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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.

Wednesday, May 2, 2012

What A Month

Day T-Minus 17, Thursday

I went in for a right inguinal hernia repair. If it sounds painful, it was. The pain lasts for weeks.

Day 1, Saturday

Honestly, I don't remember what I had for dinner. I hope it was good because it would be my last solid for over a week. Around 0300 I woke up with a touch of nausea. Something I'm not used to having. I rolled over and uneasily went back to sleep.

Day 2, Sunday

The kids starting waking up around 0730 which means we did too. As my wife got out of bed I told her I was sick. The nausea was back and had worsened. I spent the next 4 hours vomiting. Well, mostly dry heaving. And then the vomiting stopped.

At noon the pain started. My entire abdomen hurt. All over.

Sunday afternoon I spiked a fever of 103. I popped some Ibuprofen and the fever came down. I would continue to fight this fever for over a week.

I spent Sunday in my med asleep unless it was to head to the bathroom. I sipped on water when I could tolerate it. That night was much of the same.

Day 3, Monday

This day was a blur. It was spent in almost identical fashion to Sunday afternoon. There was on small difference. The pain in my abdomen was now only in the right upper and lower quadrants. The left side of my abdomen was pain free.

The thought that I may have had appendicitis did cross my mind. Going against that thought process were a couple of things. First and foremost the pain I was having was not just in my lower right quadrant. The pain started all over my abdomen and then receded to the right side. I went back and forth between thinking it was appendicitis and just left over pain from throwing up since that was the side on which I recently had surgery. Secondly, most people that get appendicitis have pain first, then nausea. And as my fall back I knew that when people have appendicitis their pain suddenly ceases when their appendix ruptures, then it returns later. My pain had never gone away. If it suddenly did, I'd would've sought medical attention.

Like the day before, I slept uneasily and sipped on a little bit of water. Maybe tomorrow I'd start feeling better....
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