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.

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.

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.

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.

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.