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.
"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?"
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.
Posted by --maddog at 20:34