Not a Bad Thing The state was here inspecting our ambulances. Everything was in order except all the pedi ET tubes in the airway kit were expired as were all the replacement pedi-tubes in the supply room. 2.5, 3.0, 3.5, 4.0, 4.5, 5.0, 5.5 – all expired. I didn’t even know tubes had expiration dates, but they do. We had to throw out nearly fifty tubes. Better they ended up in the trash than down some poor children’s throats. We had to have someone from the commercial service drive us up two new sets of pedi-tubes.
Finally I had a bad GI bug last week – the worst I had ever had. Not bad enough to keep me home, but bad enough for me to be chugging pedi-lite to stave off dehydration. I called my doctor after the fifth day and his nurse said, try some immodium. So I did. Never had it before. It will save you on the toilet paper bills. Today after five days of the other extreme, we got a call for vomiting and diarrhea. There’s a lot of the GI flu going around, I told the woman who thought maybe she had eaten some bad ribs. I tell you, this woman had had a lot of ribs in her time and most of them must have been pretty tasty. She was one of those large women, whose weight you can mistake for being 325 looking at her, but then when it comes to lifting, you realize she is more like 450 plus. I went to lift up and she wasn’t going up. She was about to start going down when I gave a good grunt and almost threw her toward my also struggling partner, as if I was dropping from a dead lift to a power snatch. She must have shaken something up because as soon as we left her in the room, I finally got the call to nature, and I’m happy to report, things are back to normal.
My Bad Yesterday trudging through the snow drift now caked with road dirt, we pushed our stretcher to an apartment door, where we were told the patient would be walking out. I walked in, first brushing my boots on the mat, to see what was going on, if the patient could indeed walk out. It would have been a bit of a tight fit getting the stretcher in so I was pleased to see a man in his sixties, standing up, putting a jacket on. “I just need to use the bathroom,” he said. I grabbed the monitor and house bag and brought them back outside and trudged back through the snow to put them in the ambulance. Then I walked back and had to step somewhat awkwardly around the stretcher. As I went through the door, I felt something was wrong, something off in just the slightlest way, but I could quite decided what it was. The man was sitting down now and was saying he didn’t feel he needed to go by ambulance – his wife could take him, and he started to explain how he just had a brief episode where he had seemed confused in his thoughts, but was normal now. That’s when I looked down at the white carpet, at my boots and saw the dirty ice snow melting around my boots, I looked back toward the door – giant black footsteps leading to me. I looked at my partner and the two first responders. No footprints leading to them. “Oh, no,” the man’s wife said, seeing what I was seeing for the first time. “My carpet, I just had it cleaned.” “Sorry,” I said. I really did feel bad about it. I knew she was mad at me, but she also at least probably thought it would be rude to yell at someone wearing a uniform that said Volunteer ambulance – I’m sure she probably didn’t even consider I might be making a living at this – and who was here to help her and her husband in their time of need. I apologized again at the hospital. She still had that pained look on her face. What a day. Her husband sick. And that one little thing to push her over the edge – those unsightly footprints on her freshly cleaned carpet that would be there greeting her when she returned home. I’m going to try to not let that happen again. We all wipe our feet so much that it becomes second nature. But then I went and suffered my own moment of confusion. They Cat-Scanned her husband. If they Cat-scanned me they probably would have found a burned out bulb behind the “Please wipe your feet” flashing sign.
Pain Relief Last week I had a call for a patient who fell and hurt her hip. Typical shortened and rotated. 8 on the 1-10 scale. But then she said she was allergic to codeine and sulfa drugs. I thought about calling the doctor to see if it was okay if I could give her morphine. I seemed to remember having a patient who was allergic to codeine, but who said she had had morphine before and could take it — and I then gave it to her with no problem — but also in the back of my mind was a strong voice saying you couldn’t give morphine to someone with a codeine allergy. Conflicting signals. Unfortunately she had some dementia so I couldn’t get out of her what happened when she took codeine. So we rode in and every bump hurt her. About half way there, I thought about calling medical control again, but I didn’t. At the hospital, the nurse gave me a hard time saying she hadn’t heard you couldn’t give morphine to someone allergic to codeine. I don’t think so, she said, shaking her head. I talked to a doctor later who told me next time just call and ask medical control. They might say yes, they might say no. I looked in my protocol book later and saw a codeine allergy is listed as a contraindication to morphine. I will call next time because she was in a lot of pain and was suffering, and I felt like her torturer. I need to learn more about this. Today I had an 80 year old lady who fell and same deal, leg shortened and rotated, pain 10 of 10. I gave her 4 mg IM, and then 2 IV. Didn’t seem to touch her much. She was still laying on the rug. I like to medicate before I move a patient. I weighed just getting her on the stretcher and having her suck it up for a minute, but then I decided to call for orders for more morphine. I asked for 5, the doctor told me 3. That helped some, but she was still in pain. I think she was a bit of a drama queen. Still she was 80 and there was pain, even if it wasn’t still the 9 out of 10 she was saying. At the hospital the doctor asked if I was okay with just getting the 3. I said that was fine. I said there was a line between medicating enough to comfort them during the move and bumpy ride and overmedicating them for the ED. He said next time, I should ask for it in increments, 2mg every 5-10 minutes titrated to pain. That way you won’t overmedicate. It’s easier to add than subtract, he said. Good point. When I stopped to see the patient on the way out, she clasped my hand to her chest, called me by my first name, and thanked me. I had a hard time getting my hand loose.