Nothing is as it seems...
this being the converse of "if it walks like a duck and quacks like a duck...". I ran w/MedicJon this weekend and we had two "zebra"patients.
The first call we got was for a Diabetic emergency. LOL (little old lady) had been vomiting all day. We show up and of course she's upstairs at the end of the hall (that damn Murphy). I get in the room and she's lying in bed, lethargic but arousable/appropriate. The Engine Co. had already gotten a set of vitals, including a blood sugar, which was normal.
The family said she was just behaving more "slow" than usual. I figured she was probably just dehydrated, so as I said hello I checked her skin turgor. It was fine, too. No sooner did I ask for the Reeves stretcher & our cot @ the door (only to discover Jon was 10 steps ahead of me-as expected), she turns her head all the way to her left and becomes unresponsive. I'm thinking she is having an absent seizure. She slowly progresses to grand mal, at the end of her seizure she'd been at it a total of about 20-30 seconds. I've rarely seen someone wait til we arrive to have a seizure right in front of us! I asked the family if she'd ever had one before and they said that "they thought she did" once. Mmmmm-kay.
I go for an IV while we get O2, suction and hook her up to the cardiac monitor. I get good blood return but am unable to thread, or "float" the catheter in. Dangit. I just hope she waits to seize again until we get her in the back of the rig. When we carried her out, her respirations were somewhat snoring but that resolved itself, thankfully.
Once in the back of the unit, Jon asks me to test her grip strength. He had noticed she had a facial droop. Sure enough, she's not moving her left side at all now. We called the ER and initiated a "Code Stroke". We went enroute and I got a better IV while we made our trip. The rest of the trip was uneventful, as was the hand-off to the ER staff.
The next call, which we went to directly from the hospital, was for a man who fell of his bicycle and cut himself. I was thinking it would be a BLS injury. We arrive on scene and find this guy who just looks like poop. He's pale, diaphoretic, has an obvious closed head injury (as evidenced by his goose egg), and looks kinda mottled to boot. He also managed to sustain an open fracture of his clavicle. All together now-OW! The looks of him and his being amnestic to the accident made Steve (another Medic on board) and I both wonder if he really was a simple, minor trauma patient. His BP was a tad low and he really looked like hell, so we decided to keep him as an ALS patient. We put the Engine Co. and BLS unit in service after we put a makeshift sling on him and got him loaded up on our cot.
In the back of the unit, we did a 12-lead EKG which showed changes. Bingo! This guy had a cardiac event which caused him to take a spill. Steve got an IV in him and we were on our way. We also put him on O2 but didn't give him any Aspirin-he had Crohn's Disease and wasn't supposed to take it, plus it would've been bad had he ended up w/a bleed in his head. We also refrained from giving him Nitro or Morphine because his BP stayed low-last reading before we reached the ER was 80 Systolic.
The patient had a good attitude and sense of humor, making the trip to the ER more pleasant for me. We kidded around while Steve called report and I did a few more 12-leads.
We dropped him off @ the ER and wished him well. The ER staff insisted he wasn't having an MI. All 3 of us were completely stymied by that. It was obvious to us. The RN even said "his EKG is perfectly normal"-with a straight face. Hellooooo, lady, ever heard of an NSTEMI? Not to mention, it wasn't normal when we did one!
We got a similar response from our Assistant OMD-"He's not having an MI. His EKG is totally normal." He says this to me before he'd even lain eyes on the patient yet (he'd only seen the EKG the ER staff did). Also, when asked about our stroke patient from before, he says "She's fine. There's nothing wrong with her." Well allrighty then!
We all complained about the staff on the way back to the station. At that point, I had to get home before I turned into a pumpkin. Jon told me later on the phone that they went back to the LOL's house from earlier and had to transport her son w/a blood sugar of >600. New onset Diabetes. He told them they couldn't call anymore, our limit was 3 family members per day. :-/
The first call we got was for a Diabetic emergency. LOL (little old lady) had been vomiting all day. We show up and of course she's upstairs at the end of the hall (that damn Murphy). I get in the room and she's lying in bed, lethargic but arousable/appropriate. The Engine Co. had already gotten a set of vitals, including a blood sugar, which was normal.
The family said she was just behaving more "slow" than usual. I figured she was probably just dehydrated, so as I said hello I checked her skin turgor. It was fine, too. No sooner did I ask for the Reeves stretcher & our cot @ the door (only to discover Jon was 10 steps ahead of me-as expected), she turns her head all the way to her left and becomes unresponsive. I'm thinking she is having an absent seizure. She slowly progresses to grand mal, at the end of her seizure she'd been at it a total of about 20-30 seconds. I've rarely seen someone wait til we arrive to have a seizure right in front of us! I asked the family if she'd ever had one before and they said that "they thought she did" once. Mmmmm-kay.
I go for an IV while we get O2, suction and hook her up to the cardiac monitor. I get good blood return but am unable to thread, or "float" the catheter in. Dangit. I just hope she waits to seize again until we get her in the back of the rig. When we carried her out, her respirations were somewhat snoring but that resolved itself, thankfully.
Once in the back of the unit, Jon asks me to test her grip strength. He had noticed she had a facial droop. Sure enough, she's not moving her left side at all now. We called the ER and initiated a "Code Stroke". We went enroute and I got a better IV while we made our trip. The rest of the trip was uneventful, as was the hand-off to the ER staff.
The next call, which we went to directly from the hospital, was for a man who fell of his bicycle and cut himself. I was thinking it would be a BLS injury. We arrive on scene and find this guy who just looks like poop. He's pale, diaphoretic, has an obvious closed head injury (as evidenced by his goose egg), and looks kinda mottled to boot. He also managed to sustain an open fracture of his clavicle. All together now-OW! The looks of him and his being amnestic to the accident made Steve (another Medic on board) and I both wonder if he really was a simple, minor trauma patient. His BP was a tad low and he really looked like hell, so we decided to keep him as an ALS patient. We put the Engine Co. and BLS unit in service after we put a makeshift sling on him and got him loaded up on our cot.
In the back of the unit, we did a 12-lead EKG which showed changes. Bingo! This guy had a cardiac event which caused him to take a spill. Steve got an IV in him and we were on our way. We also put him on O2 but didn't give him any Aspirin-he had Crohn's Disease and wasn't supposed to take it, plus it would've been bad had he ended up w/a bleed in his head. We also refrained from giving him Nitro or Morphine because his BP stayed low-last reading before we reached the ER was 80 Systolic.
The patient had a good attitude and sense of humor, making the trip to the ER more pleasant for me. We kidded around while Steve called report and I did a few more 12-leads.
We dropped him off @ the ER and wished him well. The ER staff insisted he wasn't having an MI. All 3 of us were completely stymied by that. It was obvious to us. The RN even said "his EKG is perfectly normal"-with a straight face. Hellooooo, lady, ever heard of an NSTEMI? Not to mention, it wasn't normal when we did one!
We got a similar response from our Assistant OMD-"He's not having an MI. His EKG is totally normal." He says this to me before he'd even lain eyes on the patient yet (he'd only seen the EKG the ER staff did). Also, when asked about our stroke patient from before, he says "She's fine. There's nothing wrong with her." Well allrighty then!
We all complained about the staff on the way back to the station. At that point, I had to get home before I turned into a pumpkin. Jon told me later on the phone that they went back to the LOL's house from earlier and had to transport her son w/a blood sugar of >600. New onset Diabetes. He told them they couldn't call anymore, our limit was 3 family members per day. :-/
posted by S. @ 12:47 PM
1 Comments:
At 7:49 AM,
MedicChris said…
Don't let MedicJon kid you, he always ends up back at any house with an "arousable" little old lady in it. Almost always later in the evening too. Coinicidence? I think not.
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