Adventures in Emergency Medicine

This post covers multiple calls/cases from this past weekend. It will get long I'm sure.
Sat. I ran w/MedicJon. The interesting activity around the county during the AM hours was from the Marine Corps base in our area. The OCS Class had just started up and they had 10 guys fall out from heat emergencies before shutting it down. One guy had a core temp of 108F. When asked why he didn't say something, he said "We're Marines. We don't do that." Bloody hell! I've always said that a high level of testosterone poisoning is required to be a Marine. The worst-off Marine had a core temp of 110F and was having seizures, totally unconscious. I'm glad I didn't have to take care of any of those poor guys.
Our first call was for the "Oh boy!" lady. She was in the very back room in her filthy, disgusting house w/her fat slob piece of shit son and her sweet but equally neglectful husband. She had been discharged from the hospital just 10 days before on O2 and steroids. I call her the "Oh boy!" lady because that is ALL she would say. She wouldn't even look at us. From the looks of her, she had not showered since her hospital stay. She still had tape residue on her arm from the IV. She had what appeared to be 10 days worth of dried mucous around her mouth, leaving me to wonder aloud if carbon dating could be performed on sputum. Her t-shirt was stained and torn, and her saggy boobs were enough so that her nipples kept poking out the bottom over the top of her sweatpants. She was fat, too. Her family said she was short of breath. She did have a slight, audible expiratory wheeze and was in mild-to-moderate resp. distress. She was also febrile. We gave her a neb, started an IV, EKG, O2, EtCO2, yadda yadda. She peed on our stretcher, which shouldn't have been a big shock seeing as she was sitting on a chux @ home. Old ladies frequenty have some "leakage". However, when we went back to the ER later on, her RN corners us to say she had something to tell us about her. I was wondering if my dx of PNA was on the mark. Turns out, she wanted to tell us about her antics. She gets off the stretcher, walks all the way across the room and sits in a chair. She then proceeds to take a huge crap in the chair. Not some incontinent crap, either, mind you-but one she had to have on purpose. Passive-aggressive, much?
We ran several other calls, nothing to write home about. Our second-to-last call was for an MVC on the Interstate. We were placed in service, and got dispatched to another call 16 or so miles south of there. It took us 17 mins. to get there with lights & sirens. En route, we hear that the Rescue Chief from the 1st-due Co. was there, asking for help w/an arterial bleed. He called for a Medevac. I knew it had to be bad, this guy is no slouch and has loads of experience. The patient was drinking (he admitted to a 6-pack-can you believe it?) and fell onto a glass jar out front of his trailer. He had a full-thickness lac to his forearm, with damage to his radial artery. In the time it took us to get there, he'd lost so much blood, he was already in compensated shock. I was glad that he was already bandaged when we got there-he was covered in blood as was everyone who took part in the bandaging process. The girl from the Ambulance was holding direct pressure & elevating his arm, and a guy had pressure on the brachial artery proximally. He was barely conscious and the girl kept having to yell at him to wake up. I put two huge IV's in him, started fluid resuscitation, and he started to wake up and dry off from the profuse diaphoresis. As he woke up more, I explained that he'd be going on the helicopter, and that's when he started to realize the gravity of his situation (no pun intended-OK, maybe it was). He started to cry, asking if he was gonna die, and talking about his two kids. I hope this serves as a wake-up call for him, but I doubt it. Coincidentally, the week before (after I left) MedicJon ran a guy who had nearly amputated his arm after shoving it through a glass window in a fit of rage at his girlfriend. He got himself a helicopter ride, too. The scary thing about his case was, he already had a cast on his other arm from punching an inanimate object 3 weeks prior, under similar circumstances. It takes all kinds.
The following day I worked a shift in the ER. A sweet LOL from India came in complaining of nausea/vomiting/dizziness. She had a boil on her back that she'd been on ABX for, and she'd just finished the 10-day course that day. I mention this because when I went in to start an IV on her and help the RN get her into a gown, we discovered she was covered in hives. Thankfully, she was done w/the ABX that obviously upset her GI tract and she was allergic to. The MD goes in the room to do a hx & PE. He goes to look at her boil and lo and behold, it's not a boil at all, but a tick! Her MD mistook the parasite for a boil and gave her unnessecary medicine. What a quack! The tick had been there at least 10 days, certainly longer but who knows how much longer. We were all horrified. The damn thing was so engorged it was unbelievable. It was also still alive. We showed it to her and her husband before we flushed it down the toilet, and they were equally (if not more) horrified. They were also incredibly grateful that we discovered the true cause of the series of events. Poor lady had to get more ABX IV as prophylaxis for Lyme.