I've hit the year mark. One year as a paramedic. Actually that mark came about 4 months ago. But it seems almost like yesterday that I was still going to class and clinicals. Still had the world in my grasp so to speak, at least that's what I thought then. I suppose that to some, well...to most, I am still wet behind the ears and I guess I would have to agree in some aspects.
When I got out of school I thought that I was ready to take on the world. I was ready to cure the ill, bring the dead back to life and make little old ladies walk again. I can't help but to laugh at that now. It's intereseting the changes that you go through as you gain experience. It's also interesting the things you forget as time goes by.
When I was in and fresh out of class I could spout off just about anything you wanted. Pediatric dose for some off the wall drug? Bam, right there it was, on the front of my mind. Now? Hmm, have to think about it a little first. I used to look down on some medics for not knowing some of those things. Now I see why. I'm not excusing myself or others. It's our job to know these things. But sometime things just kind of fade from memory without constant vigilance.
In this past year I've went from a brand new medic to a now FTO. Thats short for field training officer. The training officers for the region that I work in have gotten together and started this program for FTO's. The old precepter program is outdated and none of the 5 services in our region nor the students riding in those counties use it. So a bunch of us from each service have been sent to all kinds of classes on how to teach in the field. A lot of it is very interesting and has helped, but the rest is fairly boring and stuff that we, being students once ourselves, already know. Anyway, I now get students that come to do clinicals on my shift and the new hires when they are doing their orientation rides.
I find that I enjoy it though. I have also been teaching for about a year now. I love to teach. In some ways, I like it more than actually running calls. I had an incredible instructor through my Intermediate and Paramedic classes. We learned so much more than what was in the books. I enjoy giving back the little knowledge that I have and the little tricks and things that the more experienced medics have taught me along the way.
As far as me being a FTO now, I'm not really sure what to make of it. We've had a lot of turnover recently, as most services around here have. There is also that gap that seems common place in EMS. There are a lot of medics with 15+ years of experience and then a lot with less than 5, with not too many in between. I don't know if I was picked to be in the program because of my competance or just lack of options. Think about it, a medic with only one year of experience is teaching others how to be a medic. Doesn't seem right to me sometimes. It seems like the more experienced people should be the ones teaching. But since it fell in my lap, I do the best I can with what I got. I hope they go away with more than they came with.
Monday, August 4, 2008
Thursday, July 31, 2008
I'm back...
I reckon I'm gonna try this bloggin' thing again. I apologize for the readers that have come back looking for something and finding nothing. I have a lot of excuses, most of them probably not good ones... So I'll spare you...
BRM
BRM
Saturday, April 5, 2008
Fight...
I hate Narcan. I really, really do....
The last two times I have given it, I got puked on for my efforts. This time I got into a fight.
We got the call for a chest pain that turned into an unconscious while en route. Me and my partner look at each other thinking this is gonna be a code. We get there and it's a whole other story.
The patient had ingested an unknown amount of alcohol and possibly taken some Vicodin. He was completely unconscious and unresponsive. We get him loaded up and do our thing. All his vitals, 12-lead and blood sugar are normal. Except for his breathing; about 8 times a minute and shallow and his pupils; constricted and nonreactive, everything is normal.
I decide to give him 0.5 mg of Narcan. A few minutes later nothing was happening so we decided to head to the ED. My partner was standing on the back step talking to a family member when the patient decided to wake up. He immediately began to struggle against the cot straps. I tried to calm him and let him know what was going on. He wasn't hearing any of it. He said that we should have let him die and when asked, he said that he had been trying to kill himself. In my county that is enough, they are then deemed a danger to themselves and they are going to the hospital one way or the other.
He then wanted to fight. He took a swing at me and caught me on the side of the face and then another on the chest before I could get around to his head to control him. I've been trained on how to subdue people, both medically and non-medically. I read an article in EMS Magazine a few months ago on restraining a patient and got several tips that I used that night. I went straight to the captains chair and laced the fingers of both my hands under the patients chin and pulled back. This pins the patients head to the cot, closes his mouth to inhibit biting and spitting and you are still able to control airway and see the entire patient and keep monitoring. A very good technique as it worked very well, is easy to do and is safe for the patient. I recommend it to anyone that needs it.
My partner jumped back in and on top of his legs. One of the first responders came in and tried to get his arms and got socked on the jaw for his effort. The patient continued to fight and curse and generally make an ass of himself while we called for the sheriffs department. All this happened in about 30-45 seconds, although it seemed like a lot longer. We got a non-re breather on him and just held him there. The reason for the mask was one to administer O2, which never hurts and another to keep him from spitting. He wasn't yet, but it usually doesn't take them very long to start after they figure out that they can't do anything else.
We held him until the deputy got there and placed him in custody then cuffed him to the cot. We got his legs strapped with cravats and put the shoulder straps on so he couldn't move his upper body. The patient then got the bright idea that he would choke himself on the V made by the chest strap and the shoulder straps. He wasn't the brightest crayon in the box, but he gave it the all American drunk try. I let him, I was tired of fighting with him and I figured that he would either give up or pass out, I didn't really care which at that point.
Eventually he gave up and he finally calmed down during the transport. Then he started bawling, going on and on about how the world was out to get him and how life generally sucked for him. I didn't feel like it, but I listened to it and tried to calm him further and told him that there were people at the hospital that would like to help if he wanted it.
We got him to the ED and turned over care with a promise from him that he wouldn't give any of the nurses any trouble. I don't know what happened to him after that, but I have a feeling that I will see him again at some point.
BRM
The last two times I have given it, I got puked on for my efforts. This time I got into a fight.
We got the call for a chest pain that turned into an unconscious while en route. Me and my partner look at each other thinking this is gonna be a code. We get there and it's a whole other story.
The patient had ingested an unknown amount of alcohol and possibly taken some Vicodin. He was completely unconscious and unresponsive. We get him loaded up and do our thing. All his vitals, 12-lead and blood sugar are normal. Except for his breathing; about 8 times a minute and shallow and his pupils; constricted and nonreactive, everything is normal.
I decide to give him 0.5 mg of Narcan. A few minutes later nothing was happening so we decided to head to the ED. My partner was standing on the back step talking to a family member when the patient decided to wake up. He immediately began to struggle against the cot straps. I tried to calm him and let him know what was going on. He wasn't hearing any of it. He said that we should have let him die and when asked, he said that he had been trying to kill himself. In my county that is enough, they are then deemed a danger to themselves and they are going to the hospital one way or the other.
He then wanted to fight. He took a swing at me and caught me on the side of the face and then another on the chest before I could get around to his head to control him. I've been trained on how to subdue people, both medically and non-medically. I read an article in EMS Magazine a few months ago on restraining a patient and got several tips that I used that night. I went straight to the captains chair and laced the fingers of both my hands under the patients chin and pulled back. This pins the patients head to the cot, closes his mouth to inhibit biting and spitting and you are still able to control airway and see the entire patient and keep monitoring. A very good technique as it worked very well, is easy to do and is safe for the patient. I recommend it to anyone that needs it.
My partner jumped back in and on top of his legs. One of the first responders came in and tried to get his arms and got socked on the jaw for his effort. The patient continued to fight and curse and generally make an ass of himself while we called for the sheriffs department. All this happened in about 30-45 seconds, although it seemed like a lot longer. We got a non-re breather on him and just held him there. The reason for the mask was one to administer O2, which never hurts and another to keep him from spitting. He wasn't yet, but it usually doesn't take them very long to start after they figure out that they can't do anything else.
We held him until the deputy got there and placed him in custody then cuffed him to the cot. We got his legs strapped with cravats and put the shoulder straps on so he couldn't move his upper body. The patient then got the bright idea that he would choke himself on the V made by the chest strap and the shoulder straps. He wasn't the brightest crayon in the box, but he gave it the all American drunk try. I let him, I was tired of fighting with him and I figured that he would either give up or pass out, I didn't really care which at that point.
Eventually he gave up and he finally calmed down during the transport. Then he started bawling, going on and on about how the world was out to get him and how life generally sucked for him. I didn't feel like it, but I listened to it and tried to calm him further and told him that there were people at the hospital that would like to help if he wanted it.
We got him to the ED and turned over care with a promise from him that he wouldn't give any of the nurses any trouble. I don't know what happened to him after that, but I have a feeling that I will see him again at some point.
BRM
Glue...
This is something that I have heard about several times, but never actually seen myself.... We get the call for a routine eye injury, no other information. We get to the house and find a guy standing at his kitchen sink flushing out his eyes.
We ask what was going on and find out that he had glued his right eye shut. To make a long story short, he picked up a bottle that he thought was his prescription eye drops and applied it to his eye. He stopped said application when he felt the burning. His teenage daughter had been putting on fake nails with the glue and had set the bottle down on the end-table where her dad, the patient, usually put his drops. To his credit, both bottles had the same color top and were the same size. It was an honest mistake, but one that me and my partner couldn't help but to laugh at. Luckily the patient thought it was just as funny.
We called the local hospital to ask for assistance in dealing with this matter and the doc on call in the ED gave us some unorthodox advise: rub some Vaseline in his eye. What? Yea, you read it right, put some Vaseline on it. He said that it would remove the super glue.
So, we did it. We asked the family if they had some and they did and then we did. To every one's amazement, it worked almost instantly. It left a glob of glue on his eyelash and he kinda ripped it off, pulling most of the lashes of with it, but he could see out of his eye.
We flushed his eye some more and he said that it wasn't burning anymore. Other than a little redness, he was fine. We tried to get him to go to the hospital, but he wouldn't hear of it. He did promise to see his eye doctor the next morning.
Like I said, I've heard about this before, but never actually seen it myself. I did learn something useful though. It's good information for anybody, but especially anyone with kids.
BRM
We ask what was going on and find out that he had glued his right eye shut. To make a long story short, he picked up a bottle that he thought was his prescription eye drops and applied it to his eye. He stopped said application when he felt the burning. His teenage daughter had been putting on fake nails with the glue and had set the bottle down on the end-table where her dad, the patient, usually put his drops. To his credit, both bottles had the same color top and were the same size. It was an honest mistake, but one that me and my partner couldn't help but to laugh at. Luckily the patient thought it was just as funny.
We called the local hospital to ask for assistance in dealing with this matter and the doc on call in the ED gave us some unorthodox advise: rub some Vaseline in his eye. What? Yea, you read it right, put some Vaseline on it. He said that it would remove the super glue.
So, we did it. We asked the family if they had some and they did and then we did. To every one's amazement, it worked almost instantly. It left a glob of glue on his eyelash and he kinda ripped it off, pulling most of the lashes of with it, but he could see out of his eye.
We flushed his eye some more and he said that it wasn't burning anymore. Other than a little redness, he was fine. We tried to get him to go to the hospital, but he wouldn't hear of it. He did promise to see his eye doctor the next morning.
Like I said, I've heard about this before, but never actually seen it myself. I did learn something useful though. It's good information for anybody, but especially anyone with kids.
BRM
Monday, March 17, 2008
Blogger Blues....
I apologize to my readers out there who haven't heard from me in quite a while. I guess I've got the blogger blues. I just haven't been running anything worth writing about, or that I haven't written about already. I have 2 calls that are somewhat noteworthy and I will try to jot them down sometime this week. I was out of work for a few weeks due to an injury and I have also been teaching an EMT class for the last month, so I haven't had a lot of time. I know that is no excuse, but there it is. Like I said, I will try to do better in the near future. I thank those who come back looking for something to read and I apologize that you have had to go away empty handed so to speak.
BRM
BRM
Tuesday, January 15, 2008
No Clue....
I ran a call last shift and I had no idea what was going on with this guy...
We get called for an unconscious. Dispatch calls us back while en route and says that the patient is now conscious. Upon arrival the patient is a mid-30's male sitting up and talking. He doesn't look as if he feels well, but not in any specific distress.
I start my assessment and found out that he has been having multiple syncopal episodes for more than a week. He had been to see his doctor and had been to the ED and was diagnosed with "Occipital Neuritis". I didn't have a clue what that was, so I started asking questions.
He said that there was something wrong with a nerve in the back of his head and that made him pass out. He was also experiencing severe headaches, sensitivity to light and nausea. The only other medical problem he had was hypertension. His only medication was a anti-hypertension med. He said that he had been diagnosed and treated for the HTN a few years ago.
The reason he had called EMS this time was because he had passed out and hit his head. He had a pretty good goose egg on the side of his head, but otherwise was OK. We obtained orthostatic vitals and there was no change. He said that he had been eating and drinking normally, no bowel or urinary abnormalities, no recent sickness and no recent trauma other than the fall. His blood sugar and 12-lead were also normal.
During all this assessment, he passed out 3 times. At first I thought he was maybe faking. But after a serious sternal rub and an extreme pinch to the web between his thumb and forefinger, I figured he was really out. Plus I've never seen a patient faking and actually smack his head against something hard enough to leave a mark and not flinch. Each syncopal episode ended within 30 seconds and he was not disorientated upon waking up.
We got him to the truck and started a line and put him on the monitor. During transport his headache, nausea and sensitivity to light seemed to get worse. I wasn't sure if it was from his condition or the bumpy/ curvy ride in the truck or both. So I turned off the lights in the back and tried to make him as comfortable as I could. He passed out several more times during transport. His vitals and 12 lead stayed normal during the episodes.
Eventually I have him 4mg of Zofran for his nausea, so he wouldn't puke in my truck and to try to make him a little more comfortable. That helped with the nausea but he still had a lot of pain. I wasn't gonna give him morphine for that and he had already taken 1000 mg of Tylenol before he called us.
We got to the hospital and turned patient care over to the nurse. The doc came in and this is usually where I make my exit but I stuck around for this one. After the doc did his assessment I followed him out and asked him what occipital neuritis was. He looked at me and said that he didn't have the slightest clue.
Since then I still don't really have a clue. I've asked several people and have done an extensive Internet search all with no real answers. So if anyone out there has any information I would be grateful. Since that call a few of my co-workers have run him for the same thing and no one seems to know what's going on...
BRM
We get called for an unconscious. Dispatch calls us back while en route and says that the patient is now conscious. Upon arrival the patient is a mid-30's male sitting up and talking. He doesn't look as if he feels well, but not in any specific distress.
I start my assessment and found out that he has been having multiple syncopal episodes for more than a week. He had been to see his doctor and had been to the ED and was diagnosed with "Occipital Neuritis". I didn't have a clue what that was, so I started asking questions.
He said that there was something wrong with a nerve in the back of his head and that made him pass out. He was also experiencing severe headaches, sensitivity to light and nausea. The only other medical problem he had was hypertension. His only medication was a anti-hypertension med. He said that he had been diagnosed and treated for the HTN a few years ago.
The reason he had called EMS this time was because he had passed out and hit his head. He had a pretty good goose egg on the side of his head, but otherwise was OK. We obtained orthostatic vitals and there was no change. He said that he had been eating and drinking normally, no bowel or urinary abnormalities, no recent sickness and no recent trauma other than the fall. His blood sugar and 12-lead were also normal.
During all this assessment, he passed out 3 times. At first I thought he was maybe faking. But after a serious sternal rub and an extreme pinch to the web between his thumb and forefinger, I figured he was really out. Plus I've never seen a patient faking and actually smack his head against something hard enough to leave a mark and not flinch. Each syncopal episode ended within 30 seconds and he was not disorientated upon waking up.
We got him to the truck and started a line and put him on the monitor. During transport his headache, nausea and sensitivity to light seemed to get worse. I wasn't sure if it was from his condition or the bumpy/ curvy ride in the truck or both. So I turned off the lights in the back and tried to make him as comfortable as I could. He passed out several more times during transport. His vitals and 12 lead stayed normal during the episodes.
Eventually I have him 4mg of Zofran for his nausea, so he wouldn't puke in my truck and to try to make him a little more comfortable. That helped with the nausea but he still had a lot of pain. I wasn't gonna give him morphine for that and he had already taken 1000 mg of Tylenol before he called us.
We got to the hospital and turned patient care over to the nurse. The doc came in and this is usually where I make my exit but I stuck around for this one. After the doc did his assessment I followed him out and asked him what occipital neuritis was. He looked at me and said that he didn't have the slightest clue.
Since then I still don't really have a clue. I've asked several people and have done an extensive Internet search all with no real answers. So if anyone out there has any information I would be grateful. Since that call a few of my co-workers have run him for the same thing and no one seems to know what's going on...
BRM
Thursday, January 10, 2008
Wondering...
Have you ever had one of those calls that you wonder about? You know, the ones that you're not sure if you did the right thing? I have them every once in a while. This is one that happened a little while back.
We get called out for a difficulty breathing. We get there and there is this 50-ish year old male sitting up and talking. He has a home health nurse and she is there giving us the report on why she felt it was necessary to call us.
The patient in question had a history of stomach cancer, COPD, hypertension, recent pneumonia and a productive cough with green tinged sputum. He doesn't seem to be in any distress at the moment. The nurse said that he had been suffering from dehydration and she had started an IV and had been administering fluids. That is apparently when the trouble began. The patient started getting short of breath and anxious. So she stopped the fluids and discontinued the IV.
The patient didn't want to go to the hospital, but apparently trusted his nurse and wife and various other family members on scene, and decided to take the trip to the Big City Hospital down the road.
We put him on some O2 and get him loaded up. His vitals were within limits, O2 saturation was good and his lungs had some diffuse congestion throughout all quadrants. 12 lead and capnography were both normal. I started an IV just for precautionary measures and kept it at a KVO (Keep Vein Open) rate. He still said that he felt fine and he didn't seem to be in any distress.
On the way down, I do a little more detailed exam and find that his ankles and abdomen are swollen. He says that this is normal for him from time to time. His abdomen has some bruising and he doesn't know why. I take another look at his medication list and he isn't on any blood thinners or diuretics.
He still says that he feels fine and I have to agree that he does not seem to be in any distress. He says that he is a little tired and just wants to sleep. So I lay his head back and turn down the lights so he can take a cat nap for the remainder of the trip.
That is when I notice the JVD (Jugular Vein Distension). I put the puzzle pieces together and come up with pulmonary edema. I take another listen to his lungs and still only hear ronchi or congestion. I was taught that if you have the patient cough while listening then the sounds will clear and then return if it is ronchi, besides the obvious sound difference between ronchi and rales. Well, this is what happened when I had him to cough.
This is my dilemma; his pedal and abdominal edema, JVD and the fact that he started having trouble breathing when he was getting IV fluids all point to pulmonary edema. The other half to the equation was that he wasn't having any trouble breathing, he wasn't anxious, his blood pressure was normal and I didn't hear any fluid in his lungs. The blood pressure and heart rate I could explain away on the beta blockers he was taking to control those very things.
I didn't treat him with anything other than O2. He made it to the hospital fine and never once displayed any signs of respiratory compromise. But I have wondered since then if I shouldn't have treated him. Maybe he did have edema and I just mistook it for ronchi. Who knows? But I still wonder...
BRM
We get called out for a difficulty breathing. We get there and there is this 50-ish year old male sitting up and talking. He has a home health nurse and she is there giving us the report on why she felt it was necessary to call us.
The patient in question had a history of stomach cancer, COPD, hypertension, recent pneumonia and a productive cough with green tinged sputum. He doesn't seem to be in any distress at the moment. The nurse said that he had been suffering from dehydration and she had started an IV and had been administering fluids. That is apparently when the trouble began. The patient started getting short of breath and anxious. So she stopped the fluids and discontinued the IV.
The patient didn't want to go to the hospital, but apparently trusted his nurse and wife and various other family members on scene, and decided to take the trip to the Big City Hospital down the road.
We put him on some O2 and get him loaded up. His vitals were within limits, O2 saturation was good and his lungs had some diffuse congestion throughout all quadrants. 12 lead and capnography were both normal. I started an IV just for precautionary measures and kept it at a KVO (Keep Vein Open) rate. He still said that he felt fine and he didn't seem to be in any distress.
On the way down, I do a little more detailed exam and find that his ankles and abdomen are swollen. He says that this is normal for him from time to time. His abdomen has some bruising and he doesn't know why. I take another look at his medication list and he isn't on any blood thinners or diuretics.
He still says that he feels fine and I have to agree that he does not seem to be in any distress. He says that he is a little tired and just wants to sleep. So I lay his head back and turn down the lights so he can take a cat nap for the remainder of the trip.
That is when I notice the JVD (Jugular Vein Distension). I put the puzzle pieces together and come up with pulmonary edema. I take another listen to his lungs and still only hear ronchi or congestion. I was taught that if you have the patient cough while listening then the sounds will clear and then return if it is ronchi, besides the obvious sound difference between ronchi and rales. Well, this is what happened when I had him to cough.
This is my dilemma; his pedal and abdominal edema, JVD and the fact that he started having trouble breathing when he was getting IV fluids all point to pulmonary edema. The other half to the equation was that he wasn't having any trouble breathing, he wasn't anxious, his blood pressure was normal and I didn't hear any fluid in his lungs. The blood pressure and heart rate I could explain away on the beta blockers he was taking to control those very things.
I didn't treat him with anything other than O2. He made it to the hospital fine and never once displayed any signs of respiratory compromise. But I have wondered since then if I shouldn't have treated him. Maybe he did have edema and I just mistook it for ronchi. Who knows? But I still wonder...
BRM
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