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Wednesday, July 19, 2006

What are the odds?

My paramedic responded to another nail gun accident yesterday. This time the guy shot himself in the leg, but missed the bone. He just lost a long nail in there somewhere. Now here's the dilemma - if you're the project manager at a construction site and you've got someone on the second floor with a nail in his leg, how do you get him down so the paramedics can work on him?

The answer is a fork lift with a sheet of plywood across the prongs for him to lay on.


-Katie

Tuesday, July 18, 2006

The proper way to start an IV in an ambulance

It's pretty crowded in the back of an ambulance when you have a patient in there. Apparently, you can't even stick your feet straight out in front of you because the gurney is in the way. So, this can cause some problems when said cramped space is also bouncy because you're driving down the road and you're trying to poke a big needle into someone. Here is the proper technique to getting the needle in the vein, without missing or going too far.

1 - Prepare the arm to be stuck.
2 - With the free hand, find the vein that's gonna get poked.
3 - Stand up and balance yourself leaning the hand that is holding the needle against the far side of the ambulance.
4 - Open the needle.
5 - Watch out the front of the ambulance for a stretch of road that Dan might drive smoothly on.
6 - Jab quickly! And hopefully, accurately!
7 - Repeat as needed.


- Katie

Wednesday, July 12, 2006

Random fact day

Have you ever seen an ambulance posted somewhere on the side of the road and felt sorry for the very bored paramedics sitting inside waiting for the next call? Well, fear not, they have devised ways to pass the time and stave off the boredom. Usually relief comes in the form of portable DVD players and the like. Yesterday was random fact day.

What, besides seeing, are a frog's eyes used for?

10 points to the first person to guess this one!

-Katie

Something that's good to know.

If you ever have a nail gun go off and shoot a nail into your knee, just head straight to the ER. My paramedic got a call to pick someone up from an urgent care center who had this happen. The poor guy - the center didn't do anything for him. They didn't even get a set of vitals or give pain medication. His friend had to elevate his leg for him to keep it from aching. The center let him just sit there in pain because they didn't want to bother admitting him if he was just going to go to the E.R. eventually. Brian gave the people at the center 20 verbal lashings for their mistreatment.

-Katie

Friday, July 7, 2006

My first EJ

The call came in about 1615 hours to respond to a man that can't breathe. As we enter the house the wife lets us know that her husband was just seen by the doctor this morning and was diagnosed with sever bronchitis and possible pneumonia. When we get to the bedroom we see a 51 year old man that looks like death warmed over. He's only breathing about 8 times a minute, is pale, cool to the touch, sweating profusely, and only responsive to painful stimulus. Not good. We quickly get him on oxygen and check his oxygen saturation level. Normal is 97% and up. We start to not like it below 95%. His was at 51%! We now have him sitting up as best he can, and have him on oxygen so we continue with our assessment. His lungs sound like they're filled with junk and tight so we put him on an albuterol (breathing) treatment. His heart rate is off to the races at 120 or so but there doesn't seem to be any problems on the ECG. His BP is a whopping 230/110!


As I try to get an IV started in an arm the wife tells me that no one can ever get one. As I search in vain my partner looks at his neck and says "he's got great jugulars." I decide to try once to get the IV in the arm and then go for the jugular. Of course I missed the IV in the arm! At this point we load him up on the gurney and take him out to the ambulance. As we're loading him up my preceptor noticed something I missed. Our patient is taking Methadone, a narcotic pain reliever. Once we're in the rig I start my IV...in his neck (more correctly his External Jugular veins or EJ's)! That was a cool procedure. I then grab the Narcan (used to reverse narcotic effects such as in an overdose) and give him 1mg. Enroute to the hospital we give him another breathing treatment. The Narcan did its job and our patient started coming around. We asked him if he took more than the normal amount of his Methadone today. He affirms that he did.


By the time that I finished the paperwork at the hospital he was looking almost normal again. It was nice to be able to tell have a good day and to have him thank us for helping him. I have to admit though; I was still jazzed about getting to start an IV in someone's neck!


Saturday, July 1, 2006

You never know!

The call goes out to respond to 1321 S. Palm Ave for a man down. When we got to the 1300 block of South Palm we discovered that there was no 1321. We notify dispatch who then realized...oops...it's North Palm Ave. So we headed North to the correct location.

As we approached we noticed that the police had the entire street cordoned off. As we got closer to the scene we saw that our 'man down' was really a TC (traffic collision) where a compact sedan had run into a telephone pole. The car sheared off the pole and moved it 6 feet. It was still dangling from the wires. Our patient, a 16 year old girl, was sitting in the grass with the firefighters trying to refuse any care. Her father on the other hand (who had time to get there since we went to the wrong location) was demanding that we take her to the hospital. Since she's a minor she had very little choice in the matter. We would have taken her to the hospital anyways, because of her age, but it's a little frustrating to have an overly concerned parent there to second guessing your every move. The father also wanted us to wait there on scene until his wife could show up. We drew a line there and told him he could meet his daughter at the hospital. If he had followed us he probably would have said that we should have gone a different route.

Oh well. You just never know what you're going to get when you're dispatched to a 'man down.'

Holistic medicine to the rescue?

You know that the day is going to be busy when your first call comes in 30 seconds after you go 'available'. The call came in at 0514 to respond to an unresponsive person. We go tearing across the city (I use this term loosely as we are in Hemet) and arrive to find CDF fire already on scene. As I approached the door the captain said that our patient is a doctor of holistic medicine and that I should "have fun." I entered the front room to find a 72 year old man sitting on his couch talking to the firefighters. So much for unresponsive. I introduced myself and asked why he called us out this morning.

He said, "I woke up this morning and my arm was numb. There were also some red lines on it here" as he motioned across his bicep.

From this point on it was a little difficult to keep a straight face but I performed a thorough assessment.

I asked if it was still numb.

"No."

"How long was it numb?"

"About 30 seconds."

I then checked to see if he had good sensation, equal pulses and movement in his hands and wrist. All was good so far.

While the firefighters got me a set of vitals (pulse rate, respiratory rate, blood pressure, skins signs) and my partner hooked him up to the ECG (heart monitor), I continued my questioning.

"Do you have a headache, weakness, blurred/double vision, ringing in the ears, chest pain, shortness of breath, abdominal pain, N/V/D (nausea, vomiting, diarrhea)...?"

"No."

"Do you have any medical conditions such as high blood pressure, diabetes, heart problems, hepatitis, strokes, seizures...?"

"No."

"Are you taking any medications?"

"No."

"Are you allergic to any medications?"

"No."

I then informed him that his vitals were all normal and his ECG was fine. I finally asked the question that I wanted to ask first.

"Sir, is it possible that you just slept on your arm wrong and it went to sleep?"

"Yeah, I guess so. I never thought of that."

"Do you want to go to the hospital to get checked out?"

"No."

"Sign here...Have a good day."

Sometimes I think that Darwin must be wrong because so many stupid people survive. I guess I should just look at it as job security.
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