Paramedics: What was your FIRST critical call(on your own), and how did it affect you as a medic?

[Jay506]

How did you do?

How soon did it happen after you were on the street on your own?

 

[Carlos Danger]

My very first call as a paramedic was for a middle-aged dude with a HR in the 20's whose implanted defibrillator kept firing about every minute or so.

I'd say the biggest way it affected me was to show me how little I knew about AICD's and electrophysiology in general.

 

[Jay506]

My very first call as a paramedic was for a middle-aged dude with a HR in the 20's whose implanted defibrillator kept firing about every minute or so.

I'd say the biggest way it affected me was to show me how little I knew about AICD's and electrophysiology in general.

How did you treat?

 

[chaz90]

Hmm...I guess an unresponsive person with a BGL of ~30 mg/dL who didn't improve after we treated his hypoglycemia. We were managing his airway through suctioning and basic adjuncts prior to administering D50 but then ended up RSIing him after his RR decreased and his BGL was in the 200s.

I think this helped teach me to expect the unexpected. We managed it fairly well in stride, but the shock of having a patient fail to respond to an easy treatment for what I thought was going to be a run of the mill call left an impression on me.

 

[COmedic17]

My first "oh s***" call as a medic was a unresponsive patient, HR In the 40s, BP of 50 by palp, spo2 in the 50's/60's. Breathing maybe 5 times a minute.

Pt had a "dnr" of sorts that said no defibrillation, CPR, or intubation/supra glottic airways. But anything else was game.

Accepted an OPA like a champ.. But even with bagging never got pt over 80.

After listening to lung sounds, which were clear, ran bilateral IVs wide open. Tried all medicinal routes to treat bradycardia with no prevail. Went to pacing but could never a get BP over 70's.

Tried every med and pacing. NOTHING helped this guy. He passed at the hospital. Pt had terminal lung and brain cancer and was at home on a hospice type situation (at home health aid). So I don't think anything would of helped them.

 

[medic6676]

Traumatic arrest: Motorcycle dump into a wire guardrail. Patient HAD a helmet on, but it didn't need to be removed by EMS, and his face had "the Joker smile" and two more parallel lacs running across his temple, brain matter showing through them.

By the time I arrived on scene BLS crew had patient loaded and were preparing to transport. Attempted to drop a tube, couldn't see anything from all the blood, and instead of wasting time auctioning and tubing, just dropped a King. Listened to breath sounds, noticed diminished left side, and decompressed. My preceptor had dropped an IO and administered 2 epis, and I gave the third. Before the third, noticed NSR on the monitor, but was PEA, two minutes later patient had NSR with a pulse and a BP.

Sadly the fact that we got him back in the rig and that he was alive at the hospital. We all knew/know that this patient was dead regardless what his heart was doing.

I believe he ended up being transported from the smaller capital district ER to Albany Medical Center and was kept alive long enough to harvest.

MD at smaller ER said that the airway and decompression was key to bringing this individual back and that as a new medic I handled myself well. Preceptor had nothing but glowing remarks for me.

Now for myself, being an individual who is overly critical of every little skill I use or med I push, I replayed the call in my head over the last two years and thought of anything that I was weak and strong in, and I do this for almost every severe call because of this and another call. But it played out those first arrest jitters for me and allowed me to feel confident in myself as a new medic and go on to trust my instincts and knowledge.

 

[DesertMedic66]

Traumatic arrest with brain matter showing is considered a do not attempt resuscitation in a lot of systems.

 

[NomadicMedic]

First day as a solo medic, first call. 19 year old, unresponsive with ineffective breathing. Required agressive airway management, including RSI. Patient died <6 hours after arrival at the ED.

 

[akflightmedic]

Sadly or fortunately (?)....I do not remember. LOL

 

[joshrunkle35]

About a month on: gang fight MCI. I had a very experienced EMT with me (I was not) and a very experienced EMT who was a supervisor. The supervisor directed incoming and outgoing transports. There were 8-9 ambulances and several engines, and about 20 police cars in the middle of the scene. My EMT partner and I split up to triage, there were about 30 people involved, most with very minor injuries like a broken finger or broken skin. We only had about 5 serious injured. After triage, the politics of the event dictated treatment: there were two pissed off gangs that we wanted to keep separated. I treated one group of about 12 people and my EMT partner treated the other group of 2 people. I really treated less people than that: I evaluated 2 very serious injuries and sent them immediately. 6 minor injuries either transported themselves or were transported to jail, I treated 4 who were eventually transported. After I was clear, I rejoined the other group who still had their two patients. The fight was 40 people vs 2 people...those two people. They were in a very bad way. From the doorway you could easily assume that one gentleman's zygomatic and orbital bone were probably broken. The skin where his eyebrow was had swollen downward to cover his entire eye. They had bruises over their entire bodies and 30-40 minor cuts that probably would have required stitches. My partners were still cleaning their wounds when I arrived. They had declined transport, but wanted medical attention from us. I jumped in to help and tried in vain to express the permanent damage that would occur if they did not seek further medical treatment. They didn't care. Despite their outrageous condition, they left under their own care after about 3 hours.

Nothing was particularly hard, I wasn't particularly innovative...I just stayed calm, did what was needed and followed what I was trained to do.

How did it effect me as a medic? Well, it gave me a lot of confidence, and it gave the people I worked with a lot of confidence in me.

 

[medic6676]

Traumatic arrest with brain matter showing is considered a do not attempt resuscitation in a lot of systems.

You're right it was, except care had been initiated and he was loaded. So at that point I chose to give it a shot. If he had been on the ground when I arrived both my preceptor and myself agreed that we would have called it.

That being said, because we did work him, he was able to save lives through his harvested organs.

 

[COmedic17]

Traumatic arrest: Motorcycle dump into a wire guardrail. Patient HAD a helmet on, but it didn't need to be removed by EMS, and his face had "the Joker smile" and two more parallel lacs running across his temple, brain matter showing through them.

By the time I arrived on scene BLS crew had patient loaded and were preparing to transport. Attempted to drop a tube, couldn't see anything from all the blood, and instead of wasting time auctioning and tubing, just dropped a King. Listened to breath sounds, noticed diminished left side, and decompressed. My preceptor had dropped an IO and administered 2 epis, and I gave the third. Before the third, noticed NSR on the monitor, but was PEA, two minutes later patient had NSR with a pulse and a BP.

Sadly the fact that we got him back in the rig and that he was alive at the hospital. We all knew/know that this patient was dead regardless what his heart was doing.

I believe he ended up being transported from the smaller capital district ER to Albany Medical Center and was kept alive long enough to harvest.

MD at smaller ER said that the airway and decompression was key to bringing this individual back and that as a new medic I handled myself well. Preceptor had nothing but glowing remarks for me.

Now for myself, being an individual who is overly critical of every little skill I use or med I push, I replayed the call in my head over the last two years and thought of anything that I was weak and strong in, and I do this for almost every severe call because of this and another call. But it played out those first arrest jitters for me and allowed me to feel confident in myself as a new medic and go on to trust my instincts and knowledge.

You ran a traumatic code with injuries not consistent with life ( brain matter showing)?

 

[COmedic17]

You're right it was, except care had been initiated and he was loaded. So at that point I chose to give it a shot. If he had been on the ground when I arrived both my preceptor and myself agreed that we would have called it.

That being said, because we did work him, he was able to save lives through his harvested organs.

Does your county/district not have an organ recovery team?

 

[medic6676]

You ran a traumatic code with injuries not consistent with life ( brain matter showing)?

Yes if you read my reply you will see why. As well as the choice was more my preceptors to run the code. Either way while the injuries at have been incompatible with life, through resuscitation efforts we were able to get him to a harvest facility and save numerous others lives.

 

[gotbeerz001]

@medic6676, good experience. It was your internship and the wheels were in motion before you got there. Sure, you could have called it but why not get some interventions, eh? You know what you'll do on the next one... And the organ donor portion is a bonus.

DesertEMT is a newer medic as well and trying to be a fireman; he likes to call people out. COmedic has lots of good of good posts and is generally worth listening to. Just don't let the wet blankets get you down; I'm curious to hear about their first stat call on their internships.

 

[STXmedic]

CHF patient circling the drain. Ended up getting a tube and coding later. After that, I became much more aggressive with respiratory complaints.

 

[Burritomedic1127]

First real call as a new medic was a syncopal. Sounds pretty weak but the pts hr was 30 with a pressure of 60/40 in the presence of a huge inferior stemi with right sided involvement. Remained hypotensive refractory to fluid challenge and was able to pace. Was the time i learned what a patient looks like when their skin color is grey. Learned how important your spidey sense is when you first see a patient

 

[medic6676]

@medic6676, good experience. It was your internship and the wheels were in motion before you got there. Sure, you could have called it but why not get some interventions, eh? You know what you'll do on the next one... And the organ donor portion is a bonus.

DesertEMT is a newer medic as well and trying to be a fireman; he likes to call people out. COmedic has lots of good of good posts and is generally worth listening to. Just don't let the wet blankets get you down; I'm curious to hear about their first stat call on their internships.

I appreciate that. I have been at the ALS game for about three years now, medic for almost two. And prior to that an EMT for 6, so I like to think my ears have dried some haha.

 

[DesertMedic66]

DesertEMT is a newer medic as well and trying to be a fireman; he likes to call people out. COmedic has lots of good of good posts and is generally worth listening to. Just don't let the wet blankets get you down; I'm curious to hear about their first stat call on their internships.

I wasnt attempting to call anyone out. It could have been his system that made him transport or some other circumstances. What does wanting to be a firefighter have anything to do with that post or are you just trying to make a personal attack?

Since you asked my first critical call during internship was a 62 year old diabetic not breathing. BVM + OPA. Attempted a line 3 times myself and my preceptor attempted 3 times without success. 1mg glucagon given with no response. Drilled an IO and infused D10. Brought his sugar up to 23mg/dL. Base was contacted and ordered D50. D50 brought his sugar up to 76mg/dL. Patient was now AOx2 and breathing on his own.

 

[gotbeerz001]

I wasnt attempting to call anyone out. It could have been his system that made him transport or some other circumstances. What does wanting to be a firefighter have anything to do with that post or are you just trying to make a personal attack?

Since you asked my first critical call during internship was a 62 year old diabetic not breathing. BVM + OPA. Attempted a line 3 times myself and my preceptor attempted 3 times without success. 1mg glucagon given with no response. Drilled an IO and infused D10. Brought his sugar up to 23mg/dL. Base was contacted and ordered D50. D50 brought his sugar up to 76mg/dL. Patient was now AOx2 and breathing on his own.

Not so much a personal attack, just a general characterization. You are obviously smart and motivated. Often, this is paired with a certain degree of cockiness which you have likely been told about by others at various times.

I have no doubt you are a good provider and that you will ultimately be successful. Those who are smarter than their peers have a hard time for reasons that don't always seem to make sense; one reason is that you choose to make (not inaccurate) points at inappropriate times.

This thread is about sharing experiences at a time when people have a lot to learn... You chose to (seemingly) question the actions of the contributor... This comes across as a ****-move and makes a new member hesitant to post further. While we all need thick skin to survive in this field, your comment came across as abrasive rather than helpful.

Just my opinion and I am open to being wrong... If you lived closer I'd buy you a beer and we'd sort it out. [emoji482]