Now Aspirin use has become so prominent that many of my patients have already taken Aspirin before I get there — either they took it themselves, were given it by a friend or coworker or a medical professional on the scene gave it to them. When I do bring them to the hospital, the first question I am asked is “Did they get Aspirin?”
The best bradycardia calls are for the patient passed out in the bathroom. You find them on the floor, cold and clammy, no pressure, pulse in the 20’s. We used to give a full amp of Atropine, now we give 0.5, and if that doesn’t work another 0.5 mg, etc. A couple times I have given the full 1 mg by mistake. Old dogs. Still the drug works well, the pulse picks up, the patient wakes up, the skin colors up and drys out and all is well in paramedic land. “You fixed them,” the doctor says to me in the ED. Music to my ears.
We don’t carry med pumps so the drip is pretty much of an eyeball, and then titrate to blood pressure. When the pressure bottoms, you bump it up. You get a pressure above 90, you ease it down.
My secret EMS pride has always been my IV skills. I like to think of myself as a Zen master of IVs. And so I know I am hexing myself when I write this — I know somewhere out there right now a diabetic with no veins is slipping into unconciousness, and I will be summoned to perform, and then empty catheter wrappers all around me, I will despair to the heavens that I have lost my IV karma and at last reach into my kit for the Glucagon.
Now as we move up the list toward what I call The Essential Eight, the choices are going to become harder.
“So, the Metoprolol finally worked,” I said to the nurse.
“No,” she said, “We gave him Cardizem.”
When Fentanyl arrives in my kit, it will likely be ranked quite high on my list and push Toradol down even further, possibly to the point where we will have no need to carry it.
I must confess that in my 21 years riding ambulances, 18 as a paramedic, I have never given Activated Charcoal to a patient.
“In summary, the use of vasopressin alone or in combination with epinephrine as the first line vasopressors during resuscitation from cardiac arrest offers no benefit related to short- and long-term survival compared to the use of epinephrine alone.”
The asphalt is white with salt. What grass pokes out from the crusted snow is a dull yellow. The houses in this lower middle class neighborhood are all grey. Walking up to house, I am struck by the only color I have seen for days. On a concrete slab of a driveway there is a…
“You sound worse than I do,” my patient said to me this morning. “How about we draw straws to see who gets seen at the ED first,” I said. My cough is actually improved from a week ago. My preceptee was treating a lady with chest pain who had a deep rattling cough. I was…
Let me say right from the outset that I love being a paramedic and dread that day that I can no longer do this work. That said I have had two moments in my career where I have glimpsed that day. These moments are not moments that you would expect. It was not a bloody,…
It’s a great feeling to wake slowly and wonder where I am and slowly open my eyes and realize my surroundings. “Hey, I’m already at work. How great is this!”
A hundred yards ahead, we can see the officer standing by the snow-covered car, but then he turns and waves his arms to get our attention. “Stay there!” he shouts.
Somewhere Around Here I have to confess in my twenty-one years in EMS, I have only gotten the bed pan out less than a dozen times. I also admit there were occasions when the bed pan was not always in the first place in the ambulance I looked (this was at a time when I…
I did an interview with Greg Friese of Everyday EMS Tips as part of his EMS Author Chat series.
Police cordon off the abandoned vehicle with yellow tape. It is an 86 Plymouth – an old man’s car. “Am I going to need all my gear, or just the monitor?” I ask the officer. “The monitor.” I look across the grass toward the tree line at the eastern end of the cemetery. I don’t…
In emergency medicine, field and hospital come together when the EMT/paramedic hands over patient care to the nurse. This transfer is almost always professional and courteous. The good feelings demonstrated on the job between paramedic and nurse are not limited to working hours. After we punch out for the shift, we often meet in restaurants,…
I finished my half marathon on Saturday, limping across the finish line in 2:34:14. Part of the run went through streets and neighborhoods in Hartford where I have responded over the years to motor vehicles, drunks, cardiacs, asthmas, shootings, diabetics and general illness. When I started as a paramedic in Hartford, I did most of…
Flu season is rapidly upon us. I woke up this morning with a slight case of the sniffles that as the day has gone on has proved to be (hopefully) somewhat of a false alarm. I am hoping to get through the week unaffected as next Saturday I hope to run* in my first half-marathon….