The fun never ends...

So I got called in right as I was getting ready to actually get to
sleep at a decent hour. Its a good thing though because I function
best on about 4 hours of sleep anyways. Yet another fire in our small
city raged through another house in the lower income part of town
displacing 4 adults and 8 children. No one was injured in this one
thankfully.

There was even a hamster that was rescued from the blaze after the
firefighters had knocked it down. I can only imagine the horror that
hamster has experienced and if anyone knows of a small furry therapist
that is accepting new patients, please let me know.

A rare occasion such as this....

It is not very often that I get to write about let alone participate in what we in the EMS field call a "Code Save"

But today was a spectacular day......

So as I am enjoying my mid morning snack of Fig Newtons and Mountain Dew, for unlike others in EMS I am a healthy eater *cough* *cough* a call goes out to my buddies car sending him to a "Working One Hundred" or what we commonly refer to as a witnessed arrest. My preceptor and I looked at each other, shrugged our shoulders, and called upstairs to let dispatch know we would be "wandering around the area" if they just happened to need a second unit for help. With that we left the bay and meandered towards the location.

Which ironically is actually in a Doctors office that is ATTACHED to the hospital. But they do not like us doing the "George Clooney" (which is the act of riding the rail of the stretcher as it is being pushed into the ER while doing compressions or *ventilating the patient)

*Only corpses and groceries are "Bagged"

So of course we get toned and just happened to be the closest unit for the assist.

So into the doctors office we go with a backboard and a collar bag because the other equipment would not be needed as the other crew should have everything but going in empty handed seemed rude. As we enter the building and walk to the elevator a poor young lady carrying Fed Ex packages is surprised as I stick the backboard into the elevator stopping the door. So she is startled but still has the presence of mid to ask which floor we were going to.

I can only imagine what was going through her mind as three men walked into her elevator and began nonchalantly putting on rubber gloves with no patient in sight. We kept our composure and refrained from making the obvious jokes that would most assuredly come later after the call.

Entering the doctors office one of the nurses at the desk told us "There is already an ambulance here" We thanked her for the info and another staff member explained to her that the more the merrier in these types of situations. So into the room past a very distraught doctor we go. You can hear the AED (Automated Defibrillation Device) chiming "Analyzing Rhythm in 2 Minutes" and we enter the room to find A Paramedic supervisor and her preceptee (A fellow classmate from my paramedic class last year) trying to move the patient on the backboard, attach the monitor, ventilate the patient, start an IV, and get meds ready. So my preceptor began helping them get the patient on the backboard while I opened our bag to get out straps (Which for some reason I brought our bag and it turns out they forgot theirs) and then went to get a brief history and story from the staff. Turns out the guy was there for routine labs and just went unresponsive when he was about to get blood drawn. The staff put the AED on him (Annoying little things but they are the best thing since Pez and I absolutely love them) and it had delivered a shock to the patient TWICE before our first unit arrived with a monitor. So at this time the man is breathing by himself at a rate of about 8 and he has a pulse and a blood pressure. Good Ole Lidocaine. So we "Clooney" him out to the ambulance (Of course the only way out was through a waiting room FULL of patients) and to the ambulance. I am setting up the intubation kit while we are securing him in the back when my partner asks me "Who's Driving?"

Now I have to explain that while I am on the clock I drive, tech etc. But while doing precepting we are not allowed to drive the ambulance. So we run crews of three. One Paramedic, One Preceptee, and one EMT-B to drive. Their driver was in a meeting in another part of the hospital (which explained why they got called to it first because they were already parked there)

"You are dude!" I say to my partner who just laughs and jumps in the front. So I am helping set up a Lidocaine drip, my friend is sitting on my lap trying to get the patient intubated, another medic is trying to get new vitals, and I am ventilating with one hand and trying to get a patch set up with the other.

Thank god we were LITERALLY in the parking lot of the hospital about 500 feet from the ER door.

So we are piling out of the back looking like what Barnum and Bailey envision EMS to be and wheel the patient in and get him transferred over while I magically produce a full history, meds, and his latest Lab results and hand them over to the receiving doctor who looks at me with surprise and a grin.

The patient has a bounding pulse, a strong Blood Pressure, and a stable rhythm. Thats all we could ever ask for.


But wait.......

15 minutes later I go in to the room to grab copies of the paperwork for the report and the man is not only conscious, but he is answering questions. I tell the rest of the guys and they don't believe me. 10 minutes after that he is sitting upright in a hospital bed, talking and he even signs for treatment and HIPPA information. He thanked us. After signing he was told to take it easy and hope he feels better soon.

"Well I could only be worse if I was dead"

"Sir you already were once today"

we walk back to our ambulance and laugh about what the woman in the elevator must have thought and make a few rubber glove jokes

Happy to be of service

A different type of call

*Beeep*

My pager goes off and vibrates as they call our car onto the air for a routine call. I sigh as I see we are doing a transfer from the maternity ward of one of our small community hospital to UConn medical center. "I probably cant count this one" I say to my partners as we pull out of the bay and onto the road. My disappointment is further fueled as we hear a call for an overdose coming over the radio as we are leaving the city.

We arrive on the maternity floor and the nurse gives us report, she mentions how quiet we all are and makes a joke at the other nurse at the desk.

"Here's a lively bunch"

I smile as I look over the paperwork, making mental notes for my report and trying to figure out how I can count this as one of my precepting calls.

"She came in for a checkup and has one of the highest urine proteins I have ever seen. She is also pre-eclampsic so we have given her labetolol and have Lactated Ringers running"

I look at my preceptor quizzically and he knows what I am thinking.... Why would you be running fluids into someone that is already hypertensive?

"She is a very pleasant woman, she is from Tanzania, this is her second pregnancy, she had a previous miscarriage, but if you ask her this is her first pregnancy. She does not know anything about the father"

These transfers are pretty routine for us. They tend to be uneventful (which is a good thing) but kind of awkward because you are in an ambulance doing vital signs every 15 minutes and there is not much care to be done.

Sometimes I hate myself for coming to conclusion based off of first impressions. She is a young immigrant woman living in a town where there is a large immigrant population living and working for the local mills and stores. So in my mind I put her into that category. Not maliciously mind you but just to start building that file in my head.

She is very pleasant and we talk about baby names and I tell her about my son. After hooking up the monitor and getting my baseline assessment I have run out of medical questions to ask so I do what I normally do and try and start a conversation. Thats when I begin to feel like an ass.

She has been in the United States for 6 years now and is just over a month away from her PhD in Anthropology. She already has a BS in sociology and a masters in cultural anthropology. We talked about the places we had lived and the differences in climate both weather wise as well as socio-economic. She was honestly one of the most intelligent and interesting to talk to people I have met in a long time.

I checked her vital signs every 10 minutes or so and we continued talking about her home in Tanzania, where it is very cold. You never really think about Africa as a cold place. But they have their mountainous regions where is is very much so. She lived near the base of Mount Kilaminjaro. She told me about driving down the road and seeing elephants, lions, zebras, giraffes, gorillas, and other animals I only see in a zoo or on the discovery channel. She talked about them like I would talk about seeing a hedgehog, squirrel, or deer on my way to work.

Too often we are blinded by our own preconceived notions of people. I am as guilty of it as the next man even though I try and put myself above that there are the inevitable times where I let it take over. A convenience of dealing with the many different people I do on a daily basis. I make no excuses for it and it is a part of my personality and thought process I would like to one day be rid of. I doubt that will ever happen but on days like today, it shows me that taking the time to talk to a patient can sometimes be more educational than you would ever think it could be.

I am glad I got sent on this call. It reminded me that no matter how many patients you take care of and however many situation you find yourself in to never take anything for granted and to take the time to appreciate the slow and easy "routine" calls.



***UPDATE****

My long time friend and colleague PMRN Cleared up a few things for me that I should have known.

1. The reason they were running Lactated Ringers is because "in pre-eclampsia you administer hypertonic IV fluids to speed up the process of getting rid of excess body water" Citation
2. Elevated proteins in the urine is a late sign of Pre-Eclampsia
3. since there's a loss of protein in the urine they're probably losing electrolytes renally more than usual (since proteins are big bastards), so the LR replaces em, while still being hypertonic enough to draw out all that third-spaced liquid


Seriously this man is a wealth of information that he can just pull out of a hat at anytime I need it. His blog is very informative and I would recommend it to anyone interested in Nursing or medicine in general.

Six random things

Thanks to Stretcher Jockey for dragging the new kid out to play.  Still getting used to this blogsphere thing.  I am always surprised to find that people actually read my stuff.

 so here goes...

Rules of the game:
- Link to the person who tagged you.
- Post these rules on your blog.
- Write six random things about yourself.
- Tag six random people by linking to their blogs.
- Let each of the six know they've been tagged by leaving them a comment (on their blogs).
- Let your tagger know when your entry is up.

Six Random Facts about Jack Of Hares:

1. I spent 8 years in the Army as a Military Police Investigator.  5 1/2 years of that in Japan
2. I have an unusual memory for details.  I remember and retain the most random bits of useless information.
3. I carry a rock with a lizard engraved in it whenever I go to work.  Its my good luck charm and my father gave it to me.  
4. I have an unusual loyalty to my boots.  I wore one pair from 1993 to 2005.  I was tricked into getting rid of them and the current pair has been around since 2005.  Always Doc Martens.
5. I forget the names of people I like within 5 minutes of learning them but the people I don't like the names stick.
6. I always have to have a fan going when I sleep.  Even in the winter time.

So I would like to see what PMRN and Equine005 have to say 

More good reading

If you all enjoy reading my blog then you will love reading Confessions of A Stretcher Jockey This is one of the guys that turned me onto this whole blogging thing. You will definitely not be disappointed.

My Morning

So tired from a strange night we managed to catch one last call of the morning. And if you were wondering, yes those are feathers. My uniform looks like I just ran through a chicken coop in some twisted three stooges sort of way. So here's what happened...

18 year old driving along the road drifted into the oncoming lane, effectively bought two cars. She was awake but did not remember the accident at all but that's common in serious wrecks. Alot of confusion, metal, glass, and the unforgettable smell of airbags deployed. Her abdomen was tender and becoming larger by the minute, probably her liver but all I can go on is probably but that's all I need. We immobilize her head and hold her still while I am ding a quick head to toe assessment. Neck pain, abdominal pain, pelvic pain upon palpation, and a strong urge to pee were her primary complaints. She was wearing a Fubu jacket, it actually made me sweat looking at it as it had been so nice out the past few days. I take no pleasure in ruining someones favorite jacket, pants, shirt etc. But on the same token I don't hesitate to cut them off a patient. Unfortunately as I began cutting the jacket to clear it from around her neck I realized it was a down jacket. What can you do though? I had already committed and besides, there was no way in hell we were getting the jacket off of her without cutting it. So we get her into the ambulance and I position equipment and begin to finish what I started and clear the jacket from her arm. I must say they are well made and there is alot of down in those jackets. So now the feathers are flying as I am getting her on the monitor and getting her vitals and I have to brush them off my face once or twice. I get her name and she denies any history of medical problems. So another more detailed head to toe while I am waiting for the blood pressure to cycle. She screams at me and keeps telling me how her belly hurts and I try my best to calm her down as we are only a minute or two away from the hospital. So then I drop a 14 gauge in her arm and now she has something else to yell at me about as I flush it and secure the line. My Observer Paramedic Partner hangs a bag of saline and then sets up the med patch for me. I give them the info, letting them decide whether to call a trauma alert on it. We are backing into the ambulance dock as I am trying to get another 14 gauge in her other arm but it won't advance so I pull the line and patch it up with gauze and tape. We open the back doors and it looks like a herd of chickens floating out. We wheel her into the ER and they have called a trauma alert due to hypo tension and the possible belly bleed. I give my story to the doctor and charge nurse as the ER staff works like a well oiled machine, stripping her the rest of the way, inserting a Foley catheter into her bladder, and doing ultrasound and x-rays, as well as drawing labs and a 12 lead EKG. I go out to the ambulance, have a cigarette and laugh as I look into the back and see the mess I made. It took an extra hour to get all the feathers out.

This is my life and I am loving every minute of it

This ones for you Jamie

Nothing breaks up the monotony of work sometimes than when you get an extraordinarily strange call. So with that said I will relate a call that happened to a co worker of mine last night.

Kind of a busy night, moon is waning, weather is nice and mild. Rode with the windows down for a while.

We get sent out to take a psych or two to the Behavioral Health Institutes (I love that title but I do prefer looney repositories)

Our first sign that something was in the air was brought into focus when we get called to the local Holiday Inn for an intoxicated person. Now let me say that I have been drunk once or twice. You can kind of rate the degrees of severity by the actions that signalled the end of the evening like hugging the throne, waking up half naked in the hallway right before you reach your door, waking up in the shower, or the classic waking up with one foot on the floor because the night before you thought it was a very clever and logical idea that if you put one foot on the floor it would stop the rest of the room from spinning. And yes, it does work.

So we find this guy, sitting in the middle of the parking lot, covered in feces. I won't go into too much detail but I had not been so happy it was my turn to drive this much for a while. So we transport him in, and while my partner did turnover to a nurse who was probably imagining creative ways to torture us at the next group party, I was compelled to ask the guy how he got all the crap on him. I mean I was not even sure if it was his. That being said my opening remark was the bizarro polite thing to say which was

"So um is that YOUR crap on your all over you?" Lets define the situation here man

"Yeah"

"How did you get crap all over you?" Now that the source had been established

"Well I tried to take a crap outside and did not have any toilet paper" A problem many of us have faced even if we do not all admit it

"So you used your shorts?" I had to bring this into perspective here

"Kind of" Kind of does not validate this situation in the least

"And your shoes?" for they were covered as well tops and the bottoms

"WHAT? my shoes? I got crap on my shoes...Dammit!" Does this make sense to anyone?

So he was more worried about the crap on his shes than the 3 foot smear down his back and leg

But wait...thats not the actually bizarre call for the night.

After relating this to my coworkers as walking out to my ambulance, another ambulance pulled in beside us and the medic got out, saw me and handed two handfuls of pill bottles ranging from barbituates to muscle relaxers and ask me to follow him into the ER with is patient, whom I notice is sitting straight up but wiggling and trying to step off the stretcher while still strapped on. She is covered in vomit and making noises the likes of I have only heard on discovery channel. We get her into the room and my friend starts giving turnover to the nurse.

Are you ready for this one?

Her boyfriend had called 911 because she had taken unknown quantities of a myriad of pills and had been acting strange. EMS gets there, fire had gotten there a few moments before only to find this woman in a squatting position on the floor near her couch retching and wiggling around making afore mentioned animal planet noises. The couch was next to her and the arm of the couch was tattered and appeared the dog had been chewing on it. The thing is, the dog had not been chewing on it. Actually I am not sure they even had a dog. The story goes she had been eating the arm of the couch and had managed to consume a respectable amount of the arm of the couch. Now normally when dogs do this they spit the pieces o the floor, but not this woman, she was a champ, she had not been spitting the pieces out but had been actually eating the couch.

"So did she have any cuts on her mouth from the wood and the staples?"

"I aint putting my fingers near her mouth...Bitch ate a couch!"

God I love my job sometimes.

Apparently after we left the ER she began mooing incessantly

Thoughts

So tonight I am starting my ride time for the last portion of
Paramedic School. I get to put all the things I have learned during
the past year and a half to the test and see how it works out. Kind
of nervous but thats to be expected.

First call is to a 89 year old womans house due to a change in mental
status. Now a "Change in Mental Status" can mean a multitude of
things and be caused by an equal multitude of things.

So we get to the residence and we are greeted by a very sweet elderly
lady. I'll never get used to the fact that my patients remind me of
family members, friends, and other people I have met over the years.
Sweet Elderly women always make me think of my Grandmothers.

The house looked neat and tidy apart from the smell of feces coming
from the living room. While my preceptor was getting basic
information from her I stayed within earshot to listen but also wanted
to observe the living room. There was a parakeet in a cage next to
the sofa chirping loudly probably due to the strangers in its home.
There were several stains on the carpet, a large one near the front
door, and a few in various stages of being cleaned up.

"Do you have a dog Mam?" I asked

She looked at me puzzled and said "No, why do you ask?"

Not wanting to point out that I had noticed the state of her carpet
due to the embarrassment it might cause her I replied.

"Just asking because I noticed the bird you have and was wondering if
you had any other pets" I smiled and made eye contact with my
preceptor who had understood why I asked the question. So I made the
mental notes and went back to the patient.

She had not eaten in three days and had called her friend because she
had just had a period of delirium in which she thought she was being
attacked and killed in the living room. She denied any previous
incidents but told us she had been having increased difficulty
remembering things and generally taking care of herself.

This had to be a very difficult and frightening feeling and I
sympathized with her. So we obtained our vital signs which appeared
to be within normal limits, collected her medication, and carefully
walked her out to the waiting stretcher. So we got her into the
ambulance, did an EKG, BGL, IV, and got her to the ER.

The elderly in general are not as willing to volunteer information if
they think it might prolong their hospital stay. the old "If it ain't
broke or hurting, it must be working right" Many times when we ask
them if they have any health problems they will tell us no but then
give us a laundry list of medications.

"Why do you take a high blood pressure medication? Do you have high
blood pressure?"

"Nope. I used to though but I take a pill for it now"

Its all a matter of perspective.

So our next call is for a 28 year old man, having a seizure. We
arrive with the fire department and go inside to find his girlfriend
quite distraught describing what sounds like a classic seizure. The
patient is diabetic and has not checked his sugar since this morning
so I do it while I am talking to him. As we are waiting for the
results he keeps telling us he is fine and all he needs is to take his
insulin and rest. His results come back as 429. Normal sugar range
is usually 80 to 120 so needless to say this was concerning.

Now what many people don't understand is that we don't necessarily
like to take people to the hospital. Meaning if we don't think you
are really in need of an ambulance or a trip to the ER we will not try
and convince you to go to the hospital if you tell us you do not want
to go. We advise you of the possible consequences, obtain some legal
signatures and we are on our way. Thats not to say we would ever
refuse to take anyone to the hospital. I could hate you as a person
and I would still do everything I can to get you to the hospital
stable, comfortable, and safe while doing anything in my power to help
you. Be it breathe or pump your heart for you as well. What I am
saying is this. If we are trying to convince you and recommending you
go to the hospital to get checked out then you should take our advice.

He was conscious, alert, oriented and able to make a sound decision so
we obtained the paperwork and info we needed and told him to call if
he needs us again.

We were back there an hour and a half later, he was more than happy to
go with us this time.

I'm telling you folks. We do have an idea what we are talking about

Another Night Shift

Another night shift. Last one on my rotation. Its always easiest to
stay awake and alert on the third one. I mean your body has gotten
used to the time shift so you aren't dragging as much but you also
know that after the last one you just have to get back into day mode.
Won't have to worry about that for a few days at least.

Tonight started off slow enough. Get called to a 15 year old girl
hanging outside one of the local Ice Cream Shoppe in need of a
psychiatric evaluation.

Before starting this job I had no idea how well adjusted I actually
was as a child. Nowadays I find many of our psychs are young kids,
having trouble relating to their parents and likewise their parents to
them.

This girl was no different. She was very manic and happy to get into
the ambulance. It was a short ride to the ER but more than enough
time for her to tell me an abbreviated life story filled with strife
and fights with her mother. Tonight it had escalated to "I wish you
were dead" statements. The girl had tried to cut her wrist with a
pair of scissors. I looked at it and thought to myself that I could
probably do a better job with a McDonalds straw. She did not want to
die. She was just looking for someone to actually pay attention to
her and listen to her story. More often than not thats what we end up
dealing with. Of course some people are a little more aggressive and
successful with their attempts but some of these people have years of
practice trying this. So I lent an ear and noted everything, giving
the nurse a good report as I turned this girl over to her care.

Later I met the girls mother, she refused to take her home and when it
was explained to her she would be charged with neglect she said a few
choice words and walked out of the ER, refusing to take her daughter
home.

Our next call was for a complaint of chest pains. A sweet little lady
of 93, lives alone, and who was just about to go to sleep after
letting her cat in and felt pain on the left side of her chest, she
thought it was just gas pains but it is best to get checked out. Many
elderly are afraid to actually go to the hospital. In their later
years they value their independence more than anything. So following
the chest pain protocol, Oxygen, Baby Aspirin, Nitroglycerin, and a 12
lead EKG and a short 5 minute drive to the ER, we turn her over to the
night staff.

Then it is off to grab coffee, straighten up the ambulance and be
ready for the next call. This is life.