Dead and just don't know it...

We were on our way to a "sick party" with abdominal pain. Nothing I was particularly excited about, but I was glad to finally be getting a call. Lights flashing, sirens blaring and through it all I can hear the tones go off again. Medic 805, medic 805 stand down from current call, need you en route code three to adams rd for a reported gun shot wound. That was strange, I thought, we don't prioritize calls, but I was kinda excited none-the-less. I'm not a trauma junkie at all, but I had been kinda wanting a GSW just so I could say I saw one. We staged for a few minutes, and talked about how strange it was that dispatch pulled us off that call for this one. We were given the all clear to proceed in, made our way over to the house, and I immediately noted that there were no first responders. As we were parking, dispatch came back over the radio, medic 805, be advised, CPR is in progress. Well, crap. Better grab all the bags now. I tossed our bags out of the stretcher and we jumped out, making our way up to the house. As we approached I saw a cop come running out of the house, coughing and spit into the grass. I figured, eh, he's probably just grossed out. Then I noticed other cops coughing, then the first medic who went in was immediately reduced to a coughing fit and came running back out, followed by her partner, and the first responders. I didn't know what was in the house that was doing this to everyone, but I didn't plan on finding out. I looked over to the medic on my truck and told her I'd take the bags to the truck and get some lines ready. So I walked into the house, trying not to breathe just in case this was some nasty crap that was making everyone cough, looked over at our guy just enough to see it was a shotgun point blank to the chest. I made a hasty retreat and got out to the truck. Our guy was loaded and the fun began. We got dual IV's, I didn't have any luck getting one cause home-boy had shit for veins on the side I was looking, if you're gonna get shot and die on us, the least you could do is have good veins. My partner is a respiratory therapist student, so while I searched for something to stick, she got the tube. By that time I'd had two unsuccessful sticks so I told her to give it a go, and I took over the airway. We put an occlusive dressing over the wound, and a big trauma dressing over the chest and started pumping him. He was in an ugly agonal rhythm, we gave EPI and he went into an even uglier junctional rhythm. After the epi wore off, he was back in the ugly agonal rhythm, second epi didn't touch it, atropine didn't touch it. We were getting to the hospital now, and nothing had changed with him, but he still had a very faint pulse and a blood pressure, the army took over from here. After about five more minutes they called him. Then, the cleanup began...

And I thought I was gonna get out with just a routine abdominal pain...

Hopeless

I gave CPR instructions on the phone for the first time last night. Well, not the first time, but this time they worked the code when my crew got there. I was going through my pre-arrival instructions, just like I'm supposed to, but when I got to the ventilations the caller said she couldn't open her sister's mouth, it was stiff. I went back to compressions. For almost 20 minutes she pumped on the chest. No one was able to relieve her. Between sobs, she counted. I was the voice on the other side of the line, supposed to send in the calvary, save the day, and in the meantime be the solution. All I could do was keep telling her to pump the chest. Stopping occasionally to check the mouth. I knew it was futile. I had already given up on this lady. Her sister never gave up though. She kept going. I felt like a fraud telling her that these chest compressions would keep her going until the paramedics got there. I told her these compressions would keep her going. I encouraged her not to give up, when I had already given up. I talked to the crew later, they transported the patient, worked the code...but I couldn't bring myself to ask if they got her back. I didn't want my thoughts to be confirmed. It just seemed...hopeless...

So I'm right in the middle of paramedic ride outs again. It's keeping me busy to say the least, but I've been getting some pretty interesting calls so far. But, today pretty much took the cake. Got a call for chest pain, and sitting in the back I even thought, hmm....will this be the big one...I dunno if I'd call it the big one, but we made scene and found a 75yo woman writhing in pain on her bed. Pale, cool, diaphoretic. Popped on some 02 and got a 12....vwala...Right sided inferior infarct. My first thought....holy cow...that's a real STEMI. She had already pre-administered one nitro before our arrival, BP was initially 122/78. We got a line and bolused her. She started puking in the truck so we gave 4mg zofran. Then she had another nitro. Followed by ASA. Followed by another nitro. Pt was in a junctional escape, so HR was between 40-50, so we never got around to morphine for fear it would crash her. We had her to the hospital in 11min from making scene. She was in the ER for 9 min before being moved to the cath lab. That was shweet.

His sat's are down to 100%, Get a tube!

We got a call for an elderly male with difficulty breathing. Got to scene, and when walking in the door you could see the man was working to breath. We approached him, first responders had a set of vitals and let us know lung sounds were diminished in all fields. He was satting at 94% on room air, so we put him on O2, brought him right up to 100%. The patient had a history of pneumonia and had been released from the hospital three weeks prior. En-route he got a combi-vent, patient was on albuterol at home. This really didn't touch him at all. EKG showed A-Fib, but patient had a history of this. Sats stayed at 100% the entire ride, he would cough from time to time but it wasn't productive. We got to the hospital, gave our report, and by the time we left the guy was RSI'd and tubed. And...I don't get it.

I understand that I'm just a student and I certainly don't know everything there is to know. It just seems to me, that if the patient was moving air, and a mask would bring him to 100% that he wouldn't need the tube. Patient had good cap refill, and ETCO2 was within normal limits. Maybe I just don't know enough, but it seems to me that you shouldn't want to tube someone unless absolutely nessecary. With the tube you generally buy them more meds, a longer hospital stay, and an increased risk of certain conditions. Here's my theory on things. I look at it as working my way up. Start with a nasal canula, if it's obvious that won't work, move on to a NRB. If the NRB isn't doing the trick, move on to bagging the patient. If bagging alone isn't cutting it, it's time to buy a tube. Maybe that's overly simplistic. I don't know. But what I really don't know is why this guy bought a tube. If you have any ideas, I'm totally open to hearing them.

School and schedule insanity

So, I'm back in paramedic school. We started cardiology last week. It's not easy, but I'm managing. I also started my clinicals last week. That's what's really hurting me as far as my schedule is concerned. Today I got to the EMS station at 0700 and got off at 1500. I came to work at 1800-0600, and I'm due back at the EMS station at 0700 until 1500, then class 1700-2200. Basically, that leaves very little time for sleep and it's really catching up to me. But such is the life of a paramedic student I guess. It kinda boggles my mind that I'll have my red patch in just a few months. Kind of a scary thought.
I still don't know what I'm gonna do after this. I don't know if I just wanna get my CCEMTP, which won't do much good in texas. Or skip over that and go on to RN. Or maybe both? I'll just be content to get through school first.
I really don't even know what kind of medic I'll make. There are days where I realize that I'm pretty good at this and that I feel like I know what i'm doing. Then, there are other days where I feel like i'm completely lost and have no idea what I'm sitting in class for. I've had preceptors tell me that I'm the best student they've had, but at the same time I know that I don't know much. I've done all my rideouts witha certain service, and I'm really hoping to get a job with them come June. I don't know that I'll get it straight out of school, but it's pretty much my dream job. Well, aside from flight medic/nurse. But...nothing really interesting is going on in life, I'm kinda bored at work and am working hard to stay awake, so I thought I'd write a little post to let you all know that I'm still alive...Hope everyone is doing well out there in blogland...

code 5

Here I am, sitting at work having a pretty boring day. We've been a little 911 heavy but nothing too bad. I don't think I've taken an actual 911 call today, maybe one, not really sure. I wasn't feeling so good earlier tonight but it has since passed. Well the quietness and routineness of it all just got shattered. I recieved a call from a local city EMS agency requesting we make scene at an area in their city but our county. So I took the call and we got a unit en route. All of a sudden three more 911 calls came in from that area. So we were a little busy and a bit stretched. When EMS talked to me they just said it was an unknown man down in a park, possibly having seizures. It sounded pretty benign so we sent our crew in counting on them to use their best judgement. Shortly afterward admist all the 911 traffic we recieved a short transmission, "Unit x needs SO NOW." And our crew sounded quite freaked out, something not normal for him. So I immediately called SO and made sure they were enroute. The dispatcher tried contacting the crew with no reply, we tried to reach them a lot and they would not respond. Needless to say, we freaked out....more to come later...
Anways...it pretty much set things into a tizzy up in dispatch. I was on the line with SO trying to find out how much longer until a unit made scene at the location, and trying to explain to the lady on the phone that we really really needed them there right this second. Another person was on the phone with our supervisor who was also on his way to location. We had to move all of the traffic to the backup channel on our radios and had a second unit en route to the scene in case our guys needed mroe help. 20 long minutes later they called out that they were transporting code three. No explanation of what happened. Well things slowly made their way back to normal. We cancelled the extra units and SO and moved everyone back. Of course everyone wanted to know what was going on, code 5 is not called very often at all.
We found out right before I left what had happened. Apparently when the unit pulled up on scene they found the pt down with a belt around his neck. So they thought it was a crime scene and needed SO to make location. Apparently their handheld radio didn't have good reception where they were located at so they didn't hear us over the radio. But we did send multiple pages to their truck's pager and personal pagers and they never got in contact so our supervisor for the evening made the call to put out a code 5 until we knew for sure what was going on.
From a dispatch standpoint, it was kinda terrifying. To know that we had a unit out who was potentially in great danger, and there was nothing we could do from where we were. Personally, I took the call and had made a bad assumption that there wasn't anything to worry about at this scene. But, lesson learned, and experience to check off the list. I'll be ok if we don't have to do that again.

What is the address of your emergency?

I might have mentioned I finished my EMD course and I am now taking 911 calls in my dispatch center. It's really not a big deal, ninety-nine percent of the calls are pretty routine and easy to get through. But there's a one percent that just throw me off my game. The people who cannot tell me what the address is. And sadly enough, these are usually other public safety agencies that are unable to give me a location for the incident. We cover for our county 911 and so we very often get calls from the different cities whose call ends up being in the county. No big deal usually. Last night a local PD called and requested we send an ambulance to a country club. I did my normal thing, asked the address, and she had no answer for me. I asked for a map-grid. Nada. I asked if she could find out and I heard her radio one of her officers, who also could not give an address. Finally I brought up the internet and looked up the address myself. There are several things wrong with that. 1)I now cannot verify this is indeed the right address, its just a hope thing. 2)I only have about 30 seconds to get the call on our board, and we are now looking at close to two minutes that this call has been waiting. 3)All the lady can tell me is that its a nurologic problem. Well hell, a nurologic problem could be anything from "I wanna die", to "Oh look, I got shot in the head and there's brain matter all over the ground." It's a little frustrating.
Then as I was about to get off I recieved a call from another PD that serves out of our jurisdiction and they were begging for help. We had the truck available so we accepted the call and began getting ready to run it. The lady once again, could not give me a good address. This location is out of our jurisdiction so our crews don't know the area like they normall would. All she was able to give me was an abscure address that was neither in our map book or on google earth. It wasn't helping us at all. I tried to find it with no luck, had three different people working on it and none of us were having luck. Finally I called her back and got her to give me directions to the scene. By this time our call had been waiting at least five minutes to be dispatched and everyone was annoyed. My supervisor decided not to run the call afterwards due to not having a decent location address and the fact that this was further out of our jurisdiction than we realized, but as he called back to let them know it appears they were tired of waiting and cancelled us.
So..Basically if you're gonna call 911, please know your address. Or at the very least the closest cross streets. And if you call for mutual aid on new years eve, be helpful, don't be a bitch. OK? Thanks.