I had not worked a city shift in nearly three years since I took my second job as an EMS coordinator. I forgot how much I loved it. I feel like I am back to my roots.
Perhaps if I had done what as a new EMT so many years ago I had done, the patient would have been more comfortable. Now, I am not saying take away my morphine and Fentanyl and just give me a pile of splints and cravats, but I am saying I recognize a clear area for improvement.
It is interesting seeing the streets you spent so many years working on the subject of film. Hartford is a small city, but like its sister cities New Haven and Bridgeport, it has always had one of the highest murder and poverty rates in the nation.
If I feel like death, like I will never be well again, but I am well hydrated and my pulse is only 72, and my sat is 99%, and my fever barely a 100, what must it feel like to be really sick?
Down the corridor Jason straddles the gurney, thumbs on her sternum.
If we can use digital cameras to capture pictures of crashed cars to show the trauma team, can we use video cameras to record our patients’ “seizures” for later rebroadcast — not on You Tube, but for the patient’s ED doctor and consulting neurologist?
We have reached the Essential Eight — eights drugs that I am not going on the road without.
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.”
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.
I did an interview with Greg Friese of Everyday EMS Tips as part of his EMS Author Chat series.
I recently taught the bougie station at an airway class for ED physicians. While there I got to sit in on an excellent airway lecture and play with some of the other airway devices in the hospital’s difficult airway cart. There was a vendor there from King Systems helping demonstrate a new product of theirs…
I came back from a week off the other day and was greeted with a cardiac arrest on my first call and then another arrest the next day. Both codes were asystole, although we managed to get pulses back briefly on the second one. I had my preceptee with me on both calls. He got…