Wednesday, November 14, 2007


Today this blog hit the 10,000 mark! Thanks goes out to all those who have me linked on their blogs and the people that have come and read and commented. Thank you all very much!


Tuesday, November 13, 2007

Two's....part two

The very next shift we get called out for another MVA about a 1/2 mile from the one the shift before. It's dark and it's raining...again. We get there and it's also another T-bone type collision. Deja vu, I think.

Luckily, this one isn't as bad. I had one patient that was sitting outside her car and crying. She had been wearing her seat belt and the airbag had deployed. I put a c-collar on and place her on the board and get her out of the rain and into the truck. A full assessment revealed some minor cuts and bruises. Overall she was a lucky kid, her car took a hell of a hit. We dropped her off at the ED and headed back to the county.

Sometime after 2am we get a call for an unconscious. When we arrive, the house is small and cluttered. There are several people standing around this large man laying on his back on a bed in the living room. He's unconscious, sweaty and barely breathing. The bystanders say that he just got back from a military hospital overseas. He had been shot 3 times in the back while in Iraq. He hadn't been stateside for 2 weeks.

His pupils were pinpoint and non-reactive. They said that he hadn't taken anything, but the fire department that showed up to help found a bottle of morphine tablets that was empty. It had been filled 3 days before. We had our culprit.

It took all four of us to get him loaded on a board and then to the truck. I wasn't working with my regular partner, he had taken the shift off. I had another full-timer from another truck. He was real laid back and made me call all the shots on every good call we ever ran together.

When we finally got the patient to the truck, everyone was looking at me for answers. I got everyone moving. Start assisting ventilation's, get a blood sugar, start a line and get him on the monitor for starters.

A minute or two later that's all done and they are looking at me again as I finish taping down the line. I re-access his breathing and decide to intubate. I tell the fireman to try to put in an oral airway to see if the guy has a gag reflex. It goes in easily. I instruct him to keep bagging while I get my stuff ready.

Tube in hand, I slide the blade in and the guy bites down, hard. Then he raises up like he's gonna get off the cot. At first I thought he had broken his teeth on the metal blade, but luckily he didn't. Hhmmm....well, intubation is out, I don't want to try that again. I look at my partner and tell him to give some narcan, 0.5 mg to be exact. He gives it while I am still at the head.

This is the part where I get puked on, again. I had eye protection on this time at least, but I still had puke all over me, including my face. I have administered narcan before, but never have I had a patient puke with so low of a starting dose.

One of the fireman suctions the patient and my partner bags him while I wipe the crud from my face. The patient is still unconscious, but his breathing has improved. I put the oral airway back in and decide to bag the patient all the way to the hospital.

When we get there the doc orders 2 mg of narcan IV. I step out of the room to finish giving my report while they give the medication. I watch in semi-amusement as the nurse that is trying to get another line sidesteps a little too late to avoid the brown stream that suddenly erupts from the patients mouth.

The patient didn't get any better and they eventually RSI the guy. We left after that and didn't go back that night so I didn't get to find out how he turned out.

So concludes the tale of the two's. You see, in my experience everything comes in two's. I had two MVA's with pediatric females and then two calls where I got puked on. This wasn't the first time I've had a case of the "two's" either.

Oh yea, if I never give narcan again it will be too soon....


Two's....part one

Most people say that everything comes in three's. My experience is that everything comes in two's....

Just after dinner we get a call for a MVA (Motor vehicle Accident) with a pin-in. We get to the scene and my partner drops me off at the first vehicle and then speeds the 100 yards down the road to the other vehicle.

The van had moderate front end damage but no one was inside, which was a good thing. That usually meant that whomever was inside is OK, at least OK enough to move under their own power. It was night time, it was drizzling and there were lots of people standing around so it was hard to make out who might have been inside the van.

I grabbed someone and asked and he points me to the 3 people sitting on the side of the road. I walk up and ask if they were indeed the passengers of the van and they said yes. I asked if anyone was hurt and they said no. They also said that they did not want to be taken to the hospital. About that time the fire department showed up and one of the guys asked me if I needed anything. I told him to do a quick check and get vitals on the three people sitting there and then if everything was OK, get the refusals. (I had known this particular Fireman for awhile and had worked with him, so I trusted his judgement.)

I turned my attention down the road toward the other vehicle and see a mass of personnel surrounding it. I trot down that way to see if I am needed. My partner was about half in and half out of the car from the passenger side trying to assess the patient and figure out exactly where she was pinned at. She probably went for about 300 lbs and she was in a semi-compact car. A fireman was in the back seat holding c-spine and everyone else was either standing and watching or getting the rescue tools together to try and pop the door.

I started my usual walk around the vehicle when someone hollered at me. I turn to look and there at the side of the road stands a woman holding a shirt to a girls forehead and there was blood all over the girls face and chest. Another teenage girl was standing beside the two crying hysterically into a cell phone.

I walk up and ask the stupid question "Is everyone OK?" The woman says that she is a nurse and that both of the girls were in the accident. The girl with the blood all over her is just standing there as if in a daze. The nurse says that she has a nasty cut on her forehead and the shirt was all that she had to put against it to hold pressure. I said that she did the right thing and then look around for some help. No one is paying any attention to me, the rescue is in full swing and no one can hear me above the roar of the machines.

I tell the woman to hold tight for a minute and that I would be right back. I run to the truck and grab the spare jump-bag and snag a first responder from another dept. that just happened to be driving by. I was glad it was her, because she is very good and I trusted her as well. I asked her to get me a backboard and to pull the stretcher from the truck. I turn back to the scene and my two pediatric female patients.

The first responder is right behind me as I get back to the patient and we put a c-collar on and immobilize her from her standing position and then get her on the cot and to the truck. The nurse and the other patient follow behind. I hear in the background another ambulance coming in hot. Someone must have called for the second in.

I pull the soaked shirt away from her head and take a look. She has a laceration from just above her eyebrows leading into her hairline. I can see the glistening white of bone as I clean the wound and get bits of glass out of it. Then I put a dressing around it and finish my assessment. She has abdominal and left hip tenderness and her vitals are a bit off, as of the beginnings of shock. I start a line and get her on O2 and the monitor. She is conscious but not really there, doesn't remember what happened or exactly where she is.

The other patient, a teenager, is still crying, but not as hysterically. She has only a minor cut on her leg and I can't find anything else wrong with her. About that time the EMT from the other truck comes up and asks me if I needed anything, I said just a driver. He runs to the scene and then runs back to my truck and gets in. He looks back through the cubby-hole and asks me where to? I tell him Big City General and make it fast.

We get to the ED with no major problems, both patients maintained all the way there with no further complications. I give my report and walk back to the truck to start cleaning up....

Later that night as we were coming back from a routine transfer to the local ED we hear another truck asking for help. We were the closest, so we asked dispatch if they wanted us to go. We got the green light and headed in that direction.

We pulled up and the crew was already in the other truck with their patient. My partner opened the back doors to a mess. The patient was a large man, he hung over both side rails and each end and was slightly blue. He was unconscious, breathing shallowly about 8-10 times a minute.

The senior medic was getting his intubation equipment out and the other medic was trying to get a line. I went to help with the airway and my partner helped with the line and getting the monitor on. I got a BVM (Bag Valve Mask) out and started assisting with ventilation's. The other medic was ready to intubate and stuck the blade in the patients mouth.

He started gagging and jerking around. He's still got a gag reflex, I thought. But the senior medic is still trying to get the tube. After about 3-4 tries he sticks it in and I listen for lung sounds. "Your in the stomach", I say. He grabs the bag and starts squeezing anyway. We watch his belly get bigger. He yanks the BVM off and at that time the patient pukes.

If you've ever put a tube in the esophagus and the patient vomits you know what happened next. The vomit now had a barrel to shoot out of. The puke hits me square in the face before I had time to react. My partner and the other medic starts to gag as puke hits the ceiling of the ambulance. Senior Medic grabs the tube and tries to pinch it off and only succeeds in increasing the velocity of the stream. Needless to say it was a mess.

The patient is still breathing on his own and starts to aspirate the vomit that is inside his mouth. The senior medic looks at me and says "You try". I said that the patient was breathing on his own and has an intact gag reflex, so if you want to tube him, why don't you do it nasally? He wasn't hearing any of it and told me to do it.

At this point I faced a delima. He is a very respected Medic with 20+ years of experience, and the ink on my certification card is still wet. If this was my patient, I would never have tried to intubate him orally. We don't have RSI, so that is out of the equation. I would have nasally intubated him if anything, barring that I would have just bagged him all the way to the hospital. In the end I gave in to the senior medics glaring stare.

I told him to leave the tube in place so there was only one hole to hit. I get it on my second try and lungs sounds are questionable. I know that I am in, because I saw the tube pass through the vocal cords, plus there was condensation forming on the tube. I tell the others to get me a capnography filter and then we would know without a doubt. About that time the patient starts coughing and I look down. Apparently I hadn't been holding the tube well enough because he coughed it back up, inflated balloon and all.

"What do you want to do now?" I ask the senior medic. He says that he will just bag him the rest of the way in. I say OK and me and my partner get out of the truck and they pull away.

I look down at myself and I am covered in reddish puke and sweat. I peel my uniform shirt off and try to wipe the chunks out of my face and hair the best I can. I feel disgusted, both with the medic on the other truck and the fact that I had backed down from him, not to mention that I was covered in someone else's puke......

To be continued....