Cindigo
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Yesterday was my fourth ride along as a EMT-B student, and I think the first time I started to feel like I might have a little bit of bearings about me. I know when to grab the heart monitor when I jump out the door, my seat is always backwards when I leave the bus, 4 x 4 gauze pads forward to the left, nasal canulas back to the right. PD and FD are starting to give me hand off reports, and asking questions about calls like I know something about something. This is probably because I'm not standing around like a deer in the headlights. All the shifts are 10 hours. Three of the four days, we ran over ten calls.
Monday started out with a 54 yo f that tripped over a three inch metal beam while walking backwards at work. Landed on her sacrum. Pain 8/10. Gave pain meds and transported. Then a 87 yo f, c/c weakness. Grandma fell and she couldn't get up. No pain, just weak. Scooped her up and transported. Then call number three. Code 10 (emergent) to a DOA. Emergent DOA? He's not going anywhere right? But, I guess, if you're the PO that calls it in and the paramedic comes to make the pronouncement and by some Hogwarts magic, he's not dead, dead....you just want to cover your ***...and....you might save a guy.
Anyway. Basically I'm still a civilian. Half way through EMT-B school, I can't really *do* anything. I just try to be as helpful as I can, soak up as much information as possible and put myself out there or jump into volunteer to do anything new. I've been trying to ride with the same crew on a set schedule since then they can teach me things, know what they've taught me and build on it each shift.
We're driving the wrong way down streets, rolling over medians, through red lights and stop signs. I'm getting bounced around like crazy only tethered to the seat with the lap belt with nothing to hold onto since I'm in the third swivel chair (there's probably a name for it that I don't know). I'm trying to focus my focus. I'm going to see something gross and disturbing. You knew this going in right? This is not learn how to pet kittens and eat cupcakes school. This is a good thing because a DOA is trauma that's over. Right? Totally right. At some point, maybe tomorrow, you're going to have to break some little old lady's ribs doing chest compressions or suction puke, blood or both out of someone's throat, but right now all you have to do is step out of a ambulance and see something gross. In the grand scheme of things, pretty easy.
AOS to PD. They tell us they've been tracking the guy's cell phone for 20 minutes. 54 yo m. Wife says he had been acting "weird". Kissed her extra long this morning, dropped their 12 yo son off at school and ten minutes later sent out a mass email telling people "not to be mad". It had been ten minutes after the cell phone stopped moving that PD found him in the warehouse parking lot. He most certainly was dead, dead. GSW to the head. We arrived on scene five minutes later. My partners pronounced him and then had to write a report for the PD. Paramedic Josh said, "go over there and poke around". So I went over there and literally felt like a ten year old with a stick (I didn't have a stick, and I hope that didn't sound disrespectful) poking at a dead animal on the side of the road.
Skin, waxy, cold and mottled, looked fake. Blood and brains in a pile next to his head, very fake. Black eye and bloody nose, fake and fake. When you're alive, you can asses circulation by capillary refill. Press on your fingernail with another fingernail, it will turn white. Let go. In about two seconds after you do, it will turn pink, you're alive. This guys fingernails were blue. I pressed on them. They stayed blue.
Then at 12:30, the guy's wife (I'm assuming it was his wife) called. I know this because I was kneeling next to his iphone that was congealing in a pool of thick fake looking blood. 12:30 exactly. I stood up and took two steps back and felt slightly nauseous, righted my world and walked back to my partners.
Call four dispached to a downtown bank. A nice 34 yo f passed out a work and hit her chin on the desk. She's five months pregnant. Everything seems okay vitals, EKG normal. No trauma from the fall. She's rightfully upset but calm and polite. Two minutes from the hospital she has one tear come out of each eye and asks, "Is my baby going to be okay?" Josh said, "I can't tell you the answer, that's why we're taking you to the hospital to get you checked out. But I will tell you with 100% confidence that every test we've done here and all the things I've observed. I don't see any problems with your baby." I will remember that. It was a good thing to say.
Call four to the Police Station. Inmate developed severe "incarsiritius". The proper medical terminology for someone that gets arrested and thinks they can get out of or put off going to jail by faking a illness. This guy had really smelly feet. A PO commented on it at the jail and a nurse said "woah" and kind of tried to politely turn away and close her nose as we wheeled him into the room. Seriously bad. He had a blue line drawing tattoo of a crying jesus on his forearm. He was a long time crack smoker that was on prozac. I said, "you know crack and prozac kind of cancel each other out right?" pause. "hey" guy looks up at me from the stretcher "stop smoking crack dude". I'm pretty sure that was a miracle working speech right there.
Call five.....
Dispached code 10 (emergent) to a 36 yo f c/c (chief complaint) shortness of breath. PT's mom stated that they don't have the resources to go to the doctor/walk in clinic. PT states her throat hurts, is swollen and has had a productive cough for two weeks. PT claims pain is a 10/10. PT is WPD (warm, pink and dry....it's what you're supposed to be) with bi-lateral chest rise and fall and adequit tital volume (she's breathing just fine). Ascultated (listened to) lungs/throat possibly heard slight wheezing on superior R anterior lung. PT walked w/o assistance down to the stretcher from the second floor with no exacerbation of symptoms. Placed PT on 3 L/min O2 via NC (nasal canula) and paramedics performed a 4 lead EKG with no abnormalities. Transported and gave full report to the charge nurse w/o incident.
Me: (On the way to the hospital) On a scale from one to ten, one being no pain, and ten being the worst pain you've ever felt, how is this pain?
PT: Oh ten! Definitely a ten!
Me: (long pause) Okay, so.....if I had a chainsaw right here and I cut off your hand and then you would compare......
PT: (Cuts me off) OH YEAH! Exactly! It feels EXACTLY like a chainsaw is cutting right through my throat.
*crickets the rest of the drive to the hospital*
I'll skip the mom that ODed on oxycodone in front of her seven yo daughter, just because this is too long already and it was uneventful other than wanting to take that kid straight out the door with me. I'm sure me telling a sobbing little girl that "we we're going to take good care of her mommy" didn't do much to help, but, what can anyone really do in a situation like that.
I'll end this day that seemed to take five minutes and two weeks all at the same time, with the copy of my trip report for the last call. What isn't listed in the report is the f is a tiny Japanese woman with a accent wearing daisy dukes. I guess you had to be there, but when she kept repeating "very heavy flow" and pantomiming a explosion of blood coming from her....ummmmm......camel toe, it was all we could do to keep it together:
Dispatched code 10 (emergent) to a residence. 48 yo f c/c heavy menstrual flow. PT said that it is "much more flow than normal" and wants to go to hospital. PT states she is on bi-polar medication, is compliant but does not recall the RX name. PT also states that she was on the "fourth floor" psych unit of X Hospital "for awhile" last month and they changed the medication she was taking. PT reports she is in no pain at all.
PT is behaving manically, finding it hard to stay still, giggling and singing. PT is WPD, has equal bi-lateral chest rise/fall with excellent tital volume (I can tell because she belted out a heartfelt rendition of Foreigner's 80's hit Urgent on and off for the entire 10 minute transport). P=76, BP=132/78.
Transported PT in a seated position to XXH without incident. Gave charge nurse full report and admitted PT to triage. *end report*
Monday started out with a 54 yo f that tripped over a three inch metal beam while walking backwards at work. Landed on her sacrum. Pain 8/10. Gave pain meds and transported. Then a 87 yo f, c/c weakness. Grandma fell and she couldn't get up. No pain, just weak. Scooped her up and transported. Then call number three. Code 10 (emergent) to a DOA. Emergent DOA? He's not going anywhere right? But, I guess, if you're the PO that calls it in and the paramedic comes to make the pronouncement and by some Hogwarts magic, he's not dead, dead....you just want to cover your ***...and....you might save a guy.
Anyway. Basically I'm still a civilian. Half way through EMT-B school, I can't really *do* anything. I just try to be as helpful as I can, soak up as much information as possible and put myself out there or jump into volunteer to do anything new. I've been trying to ride with the same crew on a set schedule since then they can teach me things, know what they've taught me and build on it each shift.
We're driving the wrong way down streets, rolling over medians, through red lights and stop signs. I'm getting bounced around like crazy only tethered to the seat with the lap belt with nothing to hold onto since I'm in the third swivel chair (there's probably a name for it that I don't know). I'm trying to focus my focus. I'm going to see something gross and disturbing. You knew this going in right? This is not learn how to pet kittens and eat cupcakes school. This is a good thing because a DOA is trauma that's over. Right? Totally right. At some point, maybe tomorrow, you're going to have to break some little old lady's ribs doing chest compressions or suction puke, blood or both out of someone's throat, but right now all you have to do is step out of a ambulance and see something gross. In the grand scheme of things, pretty easy.
AOS to PD. They tell us they've been tracking the guy's cell phone for 20 minutes. 54 yo m. Wife says he had been acting "weird". Kissed her extra long this morning, dropped their 12 yo son off at school and ten minutes later sent out a mass email telling people "not to be mad". It had been ten minutes after the cell phone stopped moving that PD found him in the warehouse parking lot. He most certainly was dead, dead. GSW to the head. We arrived on scene five minutes later. My partners pronounced him and then had to write a report for the PD. Paramedic Josh said, "go over there and poke around". So I went over there and literally felt like a ten year old with a stick (I didn't have a stick, and I hope that didn't sound disrespectful) poking at a dead animal on the side of the road.
Skin, waxy, cold and mottled, looked fake. Blood and brains in a pile next to his head, very fake. Black eye and bloody nose, fake and fake. When you're alive, you can asses circulation by capillary refill. Press on your fingernail with another fingernail, it will turn white. Let go. In about two seconds after you do, it will turn pink, you're alive. This guys fingernails were blue. I pressed on them. They stayed blue.
Then at 12:30, the guy's wife (I'm assuming it was his wife) called. I know this because I was kneeling next to his iphone that was congealing in a pool of thick fake looking blood. 12:30 exactly. I stood up and took two steps back and felt slightly nauseous, righted my world and walked back to my partners.
Call four dispached to a downtown bank. A nice 34 yo f passed out a work and hit her chin on the desk. She's five months pregnant. Everything seems okay vitals, EKG normal. No trauma from the fall. She's rightfully upset but calm and polite. Two minutes from the hospital she has one tear come out of each eye and asks, "Is my baby going to be okay?" Josh said, "I can't tell you the answer, that's why we're taking you to the hospital to get you checked out. But I will tell you with 100% confidence that every test we've done here and all the things I've observed. I don't see any problems with your baby." I will remember that. It was a good thing to say.
Call four to the Police Station. Inmate developed severe "incarsiritius". The proper medical terminology for someone that gets arrested and thinks they can get out of or put off going to jail by faking a illness. This guy had really smelly feet. A PO commented on it at the jail and a nurse said "woah" and kind of tried to politely turn away and close her nose as we wheeled him into the room. Seriously bad. He had a blue line drawing tattoo of a crying jesus on his forearm. He was a long time crack smoker that was on prozac. I said, "you know crack and prozac kind of cancel each other out right?" pause. "hey" guy looks up at me from the stretcher "stop smoking crack dude". I'm pretty sure that was a miracle working speech right there.
Call five.....
Dispached code 10 (emergent) to a 36 yo f c/c (chief complaint) shortness of breath. PT's mom stated that they don't have the resources to go to the doctor/walk in clinic. PT states her throat hurts, is swollen and has had a productive cough for two weeks. PT claims pain is a 10/10. PT is WPD (warm, pink and dry....it's what you're supposed to be) with bi-lateral chest rise and fall and adequit tital volume (she's breathing just fine). Ascultated (listened to) lungs/throat possibly heard slight wheezing on superior R anterior lung. PT walked w/o assistance down to the stretcher from the second floor with no exacerbation of symptoms. Placed PT on 3 L/min O2 via NC (nasal canula) and paramedics performed a 4 lead EKG with no abnormalities. Transported and gave full report to the charge nurse w/o incident.
Me: (On the way to the hospital) On a scale from one to ten, one being no pain, and ten being the worst pain you've ever felt, how is this pain?
PT: Oh ten! Definitely a ten!
Me: (long pause) Okay, so.....if I had a chainsaw right here and I cut off your hand and then you would compare......
PT: (Cuts me off) OH YEAH! Exactly! It feels EXACTLY like a chainsaw is cutting right through my throat.
*crickets the rest of the drive to the hospital*
I'll skip the mom that ODed on oxycodone in front of her seven yo daughter, just because this is too long already and it was uneventful other than wanting to take that kid straight out the door with me. I'm sure me telling a sobbing little girl that "we we're going to take good care of her mommy" didn't do much to help, but, what can anyone really do in a situation like that.
I'll end this day that seemed to take five minutes and two weeks all at the same time, with the copy of my trip report for the last call. What isn't listed in the report is the f is a tiny Japanese woman with a accent wearing daisy dukes. I guess you had to be there, but when she kept repeating "very heavy flow" and pantomiming a explosion of blood coming from her....ummmmm......camel toe, it was all we could do to keep it together:
Dispatched code 10 (emergent) to a residence. 48 yo f c/c heavy menstrual flow. PT said that it is "much more flow than normal" and wants to go to hospital. PT states she is on bi-polar medication, is compliant but does not recall the RX name. PT also states that she was on the "fourth floor" psych unit of X Hospital "for awhile" last month and they changed the medication she was taking. PT reports she is in no pain at all.
PT is behaving manically, finding it hard to stay still, giggling and singing. PT is WPD, has equal bi-lateral chest rise/fall with excellent tital volume (I can tell because she belted out a heartfelt rendition of Foreigner's 80's hit Urgent on and off for the entire 10 minute transport). P=76, BP=132/78.
Transported PT in a seated position to XXH without incident. Gave charge nurse full report and admitted PT to triage. *end report*
thanks for taking the time to put it all down in words. You have a flair for writing.
