Saturday, November 19, 2011

- Scaramedics

I was not a good paramedic when I first started out. Shit, I wasn't even a very competent Basic. I mean, I did OK, no truly grievous fuck-ups, but I was not Basic of the Year material. I tried, but in retrospect, I could have tried harder. I think my youth may have played into it a little, and for those of you that have been reading this blog for a while, you know that my off-duty activities played into it as well. Water under the bridge now, but not that far downstream. To be honest I didn't think when I was 19 that I would still be paramedicing when I was 26. I'm getting older I suppose - it seems like time is flying now, as opposed to when I first started.

I feel like now I've reached comfortable level of proficiency. The new guys ask me questions and I explain things, and it's not till later I realize they ask me because they trust me and/or because I've been here so long. There's only one medic senior to me on my shift.

There's been a lot of changes in protocols, equipment, and management. I've worked 3 disasters in 7 years (2 hurricanes and an oil spill). My old partner Izzy is going to be a doctor in a year. Best Partner Ever is probably next in line for a supervisory position. Ink has his own ambulance as a paramedic, and Fabio is in paramedic school. Red is in nursing school and almost done. I've taught them things I've meant to, and some things that I haven't. I could've been more patient. I could be more patient now. But really, I've had a pretty good bunch of guys and girls to work with.

...but I tell you, over the past 5 months I've had four new basics. It's driving me nuts. One was a whiner, one showed up drunk and then got a DUI, one rammed our unit into 3 a foot pole....sometimes I wonder where they're digging these people up.

-MM

Friday, August 5, 2011

- Obstructed


The room is hot. I guess the patient didn't like having the AC on so much. She's been here for days and recently returned from having a pacemaker put it. When we walked in, one nurse has her brow furrowed, attempting to ventilate the patient, with difficulty. She has no airway in. We were paged out for a respiratory arrest. The other nurse stares at us.

And that's all they're doing. I look at the monitor they have the patient hooked up to- an ugly complex obviously being fueled by the new pacer marches across the scene. I check a pulse.

"I don't feel a pulse. Start CPR," I tell Benni, my partner.

"Wait," says the nurse, grabbing Benni's arm. "She's got a rhythm. You don't do CPR with a rhythm. We just need to bag her and send her to hospital."

"You don't do CPR with perfusing rhythm," I correct her. "I don't feel a pulse. Go ahead, Benni."

The nurse gives me a dirty look that lights a rage in me so hot my eyeballs steam. "How long has she been like this?"

I guess the anger carries in my voice, because the nurse flushes and scowls at me. "Ten minutes."

"So she hasn't had a pulse for ten minutes?"

The nurse's face breaks and a look of fear flashes across it "She had a rhythm. We didn't check. "

I sigh and grab an oral airway from the bag, gently grab the BVM from the nurse, and try to insert the oral airway. She's got a lot of emesis, which I suction out. I then hand the BVM back to the nurse. I'm mad at myself. I probably could've made that a teaching moment and instead I let my anger get the better of me.

The BVM nurse is having problems, so after I push an epi through the conveniently preplaced IJ I have a recently arrived firefighter take over compressions and direct Benni to bag. I thank the nurse through clenched teeth.I can tell Benni is having a pretty difficult time trying to ventilate, even with the airway in. The patient's rhythm is unchanged, still a PEA. I grab my intubation equipment and, with the firefighter still doing compressions, intubate. The angle is horrible, but I can see the bottom of the cords and manage to slip my tube in. I watch it pass, but when I attach the BVM to the ET I can't bag, not even a little a bit. What the fuck? It's like there's no outlet for the air.

I pull the tube and reinsert the oral airway. Benni tries the BVM again, and now she can ventilate with no issues. What the hell is going on? I look back at the monitor. The patient's pulse ox is now picking up, holding steady at 79. I shake my head. At least air is going in. I push an epi and plot my next move. I as I'm disconnecting the prefill I look at the tube I pulled. At the bottom is a massive wad of blue gum, lodged in the tube. Oh.

I successfully intubate shortly after and about thirty seconds later, the patient's pulse ox goes to 100 percent, with a ETCO2 of 102. I go to check a pulse and realize I don't have to - I can see her carotids throbbing in time to the now organized sinus tach marching on.

We package and transport to the hospital, where I mention the gum and turn over care. The patient's pupils are large and nonreactive, and seem to stare up at me accusingly. But she doesn't blink, and when I move away, she stares lasers into the flourescents.

-MM

Thursday, May 19, 2011

Soaked

There is so much blood on the bed I can't believe it - the sheets are saturated with all hues of red. You can even see blood on her hands, darker than that on the sheets, where I'm assuming she was trying to hold pressure on the quarter-sized hole on her thigh before she went so hypovolmic she went unconscious. She breathing agonally, about 4 times a minute. I'm glad I told Fabio to grab an extra handful of 4x4's and Kling, and he is rapidly taping up the leg wound.

"I called as soon as she axed me," says the son, in the door way. "She gon be aright?"

"We're going to try. She's lost a lot of blood." I open her airway and slide in an OPA as I hand a BVM to a firefighter standing next to me. Her mucous membranes look like black and white photos of an airway.

I knew we were in deep shit when one of the firefighters, who arrived 45 seconds before us, came running back out. "STEP IT UP, GUYS! SHE AIN'T DOING TO HOT."

"Understatement of the Year," I mumble to myself, reaching for a pulse. Nothing at the wrist. A carotid is present, but so faint I can barely feel it. Fuck it, it's there, that's good enough for me. Fabio's pressure comes back as 70/30 and I immediately reach in the ALS kit for our EZ-IO and drill. I love this thing. Fluid is soon being pressure-infused as I take another look at the EKG. Her sinus rhythm suddenly gets squirrelly and I actually feel her pulse getting fainter as I recheck her carotid. She's going PEA. I've got the most likely cause being treated as well I can right now but the situation has some unique challenges. There's so much blood on the bed, but we can't do compressions on this mattress anyway.

We pull her off towards me, on the side of the bed, and a literal wave of blood accompaines her of the sheets, fanning out all over the floor and onto my pant knees. Fuck. Stupid. I should have backed up a little more. Nothing to do now but roll with it. Fabio starts CPR as I fire an epi down the IO. We've already got around 200mL of fluid in. Our backup arrives and I tell them to set up my intubation equipment. It's foolish to do all this, I think, her entire FUCKING VOLUME is spread out on the sheets, bed, and my pant knees. After slipping on a procedure shield I open the airway with the scope and am greeted by a wave of pale yellow mucus and emesis against what looks to be a waxwork replica of an landmarks and vocal cords. I suction and go in again, looking at the bottoms of the cords. The backup medic applies pressure and they drop.

I sink and secure, and hook up our ETCO2. The value is only 20, but at the very least confirms I'm in.


The whole neighborhood is outside, and I hear some curses about our response time. Fuck it. I did the best I could. We're not even really supposed to go to this area of town with a police escort.

We secure to a spinebord and push another epi. In the truck she briefly regains a pulse but looses it again. We can't find anywhere to stick an IV...it's all scar tissue and tiny pipes. We fire more epi in and even a bicarb.

It looked like all the blood she had was on the mattress, I tell the doc. The family told us prior to departure that she had a large aneurysm in her leg that was supposed to be operated on later in the week. They hang blood and put in a central line. They too get temporary returns of pulse and pressure, but it's to no avail. Nurses leave the code area an hour later, dripping with sweat.

I look at at our Alert and On Scene times. 8 minutes apart. She went from conscious and talking to completely vampire'd in 8 minutes.

I got blood on my shirt at some point during the run, and I toss it in the washing machine along with my pants. The detergent lifts all the blood as cold water pours in, washing it out to the sewer, and then to the sea.

-MM

Monday, April 18, 2011

- Wow

Fabio and I are blazing to the scene, a gas station off of the main drag in our company's hometown. I've been working here for about a year, following my departure from Louisiana DOC. We're en route to an "Unknown", so that means when we get on scene, it's going to be something ranging from a stubbed toe to multiple shotgun homicide.

Ah, the life of a paramedic. At least I know my new haircut kicks ass.

There isn't a mutilated body upon our arrival on scene, just one man sitting in the driver's seat of his SUV. A drunk bystander comes up to us as we get out of the unit. "He wuz pumpin' gaz, and he drop da pump and walk back to hiz truck," he says. "When he dint get up for 20 minnits and wooden talk to us, I call 911."

"Thanks."

He stumbles off as I walk to the driver's side of the SUV. The man is older and slightly out of shape, but doesn't seem to be in any phyisical distress, until I see his eyes. They have a look of pure panic in them, and when I introduce myself and take his wrist I can feel his pulse pounding.

"Sir, my name's March, with XXXX Ambulance. Can you tell me what's wrong?"

The man swallows, and tries to respond, but all that comes out of his mouth is a salad of mismatched vowel sounds and hard consonants. He stops, swallows, and tries again, but experiences the same result.

"Don't try and speak sir. Can you squeeze my fingers? Tightly, like you're trying to crush them."

The left hands squeezes my fingers tightly, but the right barely manages to keep grip on my hand.

"Open your mouth wide and try to show me your teeth." The right side of his face seems frozen while the left is normal.

"Sir, I suspect you might be having a stroke. We're going to assist you out the vehicle." Fabio grabs the man's legs and I get underneath his upper body, and we carry him out to our stretcher and lay him down. We load him up quickly and I get his vitals as my partner secures his vehicle. He is slightly bradycardic, but his twelve lead and CBG are normal. We rush him to the hospital. Dr Mick does an assessment and sends the man to CT immediately.

The staff are a little shorthanded, so I go upstairs with the nurse, a lively lesbian whom I've become chatty with. As they are cranking through the CT, she notices my new haircut.

"Does your girlfriend dig you hair?" She asks.

"Nah. We broke up ages ago, El."

"...So you're not seeing anybody?"

Uh-oh, I think, I dont want to be some 35 year-old lesbian's one last reassurance she hates dicks.

"Nope."

She has a gleam in her eye. "Seriously, no one? No girlfriend-"

"Nope."

"-or Boyfr-"

"NO. GODDAMMIT. IS IT THE HAIRCUT?"

"No! No,' she says. She turns a deep shade of red.

"What?" I say.

"...are you interested in being a sperm donor?"



to be continued.

-MM

Friday, January 28, 2011

- Damn

(This whiny, selfserving post deleted by the author. You guys don't need this bullshit)
-MM