Over the past year we had pretty prolonged and at times nasty debate over whether to change unions, which we ended up doing. While I wasn’t happy with the previous union’s representation( they in fact screwed me on the one issue I needed them to grieve for me), having sat in on the last contract…
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Florida
My brother and I went to Florida for this past weekend to see our father. I left on Friday and came back on Monday. My father had a back operation in December, and while he didn’t want us to come see him then, he finally agreed, now that he is up and walking around, to…
Empty Shoe
“How much morphine?!” the nurse asks. I see across the room in the faces of the ten staff gathered around looks ranging from shock to disbelief to not certain they heard right. “Seventeen,” my preceptee says. Again some looks, understandably. 17 milligrams of morphine is a lot, but after all we are in the trauma…
An EMS Mark Twain
Stephen “Kelley” Grayson’s book “Life, Death and Everything in Between” has been rewritten and published in hardcover by Kaplan Books as “En Route: A Paramedic’s Stories of Life, Death, and Everything in Between.” The book covers Grayson’s long career from day one EMT rookie to established paramedic. It is told in short chapters that are…
12-Lead ECG in ROSC
The other day I heard a story of an ED doctor geting angry at the paramedics who had brought in a cardiac arrest who the medics had had gotten pulses back on in the field. The doctor was angry because after he had done a 12-lead on the patient in the ED, he’d discovered the…
Dust
Cardiac arrest. Old frail man in his 80’s in a hospital bed. Wife was talking to him, and then after awhile noticed he had stopped talking back, not that he ever said much in the first place. We put him down on the floor. He was warm and limber, but asystole in three leads. I…
"Funky Troubling Looking" — Right Bundle Branch Block and MI
As I mentioned in a recent post, we have a process for instituting a STEMI alert to, in consultation with an ED doctor, activate the cath lab prehospitally based on clinical assessment and a 12-Lead ECG. The coordinator at the hospital that I transport most of my patients to told me so far EMS is…
Nursing Home Codes
I did another nursing home code this weekend. We have five nursing homes in our town. Two are very nice and are the final stop in larger retirement communities where residents start off in the own cottages or apartments, move to their own rooms and then go to skilled care before they pass on. The…
My Hall of Fame
Every now and then I marvel at how far EMS has come, I did three calls on Sunday that had they happened fifteen years ago would have gone quite differently. The first was a CHFer. Obese woman, filled up with rales, felt like she was suffocating with the nonrebreather on her. I strapped on the…
Hip Fractures (2) and Dr. Welby
So I have been talking to many people about this hip fracture issue and it is quite a dilemma. I want to change the dispatch protocols to send ALS to fall with hip pain. They don’t have to go lights and sirens. They can go “cold,” but they should at least be on the way….
Hip Fractures
A hip fracture is not a prehospital emergency. Let me repeat that. A hip fracture is not a prehospital emergency. I couldn’t believe it. But there is was written in bold. Not just a stray sentence by listed as “an axiom.” A hip fracture is not a prehospital emergency. For those who know this or…
The Company of Others
We’ve been here before to pick the woman up. 99 years old, lives in a second floor apartment, uses a walker to get around. Once she hits the deck, she lacks the strength to get up. Tiny little white lady with severe kifosis ( a hunched back). The last time we were here the fire…
Cardiac Arrest Thoughts
I’ve been doing this a long time — 15 years as a medic — and it amazes me how often I find new ways to do things or think about things. I did another cardiac arrest yesterday. Fairly routine. Yet another nursing home hospital bed one legged diabetic dialysis patient pulseless, apneic, CPR in progress,…
A Dark and Stormy Night
Well, for the last month now we have been using electronic run forms. For the most part, I like them. I like most being able to type out an extended narrative, instead of trying to scribble it all into a confined space. (I know you could always attach a supplemental page, but I rarely did.)…
Out of Time
Difficulty breathing at the nursing home. The officer who arrives on scene tells us to keep coming lights and sirens. The room in the nursing home is sparse. The patient, a large man in a hospital johnny, is pale and diaphoretic with a low grade fever and edema in his abdomen and extremities. His eyes…
Sha La Lala Lala, Live For Today
Elderly man. Alzheimers. DNR. No history of seizures. Had a witnessed seizure at the nursing home. Started with his eyes twitching, progressed to a full gran mal. Now the patient who is normally verbal, isn’t saying anything, and has snoring respirations. His pressure is 200/110. I stick an oral airway in after a slight gag,…
Run Forms
A fundamental tenet of the street medic is that you do not criticize another medic if you were not there on the call yourself. Countless times I have had people come to me and tell me what so and so medic did on a call and can I believe how stupid they were. But most…
Straps
I may have mentioned recently that I started a new part-time job. I’m an EMS coordinator at a local hospital. I’m still keeping my full-time medic job, only I won’t be working so much overtime. I haven’t written yet about the new job — I need to think more about the proper way to write…
Standing Orders and Consistency
A young doctor I know, who used to be a street paramedic, says the reason paramedics have standing orders is because no two doctors can agree on anything so they let the medics decide based on written guidelines. Otherwise there would be chaos. Where I work I transport patients to any of eight hospitals, but…
Solo Again
Yesterday my preceptee didn’t come to work. He told me he might not come in. That was okay because he is pretty much done. We’re just waiting for the hospital coordinator (who officially cuts him loose) to come back from vacation and sign the paperwork. The truth is it was great being the medic again….