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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.
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