Another day on the job.

Bruno and I happen to be working together this day. He and I graduated from the same Paramedic program and during those 4 years, we discovered we like each other a lot. We both love running, pints and EMS. He volunteers in a neighborhood not far from mine where most of the area violent crime occurs.

It's my second day out of training and I'm working as an EMT-B driver until all my local Paramedic paperwork comes back. On this particular, beautiful day, our call volume was low and easy. We spent an hour parked under a tree in an arboretum reading the paper while waiting to pick up a patient from a nearby dialysis center.

Life is good!

Except for the shooting.

Later in the afternoon, we stop at an office supply store to pick up a clipboard and some pens for me (I'm a total pen whore!!). Finished with our shopping, we're sitting in the ambulance having just started the engine. From the rear:

"Ping, Pank! Pang! Ping! Ping! Pank! Pow!"

Bruno and I look at each other.

"We've been shot!" we say simultaneously. We both know what guns sound like.

"Twenty-two?" I ask skeptically.

"Nah, smaller than that. BB gun, I think." He replies.

I hazard a glance over my shoulder to see two kids running away from the parking lot.

I look over to Bruno. We nod then go out the doors simultaneously. Low and fast we slip out of the front to our respective side's rear wheels. Cars on either side provide cover. Stay in a crouch. Quick scan reveals no other shooters. My hand automatically goes to my right hip but the only thing that sits there these days is my cellphone. Great!

I come around the back of the unit and discover that Bruno's been doing the same thing I have. Low, fast and using available cover. This kid's never been trained but he knows what to do. He might live a while!

The coast is clear and a woman comes up to us to tell us she saw it all. Now comes the fun part. I call control.

"Ambulance 138 to control, We're going to need another unit to take our 5:30 call. The rear windows of our unit have been shot out. Local PD has been notified. Our location is Suchandsuch shopping plaza on Somwhereorothher Highway."

"Control to 138. (Loooonnnnggg Pause) Um, Er, Uh, Ooookaaayyyyy. Your windows have been shot out????? Uh, Yeah, um. Wait! Is everyone ok??? yeah!"

"138, Control we have no injuries."

"Control, 138. Ok, Right. yeah, Um, .....uh......Stand by!"

I think I just rocked someone's world. A short while later, another voice comes on the radio, presumably the supervisor.

"Control, 138. Stand by your position, a supervisor is on the way. Is your unit drivable?"

"138, Control. Copy supervisor en route. Unit is drivable but not fit for patient transport. PD is on scene and we have a witness."

"Control, 138. Outstanding. Disregard supervisor en route. Return to base when investigation complete."

"138, Control. Roger that. ETA 25 minutes."

Cool, baby. Nothing but cool!

--maddog

Volunteer firehouse shift

I ran a call to a local residence. The call was for the father of a grade-school classmate of mine. When my former classmate came into the house I saw the look of anxiety on his face change to relief when he saw me. Somehow, my being there made it all right.

Unfortunately, we had a loooooonnnng wait at the emergency room. I went out to the waiting room from time to time to give the family updates and such. the second time I went out, my classmate and his mother were joined by about 5 people from the neighborhood. All of whom recognized me.

"I better see all of you at the Crab Feast this year!" I insisted. They laughed. The Crab Feast is our hugely successful annual fundraiser.

The second call came after midnight. It was dispatched as a car flipped into the woods on the major interstate. We arrived on scene to find a PT cruiser on its side in the woods. Both the driver and the passenger were out and talking to the police. They denied any pain at all. The passenger was a rather buxom young woman who's flimsy half-blouse had popped open during the vehicular antics. Bean was quick and business-like with a blanket while the cops and firefighters tried not to gawk.

I did a quick exam of both patients and found them to be unharmed. Really! They both were belted and both were asleep when the accident happened. The alcohol on both of their breaths was a contributing factor, no doubt. I left them in police custody.

The last call was for a woman presenting classic symptoms of choleocystits or gallstones. Nausea and abdominal cramping pain woke her that morning and she was retching yellow bile when we arrived. We transported her to the same emergency room I was at earlier. We arrived at shift-change and were quickly whisked into a room! Nice!

One of the off-going nurses gave me an update on my classmate's father and we both agreed that it was good we got him into the hospital. He had called us because his legs and "nether parts" were swelling and it turns out he had gone into persistent atrial fibrillation and the swelling was caused by fluid buildup in his tissues due to reduced cardiac output. Had he not gone to the hospital, his condition could have worsened over the next few days into full congestive heart failure.

The only other news from the volunteer front is I'm getting cleared to drive the ambulance. Bean is about to be cleared to ride as the EMS provider and I'll be able to free up a firefighter if I drive her on EMS calls. The big freightliner ambulance is a lot of fun to drive. I feel like I have the biggest Tonka truck in the neighborhood. Too bad it's not yellow!

Coming up.... Maddog has a job! and Blog website changes!

--maddog

Vacation

Been to the shore. Went sailing, swimming and sunning. Caught some seafood and ate it. Caught a sunburn and wore it.

Volunteer duty coming up this weekend followed by my new job.

More to come!

--maddog

The Re-test!

I had scheduled with a local fire academy to sit in on the practical test they were conducting for their paramedic and EMT-I candidates. I just needed to retest the IV start station and that's it.

I get there 1/2 hour early, my stomach a roiling storm of anxiety.

"Anxiety, Maddog?" you ask, "You just have to go in, do one thing you've done a million times and you're a paramedic! What could make you so anxious?"

Well, you're right. It is an easy thing. I just have to go, start an IV on a mannequin arm, don't do anything stupid and I'm done. The problem is the stakes.

If I fail this one thing, if I goof up or get snagged on a technicality, the consequences are maddeningly painful.

I'd have to go back to "remedial training" which is about 24-40 hours of refresher training and then take all 12 of the practical stations again!!!

All because of a 3-inch piece of tape.

Yes, I'm anxious.

I'm in a classroom full of people.

They call my name second.

I enter the adjacent auditorium and walk up to the IV testing station. On the table are two mannequin arms. One has an IV established and another is untouched. I ask the evaluator and she tells me that the one with the existing IV is for the medication administration portion of the test. I examine it and see that the catheter is secured to the arm with:

A 3-INCH CHEVRON OF F*****G TAPE!!!!!!!

Yes, that's right. The IV that was started by "the expert" is done in a manner that failed me the last time.

*Sigh!*

Back on target, I review my materials. The evaluator tells me that we don't have the clear, sterile occlusive dressings (commonly called Tegaderm), so I'll either have to use tape or simulate. Ok, no problem. I'm getting the sense that this testing site is not as picky as my last time around.

I do my thing.

I don't mess up (I think).

The evaluator gives me no indication of whether I failed or not. That's it. I've taken my shot. Now I have to wait and hear if I'm a paramedic or a Pair-of-hands.

This is the worst part.

I go back to the classroom where the rest of the candidates are waiting. A few questioning looks come my way as I come in. I shrug. I think I passed but I don't know for sure. I review my copy of the evaluation sheet. I can't see that I've done anything wrong. Still, I'm not sure if the evaluator has dinged me on anything.

Ugh.

I listen to my iPod. I meditate. I try to read. I try anything to distract myself from the maddening wait.

Finally a testing official comes in to the room with a score sheet in his hand. I'm ready!

He calls someone else! ARGH!

Again he comes in! Nope! Not me.

One more time? He butchers my last name but I don't care.

Out in the hall, I ask him, "Is it remedial training and full retest for me?"

He's got a poker face. He has to ask me the official questions, "Do you have any complaints of discrimination or were there equipment failures?" This is a requirement before they give us our results. It's also the candidate's only opportunity to lodge a complaint.

I've got no complaints and I tell him so.

The poker face vanishes. A big smile and a handshake. "Congratulations!"

YAY!!!!!!

--maddog

The aftermath......

Well, here it is. A week after everything is done.

Here's how it went down after my last post:

Tuesday, 5/16: Study Study Study Study and study some more. I took 3 pre-tests and passed them all. Went to bed early.

Wednesday, 5/17: The written exam. I finished the 180 question exam in an hour and a half. I walked out of there feeling pretty good about how I did. Considering I passed all my practice exams and reviewed the questions I missed, I felt pretty good. Ok.

Thursday, 5/18: Showed up at school around 9am and practiced my stations for the practical over and over. I had a plan, I had to do each one correctly without failing 3 times. If I failed a station, that didn't count towards my total. I had a checklist and I meant business. I worked my butt off. One thing that was giving me fits was a taping method to secure an IV. I don't have a picture nor could I find one online. I had been taught by everyone I know that a good way to be sure an IV is secure is to put a loop of tape over it and make a "chevron" to keep the catheter from getting pulled out.

Well, with gloves, sticky tape and such, it's a difficult endeavor for the beginner. Since it's been taught to me as the way to secure an IV, I practice and practice and practice. I want to get this right. Eventually, I get the hang of it and get it down. I've seen a lot of nurses and paramedics do this and I want to be sure I get the IV skill station perfect.

I spend a lot of time working up my dynamic cardiology, static cardiology, trauma assessment, spinal immobilization (seated and supine), bleeding and shock control, adult intubation, medication administration, pediatric intubation and intraosseous access. When I leave the lab Thursday afternoon, I'm feeling confident that I can get this thing done. Which is a good thing since my volunteer firehouse has a kickball game that evening and I end up pretty smashed on cheap beer. (UGH)

Friday, 5/19: Almost the day from hell. Woke up with a hangover (Damn you, Miller Light in a can!). Spent most of the day getting ready for a party I'm DJing that night for Herself's company on board a dinner cruise boat. The problem with this is I expected to show up with my laptop, iPod and mixer and just plug in to the existing system. The dinner cruise boat tells us at the last minute that it's against company policy for anyone to use the shipboard equipment except the house DJ.

An amazing friend comes to the rescue with amps, subwoofers, speakers and other electronic madness. We lug it all in a minivan to the dock, load it up and the party's rockin! Maddog has got mad tunes!! Fortunately for me, at 10:30pm, the crew shuts us down. I mean 10:30 on the dot! Pull the plug! Normally, I'd be cranked as I like to keep it going all night. Not tonight, though. I have to get up at 5:30 am to be at the community college for my paramedic practical exam.

I actually manage to get home, get about 5 hours of sleep!

Saturday, 5/20: I woke up on time, had a good breakfast, packed a lunch, reviewed my drug dosages and headed out the door! I got to the testing center early and the atmosphere was jovial. My first station was bleeding and shock control for the basic skill. I go through it, pretty well, I think, and walk out of there feeling good.

I keep telling myself to visualize a positive outcome. I don't dwell on my past performance, I keep focused on the next task. The next task is dynamic and static cardiology. I go through and think I did ok. There were a few points where I wasn't sure but I reviewed my protocols and am sure I go it right. Sort of. There's still a lot of doubt. Technically, I did the right thing but did the evaluator see it? Did I miss something critical?? It's nerve-wracking!!! I see all of my classmates doing the same thing. Ugh!

You see, with national registry testing the evaluators are not allowed to give you any feedback on your performance. The logic is that the testing is an evaluation of one's skills and abilities, not an opportunity for learning. As a result, I walk out of each station with only my own assessment as to whether or not I passed. The results are tabulated and given out when everyone has completed all the stations. It really does take a lot of effort to focus on the next evaluation and not repeatedly review one's past performance.

The day goes on.

Trauma assessment. Perfect!

Pediatric airway: Perfect!

Pediatric IO: Perfect!

Adult Airway: Double perfect!

Oral Station (where one has to talk through a call from the time dispatched to patient delivery at the hospital, including all aspects of scene management and patient care): Perfect X 2!!!!

IV start and medication administraion: Perfect!

I'm feeling pretty good. I'm thinking I've probably failed my dynamic and static cardiology. I'm delighted about my performance everywhere else but I won't know for sure until a National Registry official walks into the room, calls my name and takes me out in the hall to tell me my results.

The waiting? It kills me!

Finally, my name is called. The official tells me that I passed everything except IV.

WHAT!!! IV!!!! Wow! I must have made some dumb mistake! That means I passed EVERYTHING ELSE!!!! Woohooooooo!!!!

I'm delighted! I have this vision of leaving the testing center completely finished. Completely done!!! Wow! I just have to go back in and re-take the IV station (they're letting us take one of our two re-tests on the same day).

Ok! One more to go. No sweat. I review over and over again while I'm waiting for my name to be called. I'm going to nail this one and do it perfect!

My name is called.

I go into the station. I do it exactly as I was taught and perfectly!

I walk out of there feeling like a million bucks. Once again, I have to wait in the holding room for the official to call my name and tell me my results. This time, I'm not too worried. I pretty sure he's going to shake my hand and congratulate me.

He calls my name. I go out to the hall with him.

He's not smiling. He does not shake my hand.

I failed it again!!!!!

I'm outraged!! I cannot believe it!! What the hell! I did the station perfect! It's the most simple one of all!! I've started a bajillion IVs in the field and in the lab. What the hell did I do wrong???

Nope. Can't tell you. Thats now how national registry works. You're here to be evaluated, not trained.

I make noise.

I stomp my feet.

I almost make a scene.

Chief, the director of my program, comes to me to ask me how I'm doing. I tell him I failed when I should not have. He starts with the "well, that's how it goes..." speech but I stop him.

"No! I did everything perfect! I did it fucking perfect!" Yes, I drop the "f" bomb. Chief has never heard me cuss. He knows I mean business.

"I'll see what I can do." He says and hurries off.

The medical director for my program, my teachers and the head of the department are all present this day. Chief gets them to lean on the evaluators under the pretense that I may challenge the evaluator's ruling. A bit later, I'm asked to step out into the hall. I meet with Chief and my medical director, Dr. S.

"You violated the sterile field."

"What?"

"You put a piece of tape around the IV tubing underneath the Tegaderm, or bio-occlusive dressing at the IV site."

"Of course I did! That's how everyone's taught me to do an IV. It's supposed to keep it from coming out. In fact, I practiced my ass off to be sure I could do it right!"

"Well, apparently, that's not the proper way to do an IV." Dr. S. tells me.

I turn to chief.

"Why didn't you teach me that two years ago?"

He just shrugs.

Fuck!

As you can imagine, I'm a bit pissed. I go outside, I call a friend and vent for a bit. Ok, I missed one station, I'll have to test it again (Not until june 13th at the earliest, goddamit!), but the upshot of all this is this:

I passed all the stations I was worried about! In fact, I passed them on my first try!!!

AWESOME!

Ok, so I've got a slight delay in my process to certify for paramedic but, it's in the bag! I head downtown to meet with herself and a bunch of other people who have nothing to do with EMS.

Sunday, 5/21 to Wednesday 5/24: Played video games. Read crappy spy novels and murder mysteries. Stayed up all night goofing off. Went running and did a spot of beer-drinking.

Thursday, 5/25: I graduated from college!!!

Friday 5/26: I checked the National Registry website. Under "written exam" it says "Passed."

One more IV start and I'll be a paramedic instead of a pair-of-hands.

Yay!

--maddog

Home stretch....

Oral exam and review with my medical director today...

Written exam for NREMT-P on Wednesday...

Practical Exam for NREMT-P on Saturday.

I'll post when I can.

(waving hands in the air and running around) AAAHHHHHH!!!!!!!

--maddog

...and that's a BAD day!

If I'm doing this to you:




You're probably having a really bad day!

Speaking of bad days, one of my patients was shot in her own home. She deteriorated pretty bad during transport and developed a nasty hemothorax (blood in the chest cavity). I'll try to post more detail later. I'm hella-busy this week (and the next 2 until my registry test!!!! EEEEK!).


--maddog

monday, Monday, MONDAY!!!

In my last entry, I wrote a list of "coming soon!" items. Doc Shazam commented on them as such:

"Just some guesses:
#2 - Normal saline?

#3 - DOA?

#5 - Hyperkalemia?

#6 - Did they survive???"

Well, Doc, and the rest of you reading, here you go:

"#2: Dehydrated Patient Miraculously Restored With a Miracle Drug!"

The call was dispatched as "sick person." This kind of call induces a lot of eye rolling at Lucky McGee's station as it usually means some indigent person who doesn't feel well and doesn't have cab fare.

We arrive at a single family home to find a woman in a postal carrier uniform sitting on the couch. She's drowsy and obviously uncomfortable. She said she's been having diarrhea all day. "It's like I'm peeing out of the wrong hole." Add a little vomiting and she's rather volume depleted. I check her skin turgor and am surprised to find it actually works like in the books.

Pinch a bit of your skin on your elbow, knee or other bony part. Generally, if you're not dehydrated it plops back into the shape it was before you pinched it. This is called your skin turgor. Patients who are dehydrated have poor skin turgor, that is their skin stays a bit in the shape it was pinched. It makes a little "tent." Sure enough, this woman had a little tent on her elbow after I pinched it.

We load her onto the cot and then into the ambulance. She's fading in and out of consciousness. She's so dehydrated that I can't get a line. her veins just fall flat when I try to start an IV. Lucky comes over at my request and starts a good one in the arm. Once the IV is started we hang a bag of fluid. Some jurisdictions use Normal Saline which is just water with the same salinity as blood (0.9%) but in this place they use what's called Lactated Ringers solution. It's got a bunch of stuff in it but is basically the same. Most importantly, It's got water!

By the time we arrive at the hospital, I have squeezed about 400 ml of fluid into my patient. She's woken up fully, is feeling much better and looking about 10 years younger.

Water, the miracle drug!

"3. How a nursing home killed my patient and I get the 'blame.'"

We get a call for "trouble breathing" at a nursing home.

As it usually goes in this particular city, the Fire department arrives before us and are already preparing the patient to be transported. I walk in and see an elderly man with a gastric tube (a tube going directly into the stomach through the abdominal wall) hunched over to his left side. He's pale, sweaty and trying desperately to breathe. The nursing home has him on 2 liters per minute (lpm) of oxygen by a nasal cannula. The first thing I do is haul out a non-rebreather mask and hand it to a firefighter.

"Hook him up to about 12lpm, willya?" I ask and it's done. I listen to the patient's lungs. He sounds really "gunky." This means I hear coarse crunchy noises in his lungs when he breathes. It's a sign that he's got some fluid or something in there. He's also using his accessory muscles to breathe and this is causing a lot of retractions. This means that his diaphragm and muscles in his ribs aren't enough and he's using his shoulders, neck muscles and more to try and open his lungs up. Right away, I see this guy is in trouble and we need to PUHA.

Pick Up, Haul Ass.

A nurse or attendant hands Lucky a sheaf of papers that contains the patient's conditions, medications list and some doctors orders. After delivering her payload, she promptly disappears.

*sigh!*

In the ambulance, Lucky and I get a line started and begin to debate whether or not we are allowed to intubate. The patient has what's known as a "Do Not Resuscitate - Arrest" or DNR-A. This means if he goes into cardiac arrest, we're not allowed to re-start his heart. It's not clear if we can intubate or take heroic measures before he goes into arrest. Either way, his oxygen saturation levels climb from 77% in the nursing home to 95% in the ambulance. I've accomplished this by sitting him up higher and straighter and increasing the flow of oxygen.

The ride to the hospital is very short and we deliver the patient to the emergency room and a waiting team. I read the patient's paperwork and find that he's on a gastric tube because he has no gag reflex and there is an order not to lower him any more that 30 degrees from. Dammit! When we had arrived at the nursing home, he was completely slumped over on his left side.

When we returned to the hospital later, the doctor who treated him came over to talk to me. He said that the resuscitation team did intubate him and suctioned about 500 ml of the "food" that's pumped into his stomach from his left lung. It appears that while he had been slumped on his side, the pudding-like nutrient stuff flowed up his esophagus and into his lungs. The patient did not recover from the insult to his system and later died. If someone would have checked on him and then simply sat him up, it might not have happened.

All day long, Lucky tells everyone how great I am, "He's already killed one today!"

*sigh!*

"5. Missed dialysis becomes nausea and vomiting becomes abdominal pain becomes premature ventricular contractions."

The call went out as stomach pains. In the nursing home we find the patient in a daybed clutching his stomach and in a lot of pain. He's sweaty and warm too. It's a riot in there. There are 2 nurses, a cop and about 3 other residents of the nursing home. Each one hollers a different fact at me.

Okeydoke. Load 'im up! He's got a shunt in his arm where he hooks up his dialysis machine. It appears he missed his last dialysis session and has been suffering diarrhea, vomiting and stomach cramps all day.

Neither Lucky or I can get an IV on this guy. His veins, what are left, are horribly scarred. Between the dialysis and history of IV drug use, he's a mess. Oxygen and monitor. The 3 lead shows some S-T elevation but it looks old. I set up for a 12-lead and get a good analysis when we stop at the hospital.

In the ER, I hand the 12-lead to the nurse. Peaked T-waves and PVCs popping out all over the place.

"Missed dialysis?" She asks me.

"Yep!" says I.

Your kidneys are responsible for regulating the amount of potassium in your blood. If you need dialysis, it's because your kidneys aren't doing a very good job at all. Miss a dialysis session and the potassium levels in your blood get too high. This messes with the operation of your heart's ability to work right.

Good call, Doc Shazam!

"6. Pulmonary Embolism (blood clot in the lungs) + thrombolytics + stopped heart = the ENTIRE ER staff is exhausted!"

While Lucky McGee and I were dropping off another patient in the ER, our driver came over to me.

"Hey, man go to the resuscitation room, you'll find that interesting."

Ok! I like interesting things. In the resuscitation there's a doctor doing chest compressions while a nurse ventilates an elderly woman. The woman has a cast on her right leg. Everyone else is kind of standing around watching.

In a "code" situation, everyone is usually doing something. It looks like chaos but often is very orderly. in this case I'm puzzled that nobody's doing anything. After a minute or two, a nurse relieves the doctor doing chest compressions. I'm watching the heart monitor while compressions are being done and there's a good, regular waveform. Nice job!

"What's going on?" I ask another doctor standing next to me.

Turns out this woman was riding in a car with her son driving. He was driving her from New England to Florida. She couldn't drive because she had broken her leg a week or so before. Half way to Florida, she just slumped over and stopped breathing. The son drove directly to the emergency room of this hospital.

The doctor thinks it was a pulmonary embolism. Her heart was in asystole (flatline) so they decided to try to break up the clot. They pumped her full of Alteplase, a clot-busting drug, and were moving it around her bloodstream (and her lungs) by doing CPR.

"The problem is," says the doctor to me, "Alteplase takes anywhere from 10 to 30 minutes to take effect. We've committed ourselves to this course of action for now."

I see other ER staff lining up to take their turn doing chest compressions. They start to eye me and my student badge. Uh Oh! I'm outta there! I've done enough CPR to last me a while.

We left before I heard the ultimate outcome of the patient but it wasn't looking good. She had apparently been "down" (not breathing) for a good 5-10 minutes before the son even got to the hospital.

DANG! That's a long post! Thanks to Doc Shazam for the comment and feedback. I'm riding with Lucky McGee again tomorrow. My certification tests and finals are coming up in the next 3 weeks. I'll try to post as much as I can.

--maddog

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