The call is for a possible stroke — a fifty-year old cancer patient can’t move her right side. I’m thinking it’s not a stroke. Maybe weakness, maybe a tumor. But it could be a stroke. We’ll see when we get there. The woman is lying in bed. Her eyes look up at me as I…
Nephews
For years I have been on the regional medical advisory council. One of our responsibilities is to come out with the regional paramedic guidelines. It is always very exciting for me to get to use a new guideline for the first time. I think we worked on this for so long, went though many drafts…
Hyperexcitability and Abnormal Movement
The 84 year old woman, who lives at home, says she is light-headed, feels shaky and is seeing white spots, but she really doesn’t want to go to the hospital. “Well, if you are light-headed, feeling shaky and seeing white spots, you need to go to the hospital,” I say. “Okay,” she says. That was…
Evaluations
Some towns’ police departments call us to check out prisoners’ medical complaints, typically those suffering from jailitis. The cops get annoyed when we bring the stretcher in. He’s not going to the hospital, we just want you to check him out, they say. If you want to make the cops happy, you finesse a refusal…
Better Safe than Sorry
It was twenty minutes before my crew change when the tones went off. A fall at a local restaurant. I shook my head. I had dinner out plans for the evening that were going to get shot to hell now. Outside the restaurant we found a polite well dressed man in his sixties sitting on…
Reversals
The call is at a nursing home for groin pain. We find a seventy year old man holding his groin and writhing on the bed. He has dementia so it is hard to have any kind of conversation. The daughter looks familiar and she says I brought her father in to the hospital last week….
Home
We were there last night. The call came in five minutes before my crew change. Husband said wife was too weak to get up and he was too weak to pick her up. Sounded like a lift assist. Pick her up, put her in bed, get a signed refusal. I could still get home at…
Shock
The call is for difficulty breathing at a nursing home. A nurse meets us at the curb – a bad sign. “You have to get him out of here quick!” she says. “We can’t get his SATs above 60.” Another nurse meets us at the door. “This way,” she says and starts walking speedily ahead…
A Day in the City
I took a city shift yesterday. I try to work at least two city shifts a week, but the last couple weeks I’ve been busy with my triathlon training, plus it’s been harder to pick up overtime shifts lately. I get my 40 hours in the suburbs, but city overtime time is scarce. It’s a…
Pain
We’re on our way back from the hospital when we get sent non-priority to a motor vehicle accident for shoulder pain. The accident happened awhile ago, but one of the patients has decided they want to go to the hospital now so we are being sent. The police direct us to our patient — a…
Blue Sky
A long procession of cars, many with their windows whitewashed “RIP Hector” line both sides of the narrow road deep in the cemetery. I kneel on the lush grass. Family and friends dressed in black suits and dresses press against me as I try to calm the young woman who thrashes about and cries out…
MedicCast – Running Cardiac Arrests
Tuesday night (Tuesday, July 10, 2007) at 10:00 P.M. EST Jamie Davis will be hosting MedicCast Live an internet call-in show “Running the Code: CPR oversight and team leadership” discussing managing cardiac arrests and other difficult calls. MedicCast MedicCast Live Visit Talkshoe.com to register for free and get a pin number to login. Talkshoe.com The…
New Medic
Congratulations to Baby Medic on completing his precepting. He is out there now on his own doing some good. I look forward to his fresh, insight posts.
Listening
Listening. It seems like such a simple thing, but we’re all so busy. I had a patient the other day — an old man who has been losing weight and growing weak. He had his esophagus removed 10 years ago and has had problems ever since — diarrhea, loss of appetite. Now almost ninety, he…
“Street Cred” for EMS Physicians
I read an interesting article on Jems.com this week called “Street Cred” for EMS Physicians written by Sabina Braithwaite, an emergency physician (and paramedic) from Charlottesville, Virginia. She asks an interesting question about whether the relationship between paramedics and their medical directors is affected by the medical director’s experience or lack of experience with the prehospital environment. She asks: What…
Compelling Reasons
At our regional medical advisory committee’s meeting last week I listed a number of issues I wanted us to address when we reconvened in the fall, including changing our state’s DNR regulations to enable paramedics to accept a family’s verbal wishes not to initiate resuscitation in a patient with a terminal condition in cardiac arrest….
Triathlon
Last October I got the crazy idea* in my head that I could be a triathlete, meaning I could enter and finish one of those swim, bike and run distance races. I read an article in Men’s Health called: Anyone Can Be a Triathlete. And I met a nurse on one of my Dominican trips…
No IV
Yesterday was my last day riding with my preceptee. She rides with the chief paramedic on Friday to get cut loose. She will do great. She was a pleasure to precept. We were still checking out our equipment when we were sent for a difficulty breathing. It was an area of one of the towns…
How Doctors Think
Giving a verbal report at the hospital is an art form. You want to be able to tell a story clearly and with brevity and nuance so you can accurately convey the issues the patient presents. You want to encapsulate the entirety of your physical exam, history, treatment and thirty minutes spent with the patient…
Nut Allergy – Sneezing
There are certain calls you get that usually turn out to be nothing — baby choking, person slumped over wheel of car, fall with severe bleeding. In fact, just about every call you get, usually turns out to be nothing much. That’s good. Over time it is a great calmer. I usually say to myself,…