June 10, 2010

Did You Just Bite My Partner?

So this was my long weekend on for work, and it was actually rather action packed.

We often get sent to the local psych hospital for transportation, and every once in a while it's an emergent call. My partner and I have a system worked out where I generally pick up most of the psych calls because being a Paramedic gives me a few different methods at controlling them if something goes wrong, mainly in the form of Haldol and Valium. Plus I tend to be a bit more outgoing than he is (which is odd considering how shy I am in my personal life).

So on Saturday night we got called to the psych hospital for a, and I quote, "Confused patient". Confused patient at a psych facility? Can't be!. We're just up the road so we pull on scene pretty quickly.

Once in the main 'lounge' area, we see our patient, who is apparently having a gleeful ol' time playing with a Dinamap machine.... I felt bad tearing her away from it. Being a new grad Medic I still have half my class run though my head on every call trying to figure out what it could be... aside from psychosis that is, such as hypoglycemia, trauma and the like.

We sit our patient down on the cot and I begin asking her questions. "What's your name?". Her response: "44". Well, that just makes no sense.

"Ok, do you know where you're at right now?" Response: "Jupiter!" Ehh, not quite. I asked the nurse if these types of responses were normal for her, and the nurses stated they were not, and the patient is usually 'with it'.

Mrs. 44 decided she's had enough with this ask/answer session, and decided to undue her straps and get up off the stretcher and wander around. I obviously can't do a patient assessment with no patient, so we quickly catch her and convince her to sit back down. I have my partner start hooking up the EKG while I get the glucometer out. She decides she's going to get up again, and wander around, this time pushing us away when we came to get her.

Deciding this isn't the best way to transport a patient, I called med control. Granted in my protocols, I can give Valium and Haldol without any prior authorization, I still wanted to call since this patient WAS a voluntary committal to the psych hospital, so I wanted my own little safety net barring something going wrong. I get on the phone with the doc (who was apparently at an NREMT meeting, my bad doc!) and gave him an update and he agreed with my plan of action (first time EVER calling med control too, so I was a bit rushy). I thank him and hang up.

I get my partner and the nurse (who up until this point was all too happy just sitting back watching) to strap the patient back in to the cot while I got my Valium ready (I really hate carpuject systems, by the way). I prep the arm and do an IM in to the deltoid, giving 5mg. Surprisingly the patient was ok with me jabbing her with a needle.

My partner continues to try to hook up the EKG while I get a glucose check--- 117. I take a glance up the patient has an EKG electrode halfway in to her mouth. I quickly snatch it out. My partner goes to replace a new one, and she bites my partners hand.

I was shocked. I shouldn't have been, but I was. I managed to muster "Did you just bite my partner?". Her response was a joyful "Yessir I did!" and took a kick at me (not connecting).

Bad choice of words.

I grabbed some cravats and we physically restrained her arms and legs to the cot, she wasn't going to go anywhere. (Though it wasn't cutting off her circulation, I made sure). EKG showed NSR with no abnormalities.

We load her in to the ambulance and make the literally 2 minute drive to the ER door, the whole time me trying to hold her back as she was trying to slip her hands out of the restraints (obviously 5mg of Valium did nothing for her).

Strangely I was able to control her whenever I said "Hey, look at me" and she'd calm down for a second and look at me, waiting for my next command.... odd. We get her to the ER and I do my handoff to the nurse, who obviously was none too happy about getting a psych patient at that time of night, especially one who needed chemical and physical restraints.

After the handoff I did my most favorite part of the call.... The novel of a PCR I had to complete, detailing every little bit of the call, mainly because of the use of physical and chemical restraints.

But hey, she bit my partner, right?

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