Thursday, June 21, 2007

- Bleghmsjkdt! OR A Treatsie on Trustees of Modern Chemistry

So 2 shifts down with my new preceptor and we have had zero ALS calls. As a matter of fact we've had zero BLS calls. Nothing but transfers in two shifts. Fabulous. So here is a call I ran a while back with my first preceptor...for your amusement, this month's entry for the Haldol Critter of the Year contest.

Call Notes:
-Pt is yelling and screaming, b/f says she is hallucinating
-Pt has psych History
-Pt has Hep C
-Pt located in front yard
-Pt has history of sniffing Paint Thinner

Outstanding. We're out in the boonies and are trying to grab a lunch meal courtesy of the local greasy spoon (it sticks to your ribs...even if you don't want it to. ::shrudder::) when these call notes come across. Wheee. We turn on the flashy things and the loud things and drive over to the call. Mom-Partner is precepting me today and we chat idly about possible airway maintenance issues. If she's sniffing something really corrosive to fly the skies of Sherwin-Williams Land she might have burns to the whole breathy area (that is the correct medical terminology) and that is a BAD THING.

We creep up to see three people in the front yard - a nicely dressed older lady, a rotund middle-aged guy, and the lady I will now sweetly refer to as Mistress Freakout. Mistress Freakout is currently sitting in a lawn chair FREAKING THE FUCK OUT. Hands rubbing everything, along her shoulders and through her hair, speaking at an increased, rapid rate, with one eye squinting and the other wide open. Approximately three teeth. She looks like a deranged pirate. If they brewed Captain Morgan out here in BFE she would be the spokesperson in the big red overcoat and boots. I hate to think who would want a little of that captain in them...

The rotund middle aged man's face has lit up and he is doing his impression of a windmill, International Brotherhood of Bystander's standard signal for "Over here, ya'll". I briefly curse the fact that I didn't stay far enough back, but luckily I see the Deputy about two blocks behind us, rolling on in.

So yeah. Mistress Freakout runs towards Mom-Partner, Deputy Droopy, and Myself as we get out, gibbering and pointing at the sky. Fantastic. Having gloved up and put my safety glasses. I deftly grab her hands from in front of her and hold them in one of my hands and place the other just below her neck, above her breasts. This stops her pretty good and I can start my assessment.

"Hi, I'm MedicMarch with XXXX. What's bothering you, ma'am?"

"Meda-Marsh? Blgsi Amubluanech?" she asks me. She is meth addict skinny, wearing boxers and a tee shirt. I don't see anything immediately life threatening but I can feel her heart pounding at what I guesstimate is about 130 beats per minute. I let one her hands loose and take a pulse on the other one: bounding and regular, w/ a rate of 134. I kick ass. While all this is going on Rotund Bystander is telling the story to my partner and Dep Droopy. Apparently Mistress Freakout hasn't been hitting the turpentine, as far as he knows, but she has been "Out of Control" for 3 hours and now he's "Starting to get worried."

"Mklespitz! Nopaint shniffgsh!" interjects Mistress Freakout, eager to help.

"Can you tell me what your name is?" I ask.

"Fishnchipzer here flor me!"

"Her Name is Bobby-Joe!" (not her real name - I don't want to get sued, although I don't thik any of the yokels can even spell internet, much less access it) adds Rotund Bystander.

"Bobby-Joe! Namesh Bobby-Joshge!" says Mistress Freakout.

"Can you tell me what day it is?" I ask.

"Gish-I dont know-vmklps!" replys Mistress Freakout.

"Thursday!" Pipes up Rotund bystander. From the look on his face he's almost sure this is the correct answer, and he looks at me expectantly. I barely have time to stifle my outrage and to keep from slicing this guy to ribbons with smartassery, so I mentally image nailing a gold star into his fat, sweaty forehead. I chuckle, and this sets of Mistress Freakout, who I am still holding. She starts laughing, cracking up, and this sets of Mom Partner, who, with a very unladylike snort, bursts out into cackles of amusement. This, in turn sets of Droopy, and so now we have three first responders and one goofy ass, paint sniffin critter laughing in the sunshine.

Oh, happy day.

We get her loaded up after my partner concludes her interview with Rotund Bystander and his mom, and they ask for her to be transported to Our Lady Of Something Or Other. She gets in the back.

"Restraints," I tell her as I hook up the writhing, sweating Mistress Freakout to my EKG. Sinus Tach, looks like, but there's a lot of artifact and she's bouncing around too much for me to get a good BP. "And get an IV for me, please."

Mom-Partner quickly gets her stick and grabs the restraints. Apparently Mistress Freakout doesn't like this idea because when I turn to grab one from Mom-Partner she leans forward and tries to take a chunk out of my arm with her three teeth. I manage to dodge the chompers and I grab her forehead and slam it against the back of the upright head of the cot.

"NO BITING!" I tell her.



"Bitey! BITEY Mar-Medic!" I can't make this shit up.

"NO BITEY MEDICMARCH!" I yell into her squished up pirate face.

This sets of Mom-Partner laughing again. "Hahaha, oh Shit, March, you made a new friend, hahaha, stop it, heeheehee I'm gonna pee in my uniform pants HAHAHA!"

I'm not amused and we get Mistress Freakout tied down. Mom-Partner has recovered enough from her laughing fit long enough to put an O2 mask on the patient. "What's that for?" I ask.

"You said no bitey::giggle snort:: so this makes it so she can't BITEY! Hahahahaha! Oh, shit!"

I grumble a thank you. I try to finish my interview but Mistress Freakout is content to glare at me and grumble nonsense.

"Fergh shish MedaMarsh. Bitey"

We take her to the hospital. Other then sinus tach, everything else on the lady is fine, with a CBG of 126. I push 2mg of Narcan to see if that will do anything but Freakout just pulls against her restraints and chews the inside of her mask with her three teeth.

We spend 20 minutes on the wall. They give us a room, I give my report. As I'm walking out of the room I hear "Marsh gj ksel!" and the sound of someone having a large, liquidy bowel movement. The nurse and tech let up twin wails of disgust. I chuckle.

I walk by the Nurse's station on my way out. "Code Brown in Iso-1," I tell them.

Outside Rotund Bystander Boyfriend envelopes me in a sweaty, clammy hug before I can escape and thanks me profusely. I shudder involuntarily and grab some paper towels to wipe myself off. I get in the front of the cab and sit in the air conditioning for a minute. My stomach grumbles loudly, reminding me that we still haven't eaten. My partner is trying not to laugh.


Mom-Partner can no longer contain herself. "Want to grab a BITEY to eat? BWAHAHAHAHAHAHAHAHAHAHAHA::snort::.!"

"Oh, Shut up."



RevMedic said...

Awesome. Great writing. Remember kids, Just Say No, or you'll end up drooling all over yourself or worse - like this 'lady'.

Loving Annie said...

how come you took me off your links ? I don't think I said anything offensive .... Did I ?
Loving Annie

p.s. I don't 'bitey' !!! (lol :)

RevMedic said...

Nebulized Succinylcholine. Going once...

Medicmarch. said...

Revmedic: Sux through the neb? Niiiiiicccceee. It would've beeen real easy too - she was already tied down and I' could've just attached the neb to the bottom of the the words of Barney Fife we could've nipped it in the BUD!

You're back up.


Blue Ridge Medic said...

Hilarious story! Love the writing, keep on keeping on...


Anonymous Therapist said...

I never laugh out loud, but this is some quality entertainment. I swear I've had this exact patient before...I like the idea of a Sux neb, but I've always preferred PTF (pillow-to-face)therapy. Then again, I'm a bad person.

Seriously, though. Nice writing.

Medicmarch. said...

Anon Ther: Thanks for the compliment. We just added a similar treatment in our protocol for combative patients: Two Pounds Metal Clipboard, administered Trans-dermally to either cheek. Repeat dose as necessary.

Gary said...

I didn't find your story funny, amusing, witty, or anything else remotely approaching entertaining.

It might have been except for one thing. You admitted to committing malpractice and maybe even assault and battery on one of your patients.

How? By giving Narcan to a patient that has absolutely NO indication for a need of the drug. I've been in EMS since 1978 and given or witnessed the administration of Narcan thousands of times. Never have I seen it given to a patient who wasn't unconscious and in respiratory arrest. There is NO reason on the face of this planet to give it to a patient that is conscious and breathing. None, ever.

Do your patients and the profession a big favor and go find something else to do.

Jeff B said...

First, there's absolutely no reason to give Narcan to the patient you describe. To do so with the rationale of "Can't hurt, might help" indicates a complete lack of understanding of basic pharmacology, misinformation about the physiology involved, and a total lack of common medical sense.

Further, in the comments, I read the following:

"Nebulized succs", "Pillow-to-face therapy", and "Clipboard to the cheek."

These comments are an embarassment to EMS, and make me disgusted to think you wear the same patch I do.

For the record, I've 12 years in EMS, different settings (urban, suburban, rural, flight), different geographic areas (southeast, mountain west, southwest.)

Ambulance Driver said...

I'll chime in here and offer my thoughts. I know both Gary and Jeff B. personally, and they are two of the most intelligent and finest medics I have known. Their advice should be heeded -not about leaving the profession, but considering how your words may reflect upon you. Not everyone views humor the same way.

That said, they (and I) can come across as a bit intimidating. I wouldn't have given your patient Narcan either, but I can remember a time when I rendered treatments because I "could" under protocol, even though it was very questionable whether I "should."

I can also remember being verbally bitch slapped by none other than Bryan Bledsoe himself, for posting a frivolous comment about rendering "punitive ALS" on a patient.

EMTs understand it's a joke. Others may not, and even then some of the medical professionals may find it offensive.

My point is that Gary and Jeff B are not trolls, nor are they humor-impaired. Consider your words carefully.

I thought it was kinda funny, by the way. ;)

Bobbo said...

I'll be willing to admit, as a 20+ year urban medic that the patient and rotund bystander did indeed seem colorful and amusing.

That said...Narcan? Why wake up someone even more? Besides; it don't work on Meth, Paint thinner, alcohol, benzos, or anything else that's not some sort of opioid derivative.

Gary's right, giving Narcan to someone who's awake can do no good (and can be very harmful to those that are either on long term pain medication or are addicted).

Besides...from someone who made that mistake as a younger medic...why would you want to work that much. If they're awake, you gotta talk to them. If they're sleeping but breathing...much easier/nicer job.

BTW...for those excited delirium folks...a little haldol and or a decent benzo (or a cocktail) might be nice for knocking the wind out of their sails. Something to discuss with your medical director if the protocols don't already exist.

Gene Gandy said...

The medic who wrote this is unfit to practice prehospital medicine. Not only does he reflect an unprofessional attude, he exhibits complete ignorance about the use of Narcan and how to deal with a mental/drug saturated patient.

I would suspend this idiot until he attended a course on medical ethics, of which he seems to have none, and also a refresher course in the parmacological aspects of opiods,symathetic nervous system agonists, and pharmacological antagonists.

If he's telling the truth about his partner, she's worse than he is because she let him get away with malpractice and grossly unprofessional conduct.

Medics always whine that they are not seen as being medical professionals. Well, Gee! Look no further than this nincompoop for the reason.

Gene Gandy, JD, LP
26 year Paramedic and EMS Educator
Tucson, AZ

Medicmarch. said...

Guess we know who checked off "spermwaste" on the poll...