Monday, December 31, 2007

On Studying...

I had an instructor that once said that we would study more after we got out of school than we ever did while in class. Even though I have the utmost respect for that instructor, I had trouble believing him. Just like a teenager, as I grew up he got smart all of a sudden. By growing up I mean gaining experience as a paramedic.

I have opened my paramedic text so many times in the past few weeks I am thinking that I may have to buy another one because the spine is wearing out. I have been recently fully cleared to ride with anyone. Lately my supervisor has made full use of this. I have been working with the round-robin of brand spanking new EMT's and Intermediate's, not even one new paramedic.

One of my favorite shows to watch is ER. I have started collecting past seasons and my wife got me a few of them as stocking stuffers for Christmas. I have been watching them lately. It's kinda funny, I have watched that show for a long time. But now it invokes a much different thought pattern. I don't know if any of you readers out there watch ER, but as the name implies it's about an ER and the doctors and nurses that work there. There are paramedics in the show, but they are all just extras. They do make us look good most of the time, they roll into the ER with their patients neatly packaged, ready to hand off care with a quick, concise report. Then they roll back out, usually unnoticed as the drama of the ER unfolds.

The reason I mentioned this is that while I sit here watching this show and see the different types of trauma and medical patients that they treat, I wonder how I would treat that patient or that presentation if it were me.

So that leads me back to the original topic of discussion...studying. When I see a presentation or just think about something that may happen. A situation that is unlikely, but nonetheless a possibility each day I go to work. That in turn leads me back to my text, protocol book and of course the Internet.

It's funny how things work. They don't turn you loose until you have the experience on the street, but by the time you have the experience you are so far removed from the classroom that you've forgotten all the little details on all the stuff that hardly ever happens. I know that we are all supposed to be machines in our ability to remember every little thing on the fly, but that's not what happens. At least not to me. When I finally graduated, I never wanted to see another textbook, much less spend hours staring at one. So for the past few months, that is exactly what i have done, or rather what I have not done.

But to be honest I am terrified that something will happen and I will not remember what to do. Like the exact placement of the BIG on an adult patient, or how to mix an epi drip or some off the wall pediatric dosage. So I study, all the time, every time something new comes to mind.

I know that in the end it will only make me better, but I wonder if all new medics go through this...


Monday, December 10, 2007

Just another day...

I apologize to the readers who come back to my little corner looking for something to read and have been disappointed. With the new baby and the other two kids, the Wife, work, teaching and taking classes, I've not had that much time to write. So here is the account of my last shift...

We had a student rider to come and do his clinicals with us. Have you ever noticed that whenever a student comes, it's either feast or famine? Either you run the worst calls or absolutely nothing. Well, this student is a "white cloud", meaning that we run nothing. Every time he has showed up I can count on being able to catch up on my sleep.

I kinda hate it for the guy because my cert card is barely dry and I remember all too well what it was like to do field clinicals. I know that he wants to get out there and tube someone, push every drug we have in the box and shock people 'till all the batteries are dry. I've offered to answer any questions he has. He's asked a few, I showed him all about the monitor, CPAP, BIG gun, MAST trousers, the pressure infuser and any other piece of equipment that we have on the rig. We've went over all 42 drugs in the box and he knows them by heart. So now we just sit around and watch TV or sleep. You know, just another day in EMS.

Last shift, he had no sooner pulled his little hatch-back car with all the EMT stickers and red lights out of the parking lot than the tones went off. We didn't stop for almost 8 hours. God, I wish they'd let him ride for 24 hours instead of just 12.

First call was for a choking at a nursing home. Nothing to it, little old lady got choked up on her mystery meat and the nursing staff freaked. You shoulda seen the look on the doc's face when we brought that one in...

Next was a CVA (stroke). Middle aged man had an acute onset of right-sided paralysis with blurred vision also in his right eye. No prior history except for diabetes and migraines. His symptoms were fully resolved way before we got there, and we only had a 4 minute en route time. He's a little sweaty, but otherwise he looks fine. The first responders say that his pressure is like 280/ 140 and they took it 3 times just to make sure.

We got him in the truck and they were right on the money. IV, O2, monitor and we were on the road. I gave him 2 sub-lingual nitro's and a clonidine. We were about 40 minutes away from the hospital and I actually got to see the clonidine work. Finally got his pressure to 160/ 100 and that was good enough for me. He never had any complaints whatsoever.

The last call of the shift was for a reported unconscious. We get there and the first responders are freaking a little bit. An elderly lady is propped up in bed, unresponsive, breathing about 30+ times a minute and looked like crap. We got her out to the truck and got to work. Her O2 sat's were in the 70's and her capnography was 23mmHg. History of COPD and CHF and lung cancer that was in remission, but no wheezing and no rales. Her lungs sounded good, for the little amount of air that she was moving. She came back around before we got to the highway and stayed that way until about 5 minutes prior to pulling up at the ED. She just finally wore out. I had my intubation stuff ready, but there wasn't any time, so I got a nasal airway in and bagged her the rest of the way.

As we moved her over to the ED bed she woke back up. We waited around just to see what they would do for her. I figured about CPAP or BiPAP, my partner thought they should just tube her. I didn't think she needed it and if they did, she would probably never come off the vent. Her sats dropped to 50 by the time the doc decided to do something about it. I didn't feel like watching them let her die, so we left. Not sure what happened. We got back and slept for the few hours before the morning wake up call.

And that was just another day...


Friday, December 7, 2007

The Power of Being Nice...

My partner came to our service from the Big City EMS down the road. He has what I call the "Big City Attitude" most of the time. Don't get me wrong, he is an excellent medic and when someone is actually sick, he is one of the good ones to have around. But he had no patience whatsoever. Especially when it comes to patients that fall into the "BS" category.

We had a good day last shift, not too many calls. All but one were BLS, the other was just a simple diabetic. We sweetened her up and then she refused. She was a little old lady who had delt with her diabetes for over 20 years. Her husband had delt with it as well. All the while we were trying to start an IV he was up and moving around the little apartment they shared. You could tell he was nervous. He knew exactly what was wrong and that we would help her, it had happened many times before. But he was still anxious over his wife of over 40 years.

My partner was getting irritated at the husbands actions and how he was worrying us all with his advise and him going on and on about how she hadn't been taking care of herself as of late. I could see the growing frustration in my partner, so I stopped looking for an IV and got up to help the man look for whatever it was that he was searching for at the moment. I talked to him and offered reassurance that his wife was going to be OK. The look in his eyes was relief as someone was actually paying attention to what he had to say.

The rest of the day was all BLS. Most of them at nursing homes. Another little old lady fell and now she was having hip pain. She was scared that her hip was broken. Even though there was no deformity, shortening or rotation, I handled her with the same care that I would with my own grandmother.

A large lady had fallen out of her wheelchair while trying to get to the toilet. She was over 400 pounds and did not smell very well. She was having some trouble breathing and was embarrassed of being on the floor. We helped her up and I gave her one of our bedpans so she would not have to move from the bed to do her business. I listened to her story of how she had just been released from a long hospital stay for an infection. We got her situated and then left.

All through the day I made it a point to be nice. To listen to my patients, no matter what the circumstances or what they had to say. I noticed that as I continued to "be nice", my partner's attitude also changed. He didn't completely loose the "Big City Attitude", but he toned it down a great deal. It was as if my actions were effecting his. That by seeing how I was toward the patients, he unconsciously was doing the same.

Interesting how our attitudes and actions affect others around us, even those who we look up to and should be teaching us.....