September 16, 2011

D50 Havent Been Treating Me Well

I've given D50 to two patients this past week. Both died, one later on in the day, and one literally the moment we walked in to the ER.

What are they putting in this concoction of sugar and water?!

July 30, 2011

The Fear

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.

July 8, 2011

They Say a Partnership is Like a Marriage

If that's true... I want to stay single.

June 2, 2011

Texas Ants are meaner than Nebraskan ants!

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?

April 27, 2011

I was in the news! Kinda...

Tornadoes hit my county last night and we got sent with another truck to a tornado vs house.

If you look really closely at the blue tarp... and have x-ray vision, you can see me with the other Paramedic working on the patient!

(Photo per Jaime R. Carrero )

April 24, 2011

First RSI

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)

April 3, 2011

Pain Control

Guess what? If you don't care about even attempting to help a patients pain, you are not a good provider, you never will be, and anyone who says you are is sadly mistaken.

I give Fentanyl multiple times a week for people in pain. My view is if I was in pain, I'd want it gone. Just last week I gave a pretty big dose of Fentanyl and some Ativan for a tib/fib fracture.

My relief medic on the shift after me has the opposite views, and she has actually BOASTED that while I had given Fent 3 times in a single day, she gave it MAYBE 3 times in the past year.

You just can't get through to some people.

March 16, 2011

I LOVE Diabetic Calls

Admit it. Everyone got in to EMS to help people (oh, and the huge paychecks). I love the calls where I can tangibly help someone, even if it's as "little" as giving Zofran for vomiting, Fentanyl for extreme pain, or yes, D50 for hypoglycemia.

Hypoglycemic emergencies have to be my favorite. They are one of the few calls where you can see the fruit of your efforts. Unconscious? Start an IV, give some D50 and they wake up. 'Semi-conscious' and fighting you like you're trying to kill them? Wrestle them, somehow start the IV (with or without the aid of Glucagon), then give some D50... they wake up and become your best friend once they realize what happened. Hypoglycemia is one of the only things that we can actually FIX in the field, and is a true emergency that can quite rapidly lead to death. If fixing that doesn't make your day or week, I don't know what will.

What are some of the calls you like to go on?

March 4, 2011

"HELP" TV series in Austrailia

I was bored on Youtube (never a good thing) and stumbled upon this, which is a series titled "HELP" in Austrailia, following Paramedics and Ambulance Officers as they work, with helmet cams attached to hats to give a first person view.

The similarities between how they work and how the systems over here work are amazing, just as how "Chronicles of EMS" is trying to show now.

makes sure you check out not only "HELP", but Chronicles of EMS and give them support.

February 21, 2011

First Week Down

Whelp, first week down as a lone Paramedic doing rural 911... and I didn't kill anyone! Score.

Really no major calls, though had one that was a possible brain bleed after a fall with slurred speech and was lethargic. Went straight to CT at the hospital and doc walked up to me later stating it was negative for a bleed. Patient ended up being held in neuro for observation.

Have a good partner who does well and helps. Good crews at the station. Only down side is the mandated shift that I have coming up at a station 3 hours away...

February 12, 2011

Scary Times

Well, I got cleared this last Monday to work on my own as a Paramedic, with 'only' an EMT backing me up.

Took 3 weeks of academy and 2 months of ride outs, but I'm on my own, and scared beyond belief.

I'm 45+ minutes from the closest hospital, with HEMS 20 minutes away AFTER lift-off, and all I have to rely on is my education, my intuition, and my partner.

Exactly what I spent 2 years in school for!

February 4, 2011

What The Heck, Texas?

So, Monday we had 3" of ice on the roads. It took me 6.5 hours to drive home after my 24hr shift (I work 2 hours away)

Today (Friday) we already had 2" of snow at 7am, and expect to get a total of 7".

Crappy part? I work Saturday, and again on Monday, which means I probably won't be coming home Sunday. Grr.

Oh well, I'm nearing the end of my FTO, finally, and apparently am scheduled to do my captain ride next Saturday, which is the final ride required before being let loose with just my EMT partner as help on calls.

January 28, 2011

What Would You Do?

Quick little scenario:

Call for respiratory distress. On arrival, you can hear coarse sounds across the room. Patient has accessory muscle use of the SCM. Coarse crackles in ALL lung fields.
Respiratory rate of 50-60/min
BP- 80/30s
HR- 110-120s, sinus rhythm w/o ectopy
Spo2 going from 99% to 93% despite being put on a non-rebreather.
EtCO2 of 5 with good square waveforms
GCS of 3-4 (pt opens eyes, but you'd be hard pressed to say it's "spontaneous").

No history of respiratory problems, had a CVA a few weeks prior, and has Hypertension

Per nurse, patient had vomited just prior to your arrival but no secretions spotted. In the ambulance, both you and your parter cannot get an IV despite multiple attempts.

Let's just say it screams "sepsis", with the stupidly-increased ventilatory rate most likely a compensatory mechanism for the metabolic acidosis.

You're 15 minutes from the hospital. What do you do?
Now you're 45 minutes from the hospital. Change your plan?

IO and RSI?
IO and Etomidate (forgo the paralytics)
OG/NG tube?
Or haul butt to the hospital?

January 17, 2011

Yeah... Right

So, you know when you get a stabbing victim and to protect someone they say "No one stabbed me, I fell on the knife"?

Yeah, I think this one actually fell. Odd. Guess a couple of marijuana blunts and a Forty will do that to ya!

Ahhh EMS.

January 7, 2011

Chest Pain Magnet

I must be a chest pain magnet... that is the only explanation. Every shift, without fail, atleast 50% of my calls are "chest pain", yet they are never the same presentation, and that is what I love about medicine.

Some are classic angina. Some are acute MIs. Some get toned as chest pain, and it ends up being the kidneys. But each one, while the same, is also different.

Last shift I had two actual STEMIs, one getting a nitro drip (which I love... even if it is math), though neither met criteria to do a Code STEMI activation.

And the shift before that, I actually had an NSTEMI, which I got to see progress from just 2 leads, through nearly all of them. The patient SHOULD have been flown from the scene, but dispatch didn't dispatch the helicopter, even though it met auto-launch criteria. We got to the ED, the doc (my medical director) looked at my progressing 12-leads (was happy that I did right-sided 12s as well), called in to the cath lab, and off the patient went.