One of the biggest fears of a new Paramedic is not knowing what to do... freezing on a serious call when it matters most.
Over 17 months in to being a Paramedic, and I've had my fair share of critical calls... a full blown anaphalyxis, a profoundly bradycardic patient, anyone I've had to RSI, even an MCI MVC with fatality, stuff like that, and I've come to one conclusion:
I've been able to do what's needed to be done every time so far without delay.
I'm not saying I was always confident in my abilities, that I always knew what to do, but if there's one thing that I can pass on to new Paramedics or students is this:
You will do what needs to be done. If nothing else, your mind with resort back to 'cruise control mode' and do it itself. You just have to have composure about yourself and you'll do fine.
Yeesh.. a month long enough between posts? Been pretty busy at work, but thought I'd start again.
So anyhow, the 1 in a million call happened a couple of weeks ago, and is one of those calls that you join EMS for, and make all the other... non-legit... calls worth it.
We were initially sent to a local nursing home for a low priority call (patient pulled stitches out or something) so we started heading that way, when we heard another truck from our station get dispatched for an MVC... literally around the corner from the nursing home we were headed to. We jumped on that call instead, since we were closer and it was a higher priority call.
We arrive to find a head on collision in a neighborhood of two vehicles. When all was said and done, the only injury was a cut to one of the driver's knees, and they ended up getting arrested for DUI. We took a bit longer on scene than usual because the patient couldnt decide if they wanted to go to the hospital or not, so a 15 minute call took nearly an hour. Here's the amazing thing.
As we were about to leave and I was telling one of the officers we were headed out, one of the firefighter/first-responders yelled he needed help. I looked up and saw he was walking one of the tow-truck drivers to my ambulance. Turns out the driver was hooking up one of the cars when ants started to crawl up their arm and bite them ... to which they started having a reaction... and boy do I mean a reaction.
Urticaria, severe swelling of the arm/face/lips, obvious trouble breathing with wheezes /stridor easily audible, lethargic, nausea and vomitting. I quickly drew up some Epi and gave it IM, followed rapidly by an IV with Benadryl, Solu-Medrol, Pepcid and Albuterol. After a few short (but seemingly long) minutes, the patient made an obvious improvement.
During the transport, the patient asked what I gave them, to which I responded "Epinephrine... adrenaline".
They responded, "Damn, you should sell that on the streets, that _____ is better than heroin!"
It's amazing to think, had we left sooner and gone back to the station, what could have happened. Without a doubt, we had saved a life, and the doctor at the hospital told the patient as much. These calls don't happen often, but man when they do, they make it worth it.
I wonder if this means if my car breaks down, I get a free tow?
So I had my first RSI a couple of shifts ago.. I've had a few patients before who could have been RSI'd but being as close as we were to the hospital, hauling butt made more sense. Not so much for this one.
Called early in the morning for an elderly male having difficulty breathing. On arrival, found patient sitting in room on bed in tripod position on a nasal cannula. Pt states, in short word dyspnea, "This is it, this is the big one, I'm going to die". Pt has history of COPD and (possible) CHF, took his own albuterol before our arrival with no relief. Initial sat of 89%, etco2 of 29. Pt grey in color, accessory muscle usage, and pursed lips. BP decent, HR in the 130s.
I had a first responder put on an NRB, and had my partner call for a second truck for backup (We have a 30 minute transport MINIMUM to closest hospital). We get the patient on the cot and out to the rig, start him on a Duo-neb treatment, and while going to meet the other unit I started an IV.
As we pull up, the medic from the other truck jumped in and I told him what was going on (Said medic has been a medic longer than I've been alive). Patient was now satting 94%ish, etco2 dropped to 11, still breathing over 45 times a minute. He concurred with my plan to RSI, though suggested we probably could get away with just etomidate and skip the roc.
I give 200mcg of Fentanyl as the other medic pre-oxygenates and the 2 EMTs get some stuff set up. I proceed to give 20mg of Etomidate which promptly zonks out the patient (Zonks.. a medical word, look it up :P ) We lay the head down and discover that the patient now has trismus (lock jaw) from the Etomidate. Great. Pushed 70mg of Roc, which caused full paralysis and loosened the trismus.
Open the mouth and introduce the blade finding a very anterior glottic opening (Malampati 3). Introduce the bougie pass the glottic opening, feel the click, get tracheal lock, and slide the tube down the bougie. Tube confirmed with etco2, misting, visual, and lung sounds.
Within a few minutes of bagging, patient was 100%, etco2 kept at around 35-40, and had pink skin.
Took the patient to the hospital, and last I heard they were still in the ICU (Many days later)
I'm a 22 year old brand new Paramedic, trying to find my way in this scary profession where peoples lives are in my hands and things can change in a moments notice.
Ok, enough being melodramatic. I'm new to this profession and am loving every minute of it, and intend to post my random thoughts and musings on this site for all to enjoy... or cringe at, either is fine.