The trailer: "Coming soon!!"

Crazy day with Lucky McGee. We left on our first call at 0600 and didn't return to the station until 1545.

The highlights:

1. Everybody poops. Some more than others!
2. Dehydrated patient miraculously restored with a miracle drug!
3. How a nursing home killed my patient but I got the "blame"
4. "Seeya later, handsome!" from a 79 year old lady.
5. Missed dialysis becomes nausea and vomiting becomes abdominal pain becomes premature ventricular contractions.
6. Pulmonary Embolism (blood clot in the lungs) + thrombolytics + stopped heart = the ENTIRE ER staff is exhausted!
7. Cranky Firefighters and justice served.

I'm off to bed. I'll fill in details tomorrow.

Good night!

--maddog

Volunteer Firehouse, overnight shift.

A rainy night at the volunteer Firehouse. We had a full crew, that is, enough to staff both the ambulance and the engine. Which was fortunate later in the night as we had thunderstorms and drunk drivers galore.

I had arrived early and picked up a call nearby for a 21 year old with trouble breathing and a headache. The calls sheet also listed him as an asthmatic. Out here in the Eastern US, the pollen count has been ridiculously high so, I wasn't surprised.

We arrive at the apartment and a young woman leads us back to a bedroom. I stop her while I'm still in the doorway, hand on the handle. My crew-mates are behind me. The fresh-faced new kid doesn't understand what I'm doing but my driver knows how I work and pulls him back out of the doorway.

"Do you have any pets in the apartment?" I ask the young woman.

"No."

"Is there anyone else in the apartment?" I ask.

"Just me and him." She replies, indicating our patient aaaalllll the way in the very back of the apartment.

After a look around, I enter. I indicate for her to lead the way and I close the doors to the other rooms in the hallway as I go. I hate surprises.

In the back bedroom I find a young man lying on the bed. I ask him what's going on and he tells me he's got a really bad headache. He gives me a lot of detail and speaks in complete sentences without needing to pause for breath. My initial impression is very good. He's giving no signs of being short of breath.

I have him sit up and take off his outer shirt. He does all this with no difficulty. I listen to his lungs and hear some wheezing in the lower part of his right lung. I ask him if he has his inhaler.

"Yeah, I just got it yesterday."

"Have you used it before?" I ask him.

"I used it for the first time this morning at around 9am."

"When did your headache start?"

"About 9:15."

One shot of the inhaler and his wheezes clear up and I've got him breathing 100% oxygen from our bottle via a non-rebreather mask. He's not complaining of any shortness of breath and his vitals all look good. He had been diagnoses with asthma the day before and, it seems, hadn't gotten used to the side-effects of his albuterol inhaler.

He doesn't want to go to the hospital. In fact, his roommate had only called because his father, who's on the way from 60 miles away, had insisted. I assure him we can take him if he wants but he says no. I'm sure he's going to have quite a discussion with his dad later on.

The other call before bed was for a nursing home patient. Her doctor had done a blood test that morning and the results indicated that she might be in kidney failure. She's got a medicine and illness list that goes forever. I ask her attending nurse/technician/whatever for some background, i.e. When was the last time she took insulin? Is she normally like this? When was the last time her blood sugar was checked?

He hands me a sheaf of papers and looks at me like I have 4 head and am speaking Aramaic. It always amazes me how much better care nursing home patients get when the ambulance crew arrives. Her blood oxygen level was about 82% when we arrived and she was getting 2 liters per minute of O2 via a nasal cannula (a little pronged tube that shoots oxygen into your nose).

Well, she's breathing through her mouth so the O2 is not going anywhere. We put a non-rebreather mask on her, crank up the flow rate to 15 liters per minute and her O2 saturation goes right up to 100% and she becomes almost instantly responsive and almost alert.

Basic patient care! WOW!

Off to the hospital where I write up a very thorough patient report.

The remainder of the calls that night all happened between 2 and 6 am. They were all traffic-related (car accidents) phoned in by people who were speeding by the accident at 70mph and not stopping. As a result, half of them were not there when we got there and the other half were either non-injury, broken down cars and one person who just pulled over to sleep off all the "cerveza" he drank at the strip club. (He got a ride with the police).

Nothing too exciting, I'm afraid. I'm riding the day shift with Lucky McGee tomorrow as a paramedic student. I'll be riding in a city that is one of the top 5 heroin cities in the US. I'm sure I'll have something interesting, exciting or, at least, funny for you after that.

Whee!

--maddog

Is it appropriate to wear black on Easter Sunday?

Today has got to be one of the most painful days of my life. I awoke to the sound of my best friend dying. I carried her downstairs as she vomited and her bladder let go.

My wife and I raced her to the emergency animal clinic. There was nothing to be done.

An overdose of phenobarbital slid her silently away as we held her head and cried.

I miss you, pooch.




She was my pup for 12 years. I took her on vacations. She was the best.

I'm gonna go cry some more now.

--maddog

The difference between pre-hospital medicine and physical therapy...

"All patients lie, you know." Says the physical therapist friend to me.

"Yah. I know." says, I, thinking of the drunk/addict/prisoner who's "faking it."

"What do you do if the unconscious patient doesn't respond?" he asks.

"Well," Says I, "You put a stick down their throat or a tube in their nose; If they object, they're faking it."

(Oropharyngeal or naso-pharyngeal airway.) This is the best way to ensure someone can breathe, regardless of their mental state.

"Shit, man. You have a cool job!" He says.

The therapist is now intrigued by being a (volunteer) EMT.

--maddog

"...You say it's your birthday!" Dah Nee no Nee nee ner..;."Well, Happy day to you!" Dah Nee no nee nee ner....

I turned 35 today!

I received a ton of well wishes.

Herself got me a book. It's Karambolage by Arnold Odermatt.

From the Review:

"With thoroughness and a meticulous attention to detail, Arnold Odermatt photographed automobile accidents on the streets of the Swiss canton of Nidwalden between 1939 and 1993. For 40 years, the Swiss police office recorded the wrecked cars left in the wake of excessive speed, drunk driving, right-of-way errors, and plain foolishness, in poignant, sometimes funny, and always strange atmospheric photographs."

Let me tell you: It's a great book! What fun to look at photos of auto accidents from so long ago and done in such a style! They seem to be artistically arranged!

An example:



And another:



I love it!

Each picture tells a story for those of us who know how to read a deformed car. There is also a history lesson. There are no airbags, crumple zones or side-impact guard bars. Twisted metal and physics rule the day in these pictures. I'm particularly enamored by the prevalence of VW beetles in this book. They were, mostly, ubiquitous in Switzerland during that time and persist in being my personal fantasy car.

As it was my birthday, my family invaded my home. Wine, food, nieces (3 and 4 1/2 years old), and silly stories helped make this the happiest birthday I've had in an entire year!

I'm so lucky!

--maddog

Do you need a seatbelt if you have an airbag (or six)?

At my volunteer house, we get called out for a multi-vehicle accident. Apparently, a brand new (2006) German Import crossed 4 lanes of traffic and hit head-on into the cement barrier in the median.

By virtue of traffic, our arrival vector and the ambulances that got there first, my ambulance was assigned to a barely injured belted driver of one of the cars that was struck by the German Import as it crossed 4 lanes of the interstate.

The passenger of the German Import was uninjured. Both front airbags, Both side airbags and both curtain airbags deployed on the German Import. The passenger wore her seatbelt.

I was about 30 yards away from the German Import. From there, I could see the outwardly bulging impression in the windshield. I could also see the ring on the driver's forehead as the other crew loaded her onto the backboard and began CPR. The ring was clearly visible because it was depressed about an inch into her skull. In fact her eyes, tongue and face were protruding from the pressure of the impact.

She was driving a brand new $25,000 car with all of the latest safety features but she died because she didn't use the most basic one: a seatbelt.

MY patient, on the other hand, was driving a 10 year old, inexpensive, Japanese sedan and was only shaken up. Seatbelt.

Buckle up, kids!

--maddog