True Life is Stranger than Fiction

Too close to home

2006-10-08T07:01:00.000-07:00

I was on my way to lunch, passing through the ER as usual on the way to the deli. I noticed a significant number of Fire/EMS personnel standing around the Nurses' Station. I know from experience that something serious was going down.

I went through the doors and over to the 1st set of Trauma Bays and the entire ER staff was working on an 11-month-old girl in severe respiratory distress. I immediately got sucked-in. At the time I went in one of the MD's was attempting an I/O and one of the RN's and I started to look for venous access. (I'm proud to be one of the "go to" folks when it comes to difficult IV's). She got a peripheral line so we went w/that and abandoned the I/O.

We pushed the RSI drugs and the MD's began intubation attempts. I helped set-up the ventilator, but then we realized she didn't weigh enough-it only goes down to 10kg and she was 7.5. I ran to get some equipment and when I came back I noticed one of the RN's that used to work w/us coming through the Ambulance Bay doors. I thought to myself that she had come back on staff but then she walked over to the Trauma Bay and she flipped out, and I put it all together in my head. She had left our staff to give birth 11 months prior. It was her baby. The stress of a Peds resuscitation now became a major (controlled) freak-out b/c it was the child of one of our own.

The intubation took a long time. Her belly got a little distended and her heart rate kept dropping. I'm @ the head of the bed assisting the MD w/intubation and I notice her heart rate went down to 50. I said "We need to start chest compressions!" and someone did. I was really scared @ this point b/c when kids get to the need for CPR they usually don't come back. Thankfully, the MD got the tube in and I taped that damn thing down so it wasn't budging. We got her SPO2 to start going up and her heart rate followed, thankfully. Major relief!

We got the CXR to confirm the tube placement, and she had bilateral PNX's. Damnit! We placed two 16g IV catheters to decompress her lungs for transport to the PICU. They did the trick and her SPO2 was 100% when she rolled out the door.

We heard a lot of reports the first few days about her condition, and it wasn't looking good. We also had a CISD in the days following. The staff was all very upset. The last report we got was that she had hemiparesis.

Last week, the mom brought the baby by, and she's moving all her extremities after 2 weeks in a Rehab Hosp. She's alert & appropriate, w/only a tiny little brace on her hand. It's amazing that she's doing so well, much less alive at all. We're all so grateful that it turned out so well when things looked so bleak. As a total aside, she's also completely adorable. =)

Happy F$cking New Year

2006-08-18T13:13:00.000-07:00

Several years ago, I was on duty New Year's Day. Shortly after dark, we received a call just a few blocks away from the station We made the short response over, and walked up to the front door. We were greeted by a 71y.o. lady dressed in a shirt and nothing else, with some newspapers wrapped around her below the waist. She stated that she'd been raped. Initially, she was so darn calm, I thought maybe she was a kook. But, we soon realized that this was a real-life nightmare.
An 18y.o. M from the neighborhood (that she knew) had waited until after dusk and walked to her place. He unscrewed her porch light so she couldn't see who was at the door before he knocked. When she opened the door, he forced his way in and raped her on the floor of the hallway just off her living room.
We later discovered that PD had apprehended the suspect just a few blocks away, even before we had arrived on scene. I did my assessment while the rest of my crew remained @ the door so as not to disturb the crime scene. The patient was perfectly stable medically so I didn't need their assistance.
While speaking with her, she became more and more upset. I think the reason she'd been so calm initially was because of shock. By the time PD arrived @ the house we were ready to transport. Before we took her to the ER for her rape exam, they wanted her to identify the suspect. This is when she became very fearful and began to cry. They assured her that he wouldn't be able to see her through the window as they would be shining a light directly on him. I assured her as best I could and helped them convince her it would be OK. They drove her a few blocks to where the kid was in the car and she ID'ed him. Then it was time to go to the ER.
Enroute, we talked a lot and I held her hand. Thankfully he hadn't hit her or anything, so I was able to concentrate almost entirely on psychological support as best I could. I had no illusion that I could make things better, I just wanted to comfort her. At the ER, one of my colleagues was the S.A.N.E. on duty, and I left the patient in her good hands.
The kid confessed and got a really long sentence (I can't remember exactly).
Less than two years later, I was in the ER doing my clinical rotations as part of my Medic training. Lo and behold, I saw the old woman again. I cannot begin to describe how much of a shell of her former self she had become since the rape. She had greatly decompensated both psychologically and physically. She was in the ER that day because of suicidal ideations. It just broke my heart even further than the call did initially. I still feel an almost physical pain when I think about her, what she endured, and the effect it had on her.

Adventures in Emergency Medicine

2006-07-20T10:01:00.000-07:00

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.

Nothing is as it seems...

2006-07-12T12:47:00.000-07:00

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. :-/

Shut up or get out

2006-07-07T12:47:00.000-07:00

I've thought a long time about whether to post this or not. On one hand, I don't want to air my dirty laundry. On the other hand, it's my blog, and nobody but those who knew about it beforehand will know who or what I'm talking about anyway. It was also some years ago, and I don't plan on naming names. So, I post.

My partner and I got called in the middle of the night. I can't remember what it went out as. We arrived and found it to be a code. The BLS unit was already there w/the pt. hooked up to the AED. She was an end-stage Cancer patient w/a DNR... that was not signed by her MD. Otherwise, the story would end here.
I had to tell the family I was terribly sorry, but I had to attempt resuscitation because of a technicality. To my surprise, they said it was OK, that they wanted me to try and resuscitate. I'm in an even better mood hearing that. 3 strikes on this one already (the first being the unGodly hour).
We draged the patient into the living room, as she was wedged in between the doorway and her bed initially and I wanted more room to work. I set about starting an IV while my parter went for an airway. I'm not sure when the Engine Co. got on the scene. They were there in the living room and that's my first recollection of them being there.
I got the IV and yelled for the first round of Epi & Atropine. I love the color-coding system on the bristo-jets, so I can just say "toss me a tan one and a purple one" to anyone and get the right thing. Of course I always double-check!
I get the first round on board, and go to try intubation as my partner was unable. About this time I'm aware that the Engine Co. I/O is heckling me. He's yelling at me that we're taking too long, yadda yadda. I'm annoyed and not just for myself-he's doing this in front of the family. I'm also pissed because not only is this a patient who I am assaulting against her wishes, but everytime we get a round of drugs on board, she goes from Asystole to PEA. I think it would have been atrocious to actually succeed at this resuscitiation, but I've got no mattress to squirt the drugs into. (No, I wouldn't really do that, it's just a saying.)
I get the tube in, and then we're ready to package her up and move on down the road. I said something to the effect of "There is a God" when I got the tube, due to my wanting to have it done, and being flustered by the Engine I/O.
We got outside the house w/the patient on the Reeves stretcher (or maybe a backboard, I can't remember) and the I/O is still barking at us to hurry up. He also makes some comment to me about how things weren't going well. I said something to the effect of her being dead so it can't be any worse. I reiterate that this is outside, away from the family. I was flustered, but by no means stupid.
We transport to the hospital where the patient (thankfully) is pronounced. We are getting ready to clean up, do paperwork and replace our drugs. I go outside to get the drug box, and the Engine Co. is there to pick up one of their personnel I borrowed. The I/O is there. He and I proceed to get into a screaming match w/each-other in the Ambulance Bay. He actually told me he thought some things I said to the family were inappropriate. Me?!?! What about his verbal abuse of the Medic Crew in front of the family? Surely that's not winning any awards for professionalism. I was stymied. The argument was mercifully halted by my partner coming out and yelling at him that we had work to do. I'm still grateful to her for doing that.
We went inside and talked about things. She was pissed, too. She was pretty newly released as a Medic and this was our first code together. This was a good situation for us since the pressure should have been off to some degree. I feel like we lost a good opportunity there to feel each-other out. On the other hand, we received a different kind of bonding experience.
After all was said and done, I had an exhaustively long talk with the Chief at the time as did the other party involved. I left that person a message saying that I didn't think that we should have argued when and where we did, it wasn't the time or place, could we talk about it, yadda yadda. He never called me back. I've not spoken to him since. I gave him one chance, which apparently was more than I should've. I still do not understand what the damn hurry was for a patient who was dead and wanted to stay that way.

An enigma, wrapped up in a puzzle, wrapped up in a conundrum

2006-05-30T13:04:00.000-07:00

I ran w/MedicJon ("Hazbulance") Sun. and we ran a doozy of a call (as you can surely tell by the title of this post).
We got a call for an Unconscious at a nearby hotel. We get there and find a lady who is semi-conscious, laying on the bathroom floor in a pool of her own urine. The type of semi-consciousness we witnessed would not be inconsistent w/someone who had low blood sugar or was postictal, or maybe had ODed on Opiates. There was Insulin and liquid Methadone in the hotel room. Her blood sugar was normal so we pretty much put our stock in the Opiates.
We dragged her out of the bathroom and loaded her up on our cot. She was with it enough to swat at us w/her arms, but not w/any accuracy. She was also, for all intents and purposes, non-communicative.
Once in the back of the unit, I started an IV, and this chick had crap for veins. This further pushed us down the Opiates trail. I got one in (Supah-stah!), but I had to float it, and leave the catheter part of the way out. It was tenuous at best, and on top of that, I had to hold her arm straight for it to work. She fought the IV a bit, to be expected. I held her arm while Jon pushed 1mg of Narcan. I kept the IV flowing, but not too much longer after that. As we're waiting for the Narcan to take effect, her respiratory effort was getting less and less. I said something to that effect, and asked how long we should wait for it to work. Before we could really decide, she was nearly apneic, so Jon laid the head of the cot down and we called for the Engine Co. to come back-things like this never happen before we release them, dontchaknow.
Well, of course her jaw was clenched, and her two front snaggle teeth securely clamped down over her bottom lip. So, Jon wrenched an OP airway in her and started bagging while I went for an EJ. She had a pretty one, until I went for it... then it magically disappeared. Doh! By this time, we've pulled a driver off the Engine and are headed to the ER. Calls like this make you grateful for a short transport time.
Jon gave her another mg of Narcan IM (that never did anything either), then he and I switched seats so he could make a couple more attempts at a patent IV, but no luck. I was not getting really good compliance bagging, but it was the best we could do. We showed up at the ER w/a respiratory arrest, no line, no tube. Fan-freakin'-tastic.
We transfer her over to their stretcher, and I tell our Asst. OMD that they'll probably have to put in a central line. He kinda pooh-pooh's that, but I ended up being right. Took 'em 3 tries, too. I felt like even more of a rock star, then. =) They also got her intubated. 'Round about the time they'd blown both femoral line attempts and they were poking her subclavian area, she up and went into VTach... then VFib. I hate it when that happens!
Jon and I stood by/assisted while they worked her for a good 40-60 mins. (I'm guess-timating) I mostly felt in the way, but Jon was doing some damn fine compressions with one hand. His turn to be the rock star!
The staff threw everything in the book at this lady, and nothing was happening. We were all ready to throw in the towel when she suddenly developed a perfusing rhythm again. The Primary RN was trying to figure out what rhythm to chart and Jon said "UFB". Can I get an Amen?
Well, we never did figure out what her underlying problem was. She had a bad case of metabolic acidosis, but more so than a witnessed, agressively-worked arrest would cause. She was on her 3rd amp of Bicarb, but had a serum Bicarb of 10, Ph of 7. They were talking about starting a Bicarb drip by the time we finished all our paperwork and were ready to head out. Her other labs were remarkably unremarkable, esp. for a person who had died.
We left the ER and immediately got punched for seizures way down on the Interstate, so we ran down there, picked up the postictal patient, and ran him in. When we dropped him off, I asked the Primary RN how our lady was doing, and her words were "She's hanging on by a thread." The RT told me her lungs were full since all told, she'd gotten like 3L of NSS, and the woman barely weighed over 100lbs. Whoops!
Real interesting call. Plus, we had fun. A good day in all!

Why I Volunteer

2006-05-25T13:36:00.000-07:00

Recent posts from DTXMATT12 and MedicChris have inspired me to tell my own story. It's long and complicated, but I will try and keep it as condensed as possible.
My mom is an RN. I've always had an interest in medicine. I had the "Visible Man" puzzle/model, I took apart my "Stretch Armstrong" doll, I watched "Emergency!" and I played "Operation". There was a theme early on!
In High School, I took a Sports Medicine class, and it was hands-down my favorite elective ever. The teacher taught us CPR (I've been certified ever since, 20+ years), and encouraged us to do ride-alongs w/EMS. This was the first time I expressed interest in being an EMT. Later on in High School, I got rather sidetracked with a misspent youth, and didn't get back around to the interest for another 10 years.
In my early 20's, I developed a life-threatening Thyroid condition. Between that experience and my best friend dying some years later, I decided it was finally time to pursue my interest. I just happened to live within walking distance of the station where I've now been assigned for 10 years, so I went down one Friday evening and signed-up. My whole life changed.
Due to scheduling, I didn't actually start EMT class till I'd been a member of the VFD for 3 months. In that time, I got my other courses out of the way, and became an Ambulance Driver (really-that's all I was at the time).
Once I got into EMT class, I moved away from the county where I volunteer, and haven't lived there since. I was working full-time in the Publishing industry and traveling 70 miles round-trip two nights a week to class. I was definitely serious about it! I remember when I took my exam, a Medic named Tim that I admired very much was the Examiner at my Trauma station. When I went a smidge over 10 minutes and failed, I was outside the Academy crying. He saw me. I almost died. But, he was kind, told me to stop crying, go back and re-test, and that I'd pass. I did just those things.
For the next 4 years, I ran as an EMT-B w/the VFD and kept my Publishing career going. Then I decided to become a Medic. I started classes at GWU, and that experience also changed my life.
I went through the pilot program for EMT-Intermediate in our state. Believe me, the fact that it was a pilot program was obvious. It was a big CF. We had 8 different textbooks, a number of instructors pretty close to 20, and every one of them contradicted each-other. It was so much harder than it had to be! Between the difficulty, the time commitment, and my tendency to be a perfectionist, I thought I was going to have a nervous breakdown. But, I prevailed again. Out of 5 people in the class from my Dept., I was one of only 2 who passed the National Registry the first time.
Becoming a Medic (in VA, I and P are no different, which is why I call myself a Medic and not a Paramedic) changed me in a more profound way. I decided to give up my successful career in Publishing and work in Healthcare full-time. I accepted a job at a brand-new, free-standing, full-service ER. I still work there today. I credit the job for outrageous amount of clinical experience and knowledge it gave me every single shift for getting me through my Internship as a Medic quicker than anyone else from our class. I also credit my Preceptor, Leon-what an amazing person! He's been a Medic over 20 years, and is the most laid-back guy. He helped counter my borderline OCD, thankfully.
The family atmosphere that DTXMATT12 and MedicChris speak of was not a reality for me until about the time I became a Medic. I developed a few friendships in the Dept., and along the way I even fell in love with my partner (now my spouse). But those family-like bonds were not something I truly understood until I was finished with my Internship and had to rely very heavily on the Engine Co. at our station. The I/O on the Engine became like a father to me. He was on my first ever duty crew, as was the DPO, who I also became close with. There was one guy who was the younger brother of another who I'd befriended in the past, and I got to know him well, too. It was just me, my current spouse, and those three guys most days. The week after I finished my Internship, I was on my own-Leon was sent elsewhere. I was so vulnerable that I quickly forged those bonds that mostly eluded me in the past.
Becoming a Medic also helped me understand other Medics better. Class is like a Rite of Passage, and finishing is like entering into an exclusive club. You speak the same language, and have shared experiences that really, no one else can totally understand. EMS in general is pretty unique, as I'm sure Fire Fighting is (although I don't know that for sure-not my cup of tea).
Why am I not a member of a paid FD? Well, I have a lot of physical shortcomings when it comes to the street. I'm better off in an environment where I'm not as physically taxed, and don't have to work 24-hour shifts. I'm the first to admit I can't hack it out there on a full-time basis. I don't know how anyone could do that til they retire. I'm not even 40 yet and the thought of a 24 makes me want to go take a nap. So, I'm a wussy. But, I know my shortcomings, and in EMS, there is no room for ego. I'd just be a burden to myself, my colleagues and my patients, and that's the last thing I ever want to do.
I love my job, I love my volunteer work and the extended family that goes with it. I never regret taking a 50% pay cut to change careers, even when the bills come. I know I'm doing something important, and I'm proud of myself. I've got confidence I never had until I started this journey.
Here's to another 10 years w/the VFD-with it will come Life Membership, and no more working BINGO! =)

The hazards of multitasking

2006-04-29T05:54:00.000-07:00

This happened a few years ago in our ED.
One particular evening, "The Bat Phone" rang. EMS was bringing in a working code.
They arrive with the now resuscitated man. However, they do not have him intubated. Seems the patient was at a local nudie bar, enjoying a steak, some booze, and the show. Lo and behold, he was distracted (however did that happen?) and choked on a piece of steak. Bystanders (bydancers?) apparently either did nothing for him or didn't know what to do. (Maybe they were all blonde?)
EMS arrives on the scene after the guy has arrested due to lack of intervention. They proceed with the code, but are unable to retreive the foreign body or get a definitive airway. Despite this, they pull off an herculean feat and resuscitate him.
Jump ahead to their arrival in our ED. The EDP comes in and his first order of business is to get the patient intubated. He does so. Then, he goes in with the Magills and pulls out the biggest "bite" of steak I've ever seen. It is so big, that we literally have to shove it into a urine cup. I have to give the Doc mad props for getting an ET tube, or anything for that matter, past this gargantuan slab of meat.
Unfortunately, the patient deteriorated over the next few days, and ultimately succumbed to his anoxic brain injury.
Let this be a warning to all who would engage in drinking, dining and debauchery (simulteneously).

Post-partum (Respiratory) Depression

2006-02-20T14:07:00.000-08:00

This is a call I just went on yesterday.
I was running w/MedicChris and his driver, Wayne for a few hours yesterday. The day was mostly laid-back, spent mostly shooting the breeze and telling stories. Right after the start of the Daytona 500 (as Chris calls it, "the roundy-round"), we got called for seizures.
We head out to the call with the Tower behind us. Most of the rest of the North Side of the County was already headed to a townhouse fire in the same box.
En-route to the call, we get additional info that the patient is 40, had a baby last week, had a headache yesterday and took Tylenol, and has been seizing for 5 minutes. Don't know what to do w/all that info. The gal in the back and I are bouncing around ideas and I decide to guess Amniotic Embolus just b/c it is the least possible thing.
We get to the scene and are met at the front door by a woman wearing one of our Dept.'s BINGO t-shirts. A customer! She tells us the patient is upstairs.
We start up the stairs and when I get to the top I look over into a bedroom on my right, and I know I've come to the correct one. Inside is a young pre-teen or -tween boy, kneeling on the bed, sobbing hysterically into the phone while rubbing the back of our patient. For about 5 seconds, I think the patient is rolling around the bed in pain, but once I get closer, I realize this lady is in big trouble with a capital T.
She's rolling back & forth on the bed, working incredibly hard to breathe, and she's not responsive other than to swat at us when we touch her or try and move her in any way. She's also somewhat blue, her pupils are hugely dilated, and her skin feels hot. Groovy... not.
Chris and Wayne had already coordinated getting the Tower to bring our Reeves stretcher and gotten the O2 I'd asked for. She didn't like that mask on her face, seeing as she was suffocating, but she damn well needed it.
We barely got the LifePak hooked up with all her flailing. She's extremely tachycardic. Eventually we manage to get the SPO2 probe to stay on her finger long enough to tell us it's 92%-on a non-rebreather. Yikes. We also checked her blood sugar, since we found out she had Gestational Diabetes, but is was 200, so that wasn't her problem.
So, why she had Respiratory Distress, I don't know, but it was bad. I noticed her belly was mottled in addition to the bluish hue the rest of her had. I pushed on it with my finger and noticed her capillary refill was also slow. I said "Chris, look!" and did it for him. He's like, "What do you think that means?" and I said "It's BAD!". Later on he told me that he didn't realize why I was poking her in the belly like she was the Pillsbury Dough Girl. We had a good laugh over that one!
Meanwhile, the Tower crew had gotten the Reeves up there like we'd asked, and we were ready to get the heck outta Dodge. It took some doing to get her wrapped up in it and down the stairs, but we got it done. As we got her outside, she was getting more tired of breathing on her own. I silently prayed that she wouldn't stop breathing, as I'd already assessed that she'd be a difficult intubation. I also silently cursed the fact that we couldn't just RSI her.
We all climb in the back to hold her down so I can try and get an IV and we can try to get a BP. Wayne helps me hold her arm down and I get an 18g in her hand. Unfortunately, it infiltrates while we're trying to get it taped down. Tess (the other girl with us) tried 2x on the other hand with no luck. We really need to hit the road and not screw around with access anymore. Her BP once we finally got it was too low for Lasix... by this time we'd ascertained that she had Pulmonary Edema but we still didn't know why or how.
We started for the hospital, Wayne at the helm, the rest of us in WWF mode in the back. I'd told them I'd get another line en-route, so I had to pony up on that. Thankfully, I did. I ended up getting a 20g in her inner wrist and just wrapping the roll of tape around her wrist till it ran out. I wasn't losing access again!
Chris at some point had called the ER and told them we were coming, but I already have forgotten when in the sequence of events that happened. It was a tad on the hectic side!
We turn onto the main drag where the hospital is located, and lo and behold, that's when she decides to become responsive. She wants to sit up, and she's needing suctioning. Well, Reeves stretchers don't bend so well. I offered to sit behind her to hold her up, but Tess ended up doing that. Probably a good thing, this lady weighed about 250lbs. and we didn't need to see how much the cot could hold *ahem*...
I said out loud at some point that the hospital wasn't going to believe us about how combative she was now that she was waking up and had completely calmed down. Amazing how much good high-flow O2 alone can do. Chris joked it was that magic 10 drops of NS we infused...
We roll into the ER, disheveled, with one of our personnel behind the patient on the stretcher like it was a sled. I looked at one of the RNs and said "Don't ask!"
We roll in and manage to get her transferred over. She was still sick enough that they all realized we were not shitting them. It wasn't until we'd gotten her on their stretcher and hooked up to their monitor that I realized my hands were shaking.
Later on, before we left the hospital, I went back in to see if they'd shot her Chest X-Ray yet. The RN I'd spoken to before pointed out to me that the patient had petechii all around her eyes. Sure enough, I got up close, and it was there-in an oddly-shaped pattern similar to a raccoon, or maybe The Lone Ranger. I'll be damned, first time I'd seen it in real life.
Today, boy are my arms tired (and I didn't just fly in).

An exercise in futility

2006-02-17T08:21:00.000-08:00

This is a call I ran on the Medic unit one weekend morning some years ago.
We were dispatched to a CPR in progress at one of our sister stations. This was first thing in the morning, hadn't even had coffee yet. Didn't need any until the adrenaline wore off, then.
The basic unit did a scoop & swoop with the baby, and radioed me to meet them en route. We met up about halfway between our two stations and the hospital. Our prospective drivers stopped right in the middle of the road. I wasn't going to yell about it right then. Fortunately, we had PD with us to add to the light bar display.
I jumped up in the back and my Lt. at the time, plus her driver were doing CPR on an infant. The mother was sitting in back with them, on the bench seat.
I look down and see a bluish, mottled body. I touch the baby, and she is cold. I told the crew to continue BLS measures (by protocol we cannot stop), and then I spoke to the mother. I told her that there probably wasn't anything we could do. She was crying, but quiet-far from hysterical. That would have just made things worse.
I then made my call to the hospital. While dialing I note that the baby has bruising and/or mottling on the tip of her tongue and in the center of both lips. She also has dried, bloody mucus in one of her nares.
The MD answers and I tell her that I have a 2 month-old infant, found down, having been that way for an indeterminate period of time. I relay my physical findings and say that I'd like to terminate resuscitation efforts. She tells me to try and intubate the baby and get an IV or IO. I'm shocked and appalled. I told the mother that I'd try some other interventions while we continued to the hospital, but that the situation was still grim (I wasn't going to say pointless no matter how true-it was too trite).
I went into my ET kit and picked out a 3.0mm tube and a 1 blade. I had the crew stop CPR so I could attempt intubation. Even with the stylet, that 3.0 tube was like a wet noodle in that baby's mouth. There was no way I could pass it. She was far enough into rigor mortis that the majority of her neck and head was already affected (the first regions of the body to become rigid).
In retrospect, I was glad to have my first opportunity to attempt intubation on a baby in a less-pressured situation. I am also glad that I was at least able to visualize her airway, so I knew what a real one looked like for future reference.
I abandoned my intubation effort and never had the opportunity to try a line because by then, we were already at the hospital. I was grateful, not wanting to continue the charade with the mother as a spectator.
Once in the ER, they continued to attempt resuscitation. The anesthesiologist was actually able to tube the baby, and I was in awe of that. Pretty soon, though, they quit trying. They then did a "Kiddie-gram", what we in-hospital folks call a head-to-toe x-ray of a small child-all part of the post-mortem in an unwitnessed death and/or ME's case.
I went on my way to write my report. I was also really, really glad to have a laptop at the time, on which I wrote the longest, most detailed summary I've ever written. 1.5 typed, single-spaced pages.
There were mitigating factors that I found out about after the fact, but none of them will bring the baby back. The death was suspicious, but apparently not enough that it didn't get pinned on SIDS in the end.
A few things happened afterward (still in the ER) that I was grateful for. My Chief at the time, MedicJon, brought me coffee from Wawa as a way to show his support for me. One of my favorite cops was there as part of the investigation, and I was glad to have him to talk to. Lastly, one of my co-workers was there on duty as an RN, and I was able to get a hug from her. It's really, really nice to have such a good support system when something that tragic comes your way--and it will.

4 Medics=1 guaranteed code

2006-01-30T13:14:00.000-08:00

This past Saturday, I had the pleasure and good fortune of running w/3 other Medics. Of course, as one of them (MedicJon) put it, we were doomed to run a code.
Right when we sat down to eat lunch (another damning scenario in EMS), we got toned-out for an "Unconscious".
We get there and pull in front of the Engine Co., who were already on scene. We walked up to the wrong house, me being in the lead and looking like the Head Moron. Seems the Engine Co., who really had their shit together, pulled so far past the actual address that they were in front of the next house up. They were, of course, trying to leave us room to pull right up front. Doh!
We then proceeded to the correct address. I should have been clued in that this wasn't just an "Unconscious" when I saw the Cops, but it didn't dawn on me.
We go through the door. A woman in the living room has the telephone up to her ear, speaking to someone on the other end through sobs. The Engine Co. directs us downstairs.
We head downstairs to an incredibly cluttered basement. This is the first time we know that we actually have a CPR In Progress on our hands. I get to the bottom of the stairs and look to my right where the Engine Co. is crowded around our patient. On top of the unbelievable amount of stuff in the basement, there is absolutely no room to get an airway or IV on the patient where he is lying. I say "Oh shit." when I realize this.
Our patient is a Katrina evacuee who had turned 63 just the day before. He was quite large, I'd guess 160kg. Yes, that's kgs. Thankfully, he was lying on a sheet that we ended up using to drag him out of his room and into the common area where there was slightly more (read: any) room to work.
I set up to intubate while one of the other Medics was in the room verifying that the patient was Asystolic. She had the other guy with her, and MedicJon was with me, documenting everything. The two of us went through the "pile o' meds" on the table while we were waiting for them to drag him out.
Out came the patient, and it was showtime. I noticed he was not only a big guy, but he had acumulated a fair amount of his fat in the head and neck. Great.
I went in for a look-see, and not only couldn't I see his trachea, I couldn't even see his esophagus. Second look, same result. I passed the torch to MedicJon, who has far more experience than I. I figured I was just rusty. Not so, apparently. This man had so many jowls that we almost needed another pair of hands to pull all of it out of the way. Jon was able to visualize, but not pass the tube. We ended up admitting defeat and putting in a CombiTube. I never thought I'd have to do that. I know, "never say never".
Well, to Jon's credit, he intubated the trachea with the CombiTube! WOW
While we were working on a definitive airway, the other female Medic had gotten a line and the first two rounds of drugs on board. No change.
It was time to get the patient out of the house. This in itself was a challenge. The Engine Co. had to cut the lock on the gate to the backyard, because that was the only way we were getting him out of the house.
We got him out to the unit, when I noticed that his IV had backed up. Now, normally, that's just a few inches of blood in the tubing. Not so with this guy. The drip chamber was full of blood. We had to change out the tubing completely before we gave the third round of drugs.
We got a 4th Epi on board before arriving at the ER. The ER pronounced him almost immediately after our arrival.
I saw one of my co-workers there that day. When I saw her today, we were chatting about the patient. She tells me that the guy's wife was so upset, they had to give her Ativan. Seems they had just lost a son, in addition to their home. Eesh.

Famous last words

2006-01-18T07:16:00.000-08:00

Another one from the ER.
Medics called in report on an AMI (Acute Myocardial Infarction, AKA "The Big One"). We got ready for them.
Upon their arrival, most of the staff was waiting for them in the room, including the MD. We got him on our stretcher and I started to do a 12-lead EKG. I'm in the middle of hooking up the leads when he goes into VFib (Ventricular Fibrillation). Well, we weren't prepared for that. While waiting for the LifePak (defibrillator) to be hooked up, I asked the MD if he wanted me to "thump" the patient. He said "Sure."
"Thump" is what we call a "Precordial Thump", where you pound on someone's chest in absence of a defibrillator. It actually works. I don't know why we don't do this in the field anymore. I can tell you that if someone went into VF in the back of my unit, and I didn't have the pads on him, I'd do it.
I thumped the guy, but immiediately realised I'd not done it hard enough. He was a large man, about 275lbs I'd guess. So, I slammed my fist back down on his sternum, and lo and behold, he came out of it.
He was obviously a bit shaken but speaking coherently. We tried to calm him down and re-assure him. I attempted to finish the 12-lead EKG while one of the RNs placed the defib pads on him. The man then looks up and distinctly says, "Oh shit, I think I shit myself." He had. He then proceeded to go back into VFib. We shocked him into Asystole, where he stayed, despite CPR and drugs.
I'll always feel sorry for him having uttered those last words. on what would be his deathbed, in front of so many witnesses. Fortunately for him, we all knew that the occurrence was perfectly natural.

"Captain Cachectic"

2006-01-05T13:23:00.000-08:00

This is the nickname I've given a patient I helped care for here in the ER yesterday.
This is also my first post about working in the ER, as opposed to the field. I will try to explain things that I think may be outside of the realm of a fellow Medic (stuff we don't need to know pre-hospital).
The first explanation I'll make is for the word cachectic. I never heard it myself before working here. It basically means a frail, old, pathetic and beyond-emaciated person. And that, he was.
He comes in looking whiter than the MD's lab coat and panting for breath. He's also not making a whole lot of sense. He's so dry his skin is flaking off. His feet are being eroded by decubitus ulcers. He's got a G-tube (into the stomach feeding tube) and has an indwelling Foley catheter (tube that goes up the urethra into the bladder). He's also wearing a diaper.
This guy was septic. More times over than someone healthy could probably handle. Yet, he was still alive, although for how long, I couldn't say. I thought he was gonna die right in front of me.
He had a whole host of problems. The first was his sepsis, which I mentioned. He also was in A-Fib w/RVR (Rapid A-Fib as we sometimes call it). He was hypotensive, requiring Dopamine, and we kept having to turn it up. We switched to Levophed ("Leave 'em Dead", or Norepinepherine) later. He was in Respiratory (and probably Metabolic) Acidosis (HC03 of 13 on the ABG, for those who care). He was dehydrated (as established earlier) and Hyperkalemic. He also "ruled-in" for an MI via lab results. The question became, what wasn't wrong with him.
The causes of his sepsis were many. He had multiple pneumonias and a UTI (Urinary Tract Infection). He also had a case of Cellulitis (bad skin infection that can sometimes be "flesh eating") brewing on one arm. Who knows what else was going on.
So, the story of how he got this way goes sorta like this: he fell five months ago and broke a hip. He was in hospital for some weeks, and then a Nursing Home for rehab after that. In the hospital they placed the urinary catheter. Well, turns out it had never been changed. Geez, no wonder he had an infection! (They shouldn't be left in more than a week or two.)
He lived at home, with a reported elderly wife. Said wife shows up here shortly after he arrives via Medic. To look at her, she doesn't seem like she's too incapable of taking care of the guy. Plus, his brother or uncle is with her, and tells me he has a Home Health Nurse. Hmmmm. OK, so the "Nurse" is obviously an idiot. Wifey, upon first impression, smells like she's been drinking. The picture becomes clearer and more maddening.
This man had languished, unnoticed to everyone around him. Poor guy. Seems despite their lack of effort and caring, he had hung on.
The pneumonias probably developed from him not ambulating enough after surgery, and thus the decubitus ulcers also formed. He probably had the heart attack from any number of causes. We're lucky he didn't go into a Ventricular Dysrythmia, too, with the K+ problem.
We did what we could for the guy. Intubated him, put in a central line, gave him drugs for his pressure and antibiotics for his multiple infections, yadda, yadda, then shipped him off to the ICU. I hope someone in the ICU decides to help him with his social situation, if he lives. Which I doubt.
I really like old people. I really hate people who don't take care of old people.

Who you gonna call?

2005-12-28T12:24:00.000-08:00

http://photobucket.com/albums/y147/suellenr/?action=view&current=waaaahmbulance.bmp

Another crackhead I coded (Alt. title: I hate my OMD.)

2005-12-26T09:42:00.000-08:00

My protocols are kinda screwy. One of the drugs I don't carry is Magnesium Sulfate. I'm sure you can see where this is going, being about another crackhead and all.
While I was still precepting as a Medic, we got a CPR call in the summertime. It was hot, and the guy was dead. He was reportedly smoking crack on the back stoop, came inside, and promptly dropped dead.
He was in Torsades-de-Pointes. Move along, nothing to see [do] here. So, we shock him anyway. I get an IV, and we push Lidocaine anyway. We do have Amiodarone, but I hate it. It's expense ($1/mg.) and habit of causing hypotension also turn me off.
Of course none of our actions did anything for the guy. I go to tube him, but can't. My preceptor gets the tube and we hit the road. I actually didn't get a successful tube during the whole time I was precepting, but I haven't missed one since I got turned-over. Go figure.
En-route, I continue to shock the crap outta the guy, to no avail.
We get to the ER, and Dr. Dave the Trauma Magnet is there. He's pissed because the pt. needed Mag and didn't get it, and by this time, it was too late.
Time of death...

Despite our best efforts...

2005-12-21T10:29:00.000-08:00

You may think you know where this is going, but I guarantee you don't.
It's early on a Saturday morning, duty crew starts at 0800. We're just pulling into the parking lot of a local strip mall for breakfast. Being that early in the morning, staffing is at bare minimum. I have a Firefighter/EMT driving for me, and the Engine Co. has the minimum 3.
This particular Saturday, I was fresh from being precepted and newly on my own as a medic.
We get toned-out for a CPR in-progress. I'm immediately freaking out. We head that way. En-route, my driver tells me she's never been on a code. Great.
I'm grateful to have the folks I do on the Engine Co., we have a great relationship and I know I can count on them. I also hear Ambulance 12 being dispatched, and am glad to hear that-MedicChris and MedicCat are both on board, and they are a solid BLS crew at the time. This transpired when MedicChris was still in class to be a Medic and MedicCat had not started the process yet. I was glad to have at least a Medic-in-training coming along.
We arrive on scene and grab everything plus the kitchen sink off the unit. We proceed inside a small, single-story, single-family home. Once through the door, we are in a tiny living room with a sectional taking up two whole walls. On the sectional, there are several children, staring down at what will be my patient-a pulseless, apneic 38yo M, lying supine on the living room floor. There is also an audience of adults in the kitchen. Nobody is even attempting to shield the children from the horror on the floor.
I essentially throw my clipboard at Curt, the Firefighter on the Engine, and order him to write down everything I tell him to. I needed to keep track of things while I worked, and I sure as heck wasn't going to be writing anything down unless I sprouted five more arms in a hurry.
When we hook up the pt. to the LifePak12, he's in Asystole. Thanks to said LP12, I don't have to switch leads to verify-I get three right on the screen, and I can print a Code Summary later. Check.
We've gotten from the bystanders that he has been down for an unknown period of time. They tell us he's been drinking and smoking crack all night. I'm getting the feeling this will just be practice, but I'm still nervous.
I have the officer from the Engine Co. and MedicChris take the airway. I have Chris appy Cric pressure while Clancy bags the pt. so as to cut down on gastric distention. I proceed to estabilsh and IV and get the 1st round of drugs on board.
I then proceed to set up for intubation. I get my stuff together and then pull out of my airway kit a piece of equipment I've never seen before. This thing was the sorriest excuse for an ET tube holder I've ever seen. It was basically a piece of string and what barely resembled plastic. I hold it up and say "What the hell is this?" and get nothing but blank stares back. Whoops, I'm supposed to know what I'm doing! I abandon my temporary lack of sanity and intubate the guy. I apply the wet noodle device, but poor Chris ends up holding the ET tube in place the rest of the call anyway. Hindsight being 20/20, I don't know why I didn't just grab some dang tape.
Once I tube him, I push the second Epi and Atropine, and we load him up and move him out to my unit. We get him in the back, and I call report while Chris and Curt keep up their end of things. At this point, poor Chris is not only holding my ET tube in place, but bagging and chest compressions with one hand.
I tell the ED we're bringing in an Asystolic pt. who's intubated, has an IV, and has two rounds of drugs on board, a third to follow. ETA 5-6 minutes or less. I hang up, then push the third Epi. Chris says he sees something on the monitor. I look over, and sure enough, the pt. is in VF or VT (I can't remember which, either way it was a shockable rhythm!). I'm flabberghasted, as is Chris. So, I shocked him. He goes into a Sinus rhythm. At this point, I don't know what to do. This outcome is completely and totally unexpected.
So, I suction his airway and by then we're at the hospital. We practically sprint in and I announce (nearly gleefully) that he's got a pulse-NOT what they were expecting. They get a BP (he has one!).
My complete shock and awe continues as he is released from CCU within a few weeks and then released from the hospital all together later on. By this time, I've met the man and talked w/him at some length. He swears that he'll never do drugs again, but I've heard it before. I don't hold my breath on that one.
A year later, he has ZERO deficit, and is still drug-free. His children have their father, and in a way they never did before. They keep him another year before he goes back to drugs. I'm not surprised, but am disappointed.
Yes, I've made my contribution to society-another crack head. Despite my best efforts, he lived.

Love Potion No. 9mm

2005-12-03T07:48:00.000-08:00

I ran this call a little over a year ago. I remember the exact date, but won't post it for obvious reasons.
It's a weeknight, after dark, although I can't remember exactly what time it was. I just remember we hadn't gone to bed yet. We get toned-out for a shooting. The address is just a few short blocks of residential streets from our station, so I decide to stage on the ramp. From this point, I cannot remember what came over the radio, only that PD was on the scene very quickly, and told us it was OK to come.
We proceed to the scene, the Engine Co. pulls in first and we follow. First thing I see from the unit is a small sedan on someone's front lawn. There is a person in the drivers' seat, cops are all over the place, and folks have made their way to the passenger side of the car.
I get out of the unit, and Dave (the Lt. on the Engine) is waving me over to the passenger side of the car. Other folks are tending to the driver, who I note is talking so I make my way to the other side to where a pt. is not talking.
I arrive on the passenger side of the car, which is literally on the front walk to the house, and the pt. is lying next to the car almost on the front steps. I look down and I know immediately she's dead. In fact, I believe my words were, "Oh s---, she's dead." I bent down to check for a carotid pulse. Nada.
Here's where it gets complicated, all in the span of a few seconds. I've got two victims shot, and there's only one Medic there (me). So, triage takes precedence, and I direct Ryan, a FF, to hook up the LifePak-12 and wait til there's a flat line, and run me a strip. I've essentially declared this young, unfortunate woman dead. I insist that nobody else make their way over, so as not to disturb the crime scene.
I then turn my attention to the man in the front seat. I lean over the passenger seat to see he is still talking, I figure out that he's also alert & oriented. Airway, LOC, check. I can't remember how his shirt came off, but upon exposing his chest, I notice two large, circular holes in his right anterior chest wall. Oh, boy. I was already incredibly hyped-up, now I was near freaking-out (in my head). I was outwardly terse and rushed, but hope I didn't portray the true panic I actually felt. I ordered a Med-Evac.
I did a quick rapid survey of his body to identify any other life-threatening injuries. There were none. Check. I asked him a few pertinent questions, and then proceeded to make my way to his side of the car for his extrication.
I stand up and turn back to Ryan, who says he's still not getting a flatline. At some point I had turned back to check the actual rhythm, and it was agonal. It was still agonal. I asked him just to print me a strip right then and be done with it.
At some point, Jon (my Rescue Chief at the time) had shown up. While I was concentrating on the still-living pt., he was verifying that the other one was indeed deceased. When I realized he was there, I was so relieved, I cannot begin to express how much.
We got my pt. out of the car, onto my stretcher, and into the back of my unit. During his brief extrication (I think my words were "Let's get him out NOW!"), word came over the radio that there was another shooting just a few blocks away. The next-closest medic unit was on the way there, with another Engine Co. headed their way, and one headed to the LZ.
I cannot remember who was in the back of my unit w/me other than Jon. He was at the head of the pt., placing Bio-occlusive dressings on the entry wounds for me. I knew they were entry wounds, because the pt. had been driving when he was shot, and there were holes in the windshield. Scene survey can tell you so much!
I got two IVs started quickly, and initiated a fluid bolus, because he was initially tachycardic and hypotensive. I'm thinking the worst despite his still-positive LOC.
We get several sets of vitals, and I dress the defensive wound on his hand (he put it up to shield himself from the bullet[s]). The bleeding was controlled from all three wounds. During all this, we were enroute to, then arrived at the LZ.
We find out that the other pt. is also getting a helicopter ride, but that mine is going first. Either that says something bad about my pt., good about the other guy, or vice-versa. We use the same LZ for both guys.
The flight crew arrives and we place my pt. on a backboard & c-collar for the trip. Upon placing him on the backboard, a bullet comes out of the exit wound on his back. Jon collects it for PD. There is no other exit wound. So, we have two projectiles, one still in him.
My guy tells us he loves us as he's wheeled away to the LZ. How sweet. I know he was just scared out of his mind, and grateful to still be alive.
Jon says to me, "Do you ever get tired of kicking ass and taking names?" I'll never forget that. I think we high-fived, but I can't remember.
I then showed him my shaking hands, and made a reference to a medic who came before me (S.M.) who's hands shook with adrenaline, too. It's amazing how they steady just before I insert IV catheters, then go right back to shaking after. Apparently, his did the same, or so I've been told/compared to.
Our guy's bird takes off, the other guy's lands. I watch as "Doc" and his crew load him up, and they have intubated and are bagging him. Not a good sign.
The second helo takes off, and I made my way back to the scene. I had to make some notations about the pt. whom I had declared dead.
I walk down there, my driver Chris by my side. We had to park several blocks down and hoof it, because there was a large area now declared a crime scene. Gang Task Force and other Plain-Clothed police were there, and we saw them in a driveway. I supposed this was where my pts. were shot. I'd already learned that they tried to escape their attacker by driving away.
I arrive on our scene and talk to "Ward", one of my favorite police officers. He was the one who pulled her out of the car. Apparently he knew she was dead, too, because he never bothered to initiate CPR.
I make my way to the other side of the car, being taking care not to disturb the crime scene (again). She now has a sheet draped over her. I think back to a lecture I attended given by a Medical Examiner where they said they don't like that. Sheets can transfer fibers and muddle forensic evidence. But, the onus of Chain of Custody fell on PD now, so I bit my tongue.
I lift the sheet to examine her bullet wound. It is located on her left side, in (I think) her 5th or 6th intercostal space (can't remember which, but it was a vital one). No exit wound. She either took it right in the heart, or the aorta, or spleen... who knows. Whatever happened, she bled out in seconds.
We make our way back to the unit and then the station where I write my reports and we clean the unit. I'm cleaning the stretcher and realize I've gone over the same spot somewhere like 3 or 4 times. I recognize the sign that I'm a little shook up by the call. I immediately place the unit OOS because I'm in no shape to come to anyone's aid but my own.
Almost immediately after the dispatcher announces that my unit is OOS, Jon calls me. He asks me what's up, and I tell him I'm freaking a bit. He says, come talk to me, I'm in the parking lot.
I make my way outside to his buggy, and Ed (the Rescue Captain) is there, too. We talk for about an hour. I feel much better, and am grateful for their understanding and reassurance. Informal as it was, I was debriefed.
While we're talking, we're actually observing the third crime scene, and the press swarming around it. That particular crime scene was literally across the street from my station.
The story behind all this is one of a real or imagined love triangle, which I do not know. The woman who died on the scene and the man she was with were shot by her ex-boyfriend. My male pt. was either her new love interest or perceived to be by her ex.
The driveway the police had cordoned-off was to her residence. Apparently the two were sitting in his car outside her house and approached by the shooter.
Once shot, they drove away, and ended up landing in some poor guy's front lawn. Their car took out his light pole, and had dented his brand new SUV (still had 30-day tags on it). I felt bad for the homeowner, having all this drama transpire right in front of his house.
After shooting my two victims/pts., the assailant proceeded to the third and final crime scene, the one across from our station. When he got there, he shot himself twice-once in the chest, and once in the head. He was pronounced dead at the hospital.
My pt. lived. He had a few broken ribs, and a PNX. I actually got to follow-up on him, because I work for the company that owns the hospital where he was flown. I also work with the MD that was the Attending that night, who later filled me in on the continuum of his care.
This one made TV news. I still have the clipping of the article that was in the paper.

Sudden death MI

2005-11-21T12:10:00.000-08:00

This happened when I was a Medic intern.
We get toned-out for a chest pain early on a weekend morning. Just by the time of day, it is statistically likely it will be the real thing. In the bizarre Murphy's Law of EMS, the condo is several flights up, stairs only. This also greatly increases the risk of the patient being very ill. Sure enough, my precepter and I get to the top, go all the way back in the bedroom (more bad signs), and there's this really grey man lying there. His BP is 60 and his HR is 40. We're batting 1000.
I start an IV immediately, and my precepter does a 12-lead EKG. We see what we expect-an AMI. I immediately call Med Control for Dopamine orders, which they immediately deny. F-ers.
We proceed to load the guy up on a Reeves' stretcher for ease of transport down all those stairs. I had everyone carry him down head first to try and boost his BP. It worked-he got up to a whopping 80 by the time we made it to the ER.
We hauled ass, not being able to do a whole lot besides ASA and O2. I held the man's hand all the way to the ER. It started out as keeping his arm straight for the IV to run in (I started an AC), but it ended up being emotional support. He was visibly scared. In the end, I was quite glad I did, because he was dead an hour later.
Turns out, this guy was a close friend of my Sgt.'s (who was on the call). Also turns out, he waited most of the night to call us, because he didn't want to leave his wife home alone-she was suffering from CA. Oh, the irony.

For Zhane

2005-11-20T06:47:00.000-08:00

I'm starting with the most gruesome, anger-inspiring and gut-wrenching call I've ever run. I want to get this one out, and out of the way. Zhane was the name of my patient.
It was a cool night, late in winter, and we were toned-out for a possible structure fire. During our frenzied response, reports kept coming over the radio that there were injuries, and possibly a CPR, and possibly a real fire. The radio traffic from Comm was confusing and busy. I knew something bad was happening.
I was a BLS AIC at the time. John and I were the first EMS unit on scene, following PD and multiple fire apparatus. As we're pulling onto the street where the call originated, I notice a police officer and a fire fighter performing CPR on a small child, on the sidewalk. I mark up on scene, and notify Comm that we have CPR in progress.
The fire fighter performing CPR (Joe) is a really calm guy. I am completely alarmed when he sees us, picks up the child, and runs toward me at top speed, yelling "Open the door! Open the door [to the ambulance]!" I did so, and we very quickly had the child on our stretcher.
The child was indeed pulseless and apneic. I was at the head to bag the patient.
Here is where I will try to describe her. She was a beautiful, 15 month-old little girl. From the front, she looked almost like a doll. We thought she had a chance, from that view. But then, as I tried to open her airway, my hand slipped behind her head and I realized why this little girl was clinically dead. Her entire back side, and when I say back side, I mean the back hemisphere of her entire body, had the consistency and appearance of charcoal. At that point, I was screaming at the top of my lungs inside my head. It still elicits a sense of alarm inside me when I think about it, and this was about 7 years ago.
I'm sure I uttered something like "Oh my God" out loud. But, no screaming on the outside. That would not accomplish anything.
Another thing I discovered upon trying to open her airway was that she was stiff. She was warm, though. I figured that her muscles had stiffened from her burns. But, when I tried to insert an OP airway, her mouth wouldn't open. This made me wonder if she also was in rigor mortis, in retrospect. More on that later.
I bagged her as best I could, then Lori, the Medic on duty arrived. She couldn't intubate the baby, because of the stiffness. We do not carry paralytics, so there was nothing she could do but allow us to continue w/the best BLS airway we could.
Then, Lori tried to obtain an I/O, but she was unable to do that, either. We continued CPR and made our way to the LZ. I'm positive the only reason that Zhane got a helicopter was her age and her burns-helos don't fly CPRs.
We got to the LZ and the flight crew got her intubated w/a great deal of drugs. She was that stiff. They whisked her away to Children's Hospital where she was pronounced dead.
We all made our way to the local hospital to clean our rig. It had that charcoal-like stuff all over it. We were all pretty freaked-out.
Lori got a call from the MD up at Children's stating that there was really nothing more we could have done for Zhane. It was very kind of him to make that call trying to reassure us. Usually, we never get any feedback, especially from hospitals other than our own.
After we cleaned up, we went back to the station closest to the hospital and had a Debriefing.

I later found out some details about the call that made me feel worse. The fire had originated in Zhane's crib. Fire fighters from my crew who were in the house described her room to me. The fire was started w/a table lamp. There was no table within reach of her crib. Her mother wasn't home, but her father was downstairs (this was a TH) at the time the fire started (supposedly). The parents claim that her big brother, who was quite young himself, knew she liked the lamp and put it in her crib for her. According to the police officers I spoke with, and the fire crew, her parents had totally inappropriate reactions to the situation. The whole thing was fishy.
One thing I noticed, being on airway, was that she had no soot in her airway. If she had died of smoke inhalation, a possible reason that she didn't cry when she was being burned, than it would have shown up that way. The MD at Children's also said that her lungs were wet.
The conclusion that most of us who were there came to was that she must have been dead before the fire. However, the ME didn't agree. The parents were not found to be responsible, instead, they blamed it on her brother and the lamp. You draw your own conclusion.

The next day, I went in to work late. We were up til about 4am w/the debriefing. My boss was totally understanding. John faxed me the article that showed up in the paper about it, which is how I learned of her name and actual age. We will never forget her.

Greetings!

2005-11-20T06:18:00.000-08:00

I've been sucked in to creating a blog by my pals MedicChris and MedicCat. OK, it's not really their fault... I was just inspired by their blog, Night Runs.
As stated in my profile, I work in an ER and I also run as a Medic for a local VFD. I'm a glutton for punishment.
Most frequently, my husband John is my driver. We've been running together the entire 10 years I've been in EMS. The VFD is where we met. The rest is history, as they say.
Abandon all hope, ye who enter here!