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Monday, December 31, 2012

A Thank You Visit

Dispatch informed us that we were responding for a 38 year old female complaining of weakness. We groaned a little bit because this sounded like another BS call.

Walking up to the front door we were met by an older lady. She turned out to be the mother of my patient. She said that her daughter had been getting ready for work this morning when she started feeling weak and dizzy. The mom led us to the couch where her daughter lay.

When paramedics approach a patient we are already assessing the patient. We are checking to see if they're breathing and how hard they are trying to breath. We're looking at their skin color, if they're tracking us and appear alert. We are also looking for anything that is out of the ordinary weather that's empty alcohol bottles or a knife sticking out of the patient.

The urgency on this call went from low to high with one look at my patient. On side of the woman's face was drooping. My continued walking assessment showed that she was breathing adequately and had good skin color. I checked for a radial pulse as I knelt down next to her and introduced myself.

I then checked to see if she had equal grips and was able to push and pull with her feet, which she wasn't. Then entire left side of her body was paralyzed. Working while I talked I started an IV. She said that the symptoms had started about 15 minutes ago, well within the window for thrombolytics.

I explained to my patient what my worries were. That she could possibly be having a CVA. I then explained what was going to happen at the hospital. I also gave her the possible outcomes and reassured her that because of her quick action, she gave herself the best chance at recovery.

Once AMR showed up we loaded the patient up. I gave them a brief run down and said that I'd be riding in too. In the back of the ambulance there were no changes, for better or worse. The entire time my patient remained calm. At the hospital I let the AMR medic give the report (he was the one that had the rapport with the MD) and I answered questions as needed.

The next tour the doorbell rang just as we were sitting down to brunch. I slid down the pole and answered the door. It was my patient from the previous week. She stopped by the station with her mom and nephew to say thank you and to drop off a plate of cookies. She has spent a couple of days in the hospital but her symptoms had subsided within a couple hours of our meeting. She had a TIA (mini stroke). We talked a bit about her condition and I answered some questions that the neurosurgeon hadn't. I also gave her nephew a tour of the truck.

It was nice to get a thank you like that. It was great to see that one of my more serious patients had recovered.

Monday, December 3, 2012

Freeway Dangers

This engine was struck not once but twice, sending 3 firefighters to the hospital. Please slow down when you see flashing lights. Our families want us to come home at the end of the shift.

Monday, November 26, 2012

Strucure Fire, Multiple Callers

Right after lunch we heard engine 59 get dispatched on a smoke investigation. Since it was the middle of the afternoon on a clear day I assumed it was a nothing call. Someone was probably using their BBQ or had put too much oil in their lawn mower fuel or at worst was burning something illegally in their backyard.

Less than a minute later the tones went off dispatching us and the rest of the first alarm assignment to a structure fire in 59's district. Dispatch crackled over the radio as we donned our turnouts saying that they had multiple callers and the fire timer had been started. We had ourselves a working structure fire.

As engine 59 arrived on scene they gave a size up. They had a single story, single family residence with the garage fully involved. They had their own water supply and were starting fire attack. Our BC arrived and took over IC. Engine 59 reported that the fire had extended into the attic.

When we arrived on scene we were assigned to the garage fire. Engine 59 was inside so we would need to make sure our hose stream didn't go into the house from the garage lest we give that crew steam burns. I grabbed the #1 crosslay off of engine 59 and headed for the fire.

Because the wind was at my back I was able to get close to the garage before I masked up. Once my BA was on I got down to business. The 150 gallon/min flow from my nozzle wasn't doing a lot to combat the high amount of BTU's being put off from the fire. The gasoline from the rupture gas tank on the car in the garage wasn't helping any.

A couple minutes later my captain showed up at my side with the bumper line off of the engine. He had noted that we needed more water to get the fire under control and had grabbed the second line. With the two of us flowing water we were able to quickly knock back the fire.

With my engineer backing me up I moved around the the Delta side of the building (in the fire service we label the sides of the building in a clockwise rotation starting with the front which is the Alpha side). There on the side of the building we found what was left of the gas meter. It was hissing and shooting up a fireball about 7 feet in the air.

My engineer and I came up with a plan. I would cover him with the nozzle while he shut off the gas valve. My engineer started to look for a tool with which to shut off the valve. He kept digging into his turnout pockets and coming up with more things. Eventually he found what he was looking for but not before a semicircle of miscellaneous tools were strewn about him like some sort of a mechanical rainbow.

Once he had the tool I switched nozzle from straight stream to fog and covered fireball. I adjusted my stream so that the smoke and flames were being pushed away from the valve. My engineer then reached in and shut it off. It was only then that we noticed a 5 gallon propane bottle was off gassing a few feet away. He grabbed that and took it a safe distance from the house.

On the side of the house there was a wood shed filled with stuff. It was also fully ablaze. After knocking the fire out there I made my way in the side door of the garage and finished off the fire under the hood of what was once a car.

By now most of the fire was out. My captain called me over, we had been reassigned to the roof. The fire was still skunking around in the attic and the IC wanted to get someone on the "good" (that's a relative term) part of the roof to see if they could put out the smokers from up there.

I grabbed the ladder and went to the alpha/bravo corner. I threw the ladder up and climbed. Before stepping off of the ladder I pounded on the roof to see if it would hold my weight in a process we call sounding. I sounded my way up the slippery roof (it was covered in moss) almost to the apex. Up that high the roof started to feel a bit soft. My captain and I decided that there was no point in risking a fall through the roof for a small fire that could be extinguished with an interior line and some pulled ceiling.

Back on the ground we assisted with overhaul. Fortunately for the owners the fire was confined mostly to the garage and attic. It looked really bad from the outside and the fire itself had no doubt looked impressive the the gaggle of people that were watching but a lot of the personal items in the house were able to be saved.

We were cleared not too much later. Back at the station we had to wait about 30 minutes before we were dispatched to another fire. This time someone had set some debris and a couch on fire in the middle of a vacant lot. We hosed that off and doused all the other rubbish and furniture in the area to prevent the Spark from lighting another fire.

Wednesday, November 7, 2012

Assault With Bodily Fluids

I am usually a very cool customer when it comes to dealing with patients. Even the ones that are really annoying and/or offensive. But there are times when my limits are stretched.

Or both

We were called to one of our local dive bars for a 'man down.' As we pulled up we could see that PD was there talking to a man sitting on the sidewalk. There was blood all over the concrete.

My patient was walking out of the bar and was supposedly hit in the back of the head by someone with something. He then fell to the ground and hit his head causing a 4 inch laceration. Being a head wound there was quite a bit of blood.

I knelt down next to my patient and inspected his head wound while holding his head and neck still. The bleeding had mostly stopped. I asked my engineer to bandage it up and I started my assessment to see if I could clear c-spine. I asked my patient if he had any pain in his head or neck? He responded by swearing at me and telling me that he was bleeding.

No ****ing duh Sherlock.

I tried again and got the same response. After a couple of other questions to determine if he was alert and oriented (he was) I asked him how many drinks he had had. In response he reached his hand up to his head, covered his hand in blood and proceeded to wipe on my turnouts.

At that point I was done. I asked my captain to throw a c collar on the guy. By this time AMR was pulling up. I walked over and gave them a rundown on the call. Basically I told them that the....patient was hit and the head, was bleeding, was alert and oriented and being a prick. Since he didn't want to answer questions he was going to have to be placed on a backboard. Just precautionary. Usually I don't like placing people on a board because it's really uncomfortable, even painful. This time I was happy to do it.

While I was talking to the AMR guys I could hear my captain yelling at the patient not to grab him. At least the drunk wasn't just being difficult with me.

While strapping him to the board the pain in the caboose kept trying to sit up and yell that we should be trying to find the guy that hit him. We assured him the the police were doing just that. We finally got him good and strapped down and loaded in the ambulance. The last thing I heard from him was him yelling obscenities at the medic in the back of the ambulance.

Stupid patients.

Monday, October 15, 2012

I Could Have Done That

We were being dispatched to assist PD with a wellness check. A wellness check is when a neighbor a family member calls 911 and asks that we check on someone. Usually it's because they haven't been heard from in a while. Sometimes it's because of a smell. Thank goodness for SCBAs. This time the old man that lived at that address hadn't been seen in several days and his garage door was open.

In front of the house we met the sergeant. According to him his officers had been around the house and checked every window and door. All were locked. We were called to force open one of the doors.

The officer in charge said that after we made entry his guys would clear the house and make sure everything was safe. I was ok with that. I grabbed the irons and headed for the garage.

I sized up the door. It was a hollow core wood door. Easily forced. I handed the irons to my captain and set up to kick the door in. With a good kick the door flew open. The officers announced themselves and asked that anyone inside do the same. An old man asked what was going on.

After a short conversation with the home owner the police cleared us. The sergeant pulled me aside and said that he could have opened the door that way. He further explained that they had called us because they thought we would do less damage. I showed him the irons and said that I had a flat head axe and a mid-evil weapon looking tool called a halligan. Did he really think I would cause less damage with those?

Friday, October 12, 2012


I love that my better half has a sarcastic side (she has to have one to be able to put up with me). She has been spending some time on a political blog arguing with people. After the last Presidential debate there has been a lot of uproar about Big Bird losing his job. This was her response:

"If only there were some way we could contribute to PBS so that Big Bird doesn't get axed... if only PBS made it easy and asked for our support, maybe with a regular telethon... if only we could contribute our money directly to PBS, instead of sending it to the government to send to PBS... and what if they gave credit before each show to the many, many private donations and foundations that make these shows possible..."

That's not even the best part. Someone actually thought she was serious and were nice enough to point out that you can donate.

"Actually it is possible to donate directly to PBS. They have telethons about once per quarter and still accept donations at other times. It is tax deductible as well if you meet the threshold on your taxes."

Sarcasm becomes even funnier when someone doesn't get it.

Wednesday, October 10, 2012

Hate Shots? This One's For You

Here's an interesting article from Popular Mechanics that describes how we are going to be getting rid of least for giving shots.

I found this article interesting since we just went through our infectious disease control class. One of the biggest improvements for us in the medical field as far as engineering controls to stop the spread of infectious diseases was the adoption of a needle-less system for medication administration through IVs. This may help in much the same way.

Tuesday, October 9, 2012

Why So Serious?

There were cops everywhere. The blue and red lights on their vehicles mixing with our red and white lights caused an almost strobing effect on the scene.

A sergeant met us at the sidewalk and said the guy was inside on the floor. The assailant was gone. Walking around the outside of the house were several other officers. From the back of the K-9 unit a police dog could be heard excitedly barking. In the front yard a woman sat in a state of shock.

The blood trail started on the walkway to the house. As we followed it up the three steps to the front door the splotches of reddish brown grew in size. Through the door I could see my patient laying on his right side. He was wearing a sweatshirt and Levi's which were both soaked with blood. The man was trying to cradle the side of his face and head with a towel.

I squatted down (I didn't want to kneel like I would normally do because of all the blood on the floor) next to my patient and introduced myself. He was alert and oriented but understandably a little panicked. He said that he had been stabbed at least once and then had walked into the bathroom to get a towel. On his way back outside he had only made it to the living room.

I had the man remove his hands and his towel so I could get a look at what I was dealing with. He had a full thickness laceration starting about 2 inches behind his left ear. The knife had sliced forward from that point just missing the ear lobe and stopping less than an inch away from the corner of the mouth. It looked like the knife wielding bad guy had tried to slit my patients throat but was thwarted by a downward tilted head. Unfortunately for my patient the bleeding had stopped. He was too low on blood the keep bleeding from this serious wound.

My engineer started cutting the clothes off my patient while I applied a trauma dressing. As we rolled the patient off of his right side we discovered another stab wound. This one was in the upper right quadrant of his abdomen right where his liver should be. It was bleeding quite a bit and his skin was bulging from blood that had accumulated it. In my mind my patient just went from very serious to critical.

Thankfully AMR showed up just then. The paramedic had been told outside that it was a bad facial wound but realized as soon as he saw us working that it was more serious. We placed a hasty dressing on the abdominal wound and lifted the patient onto the gurney. On the way out we put him on oxygen. Since we couldn't strap the mask to his face we simply tried to balance it as best we could.

In the back of the ambulance I checked lung sounds to make sure the knife hadn't caused a pneumothorax. The EMT had everything set up for an IV so I went for it. I heard the driver jump in the front seat. She asked if we were ready to roll. I asked for 5 seconds. Within three seconds there was a large bore IV in his left arm. We then rolled code 3 to the trauma center at the local university.

The patient was compensating well for the loss of blood. While his heart rate had increased his BP stayed above 110 systolic. We watched his BP closely. If it fell too far we would have to give him some fluids to make up for the loss of blood.

With one IV in and dressings on the wounds I found I had the time to do another quick head to toe.I hadn't missed any other wounds. Then I focused on keeping the oxygen mask on my patient and talking to him. Both to reassure him and to continually assess his mental status. An altered mental status would probably be one of the earliest signs that he was losing too much blood.

While talking to my patient I noticed there was some blood coming out from the bandage on his face. A lot of blood. I asked for another trauma dressing and held both in place with direct pressure. The patient was now becoming slow to respond to my questions. His BP was falling. We gave him a fluid challenge to keep it up. The problem with that is that blood carries several vital things to and from the body which saline is not capable of doing. At best we were stop gapping. The patient needed blood and surgery, fast.

The AMR medic started a second line, put the patient on the heart monitor and rechecked vitals. He also called ahead to the medical center to let them know we were coming.

Just a few never ending minutes later we pulled up to the ER. Everyone cleared out of our way and stared at out blood covered patient and gurney. Inside we were met by an army of hospital staff. We swapped the patient over to the hospital gurney and I started to give my report to the MD.

Now I don't mean to offend trauma docs but you guys are arrogant pricks. At least a lot of you are.

I had not even finished my first sentence and the doctor put up his hand and ssshhhhh'ed me. He didn't want to hear a thing I had to say. No chief complaint, vitals, treatments....not a thing. He wanted his trauma nurse to do a once over on the patient and to tell him what she had found. The last thing I heard was the MD yelling (so much for staying calm, cool, and collected) that he wasn't interested in the laceration to the patients face.

After the call the AMR crew cleaned their rig and did paperwork. They were kind enough to drop me off at my station as well. When I got back to the station I had to swap out my turnouts so I could wash out the blood on the ones I was wearing. Then it was back to bed.

Monday, October 1, 2012

When A Fall Isn't Just A Fall

We walked into the house and found the patient laying on the ground on his right side. The daughter said that her father didn't speak English but she was willing to translate. Thankfully he was a Spanish speaker so I didn't need her assistance. There always seems to be something lost in translation when using an interpreter.

It was obvious from the beginning of my assessment that the patient had a problem with his right hip. He was holding it and moaning in agony. I asked how he had fallen and he said he wasn't sure. He explained that he had more or less crumpled to the ground landing on his hip. Then he tried to curl up in the fetal position to ease the pain.

My engineer grabbed me a set of vitals, which were all WNL. I set up my IV equipment and got a line in with the intent of giving some morphine ease his pain. While I was doing this there was still that nagging feeling that I was missing something major. I asked the patient again how he had fallen. Same answer. I asked if he felt weak or dizzy before falling. Yes, and he still felt dizzy and lightheaded.


I had my engineer toss on the electrodes and I took a look at the monitor. In lead II there was ST segment depression (I guess I should add a 12 lead interpretation to my cardiac series). I set up and shot a 12 lead and saw what I was expecting. The patient had ST elevation in leads V1 through V3 with reciprocal ST segment depression in leads II, III and aVF.

In laymen terms, he was having a heart attack.

Thankfully by this point AMR was on scene. I gave the patient some aspirin and then some morphine. The patient denied any chest pain, pressure, or discomfort so we didn't administer nitroglycerin. After rechecking his vitals we gave him a little more morphine and then loaded him up as best we could.

Since the patients condition was serious and because I was the only one with the ability to communicate with the patient I got to ride along to the hospital. The trip was uneventful.

Once in the ER the patient met the cardiologist and from there was sent to the cath lab.

Monday, September 24, 2012

I Am Optimus Prime

So we started a new tradition. My kids are picking out new sheets for me (for work) every year. So for the next year I will be sleeping with Optimus Prime and Bumble Bee.

The Autobots barely beat out Sponge Bob. Better luck next year my yellow, squishy friend.

Wednesday, September 19, 2012

Smell Ya Later

We walked in the front door to a familiar house. One of the tenets, a 55 year old man, rented a room and frequently needed our assistance. He had had a stroke several years ago and now had significant weakness to one side. He was also rather obese. Because of these factors, and sometimes alcohol, he frequently fell and couldn't get up.

This time we walked in and found the patient laying on the floor at the foot of his bed. The room was rank. The patient didn't shower regularly and he had a cat. The cat lived in the room and, because the kitty litter box was full, had proceeded to urinate and defecate all over the room. The patient had also lost control and peed on himself. All of those smells on their own are bad but put together can cause a firefighter to gag.

We talked with the patient and smelled some alcohol. He said that he had simply missed the bed when trying to sit down and that he wasn't hurt. After a quick assessment we helped him to the bed. My engineer and my captain pulled him up by his arms while I pushed/lifted from behind.

Once the hard part was over AMR showed up. We talked with the patient for a few minutes and convinced him that it was in his best interest to go get checked out.

The next day, at various times during the day, everyone on my crew, myself included, smelled the patient from the night before. It came on suddenly and vanished just as quickly but there was no mistaking the stench. It was time to wash our turnouts.

Monday, September 17, 2012

Alarm Sounding

It was one of those nights. The kind where you get hammered to make up for the last several decent nights sleep.

At 0230 the tones sounded for the third time. We padded down to the truck and headed for a manufacturing plant that had an alarm sounding. Per the alarm company it was a manual pull alarm on the second floor.

On scene my captain and I headed in to check things out while my engineer stayed with the rig. We met up with the night supervisor who gave us a very confused look. He hadn't heard any alarms at all and it was business as usual.

The supervisor led us through a maze of large rooms toward a staircase. He informed us that there was not a "second floor" per se but that there were several platforms above some of the equipment that might be considered a second floor. Reaching the metal staircase I couldn't help but notice that his idea of a second floor was 4 stories up. So climb we did.

Up top we found access to several machines. There was only one manual pull station and it hadn't been used. There was no alarm sounding and everything seemed to be running as it should be. So we headed back down the stairs and onto the next area.

We repeated that process several times. Almost an hour later we cleared from the call. Now I was completely awake and covered in sweat. Getting back to sleep wouldn't be easy.

After changing my clothes and reading for a while I was finally at a point where I thought I'd get back to sleep. I turned off my light and curled up under my blanket just in time for the tones to go off again.
The factory had another manual pull alarm sounding.

This time we checked everything and then had the supervisor call the alarm company to take the system off line. This afforded us just enough time to get a nap in before it was time to get up for the day.

Tuesday, September 11, 2012

Never Forget

Tuesday, September 4, 2012

There And Back Again

It was right out of the commercial. Out patient had fallen and couldn't get up so she used her call button to summon help. The operator even informed us that the woman had a key hidden in one of her flower pots. Seemed like this was going to be an easy call.

Not so much.

She lived on the second floor of her apartment building. As we made our way to the front door we started looking for the specific flower pot. Carefully looking around the fake plant we spied the key. The wrong key. It wasn't even the right type of key. Although if we wanted to take her Toyota for a joy ride we could. Fortunately for our patient firefighters aren't easily discouraged. Getting into her home was now a challenge.

The first thing we did was to check the kitchen window. We were able to do this just by leaning over the railing. It was locked. The next step was to check the balcony on the back of the apartment. Of course to do this I needed the ladder. Off the the rig I went.

On my way to the rear of the building my captain stopped me. He said that a neighbor had a key. The poor guy had to wake up at 1 in the morning, get dressed, find the key and give it to us. So back to the rig I went to put away the ladder. On my way I ran into the AMR crew that had just shown up. I pointed them in the right direction and then put the ladder away.

Meanwhile, back at the front door, my captain tried the newly found key on the door. After getting the security door open he was unable to unlock the front door. Perhaps it was a different key. So while he continued the frontal assault I decided to go get the ladder.....again.

By the time I made it to the bottom of the stairs the front door clicked open. It had just been a sticky lock.

Inside we found the 84 year old woman laying on the floor at the foot of her bed. She was alert and oriented and said that she just stumbled and fell. She denied any loss of consciousnesses but was complaining that her left hip hurt really bad. After the AMR medic cleared C-Spine we discussed how we were going to get her out.

I suggested that we use a KED device around her hips to stabilize them (her left side was dislocated or fractured) and then try to move her on a carry all (a large tarp with handles). I watched as the AMR crew started to move the old lady. She immediately winced in pain.

The AMR medic looked at me and said that she didn't think this was going to work and then asked for ideas. I suggested that she start an IV and give her some morphine before we move her. That way we have done everything we could to make her comfortable.

After a couple of doses of the narcotic was placed the patient in the KED and moved her downstairs to the gurney. Needless to say after all that I had a tough time falling back to sleep.

Monday, September 3, 2012

Don't Be Afraid

I was recently contacted by Joe Galizio. He has been writing a children's book which he hopes will "raise awareness that Firefighters, EMT's and Paramedics are there to help in stressful situations." That way, when they need us, they would be less likely to run and hide.

Joe is looking for some financial contributions to help get his project off the ground. If you would like to help, visit his site here.

Monday, August 27, 2012

A Break From The Norm

The call came in around 3 in the afternoon. It was for an unknown medical (which always makes me wonder how dispatch knows there's a medical problem in the first place). As we turned the last corner we noticed several PD units right about where we needed to go (while they are usually there at the same address we had, on the previous call, ran into an officer taking a report from the neighbor of our patient). Dispatch also updated us and said we were assisting PD with a ladder.

After talking with the officers we found out that our potential patient was a 65 year old man that had recently lost his job. His mom said that he had been heavily drinking for several days and that he hadn't answered knocks on the door for quite a while. She said that there was also a loaded shotgun by the locked bedroom door.

The sergeant set up a plan where PD would stack up outside his bedroom door and wait for the signal to bust in. Meanwhile we would very quietly set up the ladder outside the bedroom window. Thankfully the blinds weren't drawn all the way down. Then another officer would scale the ladder and peek in the window. If the suspect/patient was not near the weapon he would give the signal and the officers in the hallway would make their entry.

It all went off without a hitch.

The man had been sleeping off his booze and wasn't really thrilled to see us but was none the less cooperative. He was adamant that he didn't need medical attention but the officers disagreed. They placed him on a psychiatric hold (5150) and AMR took him to the hospital.

In the end we were all just happy that the outcome was such a good one. There was a lot of potential for things to go sideways.

Friday, August 17, 2012

New Traditions

This last shift I was talking to my BC. He's been in the fire service for 35 years and is getting close to retirement. He spoke of a tradition that he has with his kids and it's one that I'm adopting for mine.

Every year his kids choose new bed sheets for him. Doesn't matter what it is. It's a way to connect with the his kids even though he's at work. Admittedly his sons have tried to get him some pink unicorns or something like that but his wife put the kabosh on that one.

So coming soon to my bed will be my new sheets chosen by my kids. I wonder what they'll get me.

Thursday, August 16, 2012

Just Knock Louder

When the tones got me up at 0230 I instantly knew that I was going to have a hard time going back to sleep. There are times when I wake up and my body thinks that I've slept enough when I clearly haven't. This was one of those time.

When we pulled up to the apartment building we noticed a young man behind the closed parking lot security gate. He said he was trying to open it for us but couldn't. As we made our way to the back of the large complex he informed us that he had been trying for several hours to get a hold of his mother. She had called him earlier in the day and asked him to come over but now wouldn't answer her phone or the door. Although he had heard her moaning a couple of times when he knocked loudly.

We stood on the 3 floor in front of my patients apartment and knocked. No answer. Her son was now getting very anxious and was starting to get in the way so I sent him to look for AMR. We discussed our options and decided to force the door. I then realized it was a steel door in a steel frame. At least the walls weren't concrete.

Instead of just making the long trek back to the rig to grab the irons so we could "properly" force the door I decided to give it a couple of good kicks to see if that might just do the trick. After the first kick I knew it wasn't going to give but I gave it a second one anyways. Mostly out of frustration. then, from behind the door, we were yelled at by our patient. "Don't break down my door!!"

I guess the son just needed to knock a little louder.

We announced ourselves as members of the fire department and asked her to come unlock the door. As we stepped inside I could hear my engineer apologize to the neighbors for all the noise.

My patient was alert and oriented but slow in answering questions. She admitted that every time she fell asleep she felt as if it were a deeper and deeper sleep. Thankfully she was willing to go in and get checked out because it was obvious that there was something wrong. Hopefully it all gets figured out and we don't have to go back.

Saturday, August 4, 2012

When To Roll Your Vehicle

The best way to survive a vehicle accident is not to be in one. Other things you can do is to use the safety equipment installed in your car. Doing something as simple as putting on your seatbelt can save your life.

If only you could control when the accident were to occur. I would tell you to have it sometime between 7 and 9 in the morning, at least in the city. That's because this is prime off duty firefighter commute time. If something bad happens, qualified help is probably right behind you.

After working an overtime shift I hopped on the freeway and headed home. I was about 15 miles into my commute. I was in the zone. All the windows in my truck were down, the music was blasting away. It was a beautiful morning.

Then things seemed to slow down. I watched as the black car to vehicles up was hit in the side by the car next to it. The driver hit her brakes and slid into the K-rails.

K-rails are designed to "...both to minimise damage in incidental accidents and reduce the likelihood of a car crossing into oncoming lanes in the event of a collision." It did exactly as it was designed to do. But in the process of preventing the car from entering oncoming traffic it caused the vehicle to flip. The car rolled over one and a half times ending up on its roof sliding down the number 2 lane. The vehicle that caused the accident pulled over to the right shoulder without incident.

I hit the brakes and my hazards and made sure the person behind me wasn't going to try and use my tailgate as a hood ornament.I slowly picked my way through the debris field and stopped just past the upside down car. As I exited the truck I noticed another off duty firefighter from a neighboring department mirroring my actions. We approached the drivers side window and saw that she appeared mostly uninjured and that she was climbing out on her own.

She had been wearing her seat belt and the airbags had done their job. I did a quick assessment on here and found that she had only a little bit of pain to her right arm, probably from the airbag. After a few minutes the first due engine pulled up. I gave the captain a quick rundown and headed back to the commute.

If you have to get into an accident, between 7 and 9 in the mornings would be the time to do it.

Sunday, July 29, 2012

Man Down

It was our second medical aid in 20 minutes. We had just backed the engine into the station when the tones went off. Fortunately at 7 in the morning there's still not much traffic out on the streets. Most of the way through the residential neighborhood we just used our lights but not the siren.

We walked in and were directed to the bathroom. Unlike the guy that this medic found my guy was very much alive.

The previous night by patient went in to use the bathroom. As he was leaving he blacked out and collapsed on the floor. When the elderly gentleman came to he was unable to get himself off the floor. His wife found him the next morning and called us.

The patient had a history of back problems and back surgeries and always felt pain. He said that the pain was worse than normal but still located right at L5 where his previous injury was. We decided to lay him on his side on the backboard because of the pain laying on his back caused. There was no way he was going to tolerate bouncing around in the back of an ambulance like that.

We loaded the man onto the gurney and made sure AMR didn't need anything else. Then we headed back to the station just in time for shift change. It was family time.

Friday, July 27, 2012

Shots Fired

It's been less than a week since the tragedy in Aurora, CO. It's been a hot topic at the fire house just like everywhere else. But here we talk about what we would do in that situation. How would we respond? What can we learn from those that responded that day? Would we be ready?

We were across the street getting lunch. We had placed our order at a great little restaurant and were waiting for our food when we heard engine 57 (from the neighboring district) get dispatched on a medical call. The follow up information is what got us out of our seats and headed that way. Dispatch had engine 57 stage because there were reports of shots fired at the mall.

Immediately the worst case scenario starts running through my mind. Multiple victims, triage tags, ICS, sucking chest wounds, etc. 

When we arrived on scene we met the IC at the staging point. Within a couple minutes an officer came over and filled us in. One of the stores in the mall had been robbed at gunpoint and shots were fired. At this point no victims had been identified. 

A few minutes later we were cleared from the scene. Thankfully we still don't know what the first responders in Aurora had to do.

Tuesday, July 24, 2012

Fights On

Where were you last Thursday morning just before 5? My patient was drunk, stoned, and crying while leaning on the side wall of 7 Eleven. PD had called us out when she wasn't acting right.

We started talking to her and were able to get some information about her but not what had happened to her. She was definitely altered. All seemed to be going well until AMR showed up. Then our patient decided to stop cooperating. She kept calling us cops and saying that she did nothing wrong. We all tried explaining to her that she was just going to the hospital to get checked out but she wasn't having any of it. Having her mother show up on scene didn't calm her down either.

Since she was altered we couldn't just leave her there. Our hands were tied. She wouldn't let us do an assessment and had stopped talking to us except to yell at us. So with the help of the AMR crew and the officers we tried to pick up our patient and place her on the gurney. She was quite the fighter.

I held both her arms above her head on the gurney while everyone else tried to strap down her legs. It was almost comical to watch my crew get tossed around. That was until she started spitting at us. Thankfully PD had a spit mask (a mask designed to keep spitting people from spitting on us) and they got it on her quickly. Within a few minutes we were able to get the young woman restrained and on her way to the hospital.

Afterward, while talking with her mother, we found out that her daughter had been drinking and smoking pot. Her mother didn't know if she had had anything else or if the pot had been laced with something. Whatever it was a few hours in the ER with some fluids should help.

Thursday, July 19, 2012

HAZardous MATerials Response

The tones woke me from a deep slumber. We were being toned out for a HAZMAT response with engine 59 in their district. Before we made it out of the barn the radio crackled. It was engine 59 saying that they could handle the initial response without us. The location of the call was a large bakery. I know that most of you probably just pictured a bakery where you might buy a specialty cake. But I want you to think of that bakery being the size of a Costco. We go there from time to time and it's usually a false alarm.

So with sleepy eyes and grateful hearts we dismounted and padded back up to our dorms. I was unconscious as soon as my head hit my pillow. zzzzzzzzz.......

The tones woke me up again. At least this time it wasn't from a deep sleep. We were being dispatched, along with engine 57, engine 60, our HAZMAT team and our BC to assist engine 59 with an ammonia leak. An ambulance was also dispatched for 2 patients with exposure issues.

We were second on scene but engine 59 had done everything. The building had been evacuated and isolated and the 2 patients were being treated. We just had to wait for the cavalry to arrive.

HAZMAT calls are not like most things we respond to. The pace is much slower and more methodical. Understandably so since the materials we might be dealing with have some very serious hazards. One of the things we have to consider with gases is the direction of the wind and what is downwind.

Once everyone was on scene a plan was formulated. Two members of the team would make entry into the area and test for ammonia levels and shut off the valves. When they came out and said that the levels were lethally high. They were able to shut off the valve and were simply letting the room air out through an outside door.

During this time the media showed up. While the BC prepared for his live interview for the morning news it was decided that we should put up some caution tape. That way things would look more official and controlled on the news.

Firefighters usually don't like to be on TV. Fortunately we were able to confirm that the room was clear and pick up everything before the news crew were ready to film.

Back at the station we watched as our incident made top headlines. They had film footage from earlier of our rigs and the ambulance and would cut back and forth from that to our BC being interviewed. When all was said and done it was a good call. Both patients were treated and released. The leak was mitigated and no one was injured.

Tuesday, July 17, 2012

A Little Humbling

While I was working an overtime shift I stopped at a local sandwich shop to grab lunch. I had shown up just in time because a long line soon formed behind me (and no I wasn't taking that long to decide).

After paying I made way toward the exit. In line was a woman with her 12 year old daughter and her daughters friend. As I passed them the shouted, "Thank you for being a fireman!" That's humbling. At least it is to me.

All I could say was thank you for letting me serve you. I have the best job in the world and I get compensated well for it. What else can be said?

Tuesday, July 10, 2012


We were responding for a patient having "diabetic problems." While this can mean that they have elevated blood sugar levels it almost always means the opposite.

We were met at the front door by an elderly woman. She was a hoverer. You know, the type of person that hovers around you looking over your shoulder. To make matters worse, she was a nurse.

As she led us down the hallway to the bedroom she gave us a good report. She had last seen her husband a couple of hours before when he went down for a nap. He had had a good breakfast and they checked his sugar afterward. When she found him cool, clammy and unresponsive she knew immediately that his glucose levels had dropped.

While we continued with our assessment AMR showed up. I heard the wife in the background saying that the only place to get an IV was in his thumb. The problem was that the thumb in question was not really accessible in the position he was in. That and the vein really wasn't that good.

While the AMR medic went for a line in his right hand I went for one in the left. Wouldn't you know it, just as I advance the catheter the unresponsive patient jerks his arm. I committed a rookie mistake and wasn't ready for it. I lost the vein.

The AMR medic glanced up at the patients neck. He had great jugular veins, just like the one in the picture. I stabilized the head while she went in with an 18 gauge needle. Then the old RN started in on us again. "You're going for the jugular? What are the qualifications of the person doing that?"

We assured her that we watched the training video at least twice and that her husband was in good hands. The AMR medic then started the IV. We taped the line down and started administering some dextrose. Within a few minutes my patient was having a conversation with us and was being told not to move his neck too much.

Thursday, July 5, 2012

She Is Healed

We pulled up and parked in front of one of the local churches. Things seemed a bit hectic for a woman that just passed out. PD was there doing something (what, I don't know) and there were several people from the church outside to direct us.

Inside we found a small knot of people. At the center of the group there was an 18 year old woman sitting on the floor. She was leaning on the legs of a man that couldn't have been much older than her. He had his hands on her head and kept mumbling what I assume were prayers.

I don't like doing assessments in these situations. If I were on an ambulance I would have loaded the patient up without doing much on scene. Unfortunately I didn't have that option. Every time I asked a question at least one person other than my patient answered. It took several requests but I finally got through to them that I needed the patient to answer.

The patient was complaining of trouble breathing. Her respiratory rate was in the mid 30's. She was a little tachycardic but all her other vitals checked out. She had a history of anxiety and had recently been having some stressful events going on at home. She also had tingling to her lips and finger tips. All the classic signs of a panic attack.

We coached her on her breathing. Slow, deep inhales and exhales. To help her relax we got her talking about something totally different. It's amazing how distracting someone can really help them. Finally AMR showed up.

As we stood her up to have her sit on the gurney the man that had been praying (again, an assumption) stood, raised his hands above his head, and loudly proclaimed, "Praise the Lord! Praise the power of prayer! She is healed!"

At that my engineer and I shared a glance. It was the equivalent of an eye roll but sly enough that you wouldn't know it without knowing us. Part of me wonders if they set the entire thing up for a show of faith. Probably not but I wouldn't put it past them.

Hehehe. "She is healed." That saying went on for a while with our crew.

Sunday, July 1, 2012

Penetrating Trauma

We pulled out from the driveway as the apparatus bay doors started to close. Dispatch immediately raised us on the radio, "Truck 51, possible GSW, staging required."

We pulled up to the gate to the apartment complex. It was one that we visit quite often and we knew more or less where the apartment was. PD had swarmed the location managing to block all entrances with empty patrol cars. I hopped off the truck to see if one of the cruisers was unlocked so I could move it. No such luck.

A few minutes later we received an all clear notice. One of the officers ran out to move some vehicles to allow us access. We pulled in and went around to the back of the complex. I grabbed the medical equipment and looked for the right apartment. Through an open window I saw a couple of uniforms so I headed in that direction.

Once in the apartment I was directed to the front bedroom. Inside an officer somberly shook his head indicating the the suicide attempt had been successful. Rounding the corner of the bed the officer asked me to be careful of the shell casing on the ground for evidence. The 30 year old male was laying on his right side.

I checked for a pulse and breathing just to be sure. I then inspected the wound a little closer. This wasn't morbid curiosity. I was looking for brain matter because its presence would mean we wouldn't be working the mega code. In other words no life saving measures would be done. There was brain matter in several places on the body and the bed. As a matter of protocol my engineer placed the electrodes of the monitor onto the body. We watched as the line on the monitor, that would normally be making predictable jerks up and down, lay flat.

I  called it. Time of death, 2032.

Outside another officer took down our names and unit number. My engineer and I quietly continued our conversation that had been interrupted by the call while my captain finished some paperwork. The scene was turned over to the cops and the coroner was called. We headed back to the station, ready for another call.

Wednesday, June 27, 2012

A Pain In My...

We arrived on scene to find a woman waving us down. We were led into the townhouse to an upstairs bedroom. There we found a 50 year old male, shivering with pain, lying in bed.

He said that he had had a tooth ache for the last 3 days. A few hours ago he got in to see his dentist and had had a root canal. After the procedure he had been sent home with a prescription for Tylenol 3 for pain.

Let me set the record straight. I've had tooth aches. I know they hurt, a lot.

So I asked my patient how long he had been in this much pain and he replied for the last 3 hours. I then inquired if he had called his dentist? He said that he had. I had to follow that question with another, what did he say?

My patient, who was now spitting on the floor because it hurts to swallow and whispering because it hurts to talk (I thought it was as tooth ache, not a sore throat) told me that his dentist had given him a stronger script for his pain. And that his dentist had even called it in to his local pharmacy. 

But did he get it filled? No. Instead he decided to call 911 so he could hold my hand (he really did). My 7 year old daughter handles pain better.

Sunday, June 24, 2012

How Do You Say Thank You?

Over the weekend my department suffered a loss. One of our firefighters that has served for more than 34 years had recently been diagnosed with cancer. The last several months he has been away from his job (and his fire department family) going through treatment.

This last week it was discovered that the cancer had come back with a vengeance. Some of my brothers volunteered to go get him and bring him home. Some time late Saturday night or early Sunday morning my brother passed.

Most of the people in his district will probably never know that he gave everything for them. For my part, I thank him for being an example of what a fireman should be. I hope that by answering the tones when they go off he will understand that I am doing my part to carry on the tradition that he believed in. Rest in peace.

Friday, June 22, 2012

Neither Snow Nor Rain.....

We pulled up on scene to find a mail jeep and an SUV in the intersection. It was pretty clear that the jeep had pulled out and into the other vehicle. PD was already there. The officer said that there were 3 possible patients. The mailman, the guy driving the SUV and his grandson.

My engineer headed over to the grandfather and my captain started assessing the mailman. I went over to the police cruiser where a frightened 8 year old boy quietly sat. Pulling off my helmet I opened the door and knelt next to him. I got his name and age. I asked him if he was wearing his seat belt and what hurt. He said that he was and that nothing hurt any more. He said that the bag hurt the side of his head a little bit but he was better now. And he wanted to know why we had airbags.

I continued my assessment and answered questions. He was very curious. How did we know to come? Who called 911? What going to happen to the car? But most of all he was worried about his grandfather. I told him that he looked ok and that another firefighter was looking after him. Finishing my assessment I headed over to my engineer to find out about the old man. I then headed back to tell the boy that they didn't need to go to the hospital and that his grandfather was well.

Once that was done I headed back to the rig and grabbed a sticker. I knew I had hit the jackpot when I handed it to the 8 year old and he exclaimed "COOL!"

The mailman was ok too.

Sunday, June 17, 2012

Pass The Joint

It's strange how some apartment complexes never generate 911 calls while others are visited every week by the fire department. We have one in our district that we go to frequently. Stranger still, there's no frequent flyer. The calls are almost always for someone new.

This time the call came in for a juvenile that was altered. We pulled in the driveway past the security gate and parked. We grabbed our gear and headed for the apartment when the first PD unit showed up. Immediately we started wondering what was going on and what information PD had that we didn't. They showed up because there was possibly someone on drugs.

We made our way inside and found our patient sitting on the couch. Boy was he stoned. He admitted that he had smoked a bunch of weed (no, not medicinal). And with the rest he had made some muffins. Just after we started our assessment we heard a police officer outside start yelling at someone to get down on the ground. Then the sounds of a struggle followed. My captain and my engineer went out to make sure the officer had everything under control.

An 18 year old neighbor and so called friend of my patient was trying to push past the officers to see what was going on. After ignoring one officer and trying to push past him several times the officer ordered the young man to the ground to detain him for our safety. That's when the fight ensued. It was rather one sided. You can't fix stupid.

Back with my patient everything was under control. How could it not be. My patient was completely toasted. It was funny to see his delayed reaction to the police walking in his room. And it was funny to note he was more afraid of his mother when she walked in having been called home from work. 

Thursday, June 7, 2012

Insult To Injury

A nearly 80 year old man lay awake in bed trying to take a nap. His wife, laying next to him, was worried. She didn't think he looked well. He insisted he was alright and refused any help.

About 30 minutes later the old man jump up and ran for the bathroom. Half way there he started to throw up on the hard wood floors. As he tried to round the corner to make it to the toilet the combination of emesis, hardwood floors, and inertia proved too much for him. When his wife found him passed out she called 911.

We arrived to find the gentleman hugging the porcelain god in nothing but his tighty whities. He had managed to crawl over to the toilet after waking up. We collectively decided that dignity is worth a small delay in patient care so we waited while he cleaned himself up and slipped into a bathrobe.

Out in the living room we began to get a clear picture of things. The patient had had an MI about a month ago and had several stents placed. He had only been released from the hospital a few days before. After some prodding he admitted that he had been feeling ill for a couple of hours (that really angered his wife).

The patient wasn't complaining of chest pain but did say that it felt the same as it had when he had his last heart attack. That's an attention getter. While my engineer grabbed a set of vitals I set up for a 12 lead. As soon as we were finished shooting the EKG we put on oxygen and gave him some aspirin.

When AMR showed up we gave them a report along with the 12 lead showing that he was having another MI. We moved him over to the gurney, which the stubborn old guy really didn't like, and AMR sped off to the cath lab.

Poor guy. I hope we caught this one early enough for a good outcome. I guess he's looking at several more days of hospital food. Maybe he'll be visiting the porcelain god again.

Monday, June 4, 2012

Big Sick Or Psych Sick?

We arrived on scene to find several family members waiting for us. As they ushered us to the back bedroom they kept saying that he wasn't acting right. Come to find out the dad in the family was having periods of apparent unresponsiveness.

Once at his bedside I was able to see for myself that he wasn't acting quite right. He was a little slow to answer questions. Then he went unresponsive on me (how dare he right?). I called his name, shook him and caused a little bit of pain all trying to elicit a response. There was none.

So we started to try to figure out what was causing him to be altered. After a couple of minutes, the patient came around but was still confused. He was also being fairly aggressive. His sugar was 113, BP 140/88, heart rate of 90. All the rest of his vitals were good as well.

The guy had a history of high blood pressure but no history of seizures, stroke or psychological problems. No history of alcohol or drug abuse and he had been with his family all day. It kind of seemed like a possible absence seizure but there was something off about the situation.

Eventually AMR showed up and the man had calmed down. We loaded him up onto the gurney and let AMR take him away. I just hope that he behaved in the back of the ambulance or else he was going to get sedated.

Thursday, May 31, 2012

When Snoring Really Isn't Good

0200. The lights clicked on and the speakers came to life. "Engine 51, medical aid...." I slipped out of bed and made my way toward the apparatus bay. I donned my bunker pants and slid into my seat, still trying to shake the cobwebs from my mind.

Arriving on scene we found our patient laying in bed. His wife told us that she called when she couldn't wake him up. The first thing to pop into my mind was that his blood sugar was low. It's always the sugar. My patient was breathing but his tongue was partially occluding his airway causing him to snore. I think that's what woke his wife up in the first place.

While I dealt with his partial airway obstruction my engineer grabbed the glucometer. The guys blood sugar was 35. Told you it's always the sugar.

I reached into the drug box and grabbed an IV start kit. My engineer spiked my IV bag and had it waiting for me when I needed it. While I was taping down my IV AMR showed up so I told them we had a hypoglycemic patient. The medic, trying to be helpful I'm sure, stepped up to the bedside. In doing so he managed to come between me and my drug box.

I asked the medic if he would grab the dextrose for me since he was in the way. After cleaning up the trash from my IV start (I had time since I assumed the AMR medic was taking care of the low blood sugar) I Reassessed my patient to see if he was coming around. He wasn't. It was about this point that I noticed the box for the pediatric dosage of dextrose on the bed.

I asked the medic if that's what he administered. He said yes. I then asked again if he gave D25 to the elderly gentleman. Again, an affirmative response. Since he wasn't getting my point I simply asked my engineer for the other dose of D25. Then the AMR medic realized what he had done and apologized. I can only assume that he was tired too. It was after 0200.

With the second dose of sugar on board the patient started to come around. He was still confused but he was improving. We helped AMR get him to the rig and cleaned up the rest of our mess. Time to head back to the barn.

Monday, May 28, 2012

Back Stabber

The gate to the back yard was open and we were being waved down. The woman ushered us into her backyard where we found her elderly father laying on the ground. It was apparent that he had been gardening but had DFO'd for some reason.

My patient was laying face up, half on the walkway and half in the bushes. I stepped into the bushes and grabbed his head, protecting him from moving it and possibly aggravating a spinal injury. I asked the daughter about her fathers medical history.

He was a diabetic, had hypertension and a fairly recent onset of seizures. She said that they had been gardening together that morning. She went to answer the phone and came back after a short conversation. That's when she found her dad laying where we found him.

While I continued to question the daughter my engineer started a head to toe assessment. Other than a couple of cuts and bruises there was nothing obviously wrong. He checked a blood sugar which came back WNL and placed the guy on some oxygen.

As a precaution we placed the old man on a backboard. That's when things got interesting. The patient started coming around, appearing to be postictal. Then he started to get combative. Understandably so. Can you imagine waking up confused to find several men strapping you to a board all while trying to tell you that they were there to help you? I'd be confrontational too. We enlisted the daughter to help calm him down and between us and the AMR crew we were able to get him strapped down.

By the time he reached the back of the ambulance he was lucid and answering questions. He did have head and neck pain and didn't remember what happened. At least the backboard and C-collar were justified.

After the call was over I had my captain pull a couple of thorns out of my back. The bushes that I had to crawl into to take care of my patient had been rose bushes. I was fine and careful until I had to struggle with the patient. Then the bushes stabbed be in the back. Ouch.

Wednesday, May 23, 2012

Embarrassing Beat Down

The tones jolted me awake again. It was just after 4 in the morning, about 2 hours after our last call. Whenever I get these calls I always hope it's at least for something legit. I hate getting up for BS (so does everyone in this profession).

Dispatch informed us that we were responding for an assault victim and that PD was already on scene. Coming around the corner in the quiet residential neighborhood we spotted several police cruisers. We were in the right spot.

My engineer pulled past the house, parked the rig and shut off the engine. There's no need to wake up everyone with our big diesel motor. We could hear yelling from inside the house. The officer at the door told us that the step-father and step-son had been drinking (shocker) and there had been an altercation. One look at the 19 year old kid and it was easy to see who had won that fight. He already had a big black eye, swollen face, bloody nose and cut lip. He may have been missing a tooth as well but I couldn't be sure.

My patient quickly refused to service. He told me rather indignantly that he was an EMT and he knew I couldn't touch him. He then tried to give me the silent treatment. That was until I quietly told him that if he refused to answer my questions I would have to assume that he was mentally impaired. And if I assumed that he would end up naked on a backboard with a C collar on and some IV's in his arms.

The kid became almost nice to me after that but he kept yelling at and antagonizing the cops. After refusing to be treated again he started arguing with one of the officers. Just then the on duty sergeant came in. After surveying the situation for a second he ask the other officers to place the young man under arrest. That didn't sit too well with the teen and he decided to fight. Alcohol made him think he could beat down his mom's new husband and then it made him think he could defeat several officers. He was sadly (for him) mistaken.

It must be a little embarrassing to wake up in jail having lost not one, but two fights in the previous night.

Tuesday, May 22, 2012

What A Month (part 4)

Day 7, Friday

I'd never had Lasix before. It worked really well. Within a couple of hours I was able to breath easier. The fluid build up around my gut had started to abate. This was a good thing. But then my labs came back.

My nurse came in and said that because I had been retaining fluid I my body had diluted its potassium. I'm not sure I believe that explanation. If that were true wouldn't all my electrolytes be diluted? Not that it mattered. They wanted to get my numbers up so I was given IV potassium. Another problem was that the Lasix was causing me to pee off the potassium in my body.

Because I was going to need labs drawn quite a bit my RN suggested a PICC line. This is basically an IV started in the upper arm (under the bicep) but the catheter is inserted to just before the right atrium. There are 3 different lumens allowing multiple fluids or medications to be administered and one line allows for blood draws. This kept me from having to be stuck every time labs were needed.

A specially trained RN came in for the procedure. She explained what she was going to do and then started preparing. Because of where the catheter is placed it is a sterile procedure. She draped me with a sterile sheet and prepped the area. During the insertion I wasn't allowed to look at the area. When I asked why I wasn't she informed me it was because I might breath germs onto the wound. So I asked if I could watch as long as I held my breath. She let me. Within a few minutes I had the PICC line in place. An x-ray tech came buy and confirmed that the placement was good. Every day after that the PICC RN would visit me and check on her line.

The rest of the day was kind of a blur, mostly because there wasn't much to distinguish it from other days. They just kind of meld together. I still wasn't sleeping well. Every night I was getting a fever and then breaking it causing me to sweat everywhere. Mostly I hurt and was miserable. I couldn't get comfortable.

The biggest thing was the ability to breath easier.

That night my wife left my side and went up to labor and delivery. The baby had been having moments where his heart rate would drop so they wanted her to stay the night. I told her that if she had the kid I'd hobble my way up there.

Day 8, Saturday

I was still being treated with the Lasix and the Potassium. My nurse, frustrated with my continuing low lab levels, asked if I'd be willing take some Potassium by mouth. It comes in about an ounce of fluid. It's super salty and nasty. At first they were going to dilute it in orange juice but I decided that was a bad idea. That would make it so I had to drink several ounces of bad tasting medicine. Instead I slammed the medication and then used the orange juice as a chaser.

All day we alternated between checking my blood for potassium and me drinking it. Talk about a bad day.

That evening, just after shift change, my RN looked in before making a lot of noise and noticed I was asleep. She let me sleep and came back 2 hours later. Such a great nurse! That night I was feeling better than I had for a week but that's not saying much. I decided to take myself off of the oxygen to see if I would de-sat. I didn't. I also stopped taking my pain medication. Not because I wasn't in pain but because I don't like the way it makes me feel. At that point I'd rather deal with the pain than the side effects.

Day 9, Sunday

By this point I was tired of being in the hospital. Sunday was much like Saturday with the RN constantly checking my potassium levels and giving more of the stuff. I was also to the point where I would try to stay off of the telemetry as much as possible. It's a real pain to have all those cables, cannula, and IV tubing connected to you all the time.

That afternoon the doc came by. He asked me how I was doing so I told him I wanted to go home. I listed the ways in which I had improved. He agreed that me wanting to go home was a good sign but he still had some concerns. We talked about the fact that I had a kid on the way....soon. Finally he agreed. He told me that since I knew what complications to keep an eye out for that he was willing to send me home but that I had to come back immediately if something was amiss. I reassured him with a joke that I was just going to be upstairs in L&D.

By 1930 I was home. It had taken them more than an hour to finish all of the paperwork and get everything else ready to send me home. Once at home I realized that my bed was not comfortable at all in my current condition. Still, it was good to be home.

Day 10, Monday

Monday morning my wife and I went back to the hospital. This time for her. She had a non stress test done to check on the baby. All was relatively well so they sent us home. The rest of the day was spent napping, at least by me.

Day 11, Tuesday

Again we packed up and headed to the hospital. Instead of a test they were going to induce labor. You can read more about the entire experience and see some cute pictures of the baby on my wife's blog.

Needles to say we were thrilled that that month is over.

Wednesday, May 16, 2012

Rock Star Status

Ok, not quite rock stars. But there are few professions where people everywhere wave at you. Kids are super excited to see you and will stop their parents if they think they can get a closer look and random people on the street will offer to buy you dinner. All this and they don't even know your name.

The tones sounded around 7 in the evening, just as dinner was being served. We responded for a smell of natural gas outside a local pizza shop. The pizza place was one of several restaurants on the far end of the parking lot for a grocery store.

Once on scene we were able to locate the source of the smell. One of the gas meters, was leaking. We determined that none of the restaurants needed to close. We blocked off the area so that no one would be able to get close to the hazard and waited for the gas company guy to show up.

So there we were in our turnouts, in a parking lot standing guard at dinner time. At first the people eating in the restaurants would see us and wave. They could see the lights on the engine flashing so they knew something was up. They were trying to rubber neck only there was nothing to see. Next a family walked up close to rig. The two kids, around 5 and 6, were wide eyed with excitement.

My engineer and I headed toward them, after all, guard duty was boring and we had a chance to brighten some kids day. I passed out junior firefighter badge stickers while my engineer grabbed some plastic helmets and divided them up. We also gave them a closer peek at the engine. We repeated that process a couple of times more before the gas guy showed. One of the parents even tried to buy us dinner. The generosity of the public toward us sometimes amazes me.

A little after 8 the tech from the gas company arrived. He confirmed what we had reported (that the gas meter was leaking) and ordered up another truck to repair it. Thankfully he was now in charge of the leak and we were released.

As we pulled out the kids in the restaurant that were wearing our helmets and badges waved. We smiled and waved back.

Rock star status.

Thursday, May 10, 2012

What A Month (part 2)

Day 4, Tuesday

I woke up on Tuesday morning to the sounds of my wife getting the kids ready for school. We (and by that I mean she) had kids to drop off at 0800 and 0900, a doctors appointment (she was 38 weeks pregnant at this time) at 1015, and a kid to pick up at 1120. A busy morning. When she came by the bed I told her that it was time for me to go to the ER. I was fairly certain at this point that I had appendicitis.

Around noon my wife drove me to the ER. I hobbled up to the front desk and signed in. Thankfully the ER was empty and I was on deck to be seen. A couple of minutes later I was sitting at the triage station explaining my plight to the triage nurse. Before I could even finish giving my report (yes, it sounded like I was rattling off a report about one of my patients) another RN had appeared to show me to me "room." While she did offer me a wheelchair I declined. After all, I wasn't that sick. Or so I thought.

Looking back on it I should have known that I was really sick. My heart rate was above 130. I was breathing more than 30 times a minute. I had a high fever when it wasn't being controlled by medication. The only one of my vitals that didn't look bad was my BP and I'm sure that my heart was trucking away trying to keep it that way.

Up to this point I thought I had appendicitis and a flu. I hadn't really considered the chance that I could be septic. At least the ER staff was on it. They immediately drew blood for some tests (I think I gave more than when I donate to the Red Cross). Within minutes the ER MD came by for a chat. He told me that I was indeed very septic. My WBC count was well above 30,000 (above 12,000 is considered septic) and I was extremely dehydrated. While he talked my RN hung a bag of saline and two different IV antibiotics. The doc also said that I was going to be getting a contrast CT of my abdomen to find out if I really had appendicitis.

A few minutes later my RN was back with a container the size of a Super Big Gulp. It was the contrast dye that I had to drink for my CT. That stuff tastes nasty. You'd think that drug manufacturers would take into account things like taste. There's nothing like giving a nauseated patient a liter and a half of horrid tasting fluid to choke down before they can get the tests they need. It took me the better part of an hour to get it all down.

About an hour after the test the ER doc and a surgeon came in to see me. I was told that my appendix had indeed ruptured and it looked like part of my large intestine had as well. They couldn't be sure. So the plan of action was to get me into the OR as soon as it was open and to try to do a laparoscopic appendectomy. Once inside me (that's a weird statement to write) the surgeon would be able to tell if he needed to open me up and perform a bowel resection. Needless to say this really stressed me out.

I asked the surgeon how long each procedure would take. My wife was at home and I didn't want her to show up and have to wait for hours in the waiting room. He said if it was just the appendix it would only take 45 minutes. If I needed the bowel resection it would take more than a couple hours.

After signing all the waivers I waited. I called my wife and talked to her about everything. I told her when I expected to go into surgery and when I hoped to be out.

Around 2015 they came to get me to take me to the surgical suite. I sent off a quick text to my wife letting her know what time I was going in so she would know when to come.

In the surgical prep room I met the anesthesiologist. We chatted a few minutes so he could get to know my medical history. It's strange the things you notice while waiting to go under the knife. I was the only patient there and it was relatively quiet except for music coming from the OR. Once everything was readied for me they wheeled me in. I slid over to the operating table. This one only had my right arm out at a 90 degree angle. My left arm was wrapped in a sheet and tucked in close to my body.

The anesthesiologist put me on the heart monitor, pulse ox and automated BP cuff. Much like I do at work. Have I mentioned that I really don't like being the patient? He then placed an oxygen mask on me and told me to breath deeply. He told me when he was injecting the medication and then.......

....I woke up in the recovery room and the first thing I saw was a clock. It was 2330. It had been several hours since I went in. My heart started to sink as I realized that I must have needed the bowel resection.

What A Month (part 3)

Day 4, Tuesday (con't)

After a couple of moments I asked the nurse if my surgery had been done laparoscopically. She said that it had and that I would be headed for my room in a minute. Talk about a wave of relief washing over me. I was ecstatic that I only had to have my appendix removed. Later on I would try to joke with my surgeon about how I was grateful that all I needed was a simple laparoscopic appendectomy and he chided me. He said that there had been nothing simple about my surgery. I guess I was a real mess on the inside.

Day 5, Wednesday

At midnight I finally made it to my room. My wife had been there for several hours now and had assumed that I needed the more extensive surgery. She had repeatedly tried to get the nurse to call up to the OR and get some information to no avail. Fortunately for the nursing staff my wife is a patient woman.

Once in my room I was able to tell my wife what had happened. And for the next several hours I was bombarded by staff members doing all kinds of pokes, prods and checks. By 0300 I had sent my wife home for some much needed sleep. I was finally able to get comfortable enough to doze off when in walked my wonderful nurse (the one that refused to get any information for my wife). She told me she had to put the compression socks on to prevent me from getting DVTs. They would go off alternately, every 15 seconds. After 3 minutes of that I started pushing my nurse call button. When she showed up I told her the socks were coming off. She tried to protest for a moment but quickly realized she was going to lose that argument. A few minutes later I was asleep.

Let me take a minute to tell you about their new air mattresses. They are designed to keep patients from getting bed sores. They deflate and inflate depending on where the pressure points on your body are. The only issue that I had was that I was in pain. It would take me quite a while to find a comfortable spot. Then, after resting for a minute or so, the stupid bed would change pressure and shift me around to a "better" place causing me pain. That was frustrating. I should have just unplugged the thing.

By mid morning I had sunk into a routine of sleeping in small chunks. I was still getting all kinds of antibiotics and fluid replacement. For breakfast, or it could have been lunch, I got jello, lime soda, apple juice and broth. Tasty. I wasn't really hungry so I ate the jello and downed the juice.

It was that afternoon that I first noticed a little fluid build up around my abdomen. It wasn't much and I had just been through surgery. I dismissed it.

My nurses during the day were great. Very attentive and caring when I needed them and willing to skip vitals if they saw that I was sleeping. They also pushed and cajoled me until I got up and walked around the hallway. It was supposedly good for me. Mostly it just hurt.

That evening I had more jello and juice for dinner. Yum. That night was a little better than the night before. At the very least the blood sucking phlebotomist didn't wake me up for a needle poke at 0400.

Day 6, Thursday

By Thursday morning my life was starting to seem like Groundhog Day. I was still in a lot of pain, I wasn't hungry, I was tired of being in the hospital and I noticed even more fluid building up around my abdomen.

This time I was a bit concerned about the fluid build up. I knew how much NS and LR they had been giving me (almost 10 liters by this point) and I knew that I was drinking a lot of water. The problem was my urine output was next to nothing.

I talked to the RN about it and she said that she'd keep an eye on it and talk to the MD about it as well. I let it go at that for the rest of the day. My surgeon stopped by while I was in the shower and just asked me a couple of questions through the door.

By that night the swelling in my belly was hitting a critical point. About 10 that night the RN walked into my room because I kept setting off the low oxygenation saturation alarm, even though I was on supplemental oxygen. She turned the O2 up to 6 LPM (I was on a cannula) and went about her shift.

It wasn't for another hour or so that I came around to start diagnosing myself. I was still only saturating at 93%. I was short of breath. I was breathing fast. I then noticed that I was breathing using only my chest and auxiliary muscles, not my diaphragm. My belly had engorged to the point where I could no longer use my diaphragm to breathe. Now I was really concerned and it was time to get a doctor.

Looking back on the experience I almost feel sorry for the nurse.

I called the RN into the room. I explained to her how I was feeling and laid out all my vitals (which she may or may not have known but I wasn't taking any chances). She tried to quiet my concerns by telling me that she would put this all in my notes and have a doctor check on me first thing in the morning. That didn't work for me. She then explained that the only doctor in the hospital (it's a small one) was the one covering the ER.

I understood that I wasn't the only patient in the hospital and that the doctor was probably busy but I needed to see her. I told my nurse that the doctor could come to me or I could go to the ER. I didn't care. I just needed to be seen. I figured that the hospital would frown on an admitted patient with difficulty breathing walking to the ER to be seen. I was right.

A short while later the ER physician walked in. She checked me out, stopped the order for all the IV fluids and gave an order for some lasix. Now we were getting somewhere.

© FireMedic and Firefighter/Paramedic Stories, 2013. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to FireMedic and Firefighter/Paramedic Stories with appropriate and specific direction to the original content.

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