Wednesday, August 22, 2007

- Sweat

The man is cold and sweaty, lying on his floor in the kitchen, orange juice spread around my boots like a bizarre neon flood. He is unresponsive to me. I put him on the monitor

"I was here last week," says my partner. "It took G-Money four sticks to get a good line."

G-Money's IV skills are legendary. He has tubed countless victims.He has been a paramedic for 15 years and had precepted scores of paramedic students, most of whom now work solo on choppers and planes or are the EMS chiefs for local fire department. His bowel movement smell of roses. His touch heals the sick and infirm, and he's got a golden halo that spins above his company cap.

On the other hand, I'm a newly cleared paramedic with sticky orange juice boots who's only been on his own for a month, and who's friends admit he has self-confidence "issues." (actual quote.)

I leap, puma like, into action, barking orders. I order a CBG as I put my patient on the monitor and grab a pressure. It's lower than I like, but I can work with it.

"14." Says my partner, rummaging in our ALS bag.

"What? No, that's way too big. Give me an 18 or 20."

She smiles as she comes out of the bag with a tourniquet, a 20g IV catheter, an assembled amp of D50, a lock, and tape. "No. His sugar is 14."

"Oh. Ok."

I take a tourniquet to his arm and start looking for a vein. I note some scars on the arm that look surgical...something else is going on on this arm. I feel around. Something hard and plastic is under the skin. Crap. Shunt.

I wrap the tourniquet around his other arm. I can actually see bruises where G-Money was trying to get a line. This guy's veins are crap, and when I do a little test poke, roll away from me like all the girls I've ever asked out. I stick and miss an IV in his hand. I get another in his wrist that blows. I can feel panic rising inside me. "Glucagon," I tell my partner. "If I miss this one, we roll. I don't want to play around." I stick the Glook. If I can't get the stick soon, and the Glucagon doesn't take, I'm going to have to drill him, and I don't want to do that.


I rewrap the tourniquet higher up on his arm, shooting directly for his AC. I nail it! I beat G-Money!!! As I secure it I realize that our patient is too sweaty for our tape to stick. I ask for a kling wrap from one of the firefighters, who I don't recognize. He's new. Uh-oh.

I secure the IV best I can by drying off the skin and wiping it with and alcohol pad. I push in the D50. The firefighter has yet to find the kling and is now rearranging my ALS bag. Screw it. Just as I reach across to grab some more tape the patient starts moving his arms away from me. The IV, of course stays in my hand. Blood is now mixing with the orange juice on the floor, and I curse and wrap it up. Sweat is pouring from my head, into the mess on the floor.

Finally, the patient is starting to come around and wake up, and he's up enough to sit up and take some oral glutose. I get him loaded up and prepare to start looking for another site, my confidence bolstered by the fact that I managed to hit his crap veins twice already. I pop another IV in his AC and hang some D5. As we pull up his CBG reads 147.

When we arrive at the hospital, he is laughing and joking with us. I get him a sandwich. The nurse asks us if I want some OJ to go with it.

"Well, ok."

Although I have enough OJ in my pants now to provide breakfast refreshment for the Minnesota Viking's O-Line. Fabulous.


* * *
Due to staffing shortages, I am being assigned a brand new EMT-B next week on a permanent basis. Anyone have any tips or tricks for training someone new? Besides patience, and lots of it?

Also, a shout out to my man AD, who may have found him some lovin. We're rooting for you, big guy. And hey, Babs, you got a sister? ::wink wink::

Welcome Babs to the blogroll, everyone. She's a fine, upstanding southern lady nurse with a heart of gold and hair to match. Check 'er out!

-MM

EDIT: FIXED AMBULANCE DRIVER'S LINK...thanks Babs!

7 comments:

Babs RN said...

Babydoll, you linked yourself in AD's place there.

Nope, no sisters, sorry hun. Got a single brother. Does that help? :P

rookie bebe said...

Just remember what it was like when you were a brand new EMT. Patience and teaching. Just teach and explain. He learned stuff in class, but now he has to show he learned it, so just teach. At least the newbie will be with you and not a woman. I'm a girl and the female medics I'm put with lose their temper and get bitchy in front of the pt and their family. I pray I don't ever do that.

Meanwhile check out this post by Peter Canning:
http://medicscribe.blogspot.com/2007/03/letter-to-new-preceptee.html

Be the medic you would want if you were just out of school.

Anonymous said...

Put a plate of food on the dashboard and tell him that if the food lands in your lap, he doesn't get to drive for the rest of the shift. Guarantees smooth riding! If you're not in the mood to be rude, then babble. A lot. Find out what they know and what they don't know. Let them know what YOU expect. Show them where EVERYTHING is in the truck, how to check it, explain WHY you check it. If they don't know where the equipment is when you ask for it in a poopy storm, then you're in just as much trouble as not having a partner at all. I worked for a *cough cough* sorry excuse for an ambulance service transfer company who routinely put me with new people. In a truck that was set up differently EVERY shift. As a brand new intermediate, they put me with THE DUMBEST person in the company. Couldn't tell me why we took people to dialysis. Thought that kidneys were where the ovaries were. I'd ask for an IV, and she'd get out an ET tube. Had to take her EMT class (not the test...the class) three times in order to pass. That's some scary stuff...But, on the other side of that, as a new basic, I LOVED it when medics would teach me stuff...so, I agree with rookie bebe, and Be patient, and teach.

Loving Annie said...

Good Thursday evening to you, MM !

Congrats on getting the I.V. line in twice !!! WHOOO-HOO :)

cardiogirl said...

When you're good, you're good.

born_yesterday said...

tell your rookie to never lie to you...

NYC EMS said...

I cannot give you the formula for success, but I can give you the formula for failure: which is: Trying to please everybody.