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Saturday, January 30, 2010

Aaaahhhh, Sushi. Or Not.

"...Respond for an EMS...39 year old female, difficulty breathing."

As we pulled up to the house we were greeted by the patients husband. He led us inside where we found his wife sitting on the couch. As I walked in I got a quick first impression. She didn't appear to be in any kind of respiratory distress (this brought the urgency level way down) but she was very red in the face. She had hives covering he face neck and chest (which immediately started bringing the urgency level back up).  I asked her if she had any allergies to which she said no. Although later on she would admit to being allergic to Demerol. She said that she had had some soup for lunch and had no idea what could have caused the reaction. Then her eyes lit up and she said she had some sushi. We have a likely culprit. Then she said it was actually a California roll (that was a leftover from the day before)...so much for that idea. We only had time to run a quick set of vitals on her before AMR showed up. We told her that we would give her something for the rash (benadryl) and take her to the hospital.

The last allergic reaction that I heard about in my city was a 43 year old male that was allergic to crab. He went into anaphylaxis and died before the engine ever got on scene. The crew tried to perform a needle cricothyrotomy but there were no landmarks on the guys neck. He was just too swollen. I'm glad mine wasn't anywhere near that bad.

Friday, January 29, 2010

Are You A Good Friend?

Let me tell you a little story about some friends. They got together on a Thursday night and went drinking. Sometime around 0230 they decided that they were wasted enough and called it a night. They drove back to a local grocery store so two of them could get their cars. After dropping them off the other friend went home. The two guys were left in the parking lot with their cars but were unable to find their keys. Luckily, one of the vehicles was unlocked so they poured themselves into the car and passed out. The cops found them at about 0300. When they discovered that one of them couldn't even remember his name we got a call.
By the time that we had arrived on scene our patient had vomited all over the front of his car. We only had time to get a quick set of vitals and do a limited assessment before AMR was on scene. We quickly turned patient care over to them and made our way back to the station. I hate drunk calls.

I am curious as to what type of friend would leave you in that situation. Alas, they were probably just as drunk.

Monday, January 25, 2010

Patient Update

I recently found out that the patient I treated in full arrest went back into cardiac arrest as was pronounced dead in the ER. I thought we had a chance with that one.

Hair Bun Saves The Day

Just as I put the nozzle in to start fueling up the rig the tones went off. We were being dispatched to a local shopping center but were advised to stage. On our MDC (a laptop on the engine which we use to receive more information about the call and for mapping purposes...and quite possibly the occasional game of solitaire) we read that we were staging for the victim of an armed robbery at a check cashing business.

Once we arrived on scene we were informed by PD that the 22 year old clerk had been pistol whipped. Our patient appeared shaken but not injured. When questioned she said that the had been hit in the back of the head with the gun but that the blow had glanced off of her hair bun and had not really made contact with her head. We checked her out and found that she was doing as well as could be expected of someone that just got robbed at gunpoint. She signed out AMA.

Saturday, January 23, 2010

Pitbull Goes Postal

Our mailman at the station was a block away when a pit bull came running out of the house he was at and attacked him. He was quickly brought to the ground and fighting to keep the canine from biting his head and neck.



We were toned out a minute later for an EMS call at the intersection right behind our station.  We pulled out and around the corner and found nothing. Dispatch then informed us that our patient was a mail carrier down the street and that he had be mauled by a dog. We were advised to proceed at our own risk. My first thought, "I don't have to out run the dog...." Half a block down we saw our patient sitting on the sidewalk in obvious pain.



I'll say this about the mailman. He did a great job protecting his head, neck and torso, and not much else. He had been bitten at least 10 times. The dog bit every single limb at least once. Luckily the pit bull missed all the major blood vessels so there was no profuse bleeding. Our patient, still holding a can of mace in his hand (which I don't think he used) had major avulsions to his right wrist, left forearm and right ankle. He had simple puncture wounds all over those appendages as well. In addition he had scrape marks from the dogs teeth on both thighs (near the groin....that could have been bad), both lower portions of the legs, to both forearms and to the left bicep. He looked surprisingly well for what he had just been through.


By the time that AMR arrived on scene we had him cleaned and bandaged up. They had a paramedic intern who was very disappointed not to be able to see and do everything.

 
 
These are photos of a different dog attack but the wounds look very similar.


The saddest part of this call was that the mailman was just attacked and bitten by a dog two months earlier. At least he's up to date on his tetanus shot.

Friday, January 22, 2010

K9 Rescue

Los Angeles Firefighter Hospitalized After Rescuing Dog

Friday, January 22, 2010

LOS ANGELES —  A firefighter has been hospitalized with severe hand and arm injuries after being bitten by a dog he hoisted from the storm-swollen Los Angeles River in a daring helicopter rescue.

Fire officials say Joe St. Georges was taken Friday to County USC Medical Center after rescuing the German shepherd.

Los Angeles Fire Capt. Steve Ruda says the dog is doing fine and is being checked for rabies.


Officials say at least 50 firefighters responded to the scene, where the dog tried to scramble up the river's steep concrete sides for more than an hour as crews dangled life vests and a float ring from above.


St. Georges finally splashed down from the helicopter, wrestled with the frightened canine and lifted it to safety.

The dog had a collar but its owner is unknown.

Thursday, January 21, 2010

Firefighter Mayday

This is the audio from an incident where the firefighter fell into the basement.The incident occurred yesterday. The mayday happens at 5:40.


Tuesday, January 19, 2010

Short of Breath

We have a string of houses in the East end of our district where every house seems to have someone with respiratory problems. One afternoon we were toned out fora woman with difficulty breathing. When we arrived we found a woman in her early 50's sitting on the couch with a nasal cannula (attached to a 75 foot hose that was snaked all around the house).

The patient stated that she had been short of breath for several days but it has gradually been getting worse. She denied having any chest pain or recent illness. No cough either. We then moved on to her extensive medical history.She was a chronic smoker, had COPD, emphysema, asthma, lung cancer and had had her left lung removed. I'm not quite sure why she was short of breath. The funny part was that all we did to make her feel much better was turn her oxygen (on her machine) up from 2 LPM to 6 LPM.

As soon as AMR showed up we got her loaded into the ambulance and on her way. I can only imagine what the doctor told her. Probably something along the lines of' "You're feeling short of breath?! You're lucky to be breathing at all."

Sunday, January 17, 2010

Gnocchi

Dinner. A very important time in the fire house. It's one of the favorite topics of discussion early in the day at most stations. This particular day we had decided to just head to the store and see what struck our fancy. A lot of times it's whatever is on sale.


This time my captain suggested lasagna. Lasagna is one of my favorite meals so I had no problem with it. Once everyone agreed, the captain asked us, "Who knows how to cook it?" Back to square one. Once over on the pasta aisle (to look for the recipe on the back of a pack of lasagna noodles) my engineer spotted Gnocchi. For those of you who don't know, gnocchi is a potato based pasta. While trying to decide if we were going to make gnocchi we got into a debate as to the proper pronunciation. My captain was pronouncing it nyawnk-kee (kind of like donkey). We gave him a hard time asking where the second `n' was coming from. We laughed about this all the way to check out. Once back at the station, while the captain went back to his dorm, my engineer brought up dictionary.com on the computer and looked up the proper pronunciation of gnocchi. He then turned the volume all the way up and played it over and over again until we heard a very resigned "hey!" The funniest part was when the captain came out and actually listened to it he said, "See!! I was right!" To which my engineer and I looked at each other and burst into laughter.


I guess you had to be there. Dinner was great by the way.

Saturday, January 16, 2010

Kitchen Fire

A friend of mine recently had a small fire on the stove. After putting it out they looked up this video. I'm passing it along so that you can know how to put out a kitchen oil fire. Be careful. And you can always call 911.


Friday, January 15, 2010

Who Dies At 0300?

Guess what I was doing at 0306? Sleeping in my bed at the station, very comfortably I might add. Guess what I was doing 90 seconds later? Responding with lights and sirens to attempt to save someones life. While sitting in the back of the engine I couldn't help but think who notices that someone is dead at three in the morning?!

We arrived on scene just after PD. The wife was opening the front door for the officers just as I walked up. I then had to walk behind the cops up the stairs to the master bedroom. Now I am grateful for the officers especially for all they do to help us. But when there's a dead person upstairs and there's a medic behind you trying to get to the person and save them, either move faster or get out of the way!


Once in the bedroom I found my patient. I noticed immediately that the 51 year old man was over weight and appeared very dead. He in fact was just "mostly dead" (bonus points for the movie reference). I checked for breathing and a pulse. There was nothing. But he was warm to the touch and didn't have lividity or rigor. We quickly moved him to the ground and started CPR. I started on chest compressions while my engineer worked on the airway. As my captain came in with our autopulse we place the patient on the machine. This freed me up to start some ALS treatment. The AMR crew walked in just as I placed the defibrillation pads on the patient. I asked the medic to get vascular access. After establishing a secure airway my engineer had an EMT take over breathing for the patient. He then connected to patient up to capnography.




As I turned on the monitor and checked the rhythm I noticed that the patient was in V-fib. This is a good thing (relatively). It means that the heart is still alive enough to have electrical activity. We just have to get it to be a little more organized. I charged the monitor and made sure that everyone was clear. I then shocked the patient with 200 joules of electricity. I love Edison Medicine. As soon as the shock was delivered, CPR was resumed. The AMR medic did a great job getting the IV in the left arm and was administering Epinephrine. After two minutes went by I checked the heart again. He was in asystole. Not so good. We continued CPR and the AMR medic pushed some atropine. After two more minutes of CPR I checked the heart again. I saw something I didn't expect, a normal sinus rhythm. So I checked a pulse...BINGO! We got him ba....uh oh....he's in V-tach....check a pulse, no pulse, now in V-fib....continued CPR while I charged the monitor. That's just about how long his pulse lasted. But it was a good sign. I shocked him one more time and sent him back into asystole.

This went on for a few more cycles with the patient's heart rhythm going all over the place. We decided it was time to get to the hospital. Loading up a 300 pound man onto a backboard with the 30 pound AutoPulse and then trying to get him down a narrow stair case while continuing CPR and not tripping on wires and IV and oxygen lines is quite the exercise. Since this was my patient, once we had the him in the ambulance I hopped in. I took over bagging the patient and the AMR medic continued to administer meds and check the heart rhythm.


Once at the hospital we transferred the patient to the ER bed. In the move, the AutoPulse became miss aligned and stopped working. I continued on the BVM while two RN's tried to fumble with my machine. Meanwhile, the patient didn't have compressions going. I finally pushed (gently) the nurses out of the way, and started chest compressions manually. After a couple of minutes an ER tech came over and relieved me. After the call I gathered my equipment and restock from the ambulance and waited for my ride (another firefighter had to come and pick me up). Before we left, the patient regained a pulse. I hope he makes it.

So how did we get this call at 0300 instead of at 0700 when the alarm went off? The wife woke up to her husband snoring loudly. When she tried to wake him she couldn't. This prompted the 911 call. Then, while on the phone with the call taker, the patient stopped snoring....of course that's because he stopped breathing all together. If he lives I think his wife will lose the right to complain about his snoring.

Thursday, January 14, 2010

Heart Rhythms Part 2: Sinus Rhythms

This is part two of my cardiology lecture. See part 1, Basic Heart Anatomy, here.


A sinus rhythm is any rhythm that is generated in the sinus node. This is characterized on the rhythm strip by a P wave (unless otherwise stated all strips are considered to be in lead II).


The P wave is the electrical impulse passing through the atrium on it's way to the AV node. If the heart is working correctly, this will cause the atrium to depolarize and contract forcing more blood into the already full ventricles. This provides what is called atrial kick because when a muscle is stretched, it then contracts. So the atria force more blood into the ventricles which then stretch to accommodate the extra blood. Then, just as the muscle starts to contract, the AV node lets the electrical impulse pass through the ventricles. This provides for a very forceful contraction.

The QRS complex represents the electrical impulse passing through the ventricles, depolarizing them and causing a contraction.

The T wave is the re-polarization of the ventricles. Basically them recharging their batteries and getting ready to do it all over again....and again....and again....you hope.

The P-R interval and ST segment are important and can tell you a lot about what is going on with the conduction system of the heart but I'm not going to cover those here.

So as long as your heart rhythm looks like the one pictures above you have a sinus rhythm. Now, we must distinguish the rate.

<60 beats per minute- Sinus Bradycardia.
60-100 beats per minute- Normal Sinus Rhythm.
100-160 beats per minute- Sinus Tachycardia

Anything between 160 beats per minute and 250 beats per minute is considered to be SVT which I will cover in a later post.

Here are the requirements for a sinus rhythm.
  1. 1. A heart rate between 60-100 beats per minute.
  2. 2. The SA node pacing the heart.
  3. 3. Regularity- Regular
  4. 4. A "P" wave must be present for every "QRS" complex in a ratio of 1:1.
  5. 5. PR interval is between .12 second and .20 second.
  6. 6. QRS complex width should be less than .12 second.

Heart Rhythms Part 1: Basic Anatomy
Heart Rhythms Part 2: Sinus Rhythms
Heart Rhythms Part 3: Junctional Rhythms
Heart Rhythms Part 4: Ventricular Rhythms
Heart Rhythms Part 5: Premature Beats
Heart Rhythms Part 6: Heart Blocks

Back In Medic School

I just went back to medic school. For those of you that don't know, going to my medic school caused me just a hint of stress. There was difference however. This time I went back to medic school as an instructor. I can't help but think of one of the lines from one of the all time great movies (at least if you're a guy), "I thought of being an instructor, sir." ... "God help us." (points for naming the movie, bonus points for naming the to characters).


I am now a lab instructor at one of the local paramedic programs. On my first day I discovered a couple of things. First, it's a lot more fun to watch the medic students squirm that to be the nervous medic student. Second, medic students keep you on your toes. They will ask questions about things that you may not have had to think about since you were in their shoes. I realize that this job is going to push me and force me to stay on top of my paramedic knowledge. This is a good thing.

For the first part of the day I shadowed the lab coordinator. For lab day the students are broken down into small groups called squads. The students have just started airway and breathing emergencies so we gave the ones in our squad some fairly straight forward scenarios. After a couple of scenarios I was on my own.

I ate lunch with a couple of the other instructors. When you're the new guy there's a strange getting to know you process. Not only do the others want to know if you're going to fit in or not but they want to know your level of competency as a medic. You talk about your work history and share some calls that you've been on. Everyone sized me up while I was evaluating them. It's kind of like setting up a pecking order that's not solely based on seniority. I figure it would be interesting to watch for a psychologist.




 After lunch we broke back into groups and went over some skills. They had a chance to play with several different types of nebulizers and to practice removing a "foreign body airway obstruction" (in plain English, something on which you are choking). While the students were practicing these skills a young man calmly walked into the room and said, "We need a paramedic in room 4B." We all looked at each other. I couldn't decide if he was serious or not. So I asked if he really had an emergency. When he said yes, the instructors quickly shifted gears from teachers back to medics. While the other instructors grabbed equipment I followed the student. He said that a girl in his class was dizzy and had passed out.

When I arrived at the classroom (which ironically was a health class that fulfilled the prerequisite for an EMT class) the teacher was in the back of the room knelt over an 18 year old girl that was laying on the floor. The teacher rambled on with some kind of report and handed me a paper with some writing on it. It was nearly impossible to read but I assume it had some basic vitals on it. I soon discovered that my patient was having dizziness, chest discomfort and shortness of breath. As the other paramedic instructors showed up with equipment they each went right into doing what needed to get done. After a few minutes, one of the instructors asked if 911 had been called. The teacher said that they hadn't. That was something that I wasn't used to checking on. If I'm showing up with equipment on a medical aid, I'm there because someone called 911. So we had the school call for the local fire department. When all was said and done it appeared that my patient had just suffered a panic attack. She denied ever having one before but when we talked to mom on the phone she confirmed a history of anxiety.


The rest of the day was spent running more scenarios with a couple of the squads. They try to rotate the instructors around so that there's not just one person teaching a squad all day. By the end of the day I was mentally tired. I forgot how exhausting it can be being in the learning environment.I can't wait for more.

Wednesday, January 13, 2010

Concerned Neighbors

Sometimes it's nice to have neighbors that watch out for you. My neighbors have on occasion, raked my leaves and put away my trash bins while I've been on duty so that my wife doesn't have to do it. So it should be no surprise that when a citizen saw smoke coming out of his neighbors house he was concerned. She immediately went over to the house and pounded on the door while yelling for the owner. After several attempts she decided to call 911.

We were toned out for a smoke investigation. We run on so many of these that are false alarms that we are probably a little to relaxed. We got dressed and headed out. As we were approaching the house we could see smoke coming from the windows, but not much. My captain had me hang tight at the engine while he investigated. If we need a hose line he can just radio for me. After a minute or so my captain notified dispatch that it was a stove fire and that it was out. He then asked my engineer and I to grab the fan. Then, while the captain was talking to the owner outside, we went through the house opening and closing windows and doors eliminating as much smoke as possible. We found that the owner had been watching a movie in his bedroom and not that kind that he'd want his neighbor to know about.



So once we were all back in the rig, we figured that the owner must have started cooking lunch on the stove. He was then distracted by the porno in the bedroom, enough so that he didn't notice the smoke and either didn't hear, or ignored the neighbor. Imagine if his house had burned down. How do you explain that to the insurance company.... "I didn't notice the front half of my house was on fire  because...."

Friday, January 8, 2010

Cyclist Vs Bus


"Respond for a bicyclist struck by a bus." I was just thinking that I haven't had a good trauma (in this case "good" totally depends on your point of view). As we were responding station one decided to head our way (code 2) just in case there were people on the bus that were hurt. If that were the case we would need the manpower. As we pulled up we were able to see the occupants of the bus along with the bus driver standing on the sidewalk. The one thing that was missing was a patient.

According to Mr. Bus Driver the cyclist had just been clipped in the rear tire. After being hit he spun around and smacked the ground. The loser of this accident then walked over to the curb and sat down in a daze. Understandable. A bus going 30 MPH just hit him. I'd be dazed too. After composing himself he grabbed his bike and started walking home.

We found him down the street without his bike. He had locked it up to a fence. As we approached him we could see that he had an abrasion to his face. Unfortunately, he spoke no English and my Chinese sucks. Since we had no real way of communicating with him we had to assume the worst case scenario. So we had treated him as a trauma patient. I felt so bad for this guy. He doesn't speak English, gets hit by a bus, tries to walk home (assumption on my part) and then gets "stripped and flipped" placed on a backboard and sent to the hospital. I'm willing to bet that if we were able to communicate with him he would have refused to go to the hospital. He was surprisingly cooperative though.


 I found this picture of what you get when you combine a bus (OK, a short bus) and a bike.

Thursday, January 7, 2010

DNR's

We were toned out for a person having trouble breathing. When we arrived at the apartment I walked in the door and was immediately aware of the little tiny dog, on a chair next to a hospital bed (in the living room) trying to attack me. The dog jumped off the chair at me but was deflected by the 19 year old son of my patient. The dog then tried to go around the chair and attack my ankles. This time he was foiled by my 20 lb. orange drug box (it's orange so we don't forget it at someones house...from time to time we still do). After the kid grabbed the dog I noticed that my patient was slumped over with her head dangling off the far side of the bed. My patient was a woman in her early fifties that must have weighed about 100 pounds and had the look of someone that had been withered away by cancer. I quickly pulled her up to a normal position on the bed and checked to see if she was breathing. She wasn't.My engineer and I immediately grabbed her and drug her to the floor where we could work. While we were doing this my captain checked with the son about a DNR. I repositioned her airway and rechecked her breathing and I this time I also checked for a pulse. While my engineer got the BVM and oxygen out I found my landmarks to do chest compressions. Just as I was about to start my captain said that my patient had a valid DNR



At this point I placed the patient on the heart monitor to ensure that there was no electrical activity. She was in asystole in all leads. We then carefully placed the deceased back into bed and cancelled the other responding units.



According to the son my patient had been fighting cancer for several years. It had recently metastasised and his mother's health had started really deteriorating. He had gone to work just down the street despite the feeling that he should have stayed home. During his lunch break he decided to come home and check on his mother and that's when he found her slumped over in bed.

The nice thing about the DNR is it allows the patient to determine what they want done to them in just this scenario. For those of us in the EMS field we generally don't want to go through what we do for someone in full arrest. We'd rather be let go. We often joke about wearing a t-shirt or getting a tattoo of a DNR. We are a sick and twisted bunch I know.

Wednesday, January 6, 2010

Firefighter VS Neighbor

One of the firefighter with whom I work was telling me about a party that he had at his house just after he bought the place. He had only been living on the cul-de-sac for about two months when he had a modest size (couple of hundred people) birthday party. One of his neighbors came home and found that there was no parking anywhere and that people we actually double parking in the cul-de-sac. so the neighbor came over and started yelling at this firefighter about the parking issues. While this was going on the neighbor heard a back up alarm. He smiled and said that the tow truck he had called was here and he was going to start towing vehicles away. As they both walked out to see the truck they discovered (one joyfully, one disappointingly) that the back up alarm belonged to the tiller truck from the local fire station. The guys on duty wanted some free food and to say happy birthday.



I'm happy to say that since that time the neighbor and the firefighter have patched things up and they laugh about that first party.

Tuesday, January 5, 2010


Here are some statistics on LODD for 2009 as reported by USFA.

A PROVISIONAL REPORT
ON-DUTY FIREFIGHTER FATALITIES IN THE UNITED STATES
Date Range 1/1/2009 to 11/30/2009
Number of On-Duty Firefighter Fatalities: 80

Classification:

40 Volunteer 50%
32 Career 40%
4 Wildland Contract 5%
3 Wildland Full-Time 3.75%
1 Part-Time(Paid) 1.25%

Type of Incident:

30 Not Incident Related 37.5%
22 Structure Fire 27.5%
15 Wildland 18.7%
5 MVA 6.25%
3 EMS 3.75%
3 Other 3.75%
1 Vehicle Fire 1.25%
1 False Alarm 1.25%

Cause of Fatal Injury:

47 Stress/Overexertion 58.7%
15 Vehicle Collision 18.7%
6 Fall 7.5%
3 Struck by 3.75%
3 Caught/Trapped 3.75%
2 Collapse 2.5%
2 Lost 2.5%
1 Contact with 1.25%
1 Other 1.25%

Nature of Fatal Injury:

38 Heart Attack 47.5%
24 Trauma 30%
8 CVA 10%
5 Asphyxiation 6.25%
2 Burns 2.5%
1 Heat Exhaustion 1.25%
1 Violence 1.25%
1 Electrocution 1.25%

Age of Firefighter When the Fatal Injury Was Sustained:

2 - Under 21
2 - 21 to 25
5 - 26 to 30
14 - 31 to 40
23 - 41 to 50
21 - 51 to 60
13 - 61 and Over

Firefighter Fatalities by State by Location of Fire Service Organization:

2 Alabama 2.5%
1 Arizona 1.25%
3 California 3.75%
1 Colorado 1.25%
2 Connecticut 2.5%
2 Florida 2.5%
2 Georgia 2.5%
2 Illinois 2.5%
1 Indiana 1.25%
2 Kansas 2.5%
1 Kentucky 1.25%
4 Louisiana 5%
2 Massachusetts 2.5%
1 Maryland 1.25%
1 Maine 1.25%
3 Missouri 3.75%
3 Mississippi 3.75%
4 Montana 5%
4 North Carolina 5%
2 New Jersey 2.5%
7 New York 8.75%
3 Ohio 3.75%
4 Oklahoma 5%
6 Pennsylvania 7.5%
1 Rhode Island 1.25%
1 South Carolina 1.25%
5 Texas 6.25%
1 Utah 1.25%
2 Virginia 2.5%
2 Vermont 2.5%
3 Wisconsin 3.75%
2 West Virginia 2.5%

Sunday, January 3, 2010

3 Year Old Full Arrest

About 2200 we were toned out for a 75 year old woman that fell down the stairs and possibly fractured her hip. The call was on the far West side of our district, close to station one. As we were leaving the apparatus bay we heard station one get toned out for a possible full arrest in the far East end of our district. We all realized that to give the dying person the best chance of survival we should turn around and respond to that call. We were closer, already dressed, and rolling. We could get there several minutes before station one and that could make all the difference. So we turned around within earshot of the address of the first call.

As we informed dispatch that we were re-routing the confusion began. With all the chaos on the phone the dispatcher missed our radio call informing her that we were now responding the the full arrest. She continued to advise station one units that they were responding to a 3 year old full arrest and that PD was responding as well.



Now we were really glad that we decided to respond. We finally cleared things up with dispatch just before we arrived on scene. Luckily station one was on the ball and headed to the old lady that fell. As we approached we could see that two PD units were already on scene. The officers were kneeling over the patient who was laying in the grass right next to the curb. There were about 15 friends, family and neighbors outside watching things unfold. My immediate thought was this one looks real. It must be, the family ran the kid out to the first arriving unit. Before the engine came to a complete stop I was out of the rig grabbing equipment. My engineer, another medic, was thinking the same thing as me, "God help this little kid." We both have kids that are three.
http://circ.ahajournals.org/content/vol112/24_suppl/images/large/24FF1.jpeg
























This is the treatment plan that was going through my head.

As I approached the kid I noticed that the cops weren't doing CPR but were acting flustered. I knelt next to my patient and moved one of the cops out of the way. I did a quick check on the important stuff. The kid was breathing, although not well, he had a pulse and he was 11 months old, not 3 years old. We quickly started assessing the child. While he was breathing and had clear lung sounds, he was clearly struggling and had a strange almost clapping sound when his epiglottis closed. It was audible even without the stethoscope. The mom, understandably on the verge of panic, asked us to do CPR. Without missing a beat I let her know that her son was breathing and his heart was pumping. The best thing for us to do was to finish checking him out and get him to the hospital. I reassured her that if he needed CPR I would begin without hesitation. I then asked her to go get a blanket to cover up her son to protect him from the cold. This gave her something to do and some semblance of control over the outcome of her son.

The parents said that their son was standing and fell face forward onto the tile floor. He acted as if the wind had been knocked out of him. While we were assessing the patient we were able to watch the goose egg form on the right side of his forehead. The patient had periods of crying (seen by medics as a great thing) but mostly he was sedate. The little boy let us manipulate his arms and legs without fuss in order to get his clothes off. He didn't resist when we placed him on the pediboard. He even tolerated the oxygen mask.

http://www.dvrescue.com/pediboard.jpg
Once AMR arrived on scene we finished strapping him in and sent him off to Children's Hospital. My engineer and I were both a little shocked when the AMR medic decided he didn't want a "rider" (a firefighter to go along with them just in case the kids started to circle the drain).

I have no idea what was wrong with the child. Everything that we could check was normal (with the exception of the labored breathing). All I do know is I can tell the difference between big sick and little sick. This kid was big sick. We've asked our EMS chief to follow up on this patient for us.

The 75 year old woman, for whom we were originally dispatched did have a fractured hip but thankfully was not in too much pain.

Saturday, January 2, 2010

The Not So Roaring Fire

We were toned out for a brush fire along the freeway. It's 50 degrees outside, all the grass is green and it's been raining today. Really? A fire in these conditions?? Sure.

As we approached the area (we were told it was at the last on ramp from our city) we couldn't see or smell anything. We had another unit checking to the East of us without any luck. We decided to go down the frontage road that led out of our city (yes we were poaching on another departments jurisdiction) and see what there was to see. A mile or so down the road we ran into a CalTrans truck on the side of the freeway with a rather excited driver. He said there was a fire back by the last call box. Once we were to the call box my captain and I hopped out and looked for the fire. After a couple of looks we found it about a quarter mile further down the freeway. We jumped back into the engine and headed down there.

Once there I pulled the bumper line while my engineer set up the attic ladder against the fence for me. All it was was a small rubbish fire. After a few gallons of water the area was well flooded and the fire was out. Not exactly a roaring fire but better than nothing.

http://www.cartoonstock.com/lowres/amc0730l.jpg

Friday, January 1, 2010

We Got A Bleeder

As we walked into the bedroom of our patient we were greeted by a home care nurse that was holding pressure on the groin of our naked 33 year old patient who was laying on the bed. She told us that he had had a cyst removed from the groin ten days ago. Today, while he was taking a shower he noticed that he was bleeding. He applied pressure and waited for the RN who was already on her way for a scheduled check up. When she arrived she moved the towel to check on the 3 inch long, 1 inch wide and 1 inch deep laceration (which was left open to heel from the inside out) and found that blood was squirting out. She quickly reapplied pressure with some gauze and instructed the family to call 911. Her patients femoral artery was bleeding.

























After hearing the story we asked to to just stay where she was at. We did an assessment and found that, other than being in pain from the amount of pressure being applied to the wound, the patient was fine. We bandaged him up and instructed him to maintain pressure on the wound. We also started an IV just in case. the patient was very fortunate. He lost very little blood especially for an arterial bleed.
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