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Damn it, Jim!

1,106 comments

Starting a story with a misquotation is likely a serious faux pas, but alas, I did it. Get over it.

We were called to Jim’s house by a 3rd party. Actually a fourth party. Jim had missed a lot of work so his boss called his next of kin–and estranged daughter–she called a neighbor and between the neighbor and his boss, made the decision to call the ambulance.

I was greeted on the rickety steps by a confused looking gentleman I learned to be Jim’s boss. As I walk past him he tells me Jim had fallen and was on the ground all night. Jim says he’s not hurt. He says he is fine. Every word he speaks is enunciated in booze. The fruity smell of cheap vodka and cheaper beer permeate through his pores. Even the feces he has all over himself smell of sweet, cheap alcohol.

But Jim is adamant that he isn’t hurt. He knows where he is, he knows what day it is, but he just can’t admit that he is hurt. He just can’t admit that he needs help.

See months earlier Jim lost his mother and sister in a week or two. Jim, already an alcoholic took these double crosses and stumbled back to the ropes. He bowed out and lost control. Now the alcohol has control.

See, Jim isn’t fine. You can see the cellulitis has eaten at his legs. He’s not eating. Not bathing. Not doing anything other than getting delivered in cheap booze. Intentional or not, he’s killing himself. He’s of sound, if not sane, mind. He by law, can make decisions for himself. People are allowed to let themselves die here.

But after I’ve spent a considerable amount of time trying to get Jim to go to the hospital today, with me in the ambulance, his family arrives. His estranged daughter, her husband, and the granddaughter he hasn’t seen in a year. I try to “prep” them for what they are going to see. This isn’t going to be the “dad” you’re use to. But she walks right by.

And the crying, and the begging, and fighting begin. PD tells me they have no grounds to hold him. No threat to self or others. See, Jim insists he’s in contact with his lawyer, who is going to take him to the doctor on monday. The problem is, he can’t tell me his lawyers name. If you ask Jim how much he’s been drinking he changes the subject. If you ask Jim to stand(knowing he can’t) he changes the subject again.

Jim wants to stay home and drink another day. I think he knows that if he manages to stay home and drink enough days his body will finally give in to his mind and end this all.

But just because someone thinks they want to die a miserable death doesn’t mean we SHOULD stand idly by. I had walked out, as the city around me is imploding with 911 calls and transfers, I’d given up. Nothing was working. I waked out, got my signatures and was getting into the truck when the daughter came up to me.

“Please help me”. I don’t want him to die here. I don’t want him to die alone”. I try to explain how little there is I can do. I’ll be honest, I don’t expend a great deal of energy trying to get people to go to the hospital. If people say they don’t want or need me, I send them on their way.

But not this time. I’d already spent 50 minutes on scene, a few more won’t hurt. I walked back inside, daughter trailing behind me. We walk past an unopened box of “Omaha Steaks” with a postmark before Christmas. What kind of man leaves a box of meat–tasty meat–on their front stoop?

Inside the front door Jim’s son-in-law and granddaughter are sitting there. Granddaughter is crying. I walked up to Jim and said flatly…. “if you can stand, I will leave you alone forever”. So he tries to stand up. And flails and fails miserably. Sad, but in a way, what everyone needed to see.

I kneeled down to his now low level. Firmly, but compassionately I said…

“Jim, look. Look around this room. These are all people that care about you. Your daughter. Your granddaughter. Your boss. Your neighbor. Even me and my partner. If we didn’t care, the easy way out presented itself 100 times or more. But we didn’t take it. I stuck around. WE all stuck around. Because I’m scared that we’re going to come back tomorrow morning and pick you up in a different way. In a black bag and instead of going to the emergency room we’l have to go to the morgue. I’m terrified that I’ll have to look at this little girl over here and tell her that her grandpa is dead because we couldn’t convince him to go to the hospital to take care of some moderate medical problems. I’m scared that I won’t be able to sleep if I don’t do right by you. You have a chance to go out with some pride. Go out on your own, not be drug out of area against your will or in a body bag. Do this for your pride, if nothing else. Your pride is going to kill you”

and all he said to me:

“Well I don’t wanna hurt your beauty sleep. You need all you can get. Lets go”

And so we went. Quietly and calmly. At first he was defeated, but then the relief swept over him and the fear faded away.

In my longest scene time ever(1 hour, 48 minutes) I actually did something. More than I do on every major trauma or code or stroke I go on.

When the powers that be wanted to talk to me about the scene time delays I told them to read the narrative. I wasn’t going to justify it any other way. I wasn’t going to say sorry. I got a sick person to go to the hospital.

THAT is my job.

Damn it, Jim.

Posted by on April 11, 2012 • Filed under: Crazy Calls, ems-health-safety, ems-topics, fire-rescue-topics, funding-staffing, Good Stuff, patient-management, Psych

Booze in the Nose.

1,771 comments

of “alcohol on her breath”. I’ve started a lot of charts like this. Seen PD run reports that said the same. I’ve seen it testified to in court….  And it is pretty interesting, in part because you can’t smell alcohol. Sure, you can smell booze–the other crap in the alcoholic beverage. But nope, you can’t smell “alcohol” on someones breath.

 

Smell of alcohol on the breath. There is a very poor correlation between the strength of the smell of alcohol on the breath and the BAC. Pure alcohol has very little smell. It is the metabolism of other substances in alcoholic beverages that produces most of the smell. This explains why a person who drinks large amounts of high-proof vodka (a more pure form of alcohol) may have only a faint smell of alcohol on the breath. On the other hand, a person who drinks a modest amount of beer may have a strong smell of alcohol on the breath.

 

This is hammered on by DUI lawyers, with mixed results:

“I Smelled a Strong Odor of Alcohol on the Suspect’s Breath”

Posted by Lawrence Taylor on June 23rd, 2006

You will never see a DUI case where the officer does not report an odor of alcohol on the suspect’s breath. Never. The officer expects to smell it and it is a psychological fact that we see, hear and smell what we expect to see, hear and smell. In fact, most police DUI reports are formatted for the usual symptoms: there will be a box for “odor of alcohol”, which the officer checks off. There are often three boxes, labelled “strong”, “moderate” and “weak”; there is no box for “none”, so that is not an option for the officer.  The ”strong” box is almost always checked.  Presumably, the stronger the odor of alcohol, the more intoxicated the person arrested.

There is only one problem with this:  alcohol in a beverage has no odor.

Assuming the officer actually does smell an odor on the breath, what he is smelling is not ethyl alcohol but the flavoring in the beverage. And the flavoring can be deceptive as to the strength or amount consumed. Beer and wine, for example, are the least intoxicating drinks but will cause the strongest odor. A much stronger drink, such as scotch, will have a weaker odor. And vodka leaves virtually no odor at all.

Consider a simple experiment. Have a friend drink a can of “near beer” — the stuff that looks, smells and tastes like beer but has no alcohol in it. Then smell his breath. You will smell an “odor of alcohol” — and maybe a strong one.

And, of course, there can be any number of causes of an “odor of alcohol” on a person’s breath: mouth wash, throat spray, cough syrup. Illness, indigestion or simple bad breath has been the cause of more than one officer’s trigger-quick conclusion that the suspect has an “odor of alcohol on his breath”.

The point of all this is that the odor of alcohol has very little relevence in a drunk driving case. It may or may not indicate that the person has consumed alcohol. It has absolutely no evidentiary value on the much more important question of how much the person has consumed — orwhat he had to drink, or when. Depending upon circumstances, a person with a single drink can have a “strong odor of alcohol on his breath”, and an extremely inebriated person can have a “weak” odor. And an experienced and honest DUI officer will readily admit this….if he is ever asked.

Unfortunately, evidence of the odor of alcohol on a person�s breath can have a significant impact on a DUI case. This is because most officers who pull a driver over for some driving irregularity at night are looking for further signs of drunk driving. When the officer approaches the driver’s window and smells alcohol, that confirms his suspicions. Since few can pass the “field sobriety tests”, particularly under the conditons in which they are given, an arrest is likely.

Are there any scientific studies to back up my claim that breath alcohol odor is largely irrelevant yet disproportionately weighted as “evidence” of intoxication?

In 1999, the same scientists whose federally-contracted studies became the basis of the so-called “standardized” battery of field sobriety tests conducted another study on the effectiveness of alcohol odor in detecting intoxication. These researchers used 20 experienced officers working with 14 subjects who were tested at blood-alcohol concentrations (BACs) ranging from zero to .13 percent. Over a four-hour period, the officers smelled the subject’s breath odor under optimal conditions, with the subjects hidden from view.

The conclusions of the study: Odor strength estimates were unrelated to BAC levels. In fact, estimates of BAC levels failed to rise above random guesses. Further, officers were unable to recognize whether the alcohol beverage was beer, wine, bourbon or vodka. According to the scientists, these results demonstrate that even under the best of conditions, breath odor detection is unreliable. Moscowittz, Burns & Furgeson, “Police Officers’ Detection of Breath Odors from Alcohol Ingestion”, 31(3) Accident Analysis and Prevention 175 (May 1999).

 

So the moral of the story is that we need to examine how we chart suspected intoxicated patients. Being highly suspicious of all medical conditions that could cause these symptoms is important too:

http://www.monkeydoit.com/medical-act-drunk.php

DIABETES
Symptoms of diabetes may make a person appear drunk or intoxicated.
A person with diabetes may exhibit abnormal behavior as a result of the many different signs or symptoms associated with the disease. The signs and symptoms listed here only relate to symptoms that mimic drunk or intoxicated behavior. Generally, these are warning signs that a person needs immediate medical attention and should be treated as a medical emergency. Police dealing with suspects often times mistake diabetes for drug or alcohol use during field sobriety exercises. 

Signs & Symptoms of Diabetes
-- The smell of acetone on the person's breath
-- A distinctive fruity odor on the breath (Police Officers often mistake the smell as alcohol during a field sobriety tests)
-- Dizzy, has trouble keeping balance
-- Altered states of consciousness
-- Arousal such as hostility or mania
-- Apprehensive with no obvious reason
-- Unusual nervousness
-- Disoriented in place or time
-- Confused when asked simple questions or confused in general about circumstances
-- Sweaty with clammy perspiration
-- Inability to concentrate on what you are telling them or on the tasks at hand
-- Sudden mood changes
EPILEPSY
Epileptic seizures generally happen without warning for most people. A seizure is a brain disorder of abnormal electrical activity in the brain. Seizures may be either partial or generalized and will present signs and symptoms that very among individuals. 
Signs & Symptoms of Epilepsy
-- May appear detached from reality
-- The person might be in a dreamy state 
-- Dizzy, unable to maintain balance
-- Falls down
-- Staring spells
-- Unresponsive
-- Walks away during a conversation
-- The person may have pupillary dilation
-- Sweating
-- Problems speaking
-- They may display an inability to answer questions
-- Contorted posture / limbs appear twisted
-- Flushing
-- Memory and time distortion (they may not remember what just happened)
-- May appear unrealistically fearful
-- May exhibit emotional signs of heightened pleasure
-- May exhibit emotional signs of displeasure
-- May appear aggressive or angry
-- Complete loss of consciousness
BRAIN INJURY
Brain injures will generally have signs and symptoms that relate directly to what part of the brain was injured. Here are just a few symptoms that someone could easily mistake as the person being drunk or intoxicated. These will vary among individuals and to what extent the brain was injured.

Signs & Symptoms of Brain Injury
-- The person may exhibit tremors
-- Dizzy, unable to maintain balance
-- Unable to make simple movements of various body parts
-- Inability to perform a sequence of complex movements
-- Unable to focus on tasks
-- Sudden mood changes
-- Inability to focus attention visually
-- Difficulties with hand and eye coordination
-- The person may suffer from hallucinations or visual illusions
-- They may have difficulty in understanding spoken words
-- They may show signs of aggressive behavior
-- The person may slur their speech 


Brain Picture -EpilepsyALZHEIMER'S
Alzheimer's or dementia is unique for every individual. Alzheimer’s is a progressive and fatal brain disease and the most common form of dementia. The signs and symptoms like the other medical conditions listed here may mimic impairment or drunkenness.

Signs & Symptoms of Alzheimer's
-- The person may show signs of paranoia
-- There may be drastic changes in mood
-- Confusion is quite common with people suffering from Alzheimers or dementia
-- They may have problems speaking
-- The person may exhibit aggressive behavior
-- It's common that there will be problems with remembering things
Posted by on November 13, 2011 • Filed under: administration-leadership, Changes, Code 3, Code 4, command-leadership, Crazy Calls, Dispatch, ems-health-safety, ems-topics, Failure, fire-rescue-topics, firefighter-safety-health, funding-staffing, hipaa, in-the-line-of-duty, news, patient-management, Pediatric, Protocol, special-operations, training-development, Wow.

Lost in Translation

4 comments
We picked up a young Hispanic couple this evening along with their 5 children. I can only presume they were their children, as they did not speak a lick of English. There were no injuries. No complaints, but they wouldn’t get out of my ambulance. When we got to the hospital, the youngest child(4) speaks in clear English while the others freak out in Spanish…
“Hey taxi man, this isn’t our house”

We picked up a young Hispanic couple this evening along with their 5 children. I can only presume they were their children, as they did not speak a lick of English. I tried and tried but no one responded to my pleads in English or my piss poor attempt at Spanish.

There were no injuries. No complaints, but they wouldn’t get out of my ambulance. When we got to the hospital, the youngest child(4) speaks in clear English while the others freak out in Spanish…

“Hey taxi man, this isn’t our house”

Posted by on February 18, 2010 • Filed under: Crazy Calls, medic

Take Note:

2 comments

2 grams of Coke, plus a dash of PCP will make you f’ing nuts. Psycho Nuts.

It might just make you so nuts that you decide that your Super 8 motel room is the set of the next episode of The Detonators.

Step one. Ingest Coke, plus PCP. Step two: Freak the F out! You can ALWAYS identify a PCP high when they have destroyed the porcelain god! Always.

We wondered in through shards of drywall and porcelain, mixed with cheesy drywall and some shards of mirror to find 6 police officers with their knees on the back of a 165 lb man who was all but throwing them around. He had been shot 8 times by less than lethal rounds, OC’d twice, and was now restrained but by no means controlled.

Law Enforcement didn’t know what to do at this point, and honestly, we really didn’t either. While he may have taken that much Cocaine, the PCP has altered that reaction from what would be barely breathing to going nuts. Way nuts. We improvised and chose a less than perfect solution: face down backboarding with hand and leg irons in place. There was no doubt his airway was intact based on the repeated “I’ma fuck you up!” followed by the incoherent screams and spitting. During transport and IV was established and but narcan was NOT given, as symptoms did not match that of a narcotic overdose.

Once we got to the hospital the irons were replaced with leathers, and he was able to be restrained facing supine, but the battle still raged. During the 20 minutes we were there, they gave him 40 mg Valium and 20 mg of Ativan–enough to require you breathe for me–and he still lerched his back and gave the trademark PSYCHO look.

Before we departed they ended up RSI’ing the young fella for both his and his providers safety. His thrashing had caused him multiple cuts and it was only a matter of time before one of the people trying to care for him would be taken out too.

Goes to show just how gonzo’d you really can get!

Posted by on August 7, 2009 • Filed under: Crazy Calls, medic • Tagged: ,

Hypothermia… In August?

57 comments

Called at 0700 for a a Man Down. As we near the scene the update indicates it is a 93 year old woman in her driveway, confused and cold. I honestly expected the typical fall, and, it being 60 degrees out, she was likely a bit chilly….

What I FOUND was actually much more serious. We found a woman, lying on the driveway, wet clothes, and COLD. Very cold. No longer shivering cold. Cardiac dysrhythmia cold. She could tell me her name, and that was it. Neighbors had found her while out walking, and told me she lived alone in this huge old house in the old money neighborhood of little big town.

She was cold. Seriously cold. It is August, we’re not supposed to have hypothermia cases… but a few things left her little chance… She weighed… soaking wet, might you say… 80 pounds. I suspect that even without the dampness she would be damn cold. I suspect she has been down a long time. She has abrasions on her hips and shoulders from dong what some call the “crappie flop”. Further, at 0700, it is rare to find an elderly fall victim fully dressed. She had jeans, blouse, and shoes on. Most of our early morning fall victims have their pajamas on still.

What got me was that she was wet. Not damp, but soaked. No sprinklers near, no pool. I KNEW she had been out since 10pm last night… in the middle of a 3/4 inch downpoor. Poor thing had laid in her driveway, alone and affraid in the middle of a god damn thunderstorm. Then laid out all night, till a passerby noticed her–and I don’t know how they did! She lives on a secluded street up a bendy driveway. Lucky, if you can call her that.

In the field we can do little for cases like this. Warmed IV fluid, blankets, and heat packs in the arm pits is all I had. Fortunately it is a short jaunt to the ED.

Guess her core temp….

84.7 degrees. Yup. Thats cold. Beyond Stage 3 hypothermia. She was in V-Tach(which we did NOT treat due to temp), respiration of 9, but her eyes were open, almost as if they were trying to say something to me….

I’m not sure if she survived. Often times Stage 3 Hypothermia ends in Organ Failure and cell death. This call just goes to show you that you can’t walk into a call close minded. It is flipping August and I just ran a severe hypothermia call.

Posted by on August 4, 2009 • Filed under: Crazy Calls, medic, Wow. • Tagged: , ,

Life is Good

34 comments

I’m home with the boy and the wife today. Life is good. I love the new job and after the meeting with the medical director yesterday, I am cleared to start the FTO process.

This week I:
Delivered a baby
RSI’d a gonzo’d motorcycle driver
had Two cardiac arrests
coded a 9 day old baby
Provided lift assist to a 300 lb naked man in his shower. Ew.
made it home to see my family

Some good calls. Some bad calls. But, best of all… I’m running calls.

Godspeed, friends!

Posted by on June 26, 2009 • Filed under: Coping, Crazy Calls, medic • Tagged: , ,

Walks Like a Duck…

2 comments

Talks Like a Duck… Don’t assume its a FROG. Often in EMS we either fail to see the big picture, or we fail to notice the obvious. Most of the time we fail to see the obvious. If a case presents as a cardiac chest pain–treat it as such. If it presents as a SOB, treat it as such.

Use linear thinking to get you to the right treatment, but start at the beginning. I’ve had a few calls this week where my partners refused to see the obvious. They decided that dispatch was correct and the patients symptoms were wrong.

Expect more later. Also, I found our “protocol” books. Last revision, DECEMBER 1996.

Posted by on October 10, 2008 • Filed under: Crazy Calls, HELP • Tagged: ,

Tales from a Small Town, Pt 3

2 comments

Well, as I have made very much apparent–I live in a small town. We have:

  • 1 Grocery Store
  • 2 Sub shops–1 is a gas station
  • 2 pizza shops–1 is the same gas station as above
  • 1 Casino–Tribal and all
  • 2 restaurants–1 is at the Casino Above
  • 4 Gas stations–1 same as 1 sub shop and 1 pizza shop
  • 4 bars–all next door to each other
  • 1 bed in our ER
  • 87 beds in our Nursing home
  • 16 beds in our “hospital”
  • 3 doctors
  • 9 nurses(TOTAL)
  • 3 paramedics
  • 2 ambulances–1 staffed 24/7, 1 backup(OH SHIT, we have two calls at once?!?!)
  • 4 Churches

So, as you can see there isn’t a LOT here. Mostly, I do transfers from itty bitty hospital to Pretty Big deal hospital. Usually between 0800-1700, Monday through Friday. Sometimes, we actually get 911 calls.

Today was one of them. I got a CVA at the CASINO(note, because this is a small town, your 911 calls are either at a home, or at one of the very few above locations).

What I found so interesting was when I came in through the front door of the Casino(it is a rather large casino for a county of 6,000 people). I asked security where to go and they directed me straight through the casino floor, past slots, blackjack, poker, and more slots. In most situations, people gawk at us the whole way. People gather. They stop and watch. NOT at Casinos. No one seemed to even notice us.

That is until I let go of the stretcher(I was in back) and it bumped a chair occupied by a little old 80ish year old gray haired grandma. What is it that you think she said?

“What the F*#@ is your problem?!?!” she states boldly. I just look at her. “F*&%ing @ssh*le!” she yells as I walk away.

I couldn’t even type those words out–not after hearing someone who looked like my grandmother–but grayer hair and shorter–get so PO’d about me lightly bumping her chair…

Apparently this is common. About a month before I started they were working a code on the Floor of the casino and had the first in bag on a chair next to the scene. A casino patron was infuriated that they would take his friends seat–he did NOT seem to be concerned that someone was dead 4 feet away and 2 medics and 5 fire fighters were taking their turn pounding on his chest and shocking him with a couple hundred joules.

Whatever.

Posted by on August 27, 2008 • Filed under: Crazy Calls, creepy • Tagged: ,

I could never be this lucky…

12 comments

But my patients seem to be.

Today I was sitting in the office, doing some busy work when I hear the 911 line ring. It has a ringer that sounds like sirens… Usually this isn’t a problem. Most calls are not for us. Then, as I go back to my business a Deputy runs past my door. I get the chance to utter out “what the hell” and he just shouts “ROLLOVER”.

I stand up and my pager and radio both shout out tones. “Signal 1 on northbound interstate at other small town exit.”

Crap. Why me? Today I’m on with one of our “volunteers”. They are paid on call EMT-B’s that fill in for us 3 fulltimers. My volunteer today is a former career firefighter, and a damn good EMT. So that comforts my uneasy stomach a bit.

I hurry to the rig, pull it out and wait for my partner. 2 minutes later we are enroute and headed lights and sirens to the scene nearly 15 miles away. I hear some radio chatter, the local FD has arrived, the deputy, HP, and now the tow truck–all beat us there. When we are about a mile out the FD Chief gets on the horn to let us know we can tone it down–which really just means I turned off lights and sirens and continued at the same pace.

Upon arrival I cross the median, and pull in. We see a Chrysler Pacifica on its’ side, having obviously rolled atleast once. I start to grab the trauma pack and First In bag and a FF yells “save your back, you won’t need that”. So, with my cot in tow we walk up to the rescue rig and see our patients. 1 30ish woman and a 5yo girl in her lap. The mother has blood on her body, but no bleeding. FD has her left arm wrapped in gauze, apparently several small lacs there. The litter girl is not crying–nor does she appear to have been crying… AT ALL. She has a smile on her face. I poke, prod, and try to assess her and there is apparently not a thing wrong with her. Mom is a bit shook up, but complains of no pain other than the obvious source of the blood on her clothes. She denies head injury, neck pain, responds great, etc.

Apparently she and little girl were up walking when rescue got there. Still, I attempt to persuade my somehow intact patients to get on backboards. Mom refuses. She actually states little girl needs no care from us–we end up PRSing the 5 yo and I’m barely able to convince mom she should take a ride with us to the ED.

So, we take a little trip. Vitals good. Nothing else found in assessment. Drop her off, still in disbelief at how they managed to walk away from this–a 75+ mph rollover that missed two other vehicles by about 2 feet–and they have one injury to complain of between them, and mom didn’t want to even go to the ED.

So, about 1.5 hrs later I’m back to itty bitty ED with a Chest Pain and low and behold Mommy and little girl have been discharged.

Are you serious? Not a single problem? She didn’t even get stitches.

Posted by on August 15, 2008 • Filed under: Crazy Calls, Wow. • Tagged: ,

Since When?

3 comments

Since when are isolation rooms, Action Response Plans, and violent 3rd graders common fixtures in our schools?

Since when do paramedics know school staff and Resource Officers by name?

Since when is more than one(hell… Any) transport in a day out of an elementary school on a “psych” hold normal.

Posted by on April 25, 2008 • Filed under: Crazy Calls • Tagged:

Handcuffs? Anyone?

1 comment

2 patients from the same PD, back to back, both in custody. Who would’ve thunk…

Had a full arrest today too. Fire converted him with one shock. Sad part–he went to a ED/Urgent care clinic(crappiest one I could think of…) this morning for “racing heart” and was discharged within an hour. Went to get some lunch with friends, walked out to his car, and had a moment with death.

I smell dollar signs….. but then again maybe I should sue because of that smell…

Like most arrest patients, he vomited when he came “around” and started fighting the OPA. My catlike reflexes saved the day though…(sorry honey… had to steal your line)

We went to my favorite nursing home ever. Remember the lollipops? Pretty sure this nurse was stealing patient meds, and taking every last one. She didn’t know–or care about her patient enough to tell us why she called today… And The damn twitching… she couldn’t stop twitching… Not to mention bloodshot eyes to envy the biggest potheads I’ve seen. Here’s how our conversation started:

Me “What is going on with Bob today?”
McSatan “It’s on the paper”
Me “So… Bob, what’s going on”
Bob Blank Stare “I’m fine, she’s the sick one”
Me “ok… So I guess that your patients must take care of you?”
McSatan “What is your problem?!?! Do your job. Just take him to the hospital.”
Me “Well, I am not going to put him in my truck till I have just a vague Idea of what’s going on today… He seems fine, he doesn’t want to go, and we can’t just take him for ‘The nurse said so’ “(I even raised my hands and did the little quote gesture…)

You can see how that went… She said she was going to call my supervisor… My preceptor said…
“Ok, he doesn’t have one, but here’s the number for mine. This is his pager if he doesn’t answer” while he hands her a card.

Apparently this isn’t the first run in with Nurse McSatan. Fucking lollipops.

Posted by on April 24, 2008 • Filed under: Crazy Calls • Tagged:

Yahtzee!

967 comments

EMS is one of the few career paths where other peoples’ misery makes our day interesting. As a matter of fact, it is pretty much essential to making our days complete. If we have boring calls, we are bored. Some of us are Trauma Junkies. Some love medical calls. Me, I like crazy people. Crazy people–I can relate to them. I’m just a few clicks from being off the rocker myself so crazy people are easy for me. Plus, you can mess with them…

Today we ended our shift(literally.. we were pulling into the garage and got toned out… again) with a “psych pt on the freeway”). Yes. ON the FREEWAY. Get your attention?

Apparently our lovely 22 year old passenger had fled(ran away aimlessly) from her group home(I love group homes. They supply 40%(made up statistic) of our patients. Most of them who need an ambulance about as much as I need a meth addiction.

This girl was mildly MR, but not bad. She had some depression, which is commonly associated with mild MR young adults. She said she had thought about killing herself–this was as close to a suicide gesture as she had ever made, and I’m not so sure it was intentional. None the less, she earned herself a 72 hour stay at one of the “finest” mental health facilities in the region. By finest I mean understaffed and overworked. They aren’t bright either–their ambulance garage is 500ft of winding hallway away from the ED.

Here’s where the fun starts. She states that she is 5 months preggers and due in LATE SEPTEMBER. Wait…. I looked at my preceptor, and casually asked him: “Is my math ok?” He looks up. “You’re a friggin’ math genius”. Yup… seems that our pt has planned to carry her twins–or was it quints–a few months extra. Yup. You’re nuts.

She was also the primary care provider to 3 young children from her friend who died in a car accident–or did she kill herself? Anyways. Somehow I’m not so sure that the group home has room for the 3 youngins. Whatev. I love a good story.

At least she has an excuse. Better than the uppity people we pick up who act like they weren’t drinking when then rammed that innocent pole.

Anyways–enough about crazies… more about Craziness.

Our first call of the day was for “one down, with burns”. We hear ‘one down’ as CARDIAC ARREST. Not so much. She wasn’t burned either, but that’s neither here nor there.

Apparently our mid-forties pt had just had lunch with her friends and a nice eatery in one of the burbs. She had got into her car, started to leave and apparently lost control of the car, hit a parked car… and her foot was still on the gas. This caused the front wheels to keep going till the point of starting on fire and thus where the “burns” I mentioned earlier came into play.

A bystander punched out the window(only to get himself a trip to the ED too) and pulled her out after turning off the car.

PD and FD arrived on scene about 7 minutes before us. One of our medics just happened to be at the restaurant too. He stated her BP was 240/120, she was posturing and had lost control of her bladder. Her friends said she complained of a headache.

Upon our arrival she was no longer posturing, but her BP was still 200/100. This is a scoop and go. She responds barely to painful stimuli. Not looking good.

En Route we start two 16′s, monitor, 12 lead, blood sugar, pulse ox, blah, blah, blah. I keep trying to talk to her, occasionally getting a little grunt. 10 minutes into our transfer she starts responding with coherent phrases. Appropriate too.

She can tell me she has had a head ache for a week. She has been taking Aspirin every day for it–shit. She doesn’t remember what happened at all. She can tell me everything before it happened though.

10 minutes ago I had a tube out and ready to go, and now she is holding a bucket and wants to puke. Who woulda thunk.

At that point I was dumbfounded. She presented like a classic bleed. Her history presented that way too. But bleeds don’t wake on their own. They don’t just get better.

Wrong. Her CT showed an 11mm ACA Aneurysm near her pituitary gland. WTF. They planned on going in and coiling it(spring to open the vessel).

Yup, one of those days.

Posted by on April 10, 2008 • Filed under: Code 3, Crazy Calls, FirstTime, Psych • Tagged: , , ,

New Template and please saw with caution…

2 comments

I’m guessing you’ve figured it out! Completely new template! Let me know what ya’ll think of it and if it needs some tweaking.

At first I couldn’t find anything too exciting but I like this one a bit.

Today we got a nice finger lac/amputation. Fingers 4/5 gone, remaining are iffy. They toned out a hellicopter too. Funny thing is… we were to the ER doors before it would have been on scene.

PS, I hate nursing homes. I love nurses. I hate nursing homes. We were called to a 87 year old man who had a fever(dispatch: Sick One). While getting report from his nurse–who seemed to give me more personal knowledge of patients than I’m used to, something clicked. They called for a fever x3 days. Neg Influeza-A, etc. But then she said that on the 1st that he had a SP02% of 81%. They gave him 2L via nasal. Are you shitting me? 81%(he had sats of 98 on the 30th according to his chart…) and you let it sit there for 3 days on 2L of o’s?

No… I couldn’t have heard you right… This was for a “fever”? You didn’t think that maybe you should call us because your patient is going into heart failure? You didn’t think that maybe 81% was bad. Ironically–this was a real Nurse–not a CNA who was covering 40 beds. This is a 5-1 facility. WTF?

So, as a refresher class, what do we do when you get Oxygen sats in the 80′s that are supposed to be there…. Yes, wait. That’s it.

Posted by on April 4, 2008 • Filed under: Crazy Calls, Nurses • Tagged: ,