Boracho

Had an out-of-the-ordinary experience last night...

Most of the time we medics are called to deal with the aftermath of drunk driving, but last night we applied the proverbial ounce of prevention. Cruising down a local highway around 3am, my partner and I noticed an SUV weaving all over the road. The driver then proceeded to jump the concrete median (throwing sparks) and speed toward us. My partner stomped on the gas, veered out of the way, and looped around so we ended up behind our very drunk friend, who was still weaving his way toward an intersection.

We grabbed the radio and called for some help on police mutual aid, flipped on the lights, and sped after him. We overtook him without much trouble, and cut him off at the median. Luckily, he didn't try to ram our truck, but just came to a stop. The guy hopped out, came to our window, and asked (very drunkenly and with much alcohol on the breath), "What wrong with my truck? What wrong?" We had the guy sit down and took his keys while we waited on the police. A state trooper happened to be at the intersection, and he joined us within a few seconds. We explained what we thought was happening, and smelling the man's breath, he performed a breathalyzer test. The driver blew a .20.

Needless to say, he was cuffed & stuffed for DUI as well as no license & expired registration. The police were very complimentary, and we left the scene feeling that we'd actually made a difference. Not that hauling nursing home patients to and from various and sundry destinations isn't important, but...

Paroxysm

The body count:

+ female in her 40s with hx of SVT & pulse rate of 200 (terminated with adenosine; priority 2)

+ male in his 50s with altered LOC secondary to ingestion of unknown psych meds (priority 1)

+ minor car wreck in which several hundred pounds of turf were spilled on the roadway (priority 3)

+ male in his 60s with chest pain & cardiac hx (priority 2)

+ male in his 30s with epigastric & abdominal pain (priority 3)

All in all, a decent day. Cheers to my partner, who got a service commendation for his role in helping victims of Hurricane Katrina who were airlifted to Our Fair City.

Have a great weekend, all...

Asystole

It would seem strange not to mention my very first pediatric cardiac arrest, though it didn't really stick with me like I thought it might.

We're dispatched at about 6am on a Saturday for a "signal 9" in an apartment in the 'hood. My partner and I (along with our ride-along, a precepting paramedic) get rolling. Ahead of us, we see Engine 15 blast through a red light without so much as a tap on the brakes. Typical fire department. We proceed through slightly more cautiously. Dispatch informs us that our patient is a ten year old and that CPR instructions are being attempted. I don't give this a whole lot of credence, since we're quite often dispatched on cardiac arrests that turn out to be seizures or people sleeping, and I'm even more skeptical given the area of town we're responding to.

We arrive a split-second behind the engine company, locate the apartment, and walk inside. A low-lit room cluttered with toys and other junk. A woman screaming and crying. A young black girl lying motionless on the floor. Mom is screaming over and over, "Please don't hurt my baby!" Beyond looking dead, this girl looks sick. She's got some minor deformities along with several ports and catheters.

The father is upset, but able to speak clearly, and he tells us that the girl suffered from Sanfilippo syndrome, a genetic disorder in which the storage of mucopolysaccharides are disturbed and which results in a degeneration of cognitive abilities and eventually death (see Medline for more). While I'm prepping the heart monitor and checking for a pulse (there is none), the father hands the Do Not Resuscitate form to my partner. This changes the game entirely. With that order in hand, we are not allowed to begin resuscitative measures on a pulseless & apneic patient. I quickly attach our monitor's limb leads and print a strip. "Asystole," I say quietly.

Both the mother and father understand what has happened, and its apparent that her death had been coming for some time. This, of course, is no comfort to the mother, who rocks the dead child in her arms and cries. The fire department, feeling rather useless, bugs out, while my partner and I attempt to gather more information as well as do our best to comfort the family. The police arrive and start to do their thing. It's all very quiet and anticlimactic.

We went on with our shift, and I didn't feel out of sorts or anything. I've gotten used to adult cardiac arrests, but this was my youngest by far, and I fully expected to be in an altered state for a few days (or at least a few hours) afterwards. But I did not. This may be because the child's death was the expected, rational outcome of her disease. I find that it's easy to distance oneself from a patient (or from a patient's death) if death is impending.

In any case, the call did not throw me for a loop, and perhaps I should be a bit disturbed that it didn't.

"Hey paramedic!"

"...if I'd have known I was gonna end up here, I'd have jumped out the back of your ambulance!"

-- yelled by a nursing home resident to yours truly while working on another patient.

Hey, me too, man.

Back in Black

Apologies for the long absence...I suppose I have proven myself to be less than the hardcore bloggiste than I thought I was.

Lotsa stuff these past few weeks, chief among them being the omnipresent Katrina and her omnipresent victims. We received just under 500 of said unfortunates in our fair city, and yours truly was on hand to help receive them in our own little Superdome. Well, it was never that bad, but it was cetainly unorganized. My partner and I were the first medics on the site, and it was (at least intially, along with a few volunteer docs & nurses) our job to provide both emergenct and non-emergent care to these folks. Needless to say, with limited equipment and manpower, what followed was an MCI in its' own right.

But after two or three days of flying by the seat of our pants and haggling with various administrative types, they finally figured out a system in which the two hospitals in our city would provide round-the-clock nurse & doctor staffing and we would go back to being emergency medical technicians. Thank God.

Not much else happening...

Got to see and elderly woman take her last breath just as we walked in the door. Ended as a cardiac arrest, though dispatched as a breathing problem. Yeah, a not breathing problem.

Medicare Vacation

Not much energy for a post tonight, but I'll promote the cause of a fellow system-abusee. Read DT's latest post for a dose of everyone's favorite emergency call.

Keep those blinkies and woo-woos a-goin'!

Oh, and while you're at it, check out ResQEllie's pics of the London Ambulance Service. Great visuals for reading Tom's posts.

Daily body count:
- 60ish male with dizziness; otherwise asymptomatic; priority-3
- mid-20s pregnant female with asymptomatic pre-eclampsia; transfer across the street from clinic to hospital; priority-3
- mid-60s male with shattered left patella secondary to a fall; priority-3
- male in his 40s with severe LLQ pain; priority-2
- cancellation / water rescue
- cancellation / general illness at the airport

As if being a medic wasn't hard enough...

...we're apparently attractive targets for terrorists and other urban combatants. Say what you'd like about the current state of affairs in Iraq (and I for one do not think the US presence there is right), but the slaughter of civilians and healthcare providers of any nationality is unconscionable. Check out the news stories here.

Gonna Be Some Changes Made

Three more days till my shift changes! Wahoo! I'm moving from a 7:15 truck to a 5:15 truck, complete with a new (and good, by all accounts) partner. Can't wait.

Quoth the pager:
- pregnancy call (psychotic patient off her meds because she's pregnant...watcha gonna do? - refusal)
- unconscious person (agonal resps, pressure 50/palp, kicking, screaming, thrashing - priority 1)
- assault (6 ft blind man beat up by his 4 ft girlfriend - priority 3)
- chest pain (middle age female with minor chest pain, direct-admit to hospital across the county - priority 3)
- general illness (paraplegic pulled out his foley cath, copious bleeding - priority 3)
- stroke (elderly man with speech problems, all systems resolved upon our arrival - priority 3)
- breathing problems (young guy out of asthma medication - refusal)
- hemorrhage (middle age man throwing up coffee grounds - priority 3)

Plenty for one day, I'd say.

Oh, and the title refers to a Bruce Hornsby song that I've been looking for forever - it's the background music to the Lowe's radio commercials. Go figure.