TravelStream™ news feed for member cogliostro on TravelPod's free travel blogs service http://www.travelpod.com/syndication/rss/cogliostro en-us Copyright ©2009 TravelPod.com Wed, 29 Oct 2008 14:30:58 -0400 http://www.travelpod.com http://www.travelpod.com/travel-blog-entries/cogliostro/1/1225304640/tpod.html http://www.travelpod.com/travel-blog-entries/cogliostro/1/1225304640/tpod.html#comments Travel Blogs http://www.travelpod.com/travel-blog-entries/cogliostro/1/1225304640/tpod.html Wed, 29 Oct 2008 14:30:58 -0400 Alaskan Paramedic Happy Super Fun Time Go!

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Kenai, Alaska, United States

Well, I'm home again. I finally am home. I nearly cried when I saw the mountains of Alaska again after seeing nothing but the flat terrain of the southwest of the US. My friends had a welcome back party for me and I was so very touched to see them gathered together last night. Thank you all! Especially thank you to Todd who picked me up from the airport and organized my homecoming! (God, I love the painting!) :-) This experience has easily changed my entire perception about medicine and it has made me want to be a paramedic now more than ever before.

When we were driving to my house last night we looked out and saw the Northern Lights had begun. It really did feel like Alaska was welcoming me back home. It's so good to be here - so good to be back home. Last night I slept in my own bed for the first time in 6 weeks. It felt so awesome!

Thanks to all of you who kept up with my blog and read my ramblings. I'll be making the rounds to see everyone very soon. I love and cherish you all! :)

Signing out for the last time in this blog,
Andy
]]> http://www.travelpod.com/travel-blog-entries/cogliostro/1/1225195440/tpod.html http://www.travelpod.com/travel-blog-entries/cogliostro/1/1225195440/tpod.html#comments Travel Blogs http://www.travelpod.com/travel-blog-entries/cogliostro/1/1225195440/tpod.html Tue, 28 Oct 2008 08:06:07 -0400 Alaskan Paramedic Happy Super Fun Time Go!

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Houston, Texas, United States

Well, I'm in the airport and it's finally happening - we're about to board and head for home! I've had a pretty damn good time here in Houston, learned a lot and expect fully to come back. I look forward to seeing everyone when I get home.

See you soon!
-Andy
]]> http://www.travelpod.com/travel-blog-entries/cogliostro/1/1225113420/tpod.html http://www.travelpod.com/travel-blog-entries/cogliostro/1/1225113420/tpod.html#comments Travel Blogs http://www.travelpod.com/travel-blog-entries/cogliostro/1/1225113420/tpod.html Mon, 27 Oct 2008 09:30:22 -0400 Alaskan Paramedic Happy Super Fun Time Go!

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The Woodlands, Texas, United States

It is officially official. I just got off my last shift for a grand total of 493 hours of Paramedic Internship. My final day was actually enjoyable - very slow with only two transports. I'm looking forward to getting home tomorrow and seeing all my friends and family. I didn't get nearly as homesick as I thought I would, but I still did! I'm sitting in IHOP for the last time, mooching off their internet and eating breakfast. I've been here so many times the staff don't have to ask me what I want, they just bring it. Hah! Awesome.

Paramedic class was a great time - I got to know an amazing group of people and learned so very much. But I can say that my internship has been the single greatest learning experience of my life - thanks to my Instructor Paul for giving me the knowledge I need and to my preceptor, Patrick, for giving me real world experiences and knowledge above and beyond the classroom. Patrick told me how much he admired all the Alaskan students for coming all the way here. He talked about when he was in Paramedic school he just had to travel the 40 miles to the college and he listened to all the other students complain about that. Then he became a preceptor and had students from Alaska who traveled over 5,000 miles at great expense - just to finish their paramedic rotations. I would recommend to any Paramedic students that can to get Patrick if you come to MCHD. He'll teach you not only street medicine, but how to integrate book medicine into your treatments and diagnosis. He's one of the best medics I've met.

Texas is a nice place (considering what I thought of it before) and I am seriously considering applying for a position at MCHD and moving back here. Houston isn't that bad - though there are some spots that are just as "Cletus the Slackjawed Yokel" as you can get, though most of them seem to be in North County - and it seems that peoplea re genuinely embarassed when it's brought up. I'll probably wait until after next summer to make my final decision since there are positions opening all the time. I want to get at least one more semester of school it at KPC. I would like to graduate with a bachelor's from KPC - which has been incredibly good to me for the last two and a half years of my life.

This time tomorrow I'll be in the air above Texas, heading for Minneapolis, then home to Alaska. I was planning on going to the Johnson space center today, but I have too much to do to spend it in Houston. I've got some packages to send, bags to pack, etc. I'll probalby drop a couple more entries before I board the plane tomorrow morning. Just in case I don't, thanks for those that read my ramblings, and I look forward to seeing everyone again.

Later, ya'all! :)
]]> http://www.travelpod.com/travel-blog-entries/cogliostro/1/1224811320/tpod.html http://www.travelpod.com/travel-blog-entries/cogliostro/1/1224811320/tpod.html#comments Travel Blogs http://www.travelpod.com/travel-blog-entries/cogliostro/1/1224811320/tpod.html Thu, 23 Oct 2008 21:33:33 -0400 Alaskan Paramedic Happy Super Fun Time Go!

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The Woodlands, Texas, United States

So it was another rough shift.

Started off slow enough, we didn't even get posted all that much, which should have told me something early on that it was not going to be a good day. About 3:30 we get toned out as third-in ambulance for an MVC, Honda Accord full of kids vs. a cement truck. I knew it really wasn't that good when I heard the SO say it had been T-boned, and the MCHD supervisor broke in - she was already on scene - and ordered two helicopters. We pull up and the car is completely totaled. There are bystanders and cars everywhere stopped right in the middle of the road.
There's three of us, so we go ahead and head into the scene. One ambulance has already taken off for Herman Memorial Trauma Center in Houston. One helicopter is about to land when I see my first patient - a 10 year old girl - laying in the arms of a woman. One of the firefighters has a C-collar on her so I tell Terry (the Intermediate attendant) to get the KED and a backboard. The poor lady holding the girl is extremely calm and she just smiles at me. I ask the little girl's name and she tells me. I touch the little girl on the arm and call her name -
she doesn't do much, just kind of moans. I tell Terry that we need to get her backboarded and into the ambulance. She has a strong pulse and is breathing fine. There's glass everywhere.

Meanwhile the first helicopter lands and Mom is flown - from what I heard she's breathing but unresponsive and the little girls' big sister is being intubated in the street by the medics from the other ambulance (mom
was already intubated). The second helicopter is orbiting the scene waiting and we continue to get our patient backboarded. My preceptor looks over at the other patient and says "Is she stable? Ok, we'll take her, too." We get into the ambulance and I look on the stretcher - there's a car seat on one end of the stretcher, and a backboarded 5 year old on the other end. The kid in the car seat is kind of looking around like "What's goin on?" not really making any noise. The other girl, however, is screaming and won't stop. It doesn't help
that she doesn't speak any English.

Meanwhile, my patient is strapped down to the bench seat on her backboard. She's becoming a little more responsive and she starts to scream. I mean really scream. Blood curdling "I'm being ripped apart" kind of
scream. My ears are still ringing. Anyway, I do another quick exam and she grimaces when I touch her stomach. I palpate a little better and I can feel it's getting warmer. Her abdomen is pretty rigid, though it could be her
tensing up. I'm just not sure. My preceptor agrees that it's warmer. I get an IV on board in case she decides to crash. She wakes up and starts thrashing around, asking about her mom. She keeps asking over and over, wanting her mom. I tell her that her mom is going to meet us at the hospital. She keeps saying
"She's dead, she's dead and I'm gonna die."

I've seen a lot of stuff here... a lot. More than I think I ever will in Alaska. I can't say that any classroom, any book or movie or practice session could prepare me for something like this. What do I say? Do I tell her that her mom's okay? I have to tell her something, so I tell her that her mom's not dead, she's going to meet us at the hospital. That's the truth, right? As far as I know it. Talk about splitting hairs, but I need her to calm down because if she has a bleed inside she's only making it worse by tensing up and screaming. Did I do the right thing by maybe lying to a little girl? I don't know. All I do know is that I can't let this little girl see doubt or fear in my face, but how do I
keep it hidden? Kids are pretty intuitive - more so than people give them credit for. She kept screaming out again and again that her mom was dead and she wanted to see her mom, why was I being so mean by keeping her away from her mom? She kept getting drowsy and finally went unconscious, but her vitals were good and she was breathing. I was just happy that asleep she wasn't tensing up. I think she just wore herself out.

Every paramedic or EMT has their Call. The one call that completely changes them and the way they practice medicine. The one that sticks with us through all the blood and the crap we see as a matter of course
throughout our day. I didn't think mine would be so early. I was kind of hoping it would be more toward the end of my career instead of the beginning.

Well... I dunno. I'm done whining for now. Despite all the bad things that have happened here, they are all excellent learning experiences for me. The myriad of mundane calls we get may not stick with me forever, but there are those like this that will. I still love my job, and I can't wait until I have my own truck some day. As a student we can fall back on our preceptors; we do find out a lot of what we can handle, what we need to work on. However, as the in-charge, we find out the true test of our mettle. Nothing to fall back on but our training. That is when we find out what we really can do.

Thanks for listening to me whine. Typing it out is a lot like talking about it face to face - and there are those on here who have gone through what I'm talking about. It just helps.

I miss everyone, I'll see you soon.



]]> http://www.travelpod.com/travel-blog-entries/cogliostro/1/1224337020/tpod.html http://www.travelpod.com/travel-blog-entries/cogliostro/1/1224337020/tpod.html#comments Travel Blogs http://www.travelpod.com/travel-blog-entries/cogliostro/1/1224337020/tpod.html Sat, 18 Oct 2008 09:54:44 -0400 Alaskan Paramedic Happy Super Fun Time Go!

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The Woodlands, Texas, United States

Another sleepless night. I'm sitting here at IHOP typing this out, trying to stay awake. Finally got to sleep around 3:30 this morning only to wake up at 7:15 so I could go home.

Had some good calls last night, though nothing spectacular. More and more I'm finding my preceptor has fewer problems with how I run calls - and even the things he does find he says is more style than anything. He does a 12-lead on everyone, almost regardless of age. Since this service charges for everything they do, I really don't see a need for it on a healthy 35 year old male with no cardiac history and no chest pain. I don't fault him for it, he's been doing this a lot longer than I and probably has a very good reason for it. I'm finding myself getting more and more confident in my abilities, and actually putting my knowledge to work on a variety of real patients is helping as well. While I realize my education is never going to be complete, I feel that this learning experience is definitely helping to make me ready for the streets.

Our first really good call of the day was a poor lady who was pulled over the handlebars of her bicycle by her dog. We found her laying on the street. She had some left sided rib pain, and a growing hematoma on her left thigh. The firefighters were really helpful and they got her completely c-spined while I took a history down and did a quick physical. Being hands-off is sometimes part of my job if I have extra hands, since it allows me to focus on history and physical exams. She took blood thinners, which made me worry a little about the hematoma on her left leg. It was hot to the touch and had increased in size from the time we backboarded her and got her into the ambulance. She was in quite a lot of pain, too. I started an IV and we headed out. Other than the couple of other scrapes, she was fine though.

We had a good respiratory - a 5 year old woke up with sudden barking cough and expiratory wheezing. After getting a set of vitals, I gave her a Xopanex treatment per protocol. Her lung sounds turned out to be upper airway, I was hearing them in the lower airway though, since she was so small. The Xopanex was still appropriate, however. We also ended up giving her 60mg of Solu-medrol. When we arrived, the doctor was very cranky. She didn't even wait for us to get the patient out... she said "I can't wait for you guys" and climbed in the ambulance and immediately started to bitch. Apparently we have microscopes and a lab in the our truck that we failed to utilize in order to check that the respiratory problem is a viral infection (croupe) and we should know better than to give Xopanex for croupe since it's not a lower airway problem. The only thing that will work for croupe is solu-medrol (which I gave) and raceimic epinephrine. I bit back my apology for not doing a full set of labs during the blood draw and for not giving her a medication that no EMS service I've ever heard of carries. Deep breath, think good thoughts. Ever the student and diplomat (snort) I cornered her in the hallway and asked a few routine questions about croupe - just enough to get her to calm down a little. She did once she explained it. I think she was probably just having a bad night, so I'll give her the benefit of the doubt.

We had a real CVA with difficulty speaking but no neurological deficits. Her BP would spike upwards and then her speach problems would get worse. Unfortunately her BP wasn't high enough to treat. Ah well, we got her to the hospital on time.

I've reached the 3/4 point in my internship. Next shift will see my 360 hour evaluation and less than two weeks until I go home! I miss everyone terribly - especially my class mates. There's so much I want to discuss with them now that I've done my internship. I miss my family and my friends as well. I'll see you all soon!
]]> http://www.travelpod.com/travel-blog-entries/cogliostro/1/1224162480/tpod.html http://www.travelpod.com/travel-blog-entries/cogliostro/1/1224162480/tpod.html#comments Travel Blogs http://www.travelpod.com/travel-blog-entries/cogliostro/1/1224162480/tpod.html Sat, 18 Oct 2008 09:36:50 -0400 Alaskan Paramedic Happy Super Fun Time Go!

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The Woodlands, Texas, United States

Another busy night at Medic 82 meant little sleep for the crew of Medic 82 and me.

A few routine calls, a few big calls. Our first big one was a patient who was at an allergy clinic having tests done to figure out what she was allergic to when she, here's a shocker, went into anaphylaxis from one of the antigens she received. This lady was allergic to everything. She was even allergic to Benadryl! Oh my god. Seriously? You're allergic to an anti-histamine... an allergy medication! Not unheard of, to be sure. There's a few people I've talked to who are allergic to benadryl, but not many. Because of her allergic reaction, the doctor present at the clinic gave her 0.6mg of epinephrine, 1:1,000! That's twice the dose given in a severe allergic reaction. Did she stop there? Oh no. No that would be too easy... she gave her a Singulair dose, a dose of benadryl (which, if you remember correctly she is allergic to) as was in the process of giving her an albuterol treatment when we arrived. This lady was taching along somewhere in he 130's! She said she felt like her heart was about to run right out of her chest. I'm not surprised. We get her to the hospital, which is just right around the corner, and her doctor follows and starts fawning all over her. Seriously, it was disgusting. You could totally see this doctor was trying to suck up like nobody's business. Ah well, the epi wore off soon but the shakes still remained.

Later that night, we get a call for an unconscious patient with snoring respirations. We arrive and I immediately reposition her airway and, imagine this, she breathes clear! Woo! She's completely unresponsive, but has a pulse, and I can smell wine pretty heavily on her breath. Her SpO2 level is at 56%. She's got a dark red stain running down her nose. I listen closely to her breathing now and I can still hear some crackles in the lungs - it sounds like she aspirated some wine. I put an OPA in, both to open her airway and test for a gag reflex - no response at all. I put her on a non-rebreather since she has decent tidal volume, and her sats quickly climb up to 98%. Woo!! Her blood glucose is 109 - so this isn't diabetic related. I try even more painful stimuli - still no response. She is out. You know what that means, right?

Aspiration + inability to control own airway + no response + Absent gag reflex = Andy gets to tube you, baby!.

Oh yeah, it's time to intubate! We get her moved onto the gurney and into the ambulance with her boyfriend watching. I don't want him to see me shove a tube down her throat, so I ask one of the firefighters to get inside and close the door. This poor firefighter can't be much older than 19... and he's losing his mind! I had to really struggle to keep from laughing. He's an EMT Intermediate and either doesn't get to practice much (not surprising) or just graduated from EMT class and this is one of his first real patients (A likely case is both). I've been an EMT for a little over a year, but I ask myself if I was that scared when I saw my first patient? I'll ask Sarah when I get home, she was with me as an EMT 1. Anyway, I tell him to start a line for me while keeping eye contact so he'll maybe calm down a little. I get my intubation gear ready and tell the attendant to pre-oxygenate for me (we don't say hyperventilate anymore! Haha!). The firefighter, who is working on the line, looks up and his eyes get as big as saucers when I went in. She didn't even flinch. Her heart's still tachin along at 120, but is regular. No cardiac issues that I can see.

We get her tubed after a try, and he unfortunately misses the IV. He was a little nervous to say the least. Everything's going great, though. We put her on the port-a-pac to free up a hand. Buy this time we're running code to the hospital. We re-assess her LOC. Thankfully Patrick had a line on the other arm, so I wasn't worried about the firefighter missing his IV. The poor kid really felt like he let everyone down - he was almost on the verge of tears. Everyone reassured him it's okay, we cleaned up headed back in service.

Another busy night. Lots of other calls, but nothing really as good - but still no sleep. Though we did have this lady in her 90's who had a bradycardic rhythm with a bigeminy of PVC's. It was freakin weird - her blood pressure was normal, her mentation was normal, everything was normal. She did complain of a slight headache, but said it had started this morning. No one could figure out exactly what was going on and it was eventually decided that she'd probably been living with this for a while.

Later!
]]> http://www.travelpod.com/travel-blog-entries/cogliostro/1/1223901660/tpod.html http://www.travelpod.com/travel-blog-entries/cogliostro/1/1223901660/tpod.html#comments Travel Blogs http://www.travelpod.com/travel-blog-entries/cogliostro/1/1223901660/tpod.html Mon, 13 Oct 2008 09:33:19 -0400 Alaskan Paramedic Happy Super Fun Time Go!

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Willis, Texas, United States

Theme for the day: Now see, what we have here... is a failure to communicate. I'm going to bitch a little, so get prepared.

My shift yesterday was a little odd. The call volume was low, which was good, since I have some personal and professional issues with the attendant on the truck (though his in-charge did talk to him, and it has - at least for my part - been resolved) and don't enjoy running calls with them.

Issue #1: Attendant to the rescue!
The attendant on the shift I just completed is up for his in-charge paramedic. That means he'll get his own truck. Apparently no one told him that students are supposed to be able to do some learning, and take over some calls. I've had problems with this attendant in the past... he always, and I do mean always, rushes into the scene and starts rapid fire questioning. Even when I ask if I can take a call, he stays quiet and the in-charge says I can. I'm all 'cool, finally.' but nope, he rushes in. Then when the in-charge gets in the back of the truck, I'm expected to formulate a treatment plan without ever questioning the patient myself or hearing everything that's said. Okay, fine. I can live with that... I'll turn lemons into lemonade: I'm not with this truck very often, so what I'll do is just use it as a place to hone my technical skills and observe the style of another paramedic. Cool. Oh it gets better.

Issue #2: You've seen one intubation...
... you have not seen them all. I fully admit that I'm inexperienced when compared to the medics at MCHD. They literally have 50 times the call volume of Nikiski. The issue arose a couple of shifts ago, the same truck (shocker) when I was offered the chance to witness an intubation in the ER. I made the mistake of saying "Nah, I'm good on intubations." Apparently I commited a faux pas, because the attendant for this truck mistook what I said and went all huffy to his in-charge and told him I said I didn't need to watch the intubation because I've hit every intubation I ever attempted (I found this out while I was talking about that bad call with my regular shift, my preceptor yesterday said "But I thought you were good and never missed!" when I told him I couldn't get the tube). Anyway, so I got called on the carpet by the preceptor of this truck for not wanting to watch every intubation I have the opportunity to. Grit your teeth and move on, Andrew Joel.

Issue #3: Don't be such a know-it-all!
We brought a patient in and were in triage when we got to talking with the nurse about diet soda. No one can pronounce 'aspartame' and half of them don't know what it is, so I politely explain. Someone, as it always happens, starts expounding on the evils of aspartame and saccarine and how even one little sip will give you cancer (Dun dun duuuuuuuuuuun). I explain to them that the experiments with aspartame giving you cancer involved rats being forcefed pure aspartame, buttloads at a time... and that you get maybe two or three tablespoon fulls in a decent sized soda. My preceptor blurts out "Where the hell do you get this stuff? Why do you know that?" I explain that my mother is diabetic and that I used to be and that I like to research the chemicals I'm eating. He gives me a funny look but it ends there.

This morning on my way out my preceptor is sitting down at the table
and he says "You need to not be such a know it all." I ask what for, he
replies "Just, you know... that aspartame thing. There's no reason for
you to know all that. Your best bet as a student is to be seen, to listen and not be heard. Just observe, that's the way I learn. I observe." Then he starts blah blah'ing about how when he was a student he learned to observe and now he can draw up medications, listen to his partner questioning and watch the monitor at the same time - I dunno, I stopped listening as I attempted to count backwards from 100 in my head to calm down.

I will freely admit that sometimes I let my mouth run off with random facts and shit no one cares about. But when I get called on the carpet for being a 'schmarty pahnts' for explaining aspartame - or the side effects of neurontin and anti-seizure medications to a patient's family (oh yes, that too) I will take exception to that. These issues with this particular truck are going to feature prominently on my Internship evaluation when I get back. The only reason I haven't said anything to anyone higher up is because I am a guest here. That I am a guest who is literally paying thousands of dollars to be here, I'll choose to ignore for now.

So yes... I am a know it all. Again, I freely admit sometimes I run off at the mouth - usually about trivial nonesense like the correct number of decks on the USS Enterprise-D (It's 42, by the way... an homage to Douglas Adams. See? That's know-it-all!), but in a case such as this I can't imagine how simply discussing aspartame or counseling a patient and her family on the side effects of very powerful medications can be construed as 'know it all' - especially when I have first-hand knowledge of these medications!

Just because I have the ability to pick up a book and study something not directly related to cattle herding or the latest in tactical catfish gigging doesn't mean I'm throwing my intellectual weight around. You can call me a know-it-all when I correct everything someone says, not because I want to read pharmacology instead of the Cowtipping Monthly Newsletter.

That's my rant for the day... now that I've gotten it all out of my system, I can move on. If you read all of it, bless you in every way imaginable. You'll never get those 10 minutes back, you know. Just pointing that out! HAHAHA! God I'm such a dick.

*cough* Anyway

So I'm almost 3/4 of the way through now. I have 8 shifts left and I can go home! Almost all my 10 Cardiac, respiratory, trauma and medical patient slots are filled and I'm ready to high-tail it out of here! Now since I got about 3 hours of sleep last night, I'm going to go crash and burn for a couple of hours.
]]> http://www.travelpod.com/travel-blog-entries/cogliostro/1/1223774340/tpod.html http://www.travelpod.com/travel-blog-entries/cogliostro/1/1223774340/tpod.html#comments Travel Blogs http://www.travelpod.com/travel-blog-entries/cogliostro/1/1223774340/tpod.html Sat, 11 Oct 2008 21:52:07 -0400 Alaskan Paramedic Happy Super Fun Time Go!

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Houston, Texas, United States

I did another 36 hour shift today. I can easily say it was one of my worst shifts - not because of anything my preceptor or I did, just the nature of the calls I ran - two specifically.

The first one was an 83 year old lady who was having heart palpitations, weakness, numbness, etc - and thought she was having a stroke. We put her on the monitor and she's in a pretty clear a-fib with a rapid ventricular response. She said she had a pacemaker, but it wasn't showing up on the EKG. We load her up into the ambulance and all of a sudden her pacemaker kicks in and her heart rate jumps into the 120's. Now that its a paced rhythm, I can't give her Cardizem. Everything was going okay until she started to pray in the back of the ambulance and whisper "It's getting nearer, I can see him." She hadn't had any altered mental status before. When someone starts praying and seeing things in the back of your ambulance, you know that something is going to happen. I turned to the attendant and told her to step it up a bit. It turned out okay, she made it to the hospital and into the ICU. They put her on coumadin for her a-fib, so I'm assuming she's okay.

We ran a few more calls - a lady face planted into the cement walkway at a local home improvement store and had a nice hematoma and laceration on her eye... stuff like that.

Apparently it was trauma day for the 12 hour shift I pulled. We get toned out for a second-line ambulance for an MVC in east county - one of the more rural areas. There's a confirmed 10-79 (dead body) on scene and one victim. They asked for a chopper to land on the highway, but none were available. We roll up on scene right behind a supervisor. Some bystanders are untangling the two people - one is clearly dead and the other is whimpering. We get her into the back of the ambulance and RSI her. When I placed the OPA in her mouth to open her airway, the top of her teeth and jaw move left, right - back and forth. SHe's got what we call a LaForte II fracture (II since it's up into the zygomatic bones). They RSI her and we get out of the ambulance since they have to get going.

We're heading over toward the DB when one of the bystanders runs over screaming "A guy just drove down the road and was ejected! You guys need to get over there!" Goodie. We hop into the ambulance and drive about 300 yards down the road and sure enough, there's a motorcycle laying on the street with a bunch of people surrounding an 50'ish year old guy laying on the ground. I look at my preceptor to double check his "You're running the calls from now until you leave" rule is still in effect. He nods and I head over. I give him a quick once over - his left leg is sticking out at a 90 degree angle from his body and he's got an open femur fracture and a completely fractured right radius - I know that for a fact because the end of the radius was poking out the side of his forearm. A firefighter is sitting there and I bag him a couple of times and check for a pulse. I don't find any, so I tell the firefighter to start CPR while I get the pads put on. The stupid idiot checks while the EMT is bagging and says he feels a pulse. I tell him that no, there is no pulse - please start CPR.

This guy is a mess - we can't get a line by IV, so my preceptor breaks out the IO. Because of his bilateral femur fractures (I find that on a rapid) we had to go in through the head of the humerous. This guy is pretty hefty, so it barely goes in.... then one of the firefighters strapping him to the board yanks out the IO - our only line.

I make one attempt to intubate before I have him moved to the ambulance, but he's got no neck and has vomited. We don't have suction nearby so I scoop out some of it with my fingers and tell them to keep bagging him.

Anyway... we're in the back of the ambulance and I can't intubate... I got nothing. My preceptor makes the attempt while I concentrate on getting meds on board (since the firefighters were Basics and less than useless except for doing compressions). My preceptor finally says "Fuck it" and gets a CombiTube - it's a blind insertion. We finally get an airway and I shove some epi down the tube. We keep CPR going and I shove some atropine - he's gone from a pulseless electrical rhythm to complete asystole. I know what has happened and that it isn't going to end well, but we have to keep going. My preceptor reminds me that their protocols allow for prophylactic decompression. I do a quick exam and hear breath sounds, but his right chest is pretty flat. I tell him to give me the needle and I shove it between his 2nd and 3rd rib. Whew, done.

By now w'ere at the hospital, we pull get him out and his leg flops open when they move him to the trauma bed. This is the bad thing. Apparently when he flipped OVER his motorcyle, he did the splits over the guard rail. He was completely split up the perineum. He was not only bleeding from a femoral artery split on one side (and dumping into his leg on the other) but he had also bled out from the middle. He was completely exanguinated. I realized early on that there was nothing I could do - nothing even the best paramedic could do. He had bled out inside his pants and they were hiding quite a bit of blood - as was his abdomen. Even if we had ten lines, all we'd be doing is replacing his blood volume with salt water. Even in the hospital, once they started giving him blood he started to leak it all out again. It was just a bad call altogether. A bad day, to be sure. It would have been nice, too, if his wife not come up while we were on scene.

Whelp, I need to get to bed. I have another 24 hour shift tomorrow. I miss everyone, and thanks for listening to the gruesome details of my day, even though I did leave some details out.

By the way, congrats to all my classmates who passed their exams!

-Andy
]]> http://www.travelpod.com/travel-blog-entries/cogliostro/1/1223385300/tpod.html http://www.travelpod.com/travel-blog-entries/cogliostro/1/1223385300/tpod.html#comments Travel Blogs http://www.travelpod.com/travel-blog-entries/cogliostro/1/1223385300/tpod.html Tue, 07 Oct 2008 09:27:45 -0400 Alaskan Paramedic Happy Super Fun Time Go!

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Houston, Texas, United States

Southern Thunder. Sounds like the name of a really good beer... or a special blend of Mary and Juan's tokin powder.

I saw my first southern thunder storm this morning! The lightning was simply unreal. We had the chain lightning and such in Eastern Washington, but this is like nothing i'd ever seen before. The thunder was really loud as it passed overhead. I just kept thinking about the Garth Brooks song Thunder Rolls... surrounded by firefighters. It was a little awkward, I'm not gonna lie.

So last night I ran all the calls instead of picking and choosing. I was told "Today I'm not here, and Jolene (my preceptor's regular partner, who's a paramedic) just graduated as an EMT Basic - but she barely passed." This meant that ALL procedures had to be performed by me. IV's, assessments, lung sounds, EKG's, etc. Just as if I was alone in the back of the ambulance with my partner driving. My preceptor sat back and let it ride.

Of course the first patient we get is a bitchy, whiny old lady who's apparently pissed that she's lived so long so she's taking it out on the rest of the world. I got kudos for keeping composure and not letting her fluster me. Getting an assessment and history was complicated by the fact that she did not stop bitching the entire way in. That, and the fact that her story and complaint would change. Ah well, c'est la vie. I think I did okay, it was a slow day thankfully. We did have a chest pain with a gentlman with a blood pressure of 202/108. He got a few squirts of nitro and was fine. He seemed to think faking a few fainting episodes would get him into the ER quicker, but they soon stopped when I told him that if he didn't stay awake I would stick a tube down his throat so he could keep breathing. It isn't a threat, it's just a simple fact: you fall asleep or faint around a Paramedic and, well, we don't get a chance to intubate often.... you do the math }:o)

An altogether uneventful night after all. Our last call was around 3:30 in the morning, but it was unremarkable. I did, however, get a call yesterday giving the official approval of the job at the hospital as an ER Tech. I won't get to do a lot of the cool stuff like IV's and intubations, but I'm looking at it as a chance to be exposed to a lot more. Any kind of clinical exposure (and access to doctors) is definitely a very good thing.

I'm still not sure what I'm gonna do on my day off... I may catch a movie today if there's something playing, but in all likelyhood I'll stay in and do some laundry, watch a movie, etc.

What is it with sweet tea here, anyway?

Out!
]]> http://www.travelpod.com/travel-blog-entries/cogliostro/1/1222953420/tpod.html http://www.travelpod.com/travel-blog-entries/cogliostro/1/1222953420/tpod.html#comments Travel Blogs http://www.travelpod.com/travel-blog-entries/cogliostro/1/1222953420/tpod.html Thu, 02 Oct 2008 09:28:16 -0400 Alaskan Paramedic Happy Super Fun Time Go!

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Houston, Texas, United States

Well, I just completed my first 36 hour shift. I came in at 7pm Tuesday night expecting an easy shift. Yeah... right.

We had about four runs and a cardiac arrest. It toned out as respiratory difficulty at a nursing home and when we got there she was sitting upright in bed with her head flopped forward. There were a buttload of nurses surrounding her all freaking out. The patient had a pulse when we got to her, but after we did a quick check after we got her loaded into the ambulance we saw that she was in a PEA rhythm.... that's basically where the electrical system of the heart is working fine, thus showing a rhythm on an EKG, but there is a mechanical problem and the heart isn't pumping. We started CPR and got some vasopressin in her (though my first instinct was to reach for the epinephrine, which is not MCHD's front-line medication). I told the EMT to intubate her. The other Paramedic did compressions and I did the IO so we could get a line quick (it went in a lot easier than the trainers we had in class). We got a round of vaso in her and two rounds of atropine by the time we arrived at the hospital (we had a supervisor drive us). She was still in PEA when we transferred her to the ED. Unfortunately by then her pupils were fixed and dilated. Given that and her age, they decided to call it.

Unfortunately you lose more than you win. I'll probably never know exactly what was wrong with her, but there you have it. My first run as team lead for a cardiac arrest. It was eventful, but slow moving. Definitely not like ER where everyone is scrambling around and shouting orders.

THe next 24 hours were pretty uneventful... I ran a few calls later. My preceptor is letting me take complete control over scenes now, which is nice. Hopefully I can squeeze a few more shifts between here and the 28th and get the hell out of dodge early!

Thanks for the comments, guys. It's nice to know you guys care! I miss all of you! :)
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