DOA and a Bad Shot

I worked in the ER this weekend in a very busy ER department and I must say it was the best experience I have had yet. I ran IV's, drew blood, performed several EMT skills, many of which I have never done before except on a doll, and even saw something those working in the field have never and may never see!

1500-0300 was my 12 hour shift.

1645- Paramedics called the ER telling us to be ready. They were bringing in a cardiac arrest. Total down time so far was 35 minutes. He was dead. They brought him in the trauma room which was filled with doctors, nurses, a paramedic on staff and myself. I was first to perform compressions on the man. His eyes where open, he was intubated, his clothes completely removed.

The man was a referee during a football game and just dropped. Bystanders began CPR and hooked up an AED, the AED continuously told them "No shock advised." He was in asystole (flatline)  from the get go. He was DOA . As soon as he was placed on the bed in front of me I felt his arms, they were already cold. We worked him for what felt like hours performing CPR and pushing epi and atropine. Nothing worked. The doctor observing our life saving efforts said "Please stop CPR....Alright.....we will call it....4:45."

The man was a large man, which made compressions difficult,  but during our efforts we were getting some perfusion but there was no use, he was gone. With each compression I could hear him gurgling and had to remind myself a few times he was not coming alive again and gurgling but my compressions were creating the gurgling from the fluid accumulating in his airway now.

Later that night we discovered through his family he is a donor. His organs could don't be harvested due to the lack of perfusion during his down time but his corneas were eligible for donation. (This is the part I mentioned earlier that some in the field have never seen and may never see.) I watched a man from a donor bank remove this man's corneas. It was amazing how they do it and it was fascinating to see the parts of a human eye as I did. Once the corneas were removed I held them up to the light and it was an eerie feeling knowing I was seeing through this once alive man's eyes.

1752- A supposed security guard was brought to us in the ER by paramedics because he had been shot in the face. The GSW was just under his left eye and he had about a 2 inch long gash along with an exit wound. His zygomatic bone was obliterated, which was clearly observed during CT scan. Three Police officers accompanied him and kept watch over him for the several hours he was there in our care. He was conscious and vitals were stable. The bullet had barely missed his left eye. He had no vision problems what so ever...lucky man.

So what happen? No one really knows but him. He claims he and his partner were sitting in a vehicle. He was the passenger. His partner was cleaning his gun, no cleaning equipment was found in the vehicle, and the gun accidently discharged shooting him in the face. Hmmm things did not add up based on the path the bullet traveled through the man's face. He later changed his story saying he was in the driver’s seat which still didn't make sense. He stuck to his story last I had heard.

We also had a female prisoner who had second and third degree partial thickness burns from a boiling water pot being hurled at her back thanks to another inmate. The rest of the night was fairly calm, one drunk who punched a wall fracturing her hand, we splinted a few other bones, had a few chest pains, a headache, a mentally ill patient and a few other minor complaint patient’s. I finished my shift smoothly.

That was my night in the ER. 

Oh Dang it!

I had mentioned in a previous post that I was super excited for my interview with my local ambulance service....I unfortunately did not get the job. 

Here's what I experienced:

I applied online. I had been constantly watching the county ambulance website and one day noticed they had just opened the online application! I applied immediately with resume attached.

A few days later received an e-mail stating I had been chosen to begin the interview process.

The day of, I first took a 100 multiple choice questions exam. I thought the test was very easy thanks to the amount of studying I have continuously done.

There were 65 EMTs and 27 Paramedics. Only 14 would be chosen for EMTs and 14 for Paramedics to move on to interview, based off the highest test scores.

I learned everyone had done extremely well on their tests so the 14 EMTs and 14 Paramedics were chosen at random.

All is well though, I will try again next hiring season which will be next Spring! This gives me the opportunity to  continue my education such as EKG cert, medical terminology classes, etc.

I take this as a learning experience and I walk with my head held high.

“The Ceiling”

Paramedic: On The Front Lines of Medicine by Peter Canning, pages 123-124, The Ceiling. “Failure haunts me.”Says Peter Canning.

 I cannot speak for any other EMT-Basic but I can speak for myself when I say failure, too, haunts me. I can’t tell you how many nights I spent staring at the ceiling worry and thinking about what I am preparing for and things I’ve already seen and how it has affected me. 

            By the very first day of EMT school I was completely overwhelmed, as I’ve mentioned in a previous post, by the amount of information I was going to have to plug into over the next three months. Becoming an EMT is a big deal, not something one should take lightly. People’s lives will be in YOUR hands, that is a heavy responsibility…I began questioning myself if I could truly do it. I am now out of EMT school and preparing to venture into the real world as an EMT-Basic actually working for an agency. But I chose to stick it out and this is the day I told myself “failure is not an option.”

            During EMT school I had the opportunity to sit in at the dispatch center to see how they do things on their end. (I recommend taking any opportunities to observe ALL areas of emergency services such as paramedic services, fire departments, police departments, ER and dispatch observation.) I sat with dispatch on two separate occasions, as I’ve mentioned before, and on the first sit in the dispatcher beside myself and dispatcher Molly Stock* a call came in that was chilling. I was able to read on our screen what the EMTs were seeing on scene and I was also able to see what the dispatcher beside us was saying back to them while she spoke to a frantic father on the phone.

            “Pt is obviously dead.” Read across the screen three separate times, written by EMTs on scene. The only time an EMT can pronounce a death is when it is obvious such as decapitation, a severed body, rigor mortis, or signs of lividity. 

            I hear the dispatcher beside us trying to calm the frantic father down and speaking in a calm but remorseful tone in her voice. “Ok, I’m going to let you go now, go call your wife.” I continue to read the screen. “Father found daughter had shot herself in the head.” “Pt was 14 years old.” 

            This call haunted me for weeks afterward. It seemed to really hit me at night right before I went to sleep. I was having trouble falling asleep and would stare at the ceiling thinking about that call. What must have been so bad in her life for her to do such a thing? Are her parents also having trouble sleeping reliving that moment they found out their daughter had perished? I felt a sense of guilt as if I could have helped her, saved her in some way. Days after the call I was watching the obituary section just wanting to see her face and to learn a little more about her.

911 Dispatch Sit-in Experience

A little more than half way through our EMT class we were offered extra credit. Our teacher wanted us to get a real feel for all aspects of the EMS field and suggested we try to observe at the ER and/or the 911 dispatch center. At this point I had finished my ride along program with the county paramedics and two fire departments but didn’t feel like I had enough hands on patient contacts. I thought this opportunity would be great not only for the extra credit but for the extra experience.

          I tried to go into the ER to observe but had difficulty finding a time that would work for myself as well as the medical director, whom I needed to shadow. So I never had the chance to meet him or work in there. However, I did have a chance to observe at the 911 dispatcher center.

          *Mrs. Molly Stock is a dispatcher and welcomed me with open arms to sit with her for a few hours at a time, I observed with her two separate nights. 

She showed me how they navigate through the very intimidating computer system. There were 6 computer screens, three key boards, 3 mice and a foot petal hooked to the dispatch radio box. If she would move one mouse, the arrow would zoom across all 6 monitors that were connected together. I was so impressed by the level of multitasking it takes to be a dispatcher. She was able to answer a 911 call, talk to the caller while at the same time calling and talking to other emergency agencies and inputting information on the screen, simultaneously. 

          We took several calls almost constantly throughout the 4 hours each night I sat with her. Most of which were BS calls and I couldn’t believe people were calling 911 for half the stuff they were. Such as “My neighbor’s dog has been barking for three hours and I am sick of it. Send police!” Really? Do you have to call 911 to report this? Have you ever heard of the non-emergency phone numbers to your local authorities? I then realized the system can be abused sometimes and it really is sad. 

          About 2230 (10:30P) we receive several calls for a shooting. The switch board is blowing up with callers saying they heard shots in an alley and know nothing else. Several dispatchers including Molly are taking these calls. Police have been dispatched to the area, several police. 15 minutes pass and we receive a call from a frantic man cussing at Molly telling her “there were shots 15 minutes ago where are the ******* police!?” “I have several officers in the area sir.” She says in a rather annoyed tone. 

When police respond to an area for a crime that has been committed, often times they omit their siren and lights so they don’t alarm the criminal and scare him out of the area, they want to sneak up on him/her and catch them! Hence the fact this man heard no sirens and assumed police never showed up.

          I learned a great deal these two nights and was able to see how dispatchers and other emergency professionals communicate. I learned some code they use and also learned what is going through dispatcher’s minds when they receive 911 calls. 

 This leads me to my next post…..

*Name has been changed

Fire Department Ride Along Experience 2

0800 (08:00A) My second fire department ride along I was just not looking forward to. Several of my classmates had already done their ride along with *Mean City Fire Department and had nothing good to say about the crews they road with. I think to myself “I’m a pretty likeable person. I bet I can get the guys to warm up to me, I’ll fit in.” Wrong.

            I walk into the fire house hoping to see a happy face to greet me. “So are you our ride along today?” “That would be me!” “Come with me.” Hmmm ok. Fire Fighter *Mark Escobar shows me around and introduces me to the guys inside the fire house. As we enter he tells me they had, had a rough night last night and the guys are really tired today. 

            Long story short the Chief was the only nice one and only one who really talked to me throughout the entire shift. He took me under his wing and made me feel somewhat comfortable. 

            I tried to keep an open mind, the guys are tired from working all night, I would be a little grouchy too. I do my best to talk to them anyway whether they wanted to or not. I think they actually appreciated the fact that they didn’t intimidate me, well that’s what it looked like on the outside but on the inside I felt like I was walking on egg shells for the entire 8 hour shift.

            We got in the fire truck and took a trip to Wal-Mart so the guys could get some ingredients they needed for their world famous smothered burritos. I offer to chip in some cash to help pay for lunch, in hopes they would share with me…they say no it’s ok, keep your money. As we walked through the store I could feel all of these eyes following us. These fire fighters were looked at like celebrities. In my previous post I mentioned how all the eyes and the applause felt good while I was walking with the fire fighters, it felt good to feel like I was one of them for the day….however, with Mean City Fire I felt like the third wheel, it was awkward.

            0936 (09:36A) As soon as we arrived back at the fire house we received our first call of the day. An elderly woman had just experienced a seizure, full tonic-clonic seizure. Her daughter-in-law was with her during it so the woman never fell or anything. Paramedics arrived just as we did and rushed into the house. It was a small house with tons of nick nacks everywhere and in the kitchen was a visible basket full of medications and a note above saying “ATTENTION PARAMEDICS.” She must have this happen often.

            She was lying in the cramped hallway on her daughter-in-law’s lap and had two paramedics around her. “Get over there and take her blood pressure. Here’s the cuff.” One fire fighter says to me. I approach the woman on the floor and say hi to her. One of the paramedics introduces me to her and says “My friend here is going to take your blood pressure ok *Miss Wallace?” I try to slide the cuff on her, I’m pumping it up and wait to hear the first “boom” in my stethoscope. I can’t hear anything. I try again…still nothing. “I’m sorry I can’t hear anything” I tell the fire fighter. “It’s ok, good try though.” 

            1100 (11:00A) Lunch time. I was told to bring a sack lunch so I bring my chips, an apple and PB&J sandwich to the table to sit with the guys. They are all ready for those famous burritos of theirs. A huge pot of hamburger meat sits on the stove, lettuce, tomatoes, homemade green chili by the truck load, a bowl of cheese, fresh warm tortillas, everything they need and it smells amazing. They wolf them down….never once offered.  They pack up the left over’s and go on about their day. Now I’m not saying they should have provided lunch for me but wouldn’t it have been polite to offer at least one burrito?

            1326 (01:26P) I’m busy studying in the dark living room while the guys fall asleep in the recliners next to me. I wasn’t going to try to turn on a light because I understood they needed their rest. The tones sound. A fax comes from dispatch stating a pedestrian has been struck by a car in a local shopping center parking lot. I throw all my stuff in my bag and the guys casually sit upright and lace up their boots. I’m thinking let’s go! This is a call hello! I jump in the truck and the guys take their time. 

            We arrive to find a young kid sitting on the hood of his car speaking with a police officer. I fumble with the jump kit (medical bag) and catch up with the crew inside a small shop where the Pt is being questioned by paramedics already on scene. 

Fire fighter Escobar tells the paramedic to let me do the assessment. The Pt was hit while riding his bike. He is diaphoretic (probably only because he was riding his bike), smiling at me and standing. I wonder to myself “shouldn’t he be strapped to a board with a c-collar on?” He is refusing treatment stating he is fine.

I tell him I will just check his pulse and BP really quick. He allows me to do so. I have 5 fire fighters standing behind me and one paramedic beside me, I feel like their eyes are burning holes right through me and I feel the room’s temperature warming up. I place two fingers on the Pt’s radial pulse. It’s rapid and feels inconsistent. I was taught in class when I assess a pulse I should do so for a full minute, I was never taught anything different.  The man is talking to me and I am trying not to be rude to him but I am also trying to focus on his pulse. 

15 seconds go by and one of the fire fighters behind me asks “What’s the problem?” Great! Now I’ve lost my count for the 10^th time and have to start over I think to myself. The paramedic to the side of me has an impatient look on his face. Then 25 seconds have now passed, the Chief says “Just guess and move on.” I feel like a failure. I couldn’t even get the man’s pulse. I check his BP and am unable to hear it. Damn.

The man signs a refusal form and we leave. Back in the truck Escobar asks me what the problem was and why couldn’t I take his basic vitals. I told him I was taught to take a pulse for a full minute, he starts to laugh. “We usually just check it for 6 seconds and add a zero or 15 seconds and times by four.” Thanks. Now I know.

1500 (03:00P) The tones sound again for a fire alarm going off at the hospital. “It’s probably a false alarm. We get these a lot there.” They say to me. So I’m not too excited. We arrive and sure enough, false alarm. 2 hours left and I get to go home. That was the last call of the day.

So my experience wasn’t as enjoyable as the previous fire department I had road with however, Mean City Fire did teach me a valuable lesson…you can’t please them all, no matter how hard you try. It’s up to you to make the best of it though and to take advantage of making mistakes and learning from them, keeping an open mind and understanding sometimes you just have to prove yourself in order to be fully accepted. Press on and don’t let one bad day ruin your dreams.

*Names have been changed.

Fire Department Ride Along Experience 1

      

0800 (08:00A) *Kind City Fire Department. It’s cloudy out and kind of muggy. I’m not much of an early bird so being somewhere by 0800 can be tough for me however I was really excited this time! I was going to meet a new crew of guys/women working for a fire department I’ve heard so many great things about. This is the fire department I had mentioned in a previous post that most of my EMT class mates worked/volunteered for.

            I walk up to the big garage door and ring the little red button. This happy face greets me at the door and says “We were expecting you!” He leads me up the stairs to meet the other guys. I walk into a fair size kitchen with a large wood table in the center of the room. A few doors to the left lead to the rest rooms fully equipped with showers and down the hall are the fire fighters beds lined in rows like the dwarfs beds in Snow White.  

            Fire fighter *Dan Fuller takes me down to check out the rigs. He shows me where I will be sitting when we go out on a call, shows me where my reflective vest is in case we go out to car accident and pulls out the medical bag. We go back in the fire house and sit in the large conference room, they are getting ready for a phone conference with the Chief there in a few minutes.

            “Good Morning, how is everyone doing today?” This voice says coming from the triangle speaker box in the middle of the table. “We’re great Chief, just ready for another day. We also have an EMT student with us today.” “Great! Well I wish everyone a pleasant day today and please stay safe.” 

            The conference call is over as soon as it began and it makes me happy seeing the Chief does a morning conference call to wish his men and women a safe day. 

            Fuller and I go through the medical bag. He pulls out this mess of bandages, 4x4’s, oxygen tubing, masks of all sizes, QuickClot Blood Clotter, which is used in military trauma kits and is used to do as the name states, clot blood and he shows me the rest of the contents in each pocket. I try hard to memorize exactly which pocket he pulled things out of so when we go on a call I can be on the ball and pull out exactly what we need.

            Myself and the rest of the crew (4 fire fighters and 1 fire chief) sit around watching the news just waiting for our first call of the day….we wait and wait and wait….nothing.

            We get in the fire truck and cruise over to their training site just a few blocks away from the fire house. Now it’s cold as a witch’s titty outside, thank goodness I brought my coat. We pull up to this three story metal plated building with black smoke residue along the edges of the metal covered windows. Inside is a burnt up couch, other furniture and a male dummy laying in a corner, he’s covered in what looks like 10 miles of bad road and is missing a leg…they call him Stupid. Well Stupid has had a rough time being rescued I see.

            The guys set up a full obstacle course within the burn house and around the outside perimeter. The obstacle is for the next week’s agility test for new volunteers. 

            0300 (03:00P) We arrive back at the fire house. I go into the restroom and as soon as I take a seat on the thrown the tones sound. “Let’s GO!” I hear. “Crap! Wouldn’t you know we have no calls all day but as soon as I visit the potty room we get one!” We rush down stairs, climb in the truck, put on our head set, lights and sirens out we go. "

            “Wow what do you guys do if you’re taking a shit? And the tones go off?’ I got a good laugh out of the guys. 

            We arrive at a local dollar store where some kid had pulled the fire alarm and now the store manager can’t turn off the alarm. I’m told to wait in the truck while the guys go in to make sure there’s no fire. They go in with full gear and O2 masks on. Total call time: about 20 minutes.

            Next we head over to the city council center to attend an award presentation for the people of Kind City, including the fire fighters, some of which I was with that day received metals and awards for their heroism. We were a little late since we were on that call so once we walked in the room all eyes were on us. “We heard you were on a call, give them a hand ladies and gentlemen!” The announcer says in the mic. I knew they were clapping for the firefighters but it was kind of cool walking in as one of them for the day.

          An 8 hour day without any legitimate calls, the false alarm was the only one. But I enjoyed getting to know the guys and I got a lot of homework done! I realized riding with the fire department, despite the fact I have no interest in being a fire fighter, was beneficial. I was able to see their side of emergency calls and how they work.

*Names have been changed.

County Paramedic Service Ride Along Experience

Shift is 1800-0600 (06:00P – 06:00A) I’m riding with Matt Kerger* and Dave Phillips* One EMT and one paramedic. They show me around, we go through the ambulance showing me where everything is. I tell them both just how nervous I am and I just don’t want to get in their way on calls. Matt tells me “You’ll be fine and I promise you, you won’t be in our way.” Dave says “For sure! Don’t be afraid to get involved. Hopefully we’ll have some good calls for you.” The three of us are waiting for our first call of the night as we kick back watching “Two and a Half Men” and I of course brought my homework and 1000 pound EMT book to get some studying in during our down time. 

2130 (09:30P) 3 ½ hours pass, Matt has his feet up in the recliner now watching the news while Dave catches some Zzzzz’s in his recliner. The tones sound…”Time to go” they say to me. I throw my stuff in my back pack and we load in the ambulance. Dispatch: “80 year old female at **** nursing home with epistaxis (bloody nose). We arrive at the nursing home to find a kind woman who has been having trouble with constant bloody noses, slight confusion and minor nausea (blood running down the back of the throat into the stomach = upset tummy) Code out was emergent and code back was routine. Transferred care to the hospital.

           

0100 (01:00A) Dispatch: “32 year old female has drank an 8 oz bottle of hairspray. PD on scene, please stand by.” We run emergent to our destination, a farm house about 10 minutes away on the outskirts of the town south of us. We pull up behind a fire truck about a mile down the road from the house, We’re waiting for a “Code 4” from PD which tells us the scene is safe for us to enter. Code 4 is required being as this Pt is mentally unstable and this may have been a suicide attempt. 

PD “Code 4” We move in to a nice farm house and are directed upstairs. We find our Pt sitting on her bed, legs up to her chest, she is tearful. Her small bedroom full of fire fighters, sheriffs, police officers all staring down at her and now us. 

Matt approaches her questioning her in a calm and understanding voice, I stand back observing. She is refusing treatment; little does she know she gave up this right due to  her unstable state of mind. The Sheriff informs her she either goes with us in the ambulance or she goes with him. She chose us. 

We help her to the ambulance. She is crying hysterically and is explaining to us that her mother, whom she lives with, calls her fat and is constantly ridiculing her, yet she is thin and obviously of a fairly healthy weight. Her father is out of the picture and she is also on antidepressants. Matt asks “So why did you drink the hairspray?” She is an alcoholic and it may have just been to get some alcohol however, she is a regular pick up for paramedics and is known by name….she is constantly seen for overdoses and possible suicide attempts, although she continually denies trying to commit suicide.

0300 (03:00A) Dispatch: “PD requesting paramedics at **** Apartments for Pt involved in an altercation and now displaying an altered level of consciousness.” We arrive in a fairly rough side of town at some run down apartments on 11^th Avenue which are also connected to a bar. We walk through the dim lit hallway to find a middle age man arguing with a police officer saying “I was protecting myself and my girlfriend!” The girlfriend standing there obviously frightened and had urinated her pants. The man is bloody on his face and without a shirt, he refused treatment and we moved on down the hall.

We turn the corner to find several police officers in this tiny cramped hallway telling other apartment tenants to stay in their apartments. Two men are in cuffs surrounded by police and one man appears to be unconscious on the floor lying in right lateral recumbent position, he’s the patient. All three men are somalian men who had been harassing the girlfriend, her boyfriend stepped in trying to protect her and long story short…the boyfriend kicked the other three men’s asses. 

I was somewhat scared despite the fact there were more police there than anyone else so I stood back observing, again. Matt, Dave, fire fighters and other police officers placed the Pt on the back board, the Pt was extremely combative and it took fire fighters lying on top of him to strap him in. The Pt is now screaming obviously not unconscious. 

We take him to the ambulance and he suddenly stops screaming, stops moving and closes his eyes. Dave hooks him to the ECG monitor and we see his heart rate suddenly plummeted to 30. An IV was started and Narcan was slowly pushed. Now that the Pt, who has been picked up before by paramedics and is reported to be a spitter, is now passed out I volunteer to take his BP, I am unable to hear it. Only a few minutes pass and the Pt is suddenly awake again and seems to be in stable condition. We arrive at the hospital. The back opens, other paramedics hop on the ambulance and begin making fun of the man for his poor dental hygiene. I am taken back by the amount of unprofessionalism I am witnessing as an EMT student, as a human being.

I loved riding on the ambulance, Matt and Dave were awesome. I do wish however that I wouldn’t have been so scared to touch the Pt’s. Dave told me I did a great job but hopes I get more involved next time. Moral of the story…don’t be afraid to act. Your preceptors, fire fighters and police officers will appreciate your confidence in yourself and they will appreciate the fact that you TRIED, even if you mess up they acknowledge the fact that you tried.

*Names have been changed

EMT-Basic Student Ride Along Experiences

It’s the beginning of the semester of EMT-school. I know very little about emergency care and am barely learning about all the gooshy stuff we have in our bodies. It’s time to sign up for ride alongs with our county Paramedic service and local fire departments.

Myself as well as my fellow students are most excited about riding with the paramedic service, since that is most of our goals for the future, we have little interest in riding with the fire department either because the majority of the students are already firefighters or in my case, not looking to be a fire fighter so what’s the point of riding with them right?

I first sign up with our county paramedic service for about a month out.  I think, “Ok 1 month should be enough time to figure things out and I should be able to know exactly what I’m doing when I ride with the ambulance! Great looking forward to it!”

Next I sign up with two local fire departments. One of which is a fire department where most of my fellow students, my new friends, work. I think, “Awesome, these guys are super cool so I’m sure the other guys on the crew are just as awesome. Yeah, I guess I’m looking forward to it.”

The next fire department I sign up for is our larger city fire department so they cover a good chunk of land so I figure we should go on some good calls with them.

To fully discuss my ride alongs I will do them in separate posts. These will follow this post…

“Do unto others as you would have them do unto You”

Paramedic: On The Front Lines of Medicine by Peter Canning, page 107 has motivated me once again to point out an important message.  Peter is speaking about a call he and his partner Glenn were dispatched to at a nursing home for a female with third-degree heart block, who is for the most part asymptomatic, pulse 34 and nurses state she is bedridden and her normal state of mind is one of confusion and do not think she has heart problems in her history. 

The Pt becomes combative with Peter as he tries to start an IV and Glenn attempts to offer her oxygen. Peter is frustrated because she won’t allow the IV to happen and he yells at her “Jesus Christ!” as she jerks her hand away once he had finally placed the IV yanking it from her vein. Peter feels bad for yelling at the woman and apologizes. 

            He then begins reflecting on how he feels while transporting the elderly. “Sometimes when I’m transporting an elderly male, I look down at him on the stretcher and imagine myself there in another forty years looking up to the eyes of a faceless EMT. Neither of us speaks.” Canning P. 107

            My point here is to remain calm and understanding, two of the best things you can do when caring for patients. Think of yourself in their situation and how would you feel if you had a cold EMT/Paramedic working on you. Think of your children, sisters, brothers, parents, grandparents…how would you want EMT/Paramedics to treat them?

Lesson 1

Currently I am reading an amazingly written autobiography of Peter Canning, a Hartford Connecticut Paramedic, called Paramedic: On the Front Lines of Medicine. He tells the tales of paramedicine through his eyes, things he has felt, things he has done and seen. I’ve only just began reading so throughout my reading I will post more about it. I also plan to do a full review at the end. Here is a passage I felt was important to share with any newbies like me!

 

Page 27 speaks of a *Pt he had within the jail system. The call to dispatch came in as a man having a seizure. Peter and his preceptor Tom approach the Pt to assess him. Peter automatically assumes “Well, they called dispatch saying he was having a seizure so it must be just that, a seizure.”

            The Pt is fully responsive and in panic mode. **BP high at 160/120, ***P 108, ****RR varies between 20 and 50, pupils are responsive, lungs clear and no sign of incontinence, which is common among true seizure Pts (as well as biting of the tongue.)

            Further questioning of the guards reveal the Pt had a visitor and was expected to be transported to another facility that day.

            Tom then asks Peter what he thinks is wrong with the man. Peter responds by stating it must be a seizure so I assume I should administer Valium per medical direction. Tom then informs Peter “This is a cocaine overdose.”

            Peter asked the guard if the Pt had done any drugs, the guard said no. He then asked the Pt the same question and received the same response, no.

            Tom then told him “Don’t trust what anyone says. Focus, rule out, do your assessment.”

            I too was taught this in EMT school. Never assume anything. If you get a call for chest pain you may be expecting a heart attack right? But then arrive on scene to find you are dealing with a Pt who is a shooting victim and now you may be in an unsafe situation. Be prepared for anything, be ready for the worst.

*Pt- abbreviated for Patient

**BP- abbreviated for blood pressure

***P- abbreviated for Pulse

****RR- abbreviated for respiratory rate