Saturday, June 30, 2007

- Links

Please welcome MEDIC 110 to the blogroll!

Also welcome Podmedic and his MedicCast Blog and Talkshow! I called in on the last one he had on Talkshoe and they are available for download, so check 'em out. I'm the gimp you hear telling stories and giggling like a schoolgirl after every comment I interject

-MM

- Durrrrr

How smart are you?

-MM

- MedicMarch, MD (the Denture Call)

Spiderman (my preceptor) and I are in the northern (way northern) part of our coverage area when we get a call out for a traumatic injury. The past two days we've run nothing but transfers and both of us are itching for a real call.

Beep Beep Beep! goes my partner's pager.

Bee-bee-bee-bee-bee-beee----booo boo bo booo booo. Beee Beee BEEEE beee BEEE BEE, Beeee Beee BEEEEEEEEE! goes my pager.

"Is that the theme to Hawaii 5-0??" asks Spiderman.

"Book em, Dan-O."

I look down at the call notes:

-78 y/o female, trauma to the mouth

Ok, I think. I start going through all of my shiny new protocols in my head....is she going to be at risk for failing to maintain her airway? Is there going to be an obstruction? Be ready to tube that puppy!

Our pagers beep again.

- Fire and PD on scene.

Hmm, I think, Northern Exposure VFD is a pretty tight squad. I'm glad they're on scene. If I need to aggressive they'll be able to help. And PD can control the scene. What the hell happened to this lady?

The Theme to Hawaii 5-0 fills the cab for the third time in 2 minutes.

-Tongue is stuck in Dentures.

Abruptly, the protocol book in my head slams shut. This is not an emergency. Spiderman looks at me as we read the notes.

"She must've used too much of that stuff to attach it to her gums."

Spiderman is trying to FIGURE IT OUT. If we can FIGURE OUT what the patient might have been thinking we might be able to help the patient better.

He's silent for a moment.

"What the hell'd she put on there, though? Gorilla Glue??"

"They're not F---ing around with that Poligrip they came out with." I retort. "It's new and improved...I bet you could put some cabinets together with a couple of tubes and have enough left over to mortar down some bath tile . "


We ride on.

On scene we find the is lady waiting for us in her house. VFD gives me a report. "She says she was sticking them in about two hours ago and her tongue is caught. I can't really tell how."

I grab my safety glasses, walk in, and introduce myself.

"Hi, I'm MedicMarch with XXXX, what seems to be the problem today?"

"My tungh ish cot!" Her speech briefly reminds me of Mistress Freakout's and I suppress a shudder.

"Ok, let me take a look." I hook a miller 0 (a small, flat blade - like a tongue depressor) to my laryngoscope and hold it upside down, tomahawk fashion. With some Magill forceps I gently grab her tongue and explore her mouth. I immediately see the culprit. The lady has partial dentures that fit around her natural teeth with two wire clips. One of the clips is broken and is stuck in the side of the lady's tongue like a fishook. Using the Magills I ease her tongue around and off the broke clip and remove her dentures. Almost instantly the right side of her mouth fills with blood and I pack it with the gauze Spiderman was bright enough to grab.

Honestly, it wasn't that difficult to do. I'm surprised the lady didn't do it herself. Maybe she was just eager to see some muscular, strapping young lad in uniform (heh heh heh, she got stuck with me. That'll teach ya to abuse the system!) I change her gauze out and the wound is already starting to clot up a little. My partner gets a refusal on the lady and we walk back into the sunshine, triumphant. I clean my scope and blade and forceps. I put a very solemn look on my face and walk over to the cop and VFF after sanitizing my hands.

"How'd it go?" says the cop.

I look at Spiderman, who's joined us, and at the VFF and Cop.

"The extraction was a success. There was a puncture to the right side of the patent's tongue, but any blood loss was controlled with careful application of gauze. She's hemodynamically stable and, although it may be to early to tell, we think the operation was a complete success. She's going to live."

Everyone cracks up. The cop laughs so hard his mustache flaps,

Spiderman shakes his head. "You should be a comedian."

"What, and miss out on calls like this where I get to save lives? You've lost your mind."

-MM

Friday, June 29, 2007

- Ok

I swear I'm still alive. The birthday thing slowed me down for a few days - some guy bet me I couldn't drink my bodyweight in beer.

Silly Mortal.

Anyway, lots of fun calls and stuff happening lately and I don't go back to work until Monday so stay tuned.

Monday, June 25, 2007

- Shameless Self Promotion

Happy Birthday to me! It's a celebration, bitches!


I'm going to update the denture story when I get back!
-MM

Saturday, June 23, 2007

- Favorites.

I don't know how many of you do the whole webcomic "thing" but LUCID TV is by far one of my favorites. It's not for youngsters but it is freakin' hilarious. I also am a big fan of Dr. Mcninja, who just released thier first book. Ch-check it out.

-MM

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!"

"NO BITEY!"

"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.

"What?"

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

"Oh, Shut up."

-MM

Monday, June 18, 2007

- Here goes nothing

So in less than two hours I begin my real clear time - the company's official start to my clearance process. I'm been lucky enough to have been paired with my first choice, Spiderman - talented, smart, and humorous. I hope I kick some serious call ass tonight - although with my luck we'll log on and take a long distance transfer to Canada or some other nonsense.

Once Again, Into the Breech, Dear Friends.

-MM

- Call Notes Of the Week

These notes are all from the same call:
-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
As we roll up on scene:
-Sheriff's office enroute, ETA 4-6
It was a long ass 4 minutes. I'll post this call later - it's too hilarious.

Conversations this Week:

Dispatch: *Unit XXX?*
MM: *Unit xxx, go ahead.*
Dispatch: *Unit XXX?*
MM: *Unit xxx, go ahead, dispatch.*

::pause::

Dispatch
: *Unit XXX?*
MM (flustered): The piece of shit isn't working. *Unit XXX, go ahead dispatch*

::another Pause::

Dispatch
-with a tender, almost frightened inflection: *Unit XXX? XXX, come back for HQ. HQ to unit XXX.*
Partner: Wait, is the radio Turned On?
Dispatch: *Unit XXX?*
MM: It has to be, we can hear him.
Dispatch: *Unit XXX?*
Partner: Well Crap, try it again.
Dispatch: *Unit XXX?*
MM: (bangs on console) *Dispatch, go ahead. *
Dispatch: *Unit XXX? Down to Our Lady of Something or Other, got a psych transfer out for you.*
MM: *Roger.* Damnit. Well, let's go.
Partner: "We should've said it was broke."

Sunday, June 17, 2007

- Weirdest Call Ever

Ok, so we're tooling around one day in Metropolitan Area when we get a call, no lights and sirens. Something hasn't felt right all day, with both Dancing Partner (henceforth referred to as "Rio" - c'mon, Duran DURAN, ya'll!) and myself in a keyed up, electric mood. The calltaker says it's a lift assist for an unconscious middle-aged male. We start heading to the call and look at each other - something's not right. We tell piss-patch that we're going to go priority due to traffic (which was a good idea, as it was around lunch) and drive to the scene, a home in a VERY NICE part of Metropolitan Area. We get down with all of our equipment.


We walk into this VERY NICE home to find an unconscious male passed out in the hallway - laying directly in the middle, in his skivvies, with his head all the way against the door at the end of the hallway. He is breathing 26 times a minute. Something ain't right, little cowpoke, a voice murmurs in my empty, pointed head. A cowboy voice, apparently.


"How'd he get here?" I ask the nicely dressed lady, who, I note is extraordinarily calm.


"He was passed out sleeping on the floor. I was going to leave him, but then I noticed his respiratory rate was about 26. His pulse feels tachycardic." This lady is no Becky Bystander, I think to myself. I guess she sees me looking at her."I used to be an ER nurse" she says, grinning.

And she married the ER doc, I think to myself. "This is as far as I could drag him," she continues."He's my brother. He just came to live with us a few days ago."

I nearly knock over a Fabrage egg on a nice stand (on a nice table, in the nice hallway), and squat on the other side of Rio. Using my paramedic observation skills, I note that his breathing is Real Fast, Not Good and that is pulse is Real Fast, Not Good and that Uh Oh, He's Not Looking or Making Talky! I throw him on the monitor as Rio practically gives the man an Indian burn for a sternal rub, to which he does not respond. Sinus Tach at 130. Hmmmm, I think to myself. Cowboy voice was right. Someone's poisoned the waterhole. I grab a CBG as my partner gets a His-Tree and Fiscal. The CBG comes back as 132 and I hook up the 12 lead, following our protocol....although I think if his rate picks up much more the QRS's will be too close together to give us any picture. Dr. Lifepak shows nothing unusual and the BP is 152/88, sats are at 100. Eyes are PERL, skin is warm and dry, with a strange redness on the chest and belly. An allergic reaction? OD? Heart Problems? Turds, I can't figure it out. The Former Nurse tells us that he moved in with them recently after some personal issues up north, where he lived. Apparently he'd had a messy divorce and and spiraled into depression, drinking himself deep down into a hole. OD seems likely.

"I was just trying to get him in the car. I called you guys and then realized how bad he was, so I tried calling back, but yall pulled up as I picked it up." I look at Rio from across the patient and she gives me a little nod - let's boogie.

"We're going to work him up," Rio tells the lady. "We're going to bring him in hot since he's not really responding for us, OK?"

Nicely Dressed Former Nurse nods her consent. We drag him across the NICE hardwood floors to our stretcher and load him. He still has not come around for us. Partner starts trying for an IV and we hightail it to Our Lady of Somethin' or Other. As we pull up my partner is sticking the man's IV. He has been a hard stick and she only just got it. "I gave him Narcan enroute, but either it hasn't kicked in yet or nothing's happe-"

The man chooses this moment to make a strange gurgling noise and slumps over my partner like he's a 100 year old old quadriplegic stroke victim making a pass at his sweetie at St. Jimmy's Home for Disposable Family Members. His breathing has gone from Real Fast, Not Good to No Breathy, Uh Oh! Cowboy voice in my head was right! Someone HAS poisoned the waterhole!

I tear open a BVM and straighten him up. I can't figure out why I can't get a good seal as we jam out of the back and rush him into the ER. Finally Rio yells at me "Jesus, Medicmarch, give me the damn bag." She lays down the head of the stretcher. "Were you trying to dry his contacts?!" I suddenly realize that, with the patient sitting up, I was forced to try to bag him in that position, and my seal was going on him backwards - imagine yourself straddling a BVM mannequin but using your normal grip on him. Doesn't work too freakin' well, does it? I was blowing air into his eyes instead of his mouth and nose.

"Dagnappit! Nice Job, cowpoke!" drawls Cowboy voice in my head.
"Shut it!" I yell.
"What?" My partner says.
"Book it!" I say.

We wheel him into hallway, our bagging much to the suprise of Seen It All Twice Nurse, who up until now has been unaware of this most recent plot twist. He waves us into Cardiac in a manner reminiscent of Gomer Pyle trying to land Air Force 1 using only his hands and a goofy look on his puss. Fantastic Hair Doctor sweeps into the room like a villian in a melodrama. I manage to give a report of the events thus far and I guess since I didn't spew crumbs at him and managed to emphize the important words like "Repritory" and "Arrest" and "Unknown Cause, possible OD" he takes over."Let's get a tube! What's his rate! Is there a pulse?! Why do my scrubs make my pecs look like sculpte!d bricks?" or something like that.

I, for the life of me, decide I have no idea what's wrong with this patient. Probably the OD, but maybe not.

Nicely Dressed Former Nurse/Pt's Brother comes in the room. "I was going through his meds, and He's taken all of his Lunesta, and these." She throws down two empty boxes of OTC sleeps aides. The culprit rears his ugly head. The dirty Varmint is Quick-Doze!

We get him tubed and on a vent...blood gasses are drawn and a tox screen comes back for benzos but nothing else. The ER staff takes over, and Rio and I stock the rig and ride off into the sunset.

Six hours later, he codes. He never regained consciousnesses. Seen It All Twice Nurse tells us the culprit is his pH - a very acid 6.2

They decide that all the man's sleeping pills, combined with his failing liver (apparently badly damaged from his drinking) , was enough to screw with his system enough to make him so tachypenic, which made him acidoditc...which killed him. S.I.A.T Nurse tells me " I've never seen anyone survive below a 6.7 - although I'm just a backwoods nurse from a shithole in Northern Louisiana."

So anyone ever had anything like this before? My partner and I' had never seen it, and we didnt talk about it in P-class. I'll watch out for it now, I guess, but to be honest, if they hadn't come up with that theory, I wouldn't've known what killed the guy. A good learning experience, I guess, but not one I'd repeat again.

Ah well. Screw it. Hop a long, little dogie!

DAMN YOU COWBOY VOICE.

-MM

Tuesday, June 12, 2007

- Wow

I suddenly realize I've not read a newspaper, watched it on tv, or even gone to the The Communist News Network website like I usually do in the past two weeks. The Swiss could've invaded Canada I wouldn't know a thing about it.

I guess all this new Paramedic stuff has got me really wound up tight.


-MM

Sunday, June 10, 2007

- Tasers

I'm for 'em.
  1. They Keep officers out harm's way - you don't have to get in close quarters with someone who's probably already upset with you and not listening to your commands.
  2. Quick and effective method of immobilizing an attacker or someone who is danger to their self or others, with relatively little side effect other than a quick ride to the ER in my unit to get the barbs removed.
  3. HILARIOUS to watch. OK, this isn't a good reason, but I like it, and I don't care if you think I'm ignorant or a bad person, because I've come to peace with the fact I'm both of these things.

Basically, if you don't want to get shot by a taser, don't do anything that would make the police want to shoot you with a taser. I think this a pretty easy maxim to follow but apparently some people do not. Our metro police department has them and uses them regularly to great effect.

There's been some debate as to the safety of using tasers - that using one on an intoxicated individual can lead to arrhythmias and death. AD talks about a case that happened in Lafayette here- he pretty much took the words right out of my mouth. I'll toss a quote from his page for those of you too lazy to click -

"PCP, cocaine and methamphetamine are known as stimulants. When ingested, snorted, smoked, injected or pushed up your rectum to hide them from the Po-leece, they tend to do certain things to the human body. Blood pressure skyrockets, as does heart rate. Body temperature may rise as high as 108 degrees, offering one probable explanation for Mr. Enard's lack of clothing in December. A whole cascade of events occurs with your body's chemistry, and none of them are good. Quite often, these people are headed for a rendezvous with death that no intervention will stop. It can happen in the back of an ambulance, it can happen in an instant when the rugby scrum of officers needed to subdue the suspect finally untangles to find the patient dead at the bottom of the pile, or it can happen six hours later at a major medical center, as it did in Mr. Enard's case. The use of a Taser is incidental. Linking the two events is akin to claiming that since 89% of pilots involved in airline crashes ingested pickles in the 24-hour period before the flight, it thus follows that pickles cause airline crashes. Let's call for a ban on sweet gherkins!"

Well done, sir.

I know some of you might complain about police brutality - the kid at UCLA in the computer lab or that guy in philly, and that's part of it. With Law Enforcement there may always be an incident where more force is used than, in hindsight, might've been necessary, but shit, it's probably the most humane thing to get hit with. If I was a victim of police brutality (a term I have a problem with, btw, but don't know anything better to use) and had to pick between getting shot, maced, beaten with a stick, chewed on by a large, upset dog or getting electrocuted a little, I'd pick the last.

Ok, I know I may've handled this one lightly, so I'm opening up the comment section on this puppy. You disagree? Didn't like the way I said something? Then holler at me! Let's see some debate! And some mudslinging! And some name calling! I'm a total pushover, so hit me with your best shot!

This is going to be fantastic.

-MM

EDIT: I just went and searched for "Tasers" on youtube and I have almost PEED on myself laughing at people on COPS getting tasered. It's so funny! I'm a bad person now, I know it for sure.

EDIT II: I also have followed some links on youtube to officers without tasers, forced to scuffle with an irate detainee - I abruptly stopped laughing because these are not fun to watch - a lot more dangerous for the perp and the cop.

Saturday, June 9, 2007

- Links

Quick link love for Anonymous Therapist - I've got respect for the RT's, and just reading the few posts on the front door made me giggle. I'm about 5'9" and 220 pounds, and it's kinda hot right now and I'm not wearing a shirt, and I'm very hirsute, so all you readers out in reader land imaging me giggling a little? Probably not a good thing. Sorry for making you throw up in your own mouths a litte, ladies and gay fellows. The latter, I need to recruit you fellas with the fashion get me some new clothes. All my favorite shirts are getting old.

What were we talking about?

Shit, link love. Also a big whoop for Loving Annie who may, in fact, be the nicest blogger I've ever seen. I was totally like, +2 happiness when I read her page. For some reason in my little brain seeing her page reminded me of the actual taste and sensation of eating fresh chocolate chip cookies. I have a weird and unusual brain.

Friday, June 8, 2007

- Fear and Loathing in Louisiana

So first off, good ole Ambulance Driver was kind enough to toss me a link in his blog, so for all you guys swinging by to check me out, I appreciate it. Welcome, there's beer in the fridge and snacks on the coffee table.

Anyway....sniff sniff....You smell that aroma? That's the scent of fear and crushed spirit, the unmistakable scent you smell around brand new paramedics that have only recently been cut loose. I'm so excited! I'm so scared!

So I started my company's clearance process two days ago. The experience has been....humbling. Really humbling. For all the times I've been exasperated to open the back doors to find The Gimp or another medic bumbling around with an IV or with hardly anything done, I apologize. I have discovered it's a lot more difficult then it looks.

The sweet feeling of excitement and terror that creeps into my veins is like a drug. After a call yesterday, my preceptor told me my eyes were huge and I had a manic smile on my face. I get so excited in the back that when we arrive at the hospital I'm a sweaty nervous wreck. My pupils actually dilate. I haven't killed any one yet, and my preceptor says that I improved exponentially in between Day 1 and Day 2, but I still pour half a gallon of water out of gloves when I take them off to give my report. I'm seriously considering getting those orange arm floaties for my patients in case I sweat so much in the back that it fills up completely.

Don't know where I'm going to sit the lifeguard, though.

Anyway, I'll probably fire off a few posts this weekend, including my commentary on Tasers, the weirdest call I've ever run, and an endorsement for my patrol boots. Stay Tuned!

-MM