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Friday, January 31, 2014

A Shakey Situation

We arrived at the business park and were ushered upstairs. In one of the many generic offices a man had had a seizure.

We talked to the person with whom my patient was meeting and he said the guy just stiffened up, started shaking and rolled out of the chair onto the floor. Apparently the seizure lasted several minutes.

The business had their own emergency response team that was activated. I don't know what type of training they had but they did show up and check a pulse and they placed the patient on oxygen. I told them after the call they did a great job.

My patient was still postictal. A time period after a seizure when the brain is sort of trying to reboot. It can take several minutes. The person that experienced the seizure can be quite confused if they're responsive at all during this time. My patient wasn't responsive.

I grabbed a quick set of vitals, kept the guy on oxygen and checked his blood sugar levels. All were within normal limits.

At this point AMR arrived. While they loaded him onto the gurney we talked by phone to the wife of the patient. He was in town on business so no one around knew his medical history.

According to his wife her husband had recently been out of the country on vacation and had also been snow skiing. There was no medical history to speak of and he wasn't on any medications.

We couldn't rule out head trauma as a possible cause of the seizure. It also could have been something else entirely. Without the hospital and the tests they would perform there was no way to know.

After the patient was loaded up we headed for the rig. We took the stairs while AMR took the elevator. I waited for the crew at the back of the ambulance holding the door open for them. When the elevator doors opened the medic yelled that she needed me to start a line (meaning an IV). The patient was seizing again.

I jumped in the back of the ambulance and had an IV started in no time flat. But by that time the seizure had stopped. I asked if the AMR medic wanted me to ride along and she declined. I later found out that the patient seized one more time in the ambulance.


Note about this call. A couple of weeks later the AMR medic let me know that the patient we had here had been found to have a brain tumor which was causing the seizures. He was scheduled for brain surgery.

Friday, January 24, 2014

Thank You.....I Think

We got a call the other day for a citizen assist. These calls come in from time to time and can be anything from a cat in a tree (yes, we actually get calls for this) to someone being locked out of their house. As long as there is no emergent call I have no problem going out and lending a helping hand. After all, we are public servants.

This time the service call came in from an elderly woman that lived alone in her own house. She was unable to change the batteries in her smoke detector (Public Service Announcement: If you didn't change yours when we had the last time change for daylight savings, do it now).

This old lady has been calling us to change out the batteries in the detectors for years. This time she let us know that she had been doing us a favor. Instead of calling us every 6 months to change the batteries now she was only calling us when one of the detectors started beeping the low battery alarm.

So thank you....I think.

Monday, January 13, 2014

What Do You Want Us To Do

We pulled up to the house to find a kid about 18 years old waiving emphatically. As we followed him into the house he told us his grandfather was having a hard time breathing.

Inside we found a near 90 year old man laying quietly in bed. He looked frail and sick. Really sick. Like dang near dead sick. His daughter was by his side tending to him. The man was breathing ok and had a weak radial pulse. I noticed he also had an IV in his arm.

I asked the daughter what was going on. She introduced herself as a nurse (which meant absolutely nothing to me) and said that her father had cancer of the colon which had metastasized all over his body. He had a valid DNR and the family's wishes were for my patient to be comfortable. They had made their peace with the fact that he was dying.

The daughter than informed me that she had just given a repeat dose of dilaudid and morphine to the dad. Now she was worried because her father was having a more difficult time breathing.

For those of you that don't know both of those drugs belong to the opiate family (like heroin) and both cause a decrease in the body's respiratory drive. While we do have drugs to reverse this process it also takes away any of the pain killing affects of the drugs.

By now we had the old man on some oxygen. He was still breathing adequately but he was tiring out. We asked if they wanted us to honor the DNR which they did. That begged the question, what do you want us to do?

She just kind of stared blankly in response to that question. While the daughter had realized that her father was going to die it hadn't dawned on her that in would be that day.

We explained all the options to the family taking time to make sure they understood the possible and probably outcomes of each. They then decided to have their father/grandfather transported to the hospital with the caveat that he would be kept as comfortable as possible.

The next day I ran a call with the same medic from AMR. He said that the patient had made it all the way to the hospital but not much further. When they entered the ER the doc asked if the patient was still breathing. The MD and the medic looked down at the patient and watched him take his last breath.

At least he's is comfortable now.

Tuesday, January 7, 2014

Even Frequent Flyers

If you work in a city long enough you start to learn that there are areas that just produce calls. We have a shopping center in our district that has more medical emergencies in it than every other strip mall in the city combined. A lot of the time it's homeless people that are too drunk to stand and someone else calls for them.

We were dispatched to Taco Bell in this strip mall for a man not feeling well.

We arrived right behind the AMR unit. While they grabbed their gurney I stepped up and talked to the manager. He said the patient had walked in and sat down about 15 minutes earlier but hadn't ordered anything. He also said the guy looked sick.

Inside I introduced myself to the patient. I asked what was going on and he said that he felt weak. He denied having and trouble breathing or chest discomfort. That was about as far as I was able to get before AMR had the gurney ready.

We helped the man to the gurney and then loaded him up into the ambulance. Inside the rig they checked an initial set of vitals which were ok. I asked AMR if they needed anything else and they said they were good.

That was the end of that call. I didn't give it a second thought, until later.

About a month went by and we ended up on another call with that same AMR crew. The medic asked if I remembered the homeless man at Taco Bell and to be honest, he had to jog my memory a bit. The medic said that 5 minutes after they arrived at the ER the man had a massive coronary and died.

Food for thought, even your frequent flyers can be really sick sometimes.

Monday, January 6, 2014

Now Is Not The Time To Panic

We got the call at 3 in the morning. My first thought when we get calls at this time of night is who is up right now?!

As we pulled up to the house a woman driving an SUV almost rear ended us. We try to park Big Red just beyond the address allowing room for the ambulance to park a little closer. The crazy driver slid right past us and into the driveway (making access with a gurney more difficult). The woman, who turned out to be the daughter of my so called patient, then ran into the house.

Inside I found a man in his late 80's sitting on the couch eating some toast. His wife was talking extremely fast trying to explain what she believed was going on. The daughter, who arrived by her fathers side just seconds before us, was trying to talk louder and faster than her mother. Both of them clearly having no idea what was going on.

I asked the women to give the information to my captain allowing my to question the old guy. He told me that he had just been released from the hospital at 8 the previous evening. He had had a 6 day stay while battling pneumonia. He said that he wasn't given dinner before leaving the hospital and went to bed soon after getting home. He hadn't eaten anything other than a sandwich all day.

My patient said he awoke and felt hungry. His stomach was growling. Somehow his wife misinterpreted this to mean he was having trouble breathing and panicked. She called her daughter who lived cross town. She jumped into her car and called 911 then tried to beat us to the house.

In the end my patient stayed at his house, eating and drinking some coffee and shaking his head at his daughter and wife.
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