Confessions of a Baby Medic

D50 Havent Been Treating Me Well

2011-09-16T09:33:00.001-05:00

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?!

The Fear

2011-07-30T19:42:00.002-05:00

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.

They Say a Partnership is Like a Marriage

2011-07-08T21:09:00.001-05:00

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

Electric Daisy revisited.

2011-06-20T09:19:00.003-05:00

If anyone remembers one of my first posts on this blog, I worked a rave last year where I had a patient end up dying.

The rave was back in town this past Saturday, and while I didn't work it since I'm not with that agency anymore, they had another death, this time of a 19 year old. News has forgotten about the one from last year though... odd.

Texas Ants are meaner than Nebraskan ants!

2011-06-02T11:21:00.004-05:00

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?

I was in the news! Kinda...

2011-04-27T08:33:00.002-05:00

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 )

First RSI

2011-04-24T13:03:00.002-05:00

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)

Pain Control

2011-04-03T18:06:00.002-05:00

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.

I LOVE Diabetic Calls

2011-03-16T11:23:00.003-05:00

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?

"HELP" TV series in Austrailia

2011-03-04T15:26:00.003-06:00

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.

http://www.youtube.com/watch?v=0CimS2HZKyQ&feature=related

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.

First Week Down

2011-02-21T15:43:00.002-06:00

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...

Scary Times

2011-02-12T21:01:00.002-06:00

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!

What The Heck, Texas?

2011-02-04T10:16:00.004-06:00

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.

What Would You Do?

2011-01-28T21:42:00.006-06:00

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?

Yeah... Right

2011-01-17T21:21:00.001-06:00

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.

Chest Pain Magnet

2011-01-07T16:21:00.002-06:00

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.

And the White Cloud Continues

2010-12-29T14:45:00.003-06:00

Yup, I'm what we in EMS call a "white cloud". I went all through EMT school, all through medic school, all through my Paramedic clinicals, and on up until my second to last shift as a Paramedic intern before I had my first cardiac arrest. And I was working in Dallas...

Well, this has continued on to my new 911 agency. County of over 60,000, 5 trucks covering it, and my worst call to date is an unconscious diabetic.

We've been called to multiple MVCs with rollovers... one with "entrapment". On arrival, the patients were all walking around refusing to be seen, and the one entrapment was a drivers puppy dog that refused to come out of the wreck.

But you look over at the two other trucks that share my station, and they've gone on ACTUAL MVCs with entrapment, motorcycle vs autos, and stuff of that nature, every day. I'm lucky if I get a couple legit 911 calls in a shift and not any of the "I've had a stomach ache for 3 weeks, nothings changed but I want to go to the ER at 3am." calls.

I worked with an EMT the other week who stated each of the last 12 shifts they've had patients that they've had to intubate.... 12 patients in one month. She was SURE we would get one that day. We didn't. We slept all night.

Granted I'm not wanting anyone to get hurt. Just the opposite actually. But as a new medic, and one still in FTO, I technically NEED the 'good' calls so I can get the experience, and get cleared from field training to go on my own.

As one of my preceptors in EMT school said: People are going to get sick and hurt no matter what. We might as well be there to help them.

The other trucks are getting the bad calls, so the calls are obviously happening, just not on my truck.

Oh well, be careful what you wish for, right? I'll probably get a 30 car pile-up this weekend during my 48hr shift...

Moving Beyond EMS?

2010-12-15T11:05:00.002-06:00

The short time I've been involved in it, I have loved EMS. I love the freedom that it entails. The ability, that as a Paramedic, I make my own decisions on patient care in the field. The fact that I am actually OUTSIDE dealing with the public.

But, ever since I started medic school, I have had countless people tell me the same thing: That I am "too smart" to just stop in EMS.

My two instructors in medic school told me that I should continue on to medical school. I thought nothing of it really at the time. However the past couple of weeks at my new agencies academy, it was brought up several more times by people.

Not only did the academy instructor, a CVICU RN / Trauma RN and a flight medic for longer then I've been alive, told me that he didn't see me staying "just a Paramedic" but continuing on for my CRNA, PA or MD, but most of the people in my academy, Paramedics with over 150years combined experience, said it as well. The instructor even said "I've known many medics, and just from meeting you I can tell with a year or so of experience, you're going to be one helluva medic". I didn't know how to respond, so I smirked like an idiot.

My reputation proceeded me as well, to my FTO. I get to my new station on my first day (more on my first day later) and one of the first things he says to me is "So I've been told you're some kind of genius", and proceeds to quiz me. After the quizing, he states "Yeah, you've definitely got the knowledge, now you just need the experience to be a great medic".

Ever since I neared the end of medic school, I had toyed with the idea of getting my PA. It interested me somewhat to be a mid-level provider, and actually make a pretty decent living, and I could specialize in emergency medicine. I had also thought of doing a bridge to get my RN (no reason a medic needs to spend 2 years to get their RN...). I never even considered MD or DO, because quite honestly, I suck at, and hate, math, and going that route would be just too much math. Funny thing is, science and biology just click with me, but math is a no go.

I know I eessentially HAVE to branch off in to something else, as physically I can't be a Paramedic for 40 years, and if something happens where I can't work in the field, I'd be SOL. I'm 22, so I've got time on my side still, but before I can even think about PA school, I need to finish my degrees. I stopped halfway through my CJ degree to do Paramedicine. I still need to go back and finish my EMS associates. After that, I was toying with a BA in Emergency Management, as many PA schools I know require a BA minimum. Then, and possibly only then, would I be able to go to apply to PA school.

But like I said, need to finish my degree first, so I've been looking at colleges that offer life credit for my Paramedic (since I didn't go to a college for my Paramedic program). Hopefully I should have my EMS degree within a year of finding said school.

But beyond getting my associates in EMS, I'm lost as to what's next. RT? RN? PA? Or heck, even medic school? I guess only time will tell.

Finally, My First Shift

2010-12-11T16:51:00.003-06:00

Well, it's been a long couple of weeks. Worked 90 hours (which in the grand scheme of EMS isn't much at all) but I also drove 6 hours a day, meaning 70 hours the past 2 weeks. That is essentially 160 hours just for work related stuff the past two weeks.

Oh well, tomorrow I start my first shift on an ambulance for my FTO. Finally, after having my Paramedic since March, I'm getting to do what I've spent 2 years learning how to do.

I Feel Like I'm Back In School...

2010-12-04T21:55:00.005-06:00

Yup... I haven't posted for a while, I know. This past week I started the academy at my new agency. You read that right, I said academy, and not orientation. No one week thing of "Fill out this paperwork, and don't kill anyone", but an actual academy.

3 weeks of guidelines (they don't call them protocols), pharmacology, airway management including RSI and needle AND surigcal crics, CEVO training, HEMS training for the chopper, pathophysiology, EKGs and all the other fun stuff done in Paramedic school, but crunched in to something slightly longer than EMT school just so everyone is on the same page with the company. Ok... crunched isnt the best word to describe it, as it's still quite adequate especially considering everyone in the academy is already a Paramedic.

I'm actually (so far in my narrow naiive view) loving how this agency treats its job. They want the best people they can, and provide the best care they can to the public, just as an EMS agency should. They call them guidelines instead of protocols to influence more free thinking instead of 'cookbook medicine'. They call Paramedics clinicians instead of technicians. They have no qualms with spending money to buy good equipment. And they have a big amount of autonomy that they allow the Paramedics to practice (though I'm sure there are a few out there who don't like "Paramedic" and "autonomous" in the same sentence)

Only downside of the academy? I have to be up at 5am for a 3 hour drive out there, for a day in class, followed by a 3 hour drive back... every day, 5 days a week. Though it will be fine once the academy is over as my duty station is less than half the distance I'm currently making, and it will be for 24hr shifts.

Can't wait to start my FTO and put my years of education to actual practice.

And a New Chapter Begins

2010-11-16T10:27:00.002-06:00

They called yesterday and offered me the job :)

Luckily, at my old job, I was able to get all next week off, so this is my last week with my current employer, then I start orientation with my new one on the 29th, with 3 weeks of orienatation, followed by a lengthy FTO time.

And it begins.

In Over My Head?

2010-11-11T18:05:00.002-06:00

So, the company I interviewed with last week? I know a medic there and he emailed me their protocols, or they call them "guidelines" to get rid of cookbook medicine.

And after a read-through, jeez I feel over my head.

Just some examples that they have that ALL their Paramedics can / are expected to do;

RSI

Needle AND surgical crichs

LMAs for their Paramedics

Oral and nasal gastric tube placement

BiPAP and CPAP

Foley catheter placement.... in the field.

(Critical Care medics also have escharotomies and pericardiocentesis)

The average Paramedic also has the following drugs on their truck (beyond the norm)

Heparin

Fentynyl

Acetominophen for fever AND mild pain

Calcium gluconate

Labetalol

Metoprolol

Vasotec for CHF

Etomidate (obvious due to RSI)

Pepcid for allergic reactions

Versed

Ativan

Nitro drips

Oxytocin

Rocuronium (again, RSI)

Tetracaine (for pepper spray)

So, needless to say, I feel out of my league here. I know they'll cover it in the 3-week long orientation + 1-2 months of FTO, but it still feels like a lot.

Oh well, all that's left is to wait for my references to be contacted and hopefully I get the job offer soon.

Interview time part deux

2010-11-06T13:42:00.002-05:00

So, I had the interview yesterday. I woke up at 5:15 to be out the door by 5:45. The interview location is about 2 and a half hours away, but I also took in to account traffic going through Dallas at the time of the morning. I got to the location just before 8am... so I had an hour to kill just listening to music in my car.

Come 8:45 I went to the building and walked in. The receptionist pointed me to a door leading to the back saying "EMS is back there". I walked on back and met my interviewer, the Ground Operations manager.

He took me to another room and said that the HR lady would be a little bit, but that'd we get started on the mega code and trauma scenario...Crap, I didn't know I was going to be tested! I've only ever done one real life cardiac arrest since starting EMT class back in August of 2008... and I'm now a Paramedic in November of 2010. Yup.. white cloud. I let him know it too. He said not to worry, just run through the ACLS protocols and I'll be fine.

Ran through the code, stumbled a bit from nervousness, but he said I did fine. Went on to the trauma call which was an MVC with the patient walking around complaining of SOB. After listening to lung sounds, I determined he had a collapsed lung, so I told my interviewer that I'd do a chest needle decompression. He asked where, I said 5th intercostal midaxilary. He asked where else I could do it, and I said 2nd/3rd midclavicular. He said good job.

The HR lady finally came and he told her I did "fantastically" on the scenarios. They proceeded to ask me the usual EMS interview questions like "Name a time that your decision to do something didn't work right, and what you did to make it work" and the usual.

At the end, they made it seem like I got the job. They said they would love me to start orientation on the 15th, but understood that I had to give my current employer 2 weeks notice, so they want me to start on the 29th instead. Discussed pay and benefits and the like as well. Afterwords, they sent me to an outside location for my UA drug test.

3 weeks of orientation (5 days a week, 9-5), followed by 1-2 months of FTO time. Finally, an employer that takes FTO time seriously. It's a well respected agency around here that is hospital based.

Downside? Orientation is at a city 3 hours drive away. Now I'm just trying to figure out what to do. It will cost me about $170 a week in gas if I make the trip every day from my house. I would have to leave at 5:30 am and get hom at about 8:30 pm on average. 6 hours of driving for 8 hours of orientation. OR I could spend A LOT more money and get a hotel room, say Mon-Thurs nights, and come home on the weekends... but like I said, alot more money.

But once orientation is done, all will be good. He said I will most likely get put in their furthest west city that is not only closer to me by 45 minutes (meaning less than an hour and a half drive... for 24hour shifts, not bad) but it's also fairly busy so I'll get good experience.

So, barring my background check showing I'm a wanted axe murderer, or my UA test showing I took illicit drugs without me ever knowing, I should hopefully be starting a new leg in my career as a Paramedic at the end of the month. Finally.

Interview time

2010-11-04T22:06:00.002-05:00

FINALLY got an interview at a well respected 911 EMS agency, set for tomorrow morning. It's 2.5 hours away from where I live, and the interview is at 9am, so that means I have to be out my door no later than 6am... which to most people doesn't sound too bad, but my usual shift at my current employer is 3p-3a, which means I'm usually just getting to sleep at 6am.

And after the interview, I have my normal shift on my truck. That makes it pretty much a 24hour awake day for me. Oh yeah, and I'm sick. Fun.

Oh well, wish me luck. Hopefully I get on with this agency, or learn something that will help me get on with another one real soon.

I'm Free!

2010-10-31T23:54:00.003-05:00

So, finally after 6 months with my partner that would question my calls infront of patients ruining any trust they had in me, argue with me on the drugs we have (Saying that Narcan can reverse the effects of Marijuana...) and just not getting my awesome sense of humor:

I'm finally getting a new partner.

My old one is starting his Paramedic school internship (scary thought in and of itself) so as of right now I have no set partner and will just pickup whoever needs OT. Fine by me as I've worked with a few different people before when my partner was off for the shift and never had any qualms or problems with any of them. Should be fun.

But at the same time, I'm sending application after countless application out right now to agencies within a ~200ish mile radius looking for a 911 gig. As of right now, I wouldn't mind driving 2 hours to do a 24hr shift. Wish me luck on the job hunt.

Ahh Doctors... I love them

2010-10-28T12:36:00.001-05:00

I had to transport a dissecting abdominal aortic aneurysm last night.

Whilst in the ER one of the nurses asked the doctor "Think we should send a nurse along with in the back just in case?"

Doctor looked at me, asked "You're a Paramedic?"

I said "Yup"

Doctor said "Why would we send a nurse then?"

I love doctors that actually know the different levels of providers, and what each can do.

New CPR / ACLS guidelines

2010-10-18T02:04:00.002-05:00

Yup.. they're out. Does it make me an EMS geek for having actually looked forward to them coming out?

http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_317350.pdf

My big happiness is more of semantics rather than of sciene--- finally getting rid of ABC and making it CAB. Call it a pet peeve of mine, but ever since EMT class, I HATED saying ABCs, and I AWAYS checked for a pulse before breathing. It might just be me, but hey, if they don't have a pulse, whatever respirations may or may not exist don't really mean crap.

Now, just to find out when my company will implement these into protocols... granted it's not like we run on many codes doing transfers, but it happens.

EMS Expo 2010

2010-10-05T20:34:00.002-05:00

So, seeing as how I live in the DFW area of Texas, I was able to attend EMS Expo in Dallas last week. Loved it.

Got to meet many of the "more popular" medics in this industry such as Jamie Davis, Chris Montera and Kyle David Bates, along with the "Chronicles of EMS" creators, Thadeus Setla and Justin Schorr.

As odd as it sounds in our little community of EMS, I was star-struck. Those people are the ones that made me want to start this blog and get involved in the EMS 2.0 movement, and above all, make myself a better medic.

The expo itself had many cool exhibits, with new 'toys' I got to play around with, such as "high-def" laryngescope blades, video-laryngescopy, and the future of EVOC--- driving simulation.

If you ever get a chance to go to EMS Expo (Las Vegas next year) or any of the other EMS conventions, I'm sure, you'll have a great time.

Plus, free swag.

Dropping a Patient

2010-09-23T23:33:00.002-05:00

Nope. Never a good thing.

Even worse when you had no control over whether or not they were dropped. We had a bariatric patient yesterday, so 4 of us were handling the cot. I was at the head, where I like to be when I have a patient (lets me keep my eye on them). On unloading the cot from the ambulance, the person in control of the legs didn't lock them, and the cot went to the ground.

Luckily, the patient was strapped in all the way, and upon the landing, the other Paramedic and I made sure the patient suffered no injury... no body parts flying anywhere or getting caught in anything.

Got a call today on my day off, waking me up, from one of my supervisors wanting an incident report done. Apparently the patient went to the hospital today complaining of pain after the fall.

So, out of my control, yet I'll still probably get in trouble as well. Fantastic.

Dear EMT Partner

2010-08-17T14:16:00.004-05:00

I'm all for explaining why I did or did not do something to a patient after a call.

But never, ever, challenge my patient care decision INFRONT of a patient, if you disagree with a specific choice.

(Exception to the rule is doing something that can harm the patient, like giving them a drug they are allergic to)

Last week we got called to a person that was reported to be "short of breath" by the family. Patient was in the early 90's, no hx of COPD, no asthma, no respiratory history at all aside from recent bout of pneumonia.

SpO2 96% on 3LPM via nasal canulla. No labored breathing, and at a rate of 22. Clear lungs. No peripheral cyanosis. No other indicator that she was in in distress at all, just the family stating she was (but rehab facility nurses said that was normal baseline). I opt to keep on NC.

My EMT says, and I quote "Are you sure?"

Yes, I'm sure. I don't just randomly throw out medical decisions without thinking them through first.

I'd like to think that at some point in my 2 years of education in emergency medicine, my internship, my passing of my certification test, and the fact that I was cleared by an FTO means that I might have possessed some little tidbit about how to practice some emergency medicine.

This isn't the first time this EMT has challenged my choice, either. He's under the firm belief that his 1 year as an IFT EMT supercedes my 5 months as a medic and 7 months as an EMT... and lets it be known to the patients when he states he "has more experience".

*sigh*

I love EMTs... I stand up for them all the time and hate medics that exhibit "Paragodness", but this is getting old.

Silly manufacturers...

2010-08-08T19:35:00.001-05:00

You know what's funny?

The fact that emergency vehicles say "STAY BACK 500 FEET", yet in such small letters that there is no way in hell you can read it unless you're well within 500 feet...

New Idea

2010-08-02T17:48:00.003-05:00

I have an idea:

Every time dispatch holds a unit late for over an hour, the dispatcher gets off an hour late as well.

Fair's fair, right?

Death, and Circumstances Surrounding It

2010-07-21T15:49:00.004-05:00

I had another idea for a post on here since it's been a while, but alas life (or death) poked it's nose in and changed that plan.

I woke up this morning to a text message saying my grandma was in cardiac arrest and they were doing CPR. I got on the phone with my mom and found out which hospital. I got dressed in my Paramedic uniform and headed to the hospital (I was still expecting to go to work in a little bit anyhow, which is why I wore my uniform)

I get to the hospital and they bring me to a room where my parents and a chaplain already are. Chaplain states his presence doesn't mean she's dead, he's just there anyhow.

Doctor came in a little bit later, and gave the story. Apparently she coded this morning at a rehab facility, and FD brought her to the ER. He said after a few rounds of drugs and shocking her heart, they got a rhythm back, yet she was still unconscious. Right after stating that, his phone rang and he left the room. Came back a couple of minutes later and said she coded again and this time they couldn't get her back.

My parents, my siblings and I stayed there for about 4 hours, just soaking it in. I called in to work to get the day off. It wouldn't be fair to my patients for me to work today.

A few of the things surrounding this though made me think that God had a hand in it. I believe in God, but in the recent past I've had some questions of faith, not for anything in particular, but after today it made me reinstate my faith.

First is that my grandma is usually at a living facility 30 minutes away, but she just got sent to a rehab, 5 minutes from my parents house, just last Friday, making the trip to the hospital very short instead of a near 45 minute drive. On top of that, two of my aunts had been planning on coming down from Wisconsin to visit my Grandma tomorrow, and had been planning this trip anyway... it's just funny how it worked out to be the day after she died, so that they actually already had the week off.

RIP

"Granny"

7/21/2010

Getting a Job in EMS

2010-07-15T12:28:00.002-05:00

So one of my friends, Life of a Transport Jockey, just recently got a conditional offer by an ambulance provider for a job, which he has been looking for for a few months now since leaving his last one. (Good luck bro)

That got me thinking: I hate job searching as a new grad medic. You're fresh out of school, and sure places can mold you to the medic they want you to be, but you're still largely untested, which I can only assume is not a good thing when you have the responsibility level that being a Paramedic entails.

Now, yes, I do already have a job, and I do get some OK calls at it, but I honestly did not get in to EMS to do mainly BLS transports that, 99% of the time, do not need a Paramedic level response. Yes, I use it as a learning tool, and yes I know 911 still has the same "BS" calls as IFT has, but alas, in the 911 I HAVE done as a medic I actually feel like I'm making a difference, even if just slightly, and THAT is what I got in to EMS for. No, not the hero complex, but really just helping people.

Oh yes, and the money...

I guess my main problem is I don't want to move out of Texas, and the DFW area in particular, which limits the amount of 911 jobs that AREN'T Fire-based EMS.

The ONE thing that has kept me from getting with the local busy 911 that I've wanted to get on with since EMT school was the "I strongly agree / strongly disagree" type psych test. For some reason, the two times I've taken it at 2 different agencies, I failed it. Now how I fail a test like that I don't know, but at every other agency that had it I passed fine.

I'm going to stick with my current employer till around September/October when my 6 month probation is up, then apply to transfer to one of their Texas 911 branches. If unable, then I'll be moving.

My ultimate goal agency is Austin/Travis county EMS down in Austin... let's see if I can make it.

No, I Will NOT Move My Ambulance (Rant alert)

2010-07-10T23:14:00.005-05:00

For the people that know me in my personal life, away from the Paramedic uniform, I'm an easy going, and yes, shy, guy.

But put that uniform on and my Type-A personality comes out to play. I've attributed it to the fact that I need to get done what has to be done for my patient, regardless of how it makes me look, so I'm a lot less shy when doing my job, which can end up irking a few people that prohibit me from doing my job.

I guess that's also partly to do with medic school where they pretty much beat in to you that YOU are the leader of patient care, and YOU have to get things done. Now, that doesn't mean I pull Paragod stuff on people or think I'm the best as I treat everyone, from ECAs to EMTs and nurses with respect, but I am not beyond putting my foot down, saying enough is enough, and being a bit brunt when it comes to MY patient, and MY patient care.

Last night I thought I'd pick up an OT shift just for some extra cash, so I was with an EMT I haven't been with before. Near the end of our shift we were called to a psych hospital (yes, THAT one) for a patient "with chest pain", and once we got there, the only place to park our ambulance was by pretty much blocking 1 of 2 entrances to the lot. Once at the patient, he said he felt "palpitations"(his word), he was noticeably short of breath, and a little diaphoretic.

I took him out to the ambulance to do the rest of my assessment, and was just starting my 12-lead when some strange person opened my back doors and told me to move. I told him I was with a patient and that I'd be moving once I got some things done, but he could go to the other exit... he closed the door.

A minute later, he opens the door again, this time flashing a physicans ID and demanding that I move my ambulance so he could leave and go to another hospital. This time, I was done being polite... I told him I was with a chest pain patient and that he will have to wait until I'm done, and "please shut my door".

That obviously didn't meld with his ideals, because he promptly went to one of the police officers that was in the parking lot and started throwing a fit. Luckily the cop had actually brought a piece of my equipment out to my truck for me, so he knew I was with a patient, and therefor wasn't hearing any of the complaints that "doctor" had to yell about.

I am fully expecting this guy to phone a complaint to my work, or if he knows my medical director, to complain to him. Bring it on.

I don't care who you are, I don't care what your professional title is, you do NOT tell me to move my ambulance, or do anything else, when I'm dealing with a patient. (Unless, of course, you're a cop, my supervisor, or my med control)

And on top of that, what kind of "physician" worth their title would dismiss a chest pain/shortness of breath patient just for some convenience?

Rant over.

Update to "Doing the Minimum"

2010-07-06T12:37:00.002-05:00

I wrote a post last month about a patient who I picked up who had OD'd.

He ended up passing a couple of days later in the ICU.

Not anything shocking considering his nearly 109* temp, just a weird one as they say the ones that are your age strike you a bit differently.

All I Could Repay Him With Was Morphine

2010-07-01T15:39:00.025-05:00

I had a patient last night that, atleast temporarily, but hopefully for longer, changed my outlook on life and circumstances.

And this is the story of Billy-Joe-John-Eric (obviously not his name)

Billy-Joe-John-Eric used to be in a customer services related job that he LOVED, and much like me and Paramedicine, just sort of fell in to it, as it was neither of our plans to do what we do. He said he loved his job because he got to meet new and amazing people every day, and have fun, and it just clicked with his personality. He did that job for 21 years.

Then one day his accident happened. He fell out of a higher elevation, and broke his back, paralyzing him from the thoracic vertebrae down, though he still had function of his arms. And that's how he and I met.

We were called to transfer a patient from a hospital to a rehab, and seeing as how it was a BLS call, I opted to have my EMT partner run it (as I seemed to be getting ALL the calls lately). Once we got the the hospital my partner was getting his paperwork done as I walked in to the room to find the nurse giving Billy-Joe-John-Eric dilaudid for the trip. Billy-Joe-John-Eric was obviously in a lot of pain, arms shaking, grunting, yet when I walked in he gave me a smile and seemed as chipper as could be.

The nurse, my partner, and I moved Billy-Joe-John-Eric to our cot, causing pain due to decubitus ulcers he had present. I didn't like it. I told my partner I was upgrading to ALS and that'd I'd take over, as I wanted to get some more pain meds on board for the transport as the Dilauded obviously wasn't cutting it. We got out to the ambulance and I gave Billy-Joe-John-Eric some Morphine... though I gave it to him under one condition that he agreed to: Don't fall asleep on me, it causes too much work :D Knocked the pain from 9/10 to 3/10.

During transport he and I spoke, and he told me his story. When his accident first happened he said he questioned God: Why would a loving god take someone away from a career that they love and get to meet new people in? He finally decided that God was a jealous one, and wanted Billy-Joe-John-Eric to worship him more. I brought up the counter point that maybe he wanted Billy-Joe-John-Eric to meet people in a different capacity, and affect people in a different way. And actually, Billy-Joe-John-Eric agreed, stating that he has met a multitude of great people in the healthcare field, from doctors to nurses, and he even named me, that he would have never had the pleasure to meet had this not happened.

And that is when it struck me: This guy pretty much had his life ripped away from him, yet he was content, and maybe even happy! Not happy that he's paralyzed or that he couldn't do his beloved job anymore, but genuinely happy to be alive. We in EMS see life ripped away from people too soon, and are constantly reminded at the fragility of life, but we also build up somewhat of an immunity to it and like to pretend that it can't ever be us.

If this guy could be happy given his circumstances, and still want to live life, it makes all my current trials and tribulations in my personal life seem all that much less important. He changed my outlook on a few things, and I hope that lesson sticks as long as it can.

And all I could repay him with was morphine.

Doing the minimum necessary

2010-06-25T14:22:00.012-05:00

That phrase is ground in to our heads in school. Do just what needs to be done to your patient to get them to the hospital alive. If they don't need an IV, don't do an IV. If they can suffice off an OPA, don't use a King airway. If a King works, don't intubate. Etc etc. The problem is learning what the right amount is for us new Paramedics.

At this point in my career, I truly am uncomfortable making some of the decisions I make in terms of patient care, yet still make them because I know I have to.

Last week I had an OD at a rave who has a pulse rate well in excess of 160, and unconscious, BP 150/90 initially. We quickly got him to the ambulance and en route to the hospital, 5 minutes away. I did a quick assessment, did an EKG (SVT), made the (5th OD) call to the hospital, and tried fighting with the guys mouth to suction his gurgling respirations caused by him vomiting, to which he would clamp down on the catheter.

We got him to the hospital, they RSI'd him to get a tube, and he promptly went in to Vtach, which they shocked, and his BP went to 60/30, even with 5 liters of NS infused in two IVs. Body temp was 108.8* F... frying his brains right in front of us.

So that leads to my questioning of myself after this call. Did I do the minimum necessary? Did it suffice that I got him to the ER as quickly as possible, or should I have done more? Should I have attempted to cardiovert his SVT, with or without an IV, even though his BP was fine (elevated?) Should I have tried pushing Valium to ease his teeth so I could suction? Should I have put in an NPA? Should I have tossed on a few ice packs, seeing as he was warm, but I didn't have a thermometer?

Why do these thoughts only come to me AFTER a call, and not during?

This is why I want to do 911, and not IFT, so I'm in these situations more, and can get more comfortable with making the decisions necessary.

Stopped by the hospital a couple of days later, and one of the nurses said the guy survived the first little bit, and they had him up in the ICU, but the docs still don't have much hope for him. Even if he does live, his brains are fired.

And before anyone asks... it's not really eating me up. I'm not depressed, not sad, not mad. Just wondering if it could have gone better.

Until next time.

Can I Poke You With My Needle?

2010-06-15T12:28:00.007-05:00

IVs. Generally one of the most used physical skills a Paramedic does on a regular basis. Medics tend to pride themselves on their IV ability--- I mean who else in the healthcare field can start an IV upside down in a car wreck, or while bumping down the highway in the back of a rig? None from what I can tell.

All other healthcare professionals tend to have a much more controlled environment when starting IVs. Nice, well lit, white wash room, with a patient sitting there, all the IV supplied laid out, and all the help you could ever want or need in the form of every other person in the hospital.

Back in my Medic clinicals, I was nailing IVs left and right. I seriously only missed at most, 1 or 2 a day out of 20 attempts. The ones I DID miss, I had the luxury of having much more skilled people at the hospital that I could pass the buck off to.

Yet, somehow, in my practice as a lone Paramedic, I haven't been able to hit a thing. I'm probably getting 1 out of every 3 or 4 lines actually started. There are some patients where I can't even get a line in. I have an EMT partner, so he's unable to help.

Take yesterday for example. I had a chest pain patient with T-wave inversion on V2 and V3, pain dull and radiating to L arm 9/10. Obviously I wanted an IV, so we load her up and bring her to the rig. I look at the left arm, and found an ok AC... just barely there, but I was going to go for it. Poke it in, no flash. Work it for a little bit (which I hate doing, but I hate poking again all that much more) still no flash. Pull it out and the patient starts letting loose all the blood that I wanted in the flash chamber, on to my ambulance floor. Darnit. Well, atleast I knew I was IN the vein at some point, just didn't know why I wasn't getting a flash. So I switch to the right arm. Try the AC there after finding nothing on the hand... no flash again.

I hate giving Nitro without an IV, but I had to, as she was still in pain.

I don't know what it is. Maybe it IS just because I'm in an ambulance instead of a hospital. Maybe it's because I'm just unlucky lately. Or maybe it's because I'm psyching myself out being the only person able to get an IV. But I need to definitely start working on being able to get a majority of IVs again.

I have a long ways to go before I'm the ace at IVs like Paramedics are expected to be.

So, on to you guys (the whole 2 I have right now :P ), do you have any special ways you like to do IVs? Special equipment? Vein you go for? Angiocath size?

Did You Just Bite My Partner?

2010-06-10T14:19:00.008-05:00

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?

New Medic Signing On

2010-06-08T20:25:00.011-05:00

So, I'm a brand new medic at the age of 21 (Get it, Baby Medic? HA) been employed as a medic for 2 months, and working as a lone medic with a basic for a couple of weeks now. I've been contemplating doing a blog for a while now as I'm a fan of many blogs and podcasts such as Justin's HappyMedic, Jamie's MedicCast and Chris' EMS Garage (Don't know why I use their first names as I've never met these fellows...yet). I've always respected what they do for the EMS community and profession (yes, I said profession) and thought I'd try, even if failingly, to emulate what they do with my own awesome personality. (Egos... standard issue for Medics, right?)

And so this blog was born. I didn't initially think of doing it so early in my career, because at the moment I'm employed by a company in one of their IFT branches and didn't really think I'd see anything even remotely like what my 911 counterparts see. Man was I wrong. My company, a pretty (in)famous one, has contracts with nursing homes, clinics, and other places to provide pseudo-911 services to them as well. Infact these past couple of weeks I ran on an unresponsive head injury, a combatitve psych patient, a couple of MIs / Angina patients, and a critical care type transfer, just doing "transfers". Granted I still want to move to 911 ASAP, either with my current company or not, but it still keeps me interested.

I hope to regale some people in my adventures, worthwhile or not, and to just put my thoughts on this wonderful career in one place. If people enjoy it, great, if not, I just made you read my words anyway, so guess who won?!

Anyhow, enough with the introduction. I'll post my first true tale probably tomorrow, as for now, it's time to look up some drugs that confused the heck out of me yesterday.