File under: Something New Every Day The group home patient with a history of mental retardation was found unresponsive in his wheel chair. The small frail man has significant kifofis. His body is flaccid and he cannot even hold his head up. The quick story is he was found that way this morning. Normally he…
Author: medicscribe
Slither
We are called to a nursing home for a lift assist. I have never done a straight lift assist in a nursing home before, so I am a little puzzled. Isn’t this something that nursing homes are supposed to do themselves? The short, squat nurse demands to know why we have brought in our stretcher,…
Good Folk
One of my EMS heroes is Thom Dick, the author of People Care, and a regular contributor to both JEMS and Emergency Medical Services. He has an interesting column in the April Jems called “Spring-Man: What are your jittery patients going to do next?” The gist of the article is to be quiet, to listen, and be nonadversarial. Don’t try to…
CPAP
This morning we had a call for a 70 year old man with dsypnea and found him guppy-breathing with a BP of 210/100, HR – 144, skin ice cool and clammy, unable to get a SAT, ETCO2 of 50, RR of 32. Wheezes and crackles in lungs. Upright CO2 wave form. He was sitting on…
A Tip
Instead of writing about one of my calls – I haven’t had much to write about lately — I’m going to write about a call a medic I know did a few weeks ago. In addition to being a good story, it is instructive. The call comes in as a syncope. A basic crew responds…
Miscellaneous
I like it when my preceptee beats me to work. It shows good work ethic. And I’m almost always 15 minutes early. *** There is a pro and con article in one of this month’s emergency medical services magazines about cell phone use on the job. I hate it when my partner’s phone goes off…
Conversations
One of the best parts of this job is the conversations you can have with your patients, but not yesterday. Every patient I had yesterday had dementia or was incapable of coherent verbal speech. An old lady from a nursing home trips on a curb at the supermarket. Her friend says she is more disoriented…
Richter Scale
Precepting has been going well. My preceptee has a knack for us getting calls – no cardiac arrests yet, but a steady diet of low grade ALS calls – chest pains, COPD, hypoglycemia, broken hips, pneumonias, syncopes. For the most part, I just sit back and watch her. I might draw up a saline lock…
Pain Control
My new preceptee is doing great. On most calls I am a complete invisible man, just sitting back and watching her work. If I offer anything, it is usually just a small trick of the trade. Since she is only part-time, we only work together a couple times a week so I am still doing…
Bleach
The house is dim and smells like a dead person. Dusty, unmopped wooden floors, filthy curtains, overflowing garbage in the kitchen. The patient is down the hall in a bedroom. Old man living with his two sons, or rather two sons living with their old man because what the old man is doing really isn’t…
Random Comments
Random Comments at the ER this Week “I’m the only nurse for 30 patients so its going to be awhile.” “No! No! I just got four new patients. I cannot take another. I’m calling her back. She’s going to have to put him some place else. We’re full here! No! No! No!” “We don’t do…
Ghost Blood
A medic who used to work for us a decade ago died the other day. He hadn’t yet turned fifty. He worked as a medic for many years, but then got hurt and had to find other work. He’d had some hardships and hadn’t been particularly healthy of late. We weren’t close, but when I…
Wine Coolers
The call was for a drunk. We were updated that he was seizing, but he wasn’t when we got there. His wife said he’d been drinking vodka for a week and she wanted him to go to detox. I put in an IV lock, checked his ETCO2 which was 35 and his sugar which was…
Obsession?
“Are you going to give me back my husband’s medicine list?” the woman asks. “No,” the medic says, deadpan. “I have a collection of them at home. Boxes actually. Overflowing. I particuarly like these — the little booklets with flowers on the cover. They are the Van Goughs of my collection. I’m seeing a psychiatrist…
Load and Go/Stay and Play/Load and Go Stay and Play
Stay and Play or Load and Go? I had many interesting comments on this issue following a brief discussion of a call in my post on scene management called An Unappreciated Skill. While my style is always evolving, these are my current thoughts on the continual question. *** First off, my goal is to arrive at…
EMT to Medic School
My post on Tuesday generated quite a number of comments centering around the issue of EMTs going right from EMT class to medic school. Here are my thoughts on it: When I started you had to have at least a year of field experience before they would even consider you for admission to medic school….
An Underappreciated Skill
What makes a great EMT or a great paramedic? I’ll start of with some common and easy answers –compassion, impressive medical knowledge, outstanding airway and IV skills, cool head under crisis. I could go on. While this would clearly make a great subject for another post, what I want to talk about today is a…
You Aren’t Talking to Me
There is a scene in Apocalypse Nowwhere the Martin Sheen character shows up at an outpost base that is under fire by enemy forces and has been every night for months. He walks through the chaos looking for someone to report to. He asks a soldier who’s in charge and the flustered man says, “I thought…
Class in America
We went to a doctor’s office for an unknown. The secretary led us to an exam room where a man in his sixties sat in a wheelchair, his chin on his chest,eyes closed, looking very tired. He had a huge distended abdomen and a hint of a yellow tinge to his skin. His wife was…
Letter to a New Preceptee
You are probably excited and apprehensive about starting your preceptorship. I know I was many years ago when it was my turn. I wondered whether I would make it – whether I was cut out for this job, whether I had spent so much time and effort studying only to fail, to have to hang…