The last good call of the day

We're still on the same day, and there have been some interesting calls, a baby fell out of a car-seat, or was he pushed by an irritated aunt? We checked out the baby, through Mom's hysterical threats and left it up to the police. There was also a 20 year old pregnant female, clearly susceptible to fumes, who was exposed to bug spray and paint-thinner. We moved her outside and had her boyfriend take her to an urgent care.

It is late, around 5:00, we are sweaty, we are tired. 3 of our 6 calls today have been in other people districts. We haven't been able to do our paperwork and we haven't restocked the truck. Everything is in a state of disarray. We are out of a lot of supplies. We haven't eaten except what we could stuff in while driving each other to the hospital. It is DAMMIT hot.

We are just getting ready to go back to the station from the south side when an allergic reaction call comes out right down the street from where we are. We take it because we are the closest unit. We arrive in less than 2 minutes. There is a guy standing outside, mid-forties, and he looks fine. Well, looks can be deceiving. I get out of the truck:
"Hey there, chief, what's going on?"
"I got a shot of Toradol this morning and now I'm having an allergic reaction to it."
I ask him to have a seat on a brick retaining wall.
"I can't, I just had surgery on my ass."
"Well, okay then."
Sara goes into the house with the patients roommate to find his daily medications.
He continues by telling me that after his surgery 2 days ago, he was seen at the VA hospital this morning for pain and was given an IM injection of Toradol 8 hours ago. He has no hives, no respiratory difficulty, no edema. All of a sudden, his face contorts, he sticks his tongue out, squints his eyes and puffs out his lips.
"Aah, Aah, whuths thith? my fathe! I can't feel my fathe!" I have to stifle a laugh because he looks just like Bill Cosby doing the numb-mouth dentist routine. I ask him what medications he's taking. "Geodon" is one of the meds I hear. Geodon is a phenothiazine that was given to this patient who sometimes hears voices.
"Have you taken your meds like you're supposed to?"
"Well, I mithed my dothe last night, becauthe of my pain, tho I took three this morning to catch up."
Now it all becomes clear, its a phenothiazine overdose. Phenothiazine overdose causes what is called a Dystonic Reaction. Dystonia is often referred to as what your mother tells you when you're little about making faces: "If you keep doing that, your face is gonna get stuck that way." The patients face contorts and gets stuck, the facial muscles spasm and freeze. There is usually neck involvement. The antidote for this reaction is simple and we carry it on our truck, IV Benadryl.

After getting on the radio and telling Sara what we have, I put the patient in the truck, have the fire-fighters set up an IV line. Sara comes back with a whole list of meds while I am starting a line. I am explaining the entire physiologic process to a very green EMT-Basic student from a fellow instructors class. We start with 25 mg, which eases off the spasm and makes the him more comfortable. We start on our way to the ER. While talking to this guy, he notices my yellow ribbon with the 82nd airborne pin that I have on my uniform. He tells me he was in the 18th airborne corps of mechanics in Fayetteville and was there during the bombing of a marine bunker in Grenada. He had never been deployed during his time in the military but was still a veteran and a staunch supporter of our servicemen. I told him all about my husband, who had just recently returned from Iraq and was facing another deployment this June. He offered me prayers for his safekeeping. He began to have more discomfort and I gave him the remaining 25mg of Benadryl. When we arrived at the ER, we joked about his frozen-face. He felt much better, and became very sleepy due to the sedatory effects of the Benadryl. We dropped him off and gave a report to the nurse. It was enriching last call of the day for me. I was able to finish my paperwork, and drop it back off at the ER where I found out that this particular gentleman was doing just fine and was having no further complications.

After such a hard day, emotionally draining, and academically taxing, I was tired, but proud of what I had been able to do this day. I was proud to be a paramedic. I felt the strain of burnout fade. I felt enriched, I made a difference today.

A Day of Saving Lives- Call #2

Call number 2 comes in right after we've gotten back to the station. It's AMS-(altered mental status). It's also in a neighboring fire district because all of their ambulances are tied-up on calls. It takes us 10 minutes to get there lights and sirens. We requested a first responder since it was going to take us so long to get there, Engine 6 responded. We arrived and went into the house.

Walking into the bedroom turned the amped-up nature of the day into slow-motion movie-scene. The patient was someone I KNOW. Not someone I know well, nevertheless, a professional acquaintance. He has called the ER and told a respiratory therapist that he thought he was having a stroke. His wife is there, and she is a nurse. She is giving one helluva report about her husbands recent history related to this event. He has been dizzy off and on since the preceding day. He had a near-syncopal (fainting) episode the day before. Now, for the last 30 minutes he has had an intense headache and slurred speech. He is completely alert but sounds drunk. His blood sugar is normal, his heart looks good on the monitor and his 12-lead is normal. What is puzzling, is his blood pressure, which is 100/60 lying down and 70/40 sitting up with dizziness. Not even remotely typical for stroke patients. He does not have, nor reports having a fever, but I'm left wondering. Could this be an infection of sorts? My inclination, however, is to go with stroke. If I don't take him quickly to the ER and he is having a stroke, he will have lost precious time for clot-buster therapy. We decided to err on the side of caution. We started an IV (at least this patient had veins) of normal saline and PUHA'd (pick-up, haul-ass) to Duke.

The patient is comfortable and completely understands why we are doing what we are doing. He has no other complaints, just this slurring of speech. He may have been scared, but he didn't show it. He was a trooper.

Presented to the same doctor, who later told me the patients CT was clear, and did not suggest a head-bleed or embolism. What he was thinking was encephalitis, which can be treated with antibiotics. A far better diagnosis than a stroke though I haven't heard a follow-up on his condition.

A Day of Saving Lives-Call #1

Thursday, day shift, the last day in the last tour before a full eight days off. It is the day when everyone is the most tired and generally, the busiest. It all began at around 0830 when Sara and I got dispatched to a 'chest pain' at a local nursing facility. We arrived, get upstairs, and find 3 nurses and 2 doctors on the floor with our patient, who is also on the floor, supine, half in and half out of the bathroom. She is what EMS professionals call CTD- circlin' the drain. She is ashen, altered and still. There is no talking, moaning, writhing in agony. That's how you can always tell the really sick ones, they barely move, they don't scream, they are still, quiet, eerily quiet, as if they know it's coming and are preparing the position. The people that we find in this transitional point of pre-death death generally need us to get our asses in gear.

We get from the staff that the patient was last seen around 0830 and was fine. It is now 1000. On the monitor, SVT at a rate of 190. SVT is a rapid heart rate that occurs in the atria, the top 2 chambers of the heart. It can lead to other, more dangerous rhythms that require more invasive intervention. It can be the result of an overdose or a preexisting heart condition. In this patients case, it was the latter. The detrimental factor about SVT is that because the heart is beating so fast, it is not allowing the chambers of the heart to fill with blood, thus in the conclusion of a contraction, not pumping out enough oxygenated blood to her peripheral tissues. This causes her ashen color and listlessness. Physiology can be fun!

We check a blood sugar to rule out hypoglycemia, or a diabetic event. It is normal. We check a temperature to rule out sepsis, it, too, is normal. Everything points to SVT and a heart condition. The doctors in the room are crowding around the patient, holding her head and cooing to her like pigeons waiting to be fed. They are convinced the patient needs fluids, which is true, but getting her out of the SVT will bring her blood pressure up from 60 palp. She NEEDS Adenosine. Adenosine is the heart stopping drug that attempts to reset the pacing mechanism. It is very cool. Except, in order to give the drug, one must have IV access, which we were unable to get. We stuck her 7 times. We tried both arms, both feet and her external jugular vein. She was so hypotensive that all of her veins had collapsed. She's still taching along at 190, still altered and doctors still screaming for fluids and not getting out of the way. I literally had to put my hand on one of them and say: "MOVE!! My partner has to get in there to start an IV and you're in the way!" Maybe if I started speaking Greek, or Aramaic, or perhaps Latin. We had been trying to utilize the staff the entire call: "Can you run a 12 lead?" "No." "Can you start an IV?" "No." "Can you put the 12 lead on the patient?" "No." " Can you set up an IV line?" "No." "Can you get the fuck out of my way?" "No." It was ridiculous. These people have RN and MD after their names and they can't do anything but tell us to give fluids and hurry up. They're worthless. After numerous IV attempts, including a couple by the Fire Department, we decide to move her to the stretcher while we draw up IV Valium for sedation. We have decided to cardiovert her.

Cardioversion is like shocking, only it's designed for shock on a specific part of the heart rhythm to reset. It's electrical Adenosine. It's more invasive and it hurts like hell. It's only designed for people who can't wait for Adenosine. Who are too sick to wait for drugs. We are running out f time with this lady, she needs cardioversion and to survive, she needs it now. 5mg of Valium IM in her shoulder, followed by cardioversion at 75J. After the second shock, the patient looks over and says:"Please, don't do that again." It is pitiful and weak, but she talked and it made sense. GOOD sign. She also converted after the second shock to a Sinus Tachycardia at 120. MUCH better.

We take her in code-3 with a fire-fighter assist, who by the way, got an IV en route. It was a 22 gauge, in her foot, but it was an IV. THANKYOU Ruger. At Duke, we gave a couple of the docs report, who gave us a thumbs-up and a thankyou. "You did a great job." Dr. Hocker says to Sara and I. We did, didn't we?

I owe it all to Tits

My partner and I get dispatched to a local retirement home for another of those nondescript "fall" calls. We mosey on over there and arrive to find a LOL (little old lady) seated on the bus, awake, alert and actually quite pleasant. She is a black woman in her early eighties,wearing a t-length floral dress, leather shoes and stockings. Nothing on this woman is out of place.

"What's troubling you today ma'am?" I ask, truly wondering what IS, in fact troubling her. (she looks fine to me)

"Well," she intones in that wavering voice only litlle old ladies have, "I went to church today and felt a little unsteady and now that I'm back, every time I try to get up, it feels like something is pushing me back down."

So as my partner stands on the steps of the bus, this lady and I discuss her present weakness and whether or not she has any other problems, did she eat today, take all of her pills, invoke the spirit? What is causing her not to be able to get back up? We run through every course, check her blood sugar, and put her on the monitor. I'm stumped.

She continues to tell me through this entire assessment that she keeps trying to get up and something keeps pushing her back down. My partner at this point, cracks a mischievious smile and nudges me in the arm. I'm thinking to myself: "What's she laughing at?" At which point, my partner, Sara, or Tits as we lovingly call her, takes over my assessment.

"Ma'am, do you wear your seatbelt every day?"
"Why, yes, dear, every time we go for a ride."
"Well, is it possible today, that you forgot to take it off before you tried to get up?"

And the old lady looks down and, lo and behold, there lie, tucked neatly under her belly, an intact seatbelt.

The old lady postured with an "Oh my!" and then took it off, stood up and walked up to her 2nd story apartment.

I think our partners are meant to keep us safe but also to point out when a seatbelt is stuck in a persons layers, so to speak.