Lullaby

One of the fun things about being a paramedic is that new EMTs look at you like you know everything. This tends to make them the target of a practical joke or two.

In some hospitals (such as Little Company of Mary's in Torrance) a lullaby is played over the PA every time a baby is born. One day I was working with a new EMT who asked me about the music. After the explanation I added that he should hear what they play when they have a person die. It took him about 15 seconds before he realized that I was only joking!

"Full arrest at the park"

We arrive on scene to find the firefighters thumping away on the old mans chest. They've just intubated him and pushed the first round of meds. We quickly load the patient and get going. In the back of the rig I'm bagging the patient, a firefighter is doing compressions and another medic is pushing drugs. The firefighter and I were standing in the back of the unit for better access to the patient which should not have been an issue except that our driver that day was learning how to drive code 3. He was following the squad too close and had to slam on the brakes when the squad turned. He then took a corner at 35 mph. I ended up in the captains chair with a firefighter in my lap. The driver got chewed out for that one.

By the time that we got to the ER our patient had a good strong pulse. Two saves in a row.

"Man having a seizure"

The engine company was the first on seen with this one and quickly let us and the squad responding know that it was a full arrest. Turns out that the 42 year old man was in the bathroom and fell so the family assumed that he was having a seizure when he was really dying. We performed CPR, intubated him, shocked him, and pushed 4 rounds of drugs before we loaded him up. We pushed another two rounds of drugs during transport. I thought for sure that he was a gonner.

In the ER they pushed two more rounds of drugs and got him back! I couldn't believe it. His heart had changed rhythms 5 different times! He had no other medical problems, took no medications, and was in decent physical shape. Makes me wonder if drugs were involved.

"Man down in a parking lot"

We arrived on scene to find a man, face down on the asphalt, having fallen out of his car. He was showing all the classic signs and symptoms of a stroke (ie left sided paralysis, facial droop, unequal pupils) and he was sweating profusely. Torrance FD still does not have 12 lead ECG capability but on their monitor everything looked ok with his heart.

We quickly take cervical spinal precautions and strap him onto a backboard. During transport I do a fast assessment (the patient only spoke Spanish so I took the lead on this one). He was panicked and had a bad headache but that's it, no chest pain or trouble breathing. He has a history of high blood pressure but that all. He is taking no medications.

We wheel him into the ER and drop him in bed 6. The ER tech comes in and does a 12 lead ECG which shoes that our patient is having a heart attack on the backside of his heart. I think to myself, "what a bummer. A stroke and an MI at the same time!" About then the ER doc calls me and the other medic over to him and tells us that this is a once in 20 year call. A patient exhibiting these signs and symptoms together is suffering from a dissecting thoracic aortic aneurysm or in plain English, the largest artery in his body was slowly tearing itself in half.

I know that he was in surgery real fast but I never found out if he made it. If he did I wonder what permanent disabilities he will have.

I feel safer already

There is a security guard at Torrance Memorial Hospital that takes it upon herself to find out the destination of every patient we bring in. I can understand the questioning if we're bringing in a patient to the ER or direct admitting if we pull up without our lights and sirens on but you'd think that she'd figure it out that when we pull up with a Torrance FD vehicle with lights on and siren blaring that we might just be headed for the ER?? I'm tempted to tell her in these situations that we are just bringing some belongings to a patient in the hospital and that we asked Torrance FD to escort us!

The title of this post comes from one of the firefighters who, after hearing the security guards questions, said to me, "I feel safer already, don't you?"

Traumatic Full Arrest

The above term is known in EMS as a person with no pulse or respirations as a result of trauma. In the field there is very little that we can do except rapid transport to a hospital.

The call came out as a hit and run auto vs pedestrian with major bleeding from the head. We arrive on scene to find TFD performing CPR on a woman. From the neck down there didn't seem to be anything wrong with her. Her head however had been crushed by the wheel of a truck (from which she was evidently just pushed). It was really strange being able to watch the bones in her skull move around as we tried to breathe for her. Everyone on the scene agreed that it was one of the worst trauma they had seen. We transported her to the local ER about 2 minutes away where she was pronounced dead about fifteen minutes later. We found out later that the male party turned himself in after about an hour. He is facing several felony charges.

NREMTP

I got my national license in the mail on Saturday. I scored an 87% on the test. You need a 70% to pass. Now I just have to wait for the state government to send me my state license. Yeah, more paperwork and fees. Once I get that then I get to go to the county in which I wish to work and get my "local accreditation" which means more paperwork and fees.

Almost all wet

We were posted at our station in San Jacinto when we noticed that the sky was getting very dark. What followed was one of the worst storms I've ever seen. Of course this means we're going to get a call. The call came out as a swift water rescue in the wash just north of town. We went tearing up there at 10 mph because of visibility. As we searched for the location the rain started to let up. What had ended up happening is the mountain slid down covering the road in 12 separate locations. There were people trapped in their cars but no injuries and no one was washed away. Since we were the primary paramedic unit we got to stay on scene until everyone got rescued (which was done via several bulldozers). Unfortunately we didn't make the news. Came close though.

I'm just glad that we didn't have to go rescue someone in that rain.

Things that would've been good to know...

A couple of weeks ago we got a call to a girl seizing on a school bus. By the time that we arrived on scene the bus driver had dropped the 3 year old girl at home. The mother told us that her daughter has MS (multiple sclerosis) and a seizer disorder and that she experiences focal seizures several times a month (A focal seizure just involves a small part of the body and a lapse in awareness. In this girls case she just looked to the far right with her eyes and was unaware of her surroundings). We did a quick assessment and found nothing out of the ordinary. The mother told us that she usually doesn't send her daughter to the ER but that she would like to do so today. We loaded the girl on the gurney and the mom headed out to her car with her two other kids. So far I was thinking that this is just your average, run of the mill, seizure call.

In the back of the ambulance I was setting up to start an IV and my EMT was putting the girl on the ECG monitor when he said, "I think she's not breathing." I did a quick check and sure enough, she wasn't breathing! I told Brian to get the BVM (bag-valve-mask) and to start breathing for her while I checked for a pulse. I also asked Dan to get going code 3 to the hospital and to let them know we were coming in with a pediatric respiratory arrest. It was about this time that I noticed she was having another focal seizure. I gave her a quick shot of Versed to stop the seizure and then she started breathing again. She stopped breathing one more time before we got to the hospital but we got her breathing again just as we arrived.

After transferring care to the hospital we talked to the mother. She then told us that her daughter frequently stops breathing when she is having a seizure. Somehow she forgot to mention that when we were at her house! The nurse told us that the girl did the same thing to a different paramedic 6 weeks before and he intubated her. In the end all was ok with the little girl.

The last day - Preceptor and Intern

Kyra loves it when Dada comes home.

"Look! It's a Mommy!"

Update: Car vs. Semi

I found out today that the woman in this story had a left femur fracture, right tib/fib (shin bones) fracture, pelvic fracture, and a lacerated iliac artery. It's no wonder her blood pressure was in the toilet. All that and she still made it. Her infant was fine too.

Sometimes they come to you.

The other day my paramedic and the guys were posting at a fire station in their area. As they're relaxing at the station they hear a knock at the door - which happens very rarely. Apparently, a family was in a minor car accident and refused to call 911. While on the way home from the accident they drove past the fire station and decided they should get the kids checked out anyway (they were perfectly fine). The odd thing is that while they're in the middle of checking out this family, there's -another- knock at the door. This time it's a guy reporting a legitimate concern - an unconscious woman in the bushes around the corner. She was really drunk and had been missing for 2 days in 100+ degree temperatures. They c-spined her, started an i.v., and took her to the hospital. (She should be fine.)


-Katie

Car vs. Semi

A woman in a Sentra pulled out onto a 50 mph street without checking for traffic. She pulled out right in front of a semi truck. The truck driver said he didn't even have time to hit the breaks before they collided. When my paramedic got there, the fire department was already working on extricating the woman for him. She had her 3 month old infant with her, in a car seat, in the front seat. Thankfully, the baby appeared to be fine. A bystander pulled the infant out of the car seat before the fire department got there - FYI, if you ever come across this situation, leave the baby in the car seat. It took over half an hour for the fire department to extricate the mother for my paramedic. They ripped the door off, removed the steering column (which was pointing toward the passenger seat = airbag went off toward the passenger seat), and peeled back part of the roof.

My paramedic went in to assess the situation while they were working on tearing apart the car. The woman was alert, but her injuries were severe. She had deep cuts and crush wounds everywhere. She broke the shin bones on both legs and her femur on one leg. She also had a hip fracture and probable damage to her internal organs. Her femur fracture was so bad that her thigh had swollen to 3 or 4 times its normal size. He started an i.v. on her and had a cop standing nearby hold the bags of fluid in the air while the fire department continued to extricate her.

They got her out, c-spined her as well as the baby, and put them on backboards. The injuries were bad enough that they called for the medical helicopter to transport. (My paramedic didn't get to go on the helicopter; the hospital sends a crew over with it.)

Here's the painful part of the whole situation - with an accident that bad, my paramedic can't give ANY pain medication to the patient! The hospital has to be able to ask her where it hurts to get an accurate assessment.

Why you should listen to your passengers.

A man and his wife were out driving yesterday. She told him to stop driving so fast. An argument ensued. Sure enough, he lost control of the car and rolled it down a 15 foot embankment in the mountains. It took 25 minutes just for my paramedic to get there, rolling with lights and sirens the whole way. Amazingly, the people in the car were fine. The moral of the story - if you're the driver, leave the interpretation of feelings of impending doom to your passenger. And if you must prove your passenger wrong, don't do it on a rural mountain road. Otherwise, you'll likely be stuck in the back of an ambulance with your passenger telling you 'I told you so' for the whole long trip back to the hospital.


- Katie

The good, the bad, and the ugly.

The good - only about 4 more weeks to go! Almost there....

The bad - the other day after work, some guy ran a red light and pulled out right in front of my paramedic, causing him to rear-end the guy.

The ugly - my paramedic wasn't driving our car; he was driving our friends' car. They let us borrow it for the internship to save on gas.

More good - they're still our friends, lol. Both my paramedic and our friends have full-coverage insurance so at least the car will get fixed. And, no one was hurt.

More ugly - the driver who ran the red light tried to run. my paramedic chased him down and he finally stopped. When my paramedic got out of the car, in his uniform which looks a lot like a cop's uniform, the guy was suddenly very scared and very cooperative. The driver didn't have a driver's license on him, and the insurance information in his van was old. At least it was a van for a company, so the company and the employer can be traced.

More good - my paramedic talked to a cop right after it happened, and the cop said that he would give my paramedic a hit and run report against the driver if he needs it.

Ok, ok, an update...

Well, everything has been pretty calm on the Paramedic front. The majority of my paramedic's calls are to complaints such as abdominal pain, shortness of breath, that sort of thing. Nothing all that interesting. All he does for those patients is take their history, start an iv, maybe give a breathing treatment, and transport.

Here's a funny little story. One slow day, my paramedic and his partners went to the hospital to help out. My paramedic was starting an iv on a patient and the nurse asked him how his skills were. When he said they were fine, she said 'oh yeah, you're a paramedic.' Then she grabbed the arm of the patient and started shaking it. When the patient wanted to know what the heck she was doing, she said that since paramedics are used to starting iv's in the back of a shaky ambulance, they're not used to hitting a stationary target.

What are the odds?

My paramedic responded to another nail gun accident yesterday. This time the guy shot himself in the leg, but missed the bone. He just lost a long nail in there somewhere. Now here's the dilemma - if you're the project manager at a construction site and you've got someone on the second floor with a nail in his leg, how do you get him down so the paramedics can work on him?

The answer is a fork lift with a sheet of plywood across the prongs for him to lay on.


-Katie

The proper way to start an IV in an ambulance

It's pretty crowded in the back of an ambulance when you have a patient in there. Apparently, you can't even stick your feet straight out in front of you because the gurney is in the way. So, this can cause some problems when said cramped space is also bouncy because you're driving down the road and you're trying to poke a big needle into someone. Here is the proper technique to getting the needle in the vein, without missing or going too far.

1 - Prepare the arm to be stuck.
2 - With the free hand, find the vein that's gonna get poked.
3 - Stand up and balance yourself leaning the hand that is holding the needle against the far side of the ambulance.
4 - Open the needle.
5 - Watch out the front of the ambulance for a stretch of road that Dan might drive smoothly on.
6 - Jab quickly! And hopefully, accurately!
7 - Repeat as needed.


- Katie

Random fact day

Have you ever seen an ambulance posted somewhere on the side of the road and felt sorry for the very bored paramedics sitting inside waiting for the next call? Well, fear not, they have devised ways to pass the time and stave off the boredom. Usually relief comes in the form of portable DVD players and the like. Yesterday was random fact day.

What, besides seeing, are a frog's eyes used for?

10 points to the first person to guess this one!

Something that's good to know.

If you ever have a nail gun go off and shoot a nail into your knee, just head straight to the ER. My paramedic got a call to pick someone up from an urgent care center who had this happen. The poor guy - the center didn't do anything for him. They didn't even get a set of vitals or give pain medication. His friend had to elevate his leg for him to keep it from aching. The center let him just sit there in pain because they didn't want to bother admitting him if he was just going to go to the E.R. eventually. Brian gave the people at the center 20 verbal lashings for their mistreatment.

-Katie

My first EJ

The call came in about 1615 hours to respond to a man that can't breathe. As we enter the house the wife lets us know that her husband was just seen by the doctor this morning and was diagnosed with sever bronchitis and possible pneumonia. When we get to the bedroom we see a 51 year old man that looks like death warmed over. He's only breathing about 8 times a minute, is pale, cool to the touch, sweating profusely, and only responsive to painful stimulus. Not good. We quickly get him on oxygen and check his oxygen saturation level. Normal is 97% and up. We start to not like it below 95%. His was at 51%! We now have him sitting up as best he can, and have him on oxygen so we continue with our assessment. His lungs sound like they're filled with junk and tight so we put him on an albuterol (breathing) treatment. His heart rate is off to the races at 120 or so but there doesn't seem to be any problems on the ECG. His BP is a whopping 230/110!

As I try to get an IV started in an arm the wife tells me that no one can ever get one. As I search in vain my partner looks at his neck and says "he's got great jugulars." I decide to try once to get the IV in the arm and then go for the jugular. Of course I missed the IV in the arm! At this point we load him up on the gurney and take him out to the ambulance. As we're loading him up my preceptor noticed something I missed. Our patient is taking Methadone, a narcotic pain reliever. Once we're in the rig I start my IV...in his neck (more correctly his External Jugular veins or EJ's)! That was a cool procedure. I then grab the Narcan (used to reverse narcotic effects such as in an overdose) and give him 1mg. Enroute to the hospital we give him another breathing treatment. The Narcan did its job and our patient started coming around. We asked him if he took more than the normal amount of his Methadone today. He affirms that he did.

By the time that I finished the paperwork at the hospital he was looking almost normal again. It was nice to be able to tell have a good day and to have him thank us for helping him. I have to admit though; I was still jazzed about getting to start an IV in someone's neck!

You never know!

The call goes out to respond to 1321 S. Palm Ave for a man down. When we got to the 1300 block of South Palm we discovered that there was no 1321. We notify dispatch who then realized...oops...it's North Palm Ave. So we headed North to the correct location.

As we approached we noticed that the police had the entire street cordoned off. As we got closer to the scene we saw that our 'man down' was really a TC (traffic collision) where a compact sedan had run into a telephone pole. The car sheared off the pole and moved it 6 feet. It was still dangling from the wires. Our patient, a 16 year old girl, was sitting in the grass with the firefighters trying to refuse any care. Her father on the other hand (who had time to get there since we went to the wrong location) was demanding that we take her to the hospital. Since she's a minor she had very little choice in the matter. We would have taken her to the hospital anyways, because of her age, but it's a little frustrating to have an overly concerned parent there to second guessing your every move. The father also wanted us to wait there on scene until his wife could show up. We drew a line there and told him he could meet his daughter at the hospital. If he had followed us he probably would have said that we should have gone a different route.

Oh well. You just never know what you're going to get when you're dispatched to a 'man down.'

Holistic medicine to the rescue?

You know that the day is going to be busy when your first call comes in 30 seconds after you go 'available'. The call came in at 0514 to respond to an unresponsive person. We go tearing across the city (I use this term loosely as we are in Hemet) and arrive to find CDF fire already on scene. As I approached the door the captain said that our patient is a doctor of holistic medicine and that I should "have fun." I entered the front room to find a 72 year old man sitting on his couch talking to the firefighters. So much for unresponsive. I introduced myself and asked why he called us out this morning.

He said, "I woke up this morning and my arm was numb. There were also some red lines on it here" as he motioned across his bicep.

From this point on it was a little difficult to keep a straight face but I performed a thorough assessment.

I asked if it was still numb.

"No."

"How long was it numb?"

"About 30 seconds."

I then checked to see if he had good sensation, equal pulses and movement in his hands and wrist. All was good so far.

While the firefighters got me a set of vitals (pulse rate, respiratory rate, blood pressure, skins signs) and my partner hooked him up to the ECG (heart monitor), I continued my questioning.

"Do you have a headache, weakness, blurred/double vision, ringing in the ears, chest pain, shortness of breath, abdominal pain, N/V/D (nausea, vomiting, diarrhea)...?"

"No."

"Do you have any medical conditions such as high blood pressure, diabetes, heart problems, hepatitis, strokes, seizures...?"

"No."

"Are you taking any medications?"

"No."

"Are you allergic to any medications?"

"No."

I then informed him that his vitals were all normal and his ECG was fine. I finally asked the question that I wanted to ask first.

"Sir, is it possible that you just slept on your arm wrong and it went to sleep?"

"Yeah, I guess so. I never thought of that."

"Do you want to go to the hospital to get checked out?"

"No."

"Sign here...Have a good day."

Sometimes I think that Darwin must be wrong because so many stupid people survive. I guess I should just look at it as job security.

He passed!

The guys got a call to a house where the patient didn't speak English. The firefighters on scene were trying to communicate with him through a woman who was there. My paramedic turned to the woman and asked her whether the patient communicated better in Spanish or English. When she said Spanish, my paramedic rattled off some questions. He just doesn't look like the kind of guy who speaks Spanish like a native, and this was the first time Brian and Dan heard him do it. Brian and the firefighters stared at him dumbfounded. Dan's response was:

"HOLY SH**!!! You just passed your internship!"

A mushy aside - a special thanks to all of our friends and family who are making this internship process easier. We really appreciate all of your various forms of help!

Sugar is a very good thing.

My paramedicrolled on the scene of an elderly woman who wouldn't wake up when her house mate tried to get her up in the morning. She scored a 1-1-1 on the coma scale (that's bad). Basically, it means she was unresponsive in every way. He went through the stuff he's supposed to do to figure out what's wrong and found out that she was severely hypoglycemic. It's amazing how quickly some sugar will bring someone back from coma land. In about 5 minutes she went from the lowest end of the coma scale to the highest end. Yay sugar!

Brian's new game is 'stump the Mount S.A.C. graduate'. Apparently, my paramedic's school has a reputation as being the most difficult paramedic program. Brian asks every paramedic they meet to try to come up with a question that my paramedic can't answer so that he can make him write a paper about it. I'm just waiting for Brian to come across another Mount S.A.C. grad to face off against my paramedic. I think Brian's going about it all wrong. He keeps asking medical questions. I could give Brian some GREAT questions to ask my paramedic that he can't answer (like what he wants to name this baby). I'd love to get a paper written on that one!! Maybe we can name him Sugar.

A bad day

My paramedic had a bad day yesterday. He forgot his work boots, did the paper Brian asked him to do on a similarly named but nonetheless wrong drug, had to put up with Dan and Brian fighting bitterly with each other (over the proper use of the parking break) and with dispatch, had trouble with some procedures, and had a supervisor show up on one of the difficult calls (the supervisor noticed the street shoes, too). Brian told him not to worry about the boots; he worked a day in sandals one time when he forgot his. Paramedicine and the fashion industry - two jobs where you do not want to be caught in the wrong boots.

It's worth it!

It takes 12.5 gallons of gas to drive to Hemet and back.

"Hi, my name is John. I'm a paramedic and I'm here to help you."

My paramedic got to be a 'real' paramedic yesterday. Head on collision on a two way road, 45 mph each way. Thank goodness for airbags, seatbelts, and crumply cars. The person in the car fared well, with only a few scratches. The person in the truck rolled three times. My paramedic cut her out of the seatbelt, c-spined her, and started iv's. She was a radiology tech at the local hospital. She had one, maybe two broken arms, airbag abrasions, and a possible skull fracture from the roof getting mushed. She didn't even want pain medication. It's amazing what adrenaline will make you feel - or not feel. My paramedic asked her a series of questions to determine if she was alert and oriented.

"Do you know what time it is?"

"About 1400 hours."

"Do you know where you are?"

"Yes. I'm strapped to your f****** backboard!"

Yep, alert and oriented.

Happy, Healthy Hemet

Thankfully, the people of Hemet have been driving safely and taking care of themselves. Wouldn't it be nice if we didn't need paramedics at all? My paramedic's calls lately have consisted of a few inter-facility transports, some fainting episodes, a frequent flyer looking for drugs, and a young man who called the paramedics because of a sharp pain he felt in his abdomen. He got the sharp pain after laughing really, really hard. My paramedic did have a first - he started an iv in the back of a moving ambulance.

Dislocated hip

An elderly woman fell and dislocated her hip. My paramedic drew up a dosage of Versed (a drug not within the scope of practice for LA County; one of the benefits of not being in LA County). The woman asked if the drug would help with the pain.

"Nope."

"Then what's it for?"

"To make you forget the pain you're about to feel."

He then pulled while Brian popped the hip back into place and they transported her to the hospital.