09 October 2010

Still Alive and Kicking

Well, where do I start? My goodness it's been a long time since I've taken the time to put thought to "paper". Not that I haven't had anything to say, but there has been a lot of stuff that has either prevented me or discouraged me from continuing like I had wanted to.

I too, like Medic999, faced some opposition from my superiors. Now let me be clear about this, mine were for reasons far removed from his. Most of my opposition came from the fact that my writing style was personalized and in some sense unbridled, and some were quite unhappy with my airing our dirty laundry to the world. But true to form, I'll maintain consistency in telling it like it is, but with a little more tact and grace. Soooo, where did we leave off....

I guess the biggest change is that as of a couple weeks ago, I became a fully growed Paramedic (wink, wink). Some goofball in Columbus, OH was either sleeping on the job or slap drunk and somehow pushed my National Registry stuff through and generated a certification card with my name on it! Why is that a slip you might ask? Well, I'm glad you asked.

You see, I work nights and for the past five months we've been working CRAZY overtime. I'm talking about 130hrs a month overtime on top of my regular shift. Anywho, I had worked on a Friday night and was scheduled to test in Roanoke, Va the next Saturday morning. Just as luck would have it, we got our butts handed to us on a silver platter. I think that night between three trucks we had like 16 calls, and several were inter-facilities. I didn't even so much as get to look at a pillow much less put my head on one. During the daytime before I came on-shift I had worked eight hours at the ER(Now theres a blog series that I can't wait to get into), and that preceded by another busy shift.

So here I am in Roanoke at the Pearson Vue testing site, tired as hell, eyes bloodshot and haven't even touched a book or note card in a month. One of the reasons I waited so long to test was because I just didn't have the time too....seriously. They run me through the usual security stuff to make sure I ain't gonna cheat my way through this thing and sit me in a nice comfy cubical. There in front of me is this computer, keyboard, mouse, dry erase pad.....and a pair of ear muff thingies.

I resist the urge to put these ear muffs on because I know what's gonna happen if I do. However, there are about ten other people in there and most of them must have been taking a test that required them to type out an essay paper or something. Man, those keyboards were justa rattling away and I had to give into temptation or go mad with all that pecking.

Ahhhh, silence. Pure silence like a winter day at dawn with a fresh coating of snow. The only sound I could hear was the S1 and S2 of my heart. Sure enough, just as fate would have it, I started to get sleepy about ten questions into this beast. Now I know they have cameras everywhere watching the testing room and I am overly conscious about them laughing at me because I'm falling asleep in there. But sure as I'm typing this right now I start to do just that...I fell asleep no less than four times while taking this test! I'd be reading a question and next thing I'd know I'd wake up with my head just about on the keyboard. Once i actually woke myself up because I snored. OMG I was so embarrassed. I'm not even gonna mention how I felt when I walked out of there knowing that I was tired as heck taking this test; but I actually fell asleep taking it! I knew beyond a doubt that I had just wasted $110 and two and a half hours driving time.

For the next day and a half I felt like crap...literly. Not that I know what crap feels like mind you, but I would imagine that crap has some what of a complex being at the end of the food chain an all. All I could think about was the fact that I had told several people that I was going to take it that day and every body was expecting to know the results when they posted on Monday.

Well, that Monday about 9:00am, I entered the web address for the National Registry website. With a knot in my gut the size of a butterball turkey I entered my log in information, refusing to allow myself to believe that it would say anything other than that I was still an Intermediate. But sure enough, there it was. Right beside the word "Level" was the title that I have studied so hard for, fought so hard to defend and wanted so badly to wear with pride...PARAMEDIC. It was a surreal moment to say the least, almost like I couldn't believe what I was seeing. In the back of my mind I was just absolutely sure that somebody had messed up and sometime later that day they would realize what had happened and return to fix the mistake. So I fought off the urge to check it again...and lost.

I'm willing to bet that I checked my certification status no less that ten times that day. And every time I would see that title under my name I would get just a little more giddy each time. By the time I went to bed that night it had just about sunk in; I actually slept through the National Registry Paramedic exam...and passed!

Well, that's all for now. I've got a lot more I want to get back up to speed on, and I will over the next few days or so, but one of the biggest projects I'm going to be undertaking is a complete overhaul of my website. I want a new look and make it more "professional" if you will.

Until next time....Medic Up!

27 March 2010

Race Weekend in Martinsville

It's that time of year again...well, at least one of them.

Twice a year the population of our county triples with the influx of well over 150,000 people from all across the U.S., just to watch some cars and truck drive at a break-neck pace in a circle.

They come from everywhere; Maine, Wisconsin,New York, Florida, and I've even seen a license plate from Texas sporting around town. Everybody here for the thrill of watching their favorite drivers battle for the lead and wishing the driver they love to hate would hit the wall in the turn. It's all in good fun though.

Dedicated fans start rolling in about three days before the Sunday race and set up temporary housing in parking lots and rented out front yards. For the next few days they are our neighbors, blending in with the happenings of the locals. They shop in our stores, buy our gas and patronize our restaurants and you would never know they were foreigners unless you happened to catch the hard accent of a Yank.

Some of us just tolerate the influx of the fine folks from all over and of course the business owners can't get enough of them. I would dare say that some business owners peg their entire business on these two times a year. All in all, it is good for our economy and it does lend a certain excitement to the air.

For me it's just more of the same. Somewhere either at the track or in the surrounding area I'll have an oppertunity to make an impression on somebody and introduce them to our locality as a representative of our EMS system.

There will be the drunks (my favorite), the falls with broken bones and inevitably, without the shadow of a doubt, there will be at least one cardiac arrest in the stands where the whole world can watch you perform your art. The heightened sense of awareness will be on our minds though, knowing that this environment could be a prime target for terrorism. We'll be vigilant and bring our "A" game at every turn, but we too will get caught up in the smells of high octane fuel and the thunder of thousands of hosepowered engines hurling around the track.

So yes, once again go I...out into the crazy masses to distribute my charm and charisma, and possibly some quality-of-life sustaining care to the energized masses who will fall prey to their own inhibitions. But I will do it with a smile because I know that they will soon be gone and leave nothing but their trash and other remnants of their brief visit.

23 March 2010

Funny....real funny

A little change in pace before I pick my next carefully chosen battle.

I'm not always wound up about something as one may think, shoot I have fun just as much as the next guy and even involve other people in my antics. We've got to have a release in this line of work or we'll be as batty as those we serve.

My partner may not approve of my sharing the perils he has participated in or been the subject of...but it was funny. The first one I can't lay claim to but it goes something like this.

We'll just call my partner Paco for the sake of discussion. Paco and I have have worked together for two years now on the bus and we've seen just about everything. Paco's an all around good guy and will do just about anything you ask him to...as long as it benefits him in some way. But the guy is a little gullible and avails himself to these sort of things. The good side of it is that there is usually a learning experience in it for us all **snickering**.

Paco was working one night with Guy and there was this particularly messy call he was involved in. There they were at the hospital, transferred care and were now in the process of restocking the truck.

Guy: Damn, I knew I forgot something.

Paco: What d'ya need, I'll get.

Guy: Run inside and tell one of the nurses I need a set of fallopian tubes from the cabinet.

Paco: Okay

And he did....

We rode him pretty hard about that one for a while, after all it was funny. Admit it!! You're sitting there right now thinking of some poor schlump you can pull that one on.

It took a while before the time was just right for another one.

We are doing what seemed to be a routine transport to the hospital, but I decided to give it a twist and give it a little urgency. Now, when we're transporting in, it's the driver that calls the report in to the ER.

I'm in the back and I'm all serious, I'm taking blood pressures and looking intently at the monitor. I'm really working the patient up good. You would think the patient was a major multi-systemic trauma victim the way I'm checking her over.

Paco (from the front): What you want me to call this in as?

GK: **with ALL seriousness** Just tell them 70yo female with an acute priapism.

Paco: Want me to run code?

GK: No need to run hard, just nice and steady if you would.

You should have seen the looks on their faces when we walked into the ER. There wasn't a cheek that wasn't being bit to keep from laughing.

Then the other night it hits again. We're doing another routine transport and have just loaded the stretcher into the truck. I can tell he just doesn't feel like riding this one in...for whatever reason.

GK: Paco, jump up in there and get me a B/P, I'll come in the curb door and do my thing up there.

Paco: O.K. (and dutifully jumps on in)

What did I do? I shut the doors, got in the driver seat and we went to the hospital; all the while watching an obviously disgruntled Paco through the rear-view mirror.

I know....mine is coming! Bring it!

18 March 2010

Food for thought

I got bored...so I dug down deep within and found some pearls of wisdom. Take it for what it's worth, but it made me feel better.

1) You get what you are willing to pay for.

2) That which you neglect will eventually neglect you.

3) My dest-in-y will be determined by what's best-in-me.

4) A person only fears that which they don't understand.

5) Perception is 9/10 of reality.

6) Control is given, not taken.

7) Your success will never be determined by someone who is not determined to succeed.

8) A person of little value is easily bought.

9)In theatrics, it is the people backstage who see the real performance.

10) The person who yells into emptiness will only hear what they have said...and nothing more.

15 March 2010

Paramedic v. Nurse

**Newsflash** Hold all presses for news release, the Gate Keeper is an a$$ because he asks questions to a nurse. Well who woulda thunk. Let me fill you in on this one.

We’re called to a local managed care facility (nursing home) the other night for a patient experiencing some difficulty breathing. When we get there, as usual, there is no nurse with the patient who is in need of emergency treatment. Let me stop and spin tires here for a minute.

Would somebody please tell me why it is o.k. to call for an ambulance that is supposed to transport a patient who is supposedly sick enough to be outside the capabilities of the facility…and yet doesn’t have a nurse close by to manage said patient who is in such bad shape. Furthermore, why do the nurses not have proper training on the use of oxygen therapy and the delivery devices for said therapy? Really!?! Wouldn’t you think that we’d need to have that little baggie under the mask inflated just a little bit, and guess what my genius friends…five liters ain’t cutting it and two liters per minute with twenty feet of canula ain’t gonna do it either.

O.k., so I go to the patient’s room and sure enough she is having a rough time of it with her breathing. I ask a young lady who follows me into the room how long this has been going on.

“Oh I’m just an aide…I’ll go get the nurse.”, she says and scurries out of the room.

The patient is CA/Ox4 and also has some secondary issues with pain in her abdomen (RLQ) radiating down her right leg. For this she has had a morphine pump prescribed by her primary physician. I’m more concerned with the breathing since it is so labored with use of accessories. She is also pale and diaphoretic and which narrows my differential down even more.

Before long a nursely looking type appears in the room. I think I recognize this fella from the hospital, and if I’m not mistaking he also works in the CCU, so I breath a sigh of relief and start my interview with him. The patient was having such a hard go of it breathing, I didn’t want to stress her any more by getting her to talk.

I turned from the patient to ask the nurse, “When did all this start?”

“I’m not sure…I don’t work here all the time”, he answers not realizing he has just let me down already. Is this a standard response for any nurse who works in a nursing home that is taught in orientation or is there a special nursing class just for excuses and responses to EMS personnel?

It wouldn’t bother me so much if it was only every other time, but this is EVERY time I go to a nursing home to pick up a patient…any nursing home it seems.

Not thinking I continue on, “What kind of health history does she have?”

“That’s a good question”, is all I get.

Thinking that I may actually get somewhere with the next question, much to my chagrin I try again, “what types of medication is she taking”?

“That’s a good question too”, he responds

Really?!?! You mean to tell me that with two years training and many more years experience, the only thing that I have learned to do is ask good questions. What’s more amazing to me at this point is that this guy has just recently graduated from nursing school with the same two years of training, albeit in a different discipline. Of course you would think that a nurse would at least know the answers to some of these general assessment questions.

I’m just plain disgusted at this point and ask if we can get a chart or something or get someone who does know what’s going on with this patient.

Just then another nursely looking type walks in with some papers cradled in her arm. Maybe we’ll get somewhere with this one I hope deep from within my soul.

“Here’s her paperwork” she says while thrusting some papers in my direction.

“Whoa, just a minute…what exactly is going on here…how long has this been going on?” I ask.

“I’ve already gave the report to the ER and Dr. Hey’you wants her brought on over”.

“Well, that’s all fine and well, but I have to treat her between here and there…she’s not looking too good… I need to know exactly what’s going on”.

By this time I guess I had said some magic word that gave me security clearance to some personal medical history and events leading up to this point. She started in with her rendition of what was going on while I was in the process of hooking up the EKG, which showed an old infarct or even maybe an area of ischemia.

I’m going to stop here with the “case study” just because I want to preach a little bit about being a professional.

First of all, if a physician had came in my truck, dressed in the same uniform and asked the same questions, would it have made any difference what questions were asked. After all, are we not the eyes and ears of the physicians who have given us standing orders to act on their behalf?

I know there are nurses who don’t like us for one reason or another, and most don’t want to hear our reports at handover only because they are going to ask the same questions that we just did. Many more will certainly not want to hear about any pre-hospital treatment performed because that will just remind them that we do assessment based treatments rather than physician ordered treatments.

The reason that I’m so fired up over this is because this nurse happens to be friends with another friend of mine and called him to say that I just came across as a smarta__ and acted like an a___ole because of the questions I was asking.

I am a professional. I am a patient advocate. It is my job and responsibility to assess the mental acuity, history and needs of the patient and then render the treatments necessary to preserve life and/or the quality of life until care is turned over to a higher trained individual, or in most cases someone in their charge, such as a nurse.

It does not matter to me who the patient is, where they come from and it certainly doesn’t matter what their social standing is. I refuse to accept the mentality that just because a person is in an environment such as a nursing home, that they have given up all rights to make decisions for themselves if they are able.

I can not tell you the number of times I’ve heard a nurse tell a patient “you have to go, the doctor said to send you over” all the while the patient is protesting going anywhere. If the patient can tell me who they are, where they are, how they are and why I’m standing there…they’re in control of their destiny, period. Now I feel the need to clarify something here. I know that sometimes a patient will not want to go for fear that they might inconvenience someone, but if their condition warrants a visit to the ER, it is still my job to advocate for the patient and I’ll do everything in my power to encourage them to seek treatment. But it stops there. I don’t and will not participate in the coercion of a patient to do something they do not want to do.

For the ones who cannot speak and think for themselves, I wish I had the power to say (after a thorough assessment) “No there’s no need to for them to go to an emergency room” just because they bumped into a door. I would love to protect those that don’t need or understand what’s going on from the battery of test and the isolation of the ER.

My tongue will bare the scars from the teeth that kept me
from saying the things I want to say, but my conscious will be clear because I gave every patient the best even when others around wouldn’t.

**Just to note. This same nurse does in fact also work in the CCU. This is the same CCU where the students from ALS cources go to do their clinical rotations for their respective program training. Supposedly they have a lot to teach up there, but I’m sure this one doesn’t understand what his true responsibility is to the medical profession.

12 March 2010

A time for reflection

It’s been a whole week now since I’ve gotten back from the EMS Today/CoEms/EMS2.0/flash vacation trip to Baltimore. Little did I know that that little trip would accomplish so much. I had my expectations, but never did I suspect that it would accomplish so much in so little time.

I came back last Sat. night and went straight into work…literally. I found myself whipping through the city streets going to this belly ache call and then the next with a renewed sense of job satisfaction. Somehow those belly aches seemed just as important as the AMI to me tonight. I guess it was just realizing that there are others out there doing the same ‘ol mundane stuff I am and facing the same problems and frustrations…just like me.

Even the casual run in with the non-caring nurse (so it seemed) at transfer of care didn’t set me off this time. It was only later into the wee morning hours that I had time to reflect on the conversations I had in Baltimore and it was then that it hit me. I had been imparted a seed of wisdom from the Happy Medic that most likely has changed the course of my career.

Really? Was it that dramatic you might ask.

To me it was...let me set the stage.

I’m sitting at Uno Chicago on the inner harbor of Baltimore enjoying a beer and grilled shrimp, courtesy of JEMS and George Washington University, with some guys who have made their way down from northern Joysey. To my right is this little guy that has more energy than Chernoble before it blew. He’s a medic I’m told, but doesn’t quite fit the image of such a creature. He’s no bigger around than a sapling but has the coolest gelled hair thing going, smartly dressed and quite articulate he is.

We’re talking about this little radio type show he does. Yeah, I’d heard of it; a couple of medical types get together in some garage and talk about all things EMS. He’s just all excited and so am I for some unknown reason as we are talking like we were in a garage, a very noisy one at that.

Out of the corner of my eye I catch this ruggedly handsome paramedic type approaching and I abruptly turn to say hello. This little bite size of a guy turns too and recognizes who it is, then introduces me to this man who has probably already tagged me as a groupie from our earlier encounters. With bedazzling speed and one swift motion he is out of his chair; he grabs this tall man by the arm and guides him into the seat that he had just vacated. With that, the little bite size medic is gone. Off to his next chance encounter with an unsuspecting guest who will never guess what name really appears on his driver’s license.

Here I am, sitting with the Happy Medic to my right. “It’s him…it’s really him”, I catch myself thinking before I realize that we’ve already talked a couple of times earlier today.

“So, having a good time?” he asks leaning in for a response.

“Wonderful time, just fabulous” I replied.

We engage in some small talk about this that and the other before I decide to take the plunge.

“Is this an inappropriate time to talk shop?” I ask.

“No, not at all”, he says without reservation leaning in.

I had so much that I wanted to ask on this trip, so many unknowns. Where do we at the ground level fit into the grand scheme of things. All of the who, what, when, where, why and how’s that you could think of were running through my mind. I came with questions and so far I had only found a hint of an answer. Ted Setla and I had talked briefly about The Chronicals coming to my area and how that could be made to happen. With that I came away with a clearer understanding of the mission of the project and how conversation would provide the starting point for change. That much I could appreciate but he surely didn’t understand where I come from. Here we don’t acknowledge our problems, and we certainly don’t talk about them. How does this work for me I still wanted to know.

“How does this work for us on the ground, those at the bottom of the totem pole?”, I started. “How do those of us who have ideas, complaints, concerns or problems get heard. How do those of us with integrity effect a needed change among those who could care less?”, I asked pleading for a simple answer that would fix it all.

I was about to get the simple answer that I so desperately needed to hear. However, unbeknownst to me, I knew the answer already.

HM thought for a second and spoke forth his wisdom, “You just be the person, the medic, that you want everyone else to be”.

What? Really? Was it that simple? Could that really work? Am I the one who will set the tone and the pace for professionalism around me? These are the thoughts that ran through my mind as I registered what I had just heard. Then he continued…

“Are you a Paramedic?”

“Testing in May”, I answered.

“Then what…” he asked.

“I’ll finish my associates next Fall semester”

“…and then…” he asked returning the volley.

I motioned to the George Washington University banner hanging behind me on the wall and answered “going to GW to complete my bachelors”.

He sit back and threw his hands up, “sounds like you’ve already got it figured out. It’s then that you can go to those that matter and approach them with your field experience and tell them you’ve got an education just like them and demand to be heard. You’ve got to approach them on their level.”

From that point forward it was all a whir as he talked about how he handled situations that surfaced in his world. I was then that I realized that I was missing one ingredient that will be the catalyst for all this information…patience.

This will take time. It’s not going to be an overnight thing by no means and more than likely I may not even see it in my life time. But what I do know is that my contributions, however small, will be added in with those of like mind and spirit, and that will be what makes the difference.

So here I sit… being patient. Watching time and events unfold around me in slow motion, revealing the master plan one piece at a time.

It’s not as frustrating as I imagined it would be, but then again, it’s only been a week. But now is a growing period. This is a time to flex my patience muscle that will lead to the ability to deal with the complications that arise from the evolving of our profession.

I will just go on doing what I do…being the kind of person I wish everyone else would be.

06 March 2010

Baltimore Meet-up

I absolutely love waking up in a hotel room! I'm not sure what it is though; maybe it's just knowing that I don't have to make my bed if I don't want to. Oh shoot, who am I kidding, I don't make it at home if I don't want to.

Now that I've had a few hours sleep, maybe I can try and channel my thoughts about the happenings of last night at the EMS Today Expo here in Baltimore, Md.

We didn't get to see too much of the floor displays since we didn't get here until a little after 1:00pm. What we did see was noting short of a living combination of a JEMS, Galls, Boundtree Medical or any other EMS type catalogue. Everybody has something they want to sell that is going to make our jobs easier. I feel so loved! It's almost like they care or something, because surely they don't think that we actually have funding for any of this in these hard times. I say this with love :)

The highlight, and of course the purpose of this trip was to go to the meet-up of the Chronicles of EMS, EMS 2.0 and the bloggers of all things Fire and EMS.

Who knew that I would ever be in the good company of the guys and gals that have become like an extended family over the past five months. It was awesome to sit and talk one on one with Chris Montero from EMS Garage! I never knew they made medics in bite size.

And of course there was Justin and Ted who took the time to to really spell out the vision and offer ways to make it happen in the trenches. The heart felt sincerity of these guys and the dedication of their spirit to making EMS work for everybody was almost magnetic. Even if you hated your job now you came away with a whole new perspective and appreciation for what we all do. Better than that though, you (I) came away with a more clear vision of where this is going. Rhett Flietz was just super; he really brought the involvement and application of social media down to my level. This guy is like a guru or something and a wealth of knowledge to boot.

I would be remiss if I tried to mention everyone who was there; just so many well knowns from our little circle. Good thing this blog has an edit feature.

But more than all the people who were just great to be around, there were the people who made this happen. I'll come back later and link names and organizations this weekend and post pictures. But JEMS and Goerge Washingtom University went A-L-L out with the party. I really expected to look up at any minute and see to big guy walking in at any minute, because I thought I was in heaven. Free beer and wine; and the food just kept coming!

There's just sooooo much more I need and want to mention, and I will later when I have more time. For now I though I need to get checked out of this room at the Sheraton on the 18th floor and get to the exhibit hall and try to take in some sights. Then it's back to work and out on the streets of Henry County tonight; but the lights will seem a little brighter this time.

Be well!!

04 March 2010

Medical Unknowns Part II

Maybe this was a bad time to post something needing a reply with everybody at the EMS Expo in Baltimore this week....but let's pick up where we left off.

Just as I walk outside my cell phone rings. It’s the office wanting to know if everything all right. “Don’t mean to be short right now but this guy is kicking our arse…I’m calling the attending now..bye”

Call the ER and just my luck I get one of the doctors who doesn’t particularly like us “para”medical types. I explain the situation to him, tell him what I’d like to do and get shot down mid-flight, “I just don’t like Haldol…just get him here best you
can”, I’m told.

I walk back inside the building and back downstairs and what-do-ya-know, there stands Jim outside the bathroom door, still in his under drawers, just ‘a smiling and looking around at all the attention he’s drawn.

“Hi…how’re you?”, he says to me as I approach him.

“I’m good, how are you?” I ask quizzically

“I’m good too” he says with not a clue as to what’s been going on.

“Ummm, Jim, can I get you to have a seat over here for a second so we can talk?”

“Yep”, he says as he makes his way over to the bench and sits down. He looks down at the monitor sitting in the floor and asks, “What’s that thing?”

“That’s a heart monitor”, I explain to him, “It allows me to take a look at how your heart is behaving…are you having any…..”

“How much you reckon it cost?”, he interrupts me mid-sentence.

Willing to play this out I answer “I’d say around 18 -20 thousand dollars…some a little more depending on the…”

“Phewww, that’s a lot”, he interrupts again and says taken aback by the amount I guess, “how many channels does it get you reckon?”

I realize what he thinks it is and just so I don’t get carried away with the technical aspects of the Zoll M series, I just give him what he wants to know, “Well, this one here gets 12”.

“Phewww…. ours gets about 60”, he goes on obviously talking about the cable T.V. there.

I’m at a total loss here. For the life of me I haven’t a clue about what’s going on. Did a leak solve all his anguish? I know I can get a little bullish too when I’ve gotta go, but I would just let it go if somebody was trying to hold me down to a bench and I had to go that bad.

About that time, two county deputies walk in and look over the situation. “We were told you guys were getting you tails kicked…ya’ll ok?”

Well ain’t this embarrassing now? I spend a second or two explaining what had just happened with the staff trying to butt in at every turn to help recount the incident. They just smile and knod, “We’ve had it happen too” they say. I’m pretty sure they thought I was crazy or something and just left us to our now complacent patient.

I decide I’ll take a chance here at this point to do a proper assessment and ask Jim, “Do you mind if I hook my antenna up to you and see if I can watch channel two?”

‘Ol Jim chuckles a little and grins, “You can try…but it won’t work.”
That old saying, he may be slow but he ain’t stupid…here we have it in real life.

I do a four-lead. My wife and I take the time to explain to him everything that we’re doing. Jim just sits there, straining his neck backwards and down trying as much as he can to see everything were doing.

“Well lookie there…perfect picture…channel two looks good and coming in crystal clear”, I tell Jim while noting a normal sinus rhythm. My wife has also gotten a NIBP and Sp02 which is all in normal ranges. The B/P is a little elevated, to which I attribute to our recent scuffling.

“Awww, that ain’t no T.V. show, that’s just a bunch of lines”, he says calling my bluff.

“But they’re good lines, the kind I like to see….are you hurting anywhere?”


“Any trouble breathing or getting your breath?”


I continue with a full CNS evaluation from the head down, PERL and he can wiggle his toes.…responsive to all commands and no deficits are notable. Not a clue.

I turn to the nurse standing to my right who has since gone to his room and returned with his clothes in obvious anticipation that Jim is going on a field trip, “Do you have all his medications together?”

“He doesn’t take any…just an aspirin every week or so; I think he had one yesterday”, she states.

“Well, I tell you what”, I say directing myself to the two staff members standing there,” you guys go ahead and get him dressed. I’d like to take him on over to the hospital and get him evaluated just to be on the safe side. I don’t see anything obvious and really don’t have any reason to suspect anything specific….but I just want to be sure, for his sake. I’m just puzzled about what set all this off”.
“Oh yes, absolutely, he needs to go”, one states emphatically as if there was a question if I would really take him. Both start fussing about getting his pants and shirt on and making him presentable for his trip to the ER.

Jim stands up, looks around at everybody and says, “Ready?”

Just to be sure, and willing to give the man his due I ask him if he feels like he can walk O.K.

“Yep, come on…this way”. Jim leads off with my partner/wife holding on to his arm, up the stairs and out the door to the ambulance parked right outside.

“We goin’ in that?” he asks pointing his finger along the entire length of the truck.

“Yeah, we’ll sit right back here…I’ll let you lay back so you can take a little nap if you’d like”, I tell him while opening the rear doors and boarding the truck to lead the way for him.

“Phewww, never rode in one of these before”, he says grabbing the hand rails and hoisting himself in.

“Nothing to it, eh?” I get Jim settled onto the cot and I hook the leads and B/P cuff back up.

The trip to the ER is non-eventful and my reassessment unremarkable. We talk about where he’s from and what he likes to do for a while. Jim’s curious about the cars behind us that he can see out the back glass. Over and over he asks why they’re following us, and over and over again I explain to him that they’re not following us; they just happen to be going the same way we are. Then I spend even more time trying to elaborate where they might be going, never really appeasing his curiosity.

Even more was his curiosity about the cost of everything. He wasn’t so much concerned with what it was; he just wanted to know how much it cost, and every time I gave him a ballpark figure he would answer with the same “Phewww, that’s a lot, ain’t it?”

Well, the rides over, Jim’s got to pee again, and we’re going into the ER. Jim is sliding over to the ER bed when he says, “Phewww, my head hurts”.

Oh… really?!?

“Where does it hurt at there Doc?” I ask feeling like goon now that there is a nurse standing there watching and listening to the patient tell me something that no one has mention…and I didn’t ask.

Jim reaches back behind his head with his right hand and rubs gently, “right back here where I hit it when I fell last week”.

Well…well…WELL!! What. Did. Ronnie miss THIS time?!?

I’ll leave it here for the sake of time. But I did find out later that night that he did in fact have a subarachnoid bleed, which of course there was nothing I could do anything about.

He did have to pee, and I think that was a contributing factor to the whole ordeal.

I’m thinking that the fact he woke up and had a full bladder was causing a small fluid overload in the venous system. I further surmise that this increase in venous volume was further elevated when he awoke which triggered the sympathetic nervous system, constricting the veins and thus caused increase ICP to the point where some cognitive function was compromised due to the pressure on the brain. I’m not sure, but I believe the aspirin came into play here as well causing more internal bleeding in a possible unstable clot

I can only see this as a viable option since the symptoms were in fact relieved after urination.

What do you think?

02 March 2010

Medical Unknowns Part 1

I have a two part story that I'm going to post this week. However, this one requires some audience participation.

I like to get feedback from time to time on my assessments and handling of a situation. I don't mind constructive criticism the least bit and at times I actually encourage it... o.k. need it

So if you would, read the following part of the post and tell me a couple of things:

1) What would be your working diagnosis?

2) Would you have done anything differently?...what?

I'll post the second part Thursday evening before I leave for the meet-up in Baltimore...so here we go!

I’m sleeping the other morning and I’m jostled awake by the tones dropping for a station out in the county. Possible heart attack or seizure dispatch advises.
Surely somebody would know the difference given the location of the call I think to myself. It was at an assisted living facility that houses mostly functionally MR residents.

Anyway, the volunteer station is not able to muster a crew so I haul it up off my little nap-mat and head to the truck. My partner, who happens to be my wife this morning, and I saddle up and head on out through the city to the call. We don’t get to work together much unfortunately, but when we do I like it just fine. ;)

I’m notified over the radio that the nurses think a resident is having a heat attack or something. Regardless of what it is, it sounds serious I’m told.
I push it kinda hard because we’ve got right about a 10min. response time from where we are in the city to the scene. There’s not a lot of traffic out at 5 o’clock on this morning so we make pretty good time.

We arrive on scene at the home and pull around to the side entrance. Oddly enough the refuge for these people who need help with their ADL’s is an out of service church building converted to a home…of sorts, but hey, it works.
As I pull up I notice a nurse; RN, LPN, CNA…I don’t know, she was wearing scrubs…she is motioning frantically for us to come on in. I grab my I.V. kit and the monitor, my partner/wife grabs the jump bag and we head in to the facility. Down the steps to the basement level we go, twisting and turning through the halls around obstacles following this frazzled lady who can not take the time to tell me what in the world is going on.

I enter a room that has three beds arranged in a Tetris like fashion. On the bed to my left I see a man in his 50’s wearing nothing but his skivvies and a t-shirt, being, or attempting to be, restrained by a well meaning staff member. This guy was giving her hell. He was trying to get up and she was trying to hold him to the bed. He’d go up and she’d push down. It was kinda comical watching it for a second because it looked like she was pushing the guy down onto a spring and he would just pop back up. To add to the humor of the occasion, every time she would push him down she’d say “Jim, stay still” or “Jim, please be still”. Well Jim wasn’t having any of this.

“What’s going on this morning?” I asked holding back a laugh.

“I think he’s having a heart attack or something”, she started. “He woke up while we were dressing Larry” she said motioning to a half-dressed man watching intently from across the room, “and just grabbed his chest…he started trying to get up but he just looked like he was in so much pain and I told him to just lay still and we’d get him to a doctor.”

“What kind of medical history does he have?”

The nurse behind me chimes in and says, “Well, he is retarded and he is a diabetic…we checked his sugar after we called ya’ll an it was 162.”

Retarded huh? Now, is that subjective or objective? C’mon lady…this ain’t my first rodeo, I’ve been in this place before.

“What’s he normally like…his personality…how does he interact?”

“Oh, he’s real nice. He don’t give us no problems at all…he just likes to help out and watch T.V.”, I’m told with a voice of utmost assurance.

I told the other staff member to let him go and I grabbed Jims left hand with mine. “Sit on up here big guy”, I said as I helped him to the edge of the bed. “What’s going on with ya this morning?” I asked trying to elicit a response.

Jim just sat there on the edge of the bed kind of rocking back and forth a little and looking around the room while chewing on his tongue it looked like. I noticed that he was breathing rather hard but attributed that to the ultra light-weight UFC match I had just witnessed. He wasn’t diaphoretic and really showed no signs of distress other than the fact he seemed to be a little agitated.

“Jim, are you hurting anywhere…anything not feeling good”, I asked with no response.

Jim stopped rocking and looked up at me with big ‘ol tired eyes and expelled a big huff of air. With strength I didn’t expect he stood up and stood still for a second as if he was getting his bearings about him.

He stepped off on his right foot and headed towards the door that leads to the hallway. “Where’re going there buddy?” I asked and followed behind holding to his arm.

Now I’m trying to get into his mind and figure out what’s going on. I’ll give him all the leeway he needs so as to not agitate him and try building some report’. What must he be thinking right now? He’s probably scared…or is he mad? Does he have a clue as to what’s going on?

Jim headed out the door, turned to the left and started down the hall. “Where’s the bathroom?”, I ask curiously.

“Right down there…at the end of the hall”, the nurse says

Jim moves on with a slow and steady gait, moving on past the curios looks and gazes of the other residents. Well, maybe we’re getting somewhere now I think to myself.
Ol’ Jim here just has to pee, pure and simple…but why isn’t he talking?

Just when I thought we were about to put and end to this call just by letting the guy go pee, he walks right past the bathroom door to the end of the hall. There is an old church style bench there against the wall that faces the direction we just came from and we head towards that. By his arm I lead him to the bench and ask him to sit down, he shrugs a little and flairs his elbows out a bit trying to shake us off. O’ boy!

I certainly didn’t want it to get this way but I just couldn’t let him wander around aimlessly after being told that his mental status is altered from normal. I need to figure out what’s going on; is this a stroke…was their glucometer off of something?

I finally get him to sit down and my partner/wife is getting a lancet and strip ready. I’m attempting to do a stroke assessment when out of nowhere this guys stomps his feet and flings his arms and lunges up at me with his head into my gut. Damn, that hurt. I can’t let this guy just get up and go running off at this point because something’s not right here. I put my forearm across the back of his neck and try to push him down to the bench he’s sitting on. This guy is strong and starts bucking like a wild bull or something, flailing his arms and stomping his feet. I can’t say for sure if he actually “hit” anybody but he was wearing me out just trying to restrain him.

Complicating the event even more was the insistent shrill voices of the staff pleading with Jim to “stop” and to “calm down”. They were making me want to have a fit.

While all this is going on I tell my partner to go ahead and try getting another glucose reading while I try and hold him still. You can just imagine the battle that ensued over that; I think she did end up getting hit in the process while pricking his finger.

Glucose level 147. Well hells bells…what is up with this guy?!? He finally manages to stand up and I just back off and tell everybody to just stand back for a minute. Then he just sits back down as if it’s all over.

I get my cell phone out so I can call the ER attending physician for orders for Haldol. One thing I know for sure; I want to get this guy evaluated and find out what’s going on. I don’t have a cell signal in the basement of this building and they don’t have a cordless phone either. So against my better judgment I run upstairs and outside to call the ER. I’m not too concerned for my wife’s safety at this point; we’ve got two teenage boys and I know what she’s capable of handling. That firery red hair packs a mean punch all by itself.

O.K., so there we have it. What do you think was going on here? What did I miss? What would you have done differently?

28 February 2010

I am what I am...

I’m back! Hope I haven’t been excommunicated or anything yet since I haven’t been out “visiting” much. I just have not had a lot of spare time to devote to reading blogs and writing as I usually do, and boy do I miss it.

We’re coming down to crunch time around here as my trek towards the NREMT-P glitter enters its final stages and May 12, 2010 is circled on my calendar. This has been a long two years and there have been a lot of ups and downs along the way. A lot of learning has gotten underway and a new mindset has emerged. I will hate to see it all end soon, but at the same time I am so ready for it to be over. Luckily there is going to be a few months off for me before I trace off to the University of Georgia to take the Critical Care portion that will set me at the pinnacle of training in EMS.

With the clinical rotations at the hospital almost done, there’s nothing left really but a bunch of field time under the watchful eyes of a preceptor; who I think just appreciates the opportunity to just sit back and ride third-man. It does get mundane having to do this in a clinical/student atmosphere since this is what I do for a living as well. It just ends up being the same ‘ol stuff over and over, almost like a recurring nightmare or something. Add in amongst all this the remaining course work, studying and finals approaching; it’s almost more than I can stand. Oh, and of course let’s not forget that I fancy myself to be a family man, and all this “free” time on a truck takes some pretty valuable time from the wife and kids. But alas…it’s almost over!

A little housekeeping is necessary as I continue on. I got a message on FB the other day from an individual who was curious as to how I can call myself a “medic” when I’m just an Intermediate, but a NREMT-I mind you.

It’s a legitimate question I guess.

In all fairness I admire the person for taking the time to educate themselves. Then the other night at work another discussion came up about who calls themselves a nurse. Seems that an LPN, or a LVN in some areas, should not be allowed to call themselves nurses because they do not go through as much schooling and training as an RN…really? Apparently, a CNA is as an EMT…a LPN is as an Intermediate and of course an RN is as a Paramedic.

This to me is a wierd analogy because I as an Intermediate (we as medics) can do more outside the hospital than most of them can ever immagine doing inside the ER. I guess they will just be happy with the respect the have garnered.

Now I’m not really sure how this washes out in the hierarchical ladder of certs and licensures, nor do I really care. I came to the conclusion a looooong time ago that it doesn’t matter what my title or position is in life, just as long as I do my job to the best of my ability. John Q. Public is gonna call me a lot of other things, like an Ammalance Driver, or an EMT, and to some, everybody who shows up on the ammalance is a Paramedic. John Q. Public also doesn’t realize what I, you or anybody else on that ammalance can do as far as procedures are concerned or what drugs can be administered. They just want a ride to the ERrah , gimme sompin’ for pain and nausea or there is of course the legitimate 911 caller who will expect you perform heroically and save the day due to a life threatening illness/injury. So it really doesn’t matter what you are to me as long as you do your job as trained and certified, and do it in a professional manner.

Let me see if I can make this short and simple.

I’m not gonna get into a pissing match about who calls themselves what. What does matter is that it comes down to the discipline and the skill set. I’ve never represented myself as a Paramedic, however, the great Commonwealth of Virginia has seen fit to align the skill sets (protocols) of the I-99 level and those of the Paramedic in almost a mirrored fashion, with the exception of a drug and/or procedure two that calls for on-line orders… that are usually given depending on the provider. Do I like it? No. I know some Intermediates who will NEVER rise to the knowledge required for the Paramedic level because in truth they are incompetent in a lot of areas that matter most. But still yet, when they are on a truck, it is a medic truck none the less. On the same hand I can count the reasons some Paramedics I know should not wear the title either because the are as unprofessional as they come. But there it is folks, call it what you may, but when I show up you will get the all that I have been taught, trained for, certified by my state to practice and all that my OMD will allow me to do. I guess the beautiful thing is that when someone does get their Paramedic in Virginia, they come out into the field with a leg up in the game already having had some experience in the field.

So yes, as much as some may not like it (me included sometimes), I am a medic for all practical purposes. Just as the basic trained soldier on the battlefield who wore a red cross on his helmet was a medic, so am I. I do however, reserve and revere the title of Paramedic as someone who has been trained to the minimum levels required by a sanctioning body to practice at a certain level and has the professionalism to operate as a skilled physician outside of a skilled physician’s direct control.

Now in the words of the great Forest Gump of the renowned Bubba-Gump Shrimp Co. ……That’s all I have to say ‘bout that.