparing to extricate the driver. I pop into the car to check her out briefly. She's in a good mental state, denies loss of consciousness and her main complaint is neck and back pain. The squaddies have things well in hand so I get out of the way until the driver's out of the car.
Backboard, straps, immobilize the head, into the ambulance. Police take a report while I do a quick trauma assessment. Nothing noted but tenderness. I check the status of the area hospitals and am told by communications that the nearest hospital is open and ready to receive patients. Ok! off we go.
Unbeknownst to me, about 5 miles away was a 5-car pileup. I arrive in the ER with my patient at the end of a line of 6 other car accident victims. The nearby trauma center has been overwhelmed from previous incidents and is on re-route. Suddenly, I'm in for a long wait.
An hour later, I'm still waiting for my patient to be triaged and to hand over care. I call the Firehouse. Herself was going to meet me there to dine with us. Sure enough, she's there. I ask her to get dinner set up and start the rice. She proceeds to not only do that but to feed everyone, thereby earning the undying love and adoration of every firefighter there.
Back in the hospital, I still had a long wait before I could transfer my patient to a cot next to the nurse's station and head on out. I have to say, I was quite annoyed at the other ambulance crews that were there. One crew kept harassing the nurses for a bed for their patient when it was clear there were none. Meanwhile, one member of this crew tells me their patient has an altered mental status (AMS) so goes ahead of mine who only has pain. We're having this conversation about 15 feet away from their patient.
"AMS, Eh? When was the last time you took vitals?" asks the maddog.
"Uh, when we transported her." says the mouth-breathing dork who transported her. That would have been about an hour ago.
"Unstable patient gets vitals every 5 minutes and, unless I'm mistaken, she's still your patient." replies the maddog.
"Uh. Oh. Right!" Off dashes the mouth-breather for a stethoscope and blood pressure cuff. Meanwhile I strike up a conversation with their patient. She's doesn't have an altered mental status, she just doesn't speak English. A few sentences later, I discover she's mostly complaining because her necklace is caught in the collar and is pinching her really bad. A few adjustments later, the patient is much quieter and the crew who brought her is much meeker.
Meanwhile, my patient is becoming more agitated. She's in a lot of pain, strapped to an unforgiving and rigid backboard and unable to move anything except her hands and arms. Her head hurts. I raise her cot a bit to take some blood pressure from her head. that helps a little bit.
"I have to pee!"
"I'm sorry, Ma'am, I can't take you off the board until you've been x-rayed. We're worried about your spine and neck."
"My head hurts and I'm uncomfortable."
"Yes, I know. I'm sorry but it's for the best. I don't want you to hurt your spine." I see this isn't working so I get personal. "Ma'am, if you were my sister or mother, I would do the same thing. I'm worried that you may have injured your spine and we have to keep you from moving until we can find out what's wrong. Please don't try to move."
"This thing is uncomfortable!" She digs at the collar and tries to twist her head. Out comes my 'cop voice.'
"STOP MOVING. STOP MOVING YOUR HEAD NOW!" No shouting but firm and clear. The whole ER gets quieter. I get my face right over hers so she has no choice to look at me.
"Do not move. Do not move your head. Do not move your feet. I don't care how much it hurts. Do! Not! Move!" I stare her down.
She grows meek. "Can I hold your hand?"
"Of course you can." She does.
I find myself managing and triaging 5 patients and getting the admittance paperwork started for the nurses. All the while holding my patient's hand. As a result, things move a smidgen more quickly and I finally leave an hour and a half after I got to the hospital.
Back at the station: I manage to finish my paperwork, wave to Herself and put one spoonful of chili into a bowl when the bell rings again. 27 year old Male with Chest pains. No medics available.
Wheee!
I'll write about that one next.
--maddog
I arrived about 45 minutes early to the Firehouse to get dinner set up. I have a gallon and a half of venison chili in a pot on the front seat of my car and all the fixin's in the trunk. I'm opening the trunk of my car when the bell for the ambulance goes off.
Out the door I go! Rear-end collision on the Major Interstate. I arrive as the rescue squad from my old station is preparing to extricate the driver. I pop into the car to check her out briefly. She's in a good mental state, denies loss of consciousness and her main complaint is neck and back pain. The squaddies have things well in hand so I get out of the way until the driver's out of the car.
Backboard, straps, immobilize the head, into the ambulance. Police take a report while I do a quick trauma assessment. Nothing noted but tenderness. I check the status of the area hospitals and am told by communications that the nearest hospital is open and ready to receive patients. Ok! off we go.
Unbeknownst to me, about 5 miles away was a 5-car pileup. I arrive in the ER with my patient at the end of a line of 6 other car accident victims. The nearby trauma center has been overwhelmed from previous incidents and is on re-route. Suddenly, I'm in for a long wait.
An hour later, I'm still waiting for my patient to be triaged and to hand over care. I call the Firehouse. Herself was going to meet me there to dine with us. Sure enough, she's there. I ask her to get dinner set up and start the rice. She proceeds to not only do that but to feed everyone, thereby earning the undying love and adoration of every firefighter there.
Back in the hospital, I still had a long wait before I could transfer my patient to a cot next to the nurse's station and head on out. I have to say, I was quite annoyed at the other ambulance crews that were there. One crew kept harassing the nurses for a bed for their patient when it was clear there were none. Meanwhile, one member of this crew tells me their patient has an altered mental status (AMS) so goes ahead of mine who only has pain. We're having this conversation about 15 feet away from their patient.
"AMS, Eh? When was the last time you took vitals?" asks the maddog.
"Uh, when we transported her." says the mouth-breathing dork who transported her. That would have been about an hour ago.
"Unstable patient gets vitals every 5 minutes and, unless I'm mistaken, she's still your patient." replies the maddog.
"Uh. Oh. Right!" Off dashes the mouth-breather for a stethoscope and blood pressure cuff. Meanwhile I strike up a conversation with their patient. She's doesn't have an altered mental status, she just doesn't speak English. A few sentences later, I discover she's mostly complaining because her necklace is caught in the collar and is pinching her really bad. A few adjustments later, the patient is much quieter and the crew who brought her is much meeker.
Meanwhile, my patient is becoming more agitated. She's in a lot of pain, strapped to an unforgiving and rigid backboard and unable to move anything except her hands and arms. Her head hurts. I raise her cot a bit to take some blood pressure from her head. that helps a little bit.
"I have to pee!"
"I'm sorry, Ma'am, I can't take you off the board until you've been x-rayed. We're worried about your spine and neck."
"My head hurts and I'm uncomfortable."
"Yes, I know. I'm sorry but it's for the best. I don't want you to hurt your spine." I see this isn't working so I get personal. "Ma'am, if you were my sister or mother, I would do the same thing. I'm worried that you may have injured your spine and we have to keep you from moving until we can find out what's wrong. Please don't try to move."
"This thing is uncomfortable!" She digs at the collar and tries to twist her head. Out comes my 'cop voice.'
"STOP MOVING. STOP MOVING YOUR HEAD NOW!" No shouting but firm and clear. The whole ER gets quieter. I get my face right over hers so she has no choice to look at me.
"Do not move. Do not move your head. Do not move your feet. I don't care how much it hurts. Do! Not! Move!" I stare her down.
She grows meek. "Can I hold your hand?"
"Of course you can." She does.
I find myself managing and triaging 5 patients and getting the admittance paperwork started for the nurses. All the while holding my patient's hand. As a result, things move a smidgen more quickly and I finally leave an hour and a half after I got to the hospital.
Back at the station: I manage to finish my paperwork, wave to Herself and put one spoonful of chili into a bowl when the bell rings again. 27 year old Male with Chest pains. No medics available.
Wheee!
I'll write about that one next.
--maddog
1.20.2006
Stay Tuned? (and bring your Bean-o)
I'm filling duty tonight so I won't be with my usual duty section. I have been cooking for my duty section and the word has gotten out. I have 4.5lbs (2Kilos) of venison in my fridge and will be arriving at the firehouse with a gallon or so of venison chili.
Yum!
Hopefully, we'll have some calls that will be worth telling about. We'll certainly have some culinary stories.
--maddog
Who am I?
I went to a party tonight, hosted by Herself's company. They're a literary, book-selling company.
I played the part of the obligatory, entertaining husband. ... For a while, at least.
Everyone I met and spoke with was wowed by me being in EMS.
"That's so awesome!"
"I could never do that!"
"You're so strong to do that!"
Here I am, Amazed and in awe of the authors, publishers and the bigwigs of the book industry who are standing around me. Amazingly, they're all pumping me for stories about EMS.
HA!
I started out trying to talk about Herself and Herself's company. I ended up answering questions about EMS and what I do (and will be doing).
Well, that proves it. EMS ROCKS!.
--maddog
1.18.2006
YAWN!
Not much going on. I've run a duty night or two with no calls. I'm on semester break so, no stories from clinical rotations or classes.
*Yawn!*
Sorry about that. Well, here's some upcoming things that might be interesting:
1. I'm going to try to get the following certifications this semester: Emergency Vehicle Operator (so I can drive the Bambulance), EMS instructor, through my volunteer service, and CPR instructor. The last one is offered through my shcool. The first two through my volunteer service. The thing is, they're State certifications so, if i get a job at an agency in this state, they'll look super-good on my resume.
2. I'm going to see if I can do an independent research project this semester. I'm going to look at the number of ALS (Advanced life support or paramedic) calls that have originated from within my first due (my station's primary response area) and then see if there is a need for an ALS-capable unit in my area. This includes my home town where I and my family live. Of course my motives are somewhat selfish.
Ok. I'm filling in duty this Friday night. Perhaps something interesting will come of that.
Cya!
--maddog
1.13.2006
I'm back!
After 5 months, I have internet access at my home again! Yay!
Look for more regular updates from me (I'll try for daily). Also you'll see:
1. More specific medical and trauma musings and questions, as I have learned much and continue to do so.
2. A few soapbox rants on issues affecting EMS today.
3. Progress reports on my FINAL semester in school, including the possibility of an independent research project involving my hometown and a needs assessment for ALS service.
4. Running. I'm going to include my progress and a few thoughts as I try to prepare myself to become a 4-marathon-per-year athlete and lose some of the weight I've gained over the past couple years.
ARRRR!!!
--maddog
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