The Stolen A/C Unit

this story happened way back when i was a student. i was doing a ride along and i was with FE and, i think, SM. we got a chest pain call at like 0400 in a horrible trailer park. we pulled up and in the darkness could see a tiny african-american woman sitting on her steps. we talked to her for a couple second and placed her on the stretcher. as we were strapping her down a man appeared out of the darkness on a bike. he had a small window a/c unit under his arm. the unit was, more than likely, recently in a window that was not his. he got off the bike and started aggressively asking us where we were taking his woman. she told him she was having chest pain and we said we were going to take her to the hospital. the guy said that he was going with her. when we told him he wasn't going with her he started to mumble to himself and got louder and louder. he was obviously a very unstable person just from his movements and the way he looked at us and the things he was mumbling. as we started to pull her towards the ambulance the bike guy pulled out a very large fillet knife and began to yell at us. we loaded the pt into the ambulance as the bike/knife guy wandered around the ambulance talking crazy talk. the three of us could have easily beat the shit out of him, he was very scrawny and malnourished, which is why he never came at us. we called for police the second he pulled the knife and they arrived shortly and took him into custody. all i had that night was a metal clip board to protect me. that was the last night i ever worked with out a weapon of some kind on me and in my bag on the truck. this city is rough and i'm not gonna let some crackhead take me out.

Adventures in Vehicle Maintenance (Part II)

about a year ago i was working with JS (the male JS) and we were driving emergency traffic and he took a corner fast. not that i was worried, i had full trust in his driving. the weird thing, that hit my mind, was the fact that he was washing the windshield at that time. i was confused at this timing, what with the high speed mixed with the wiper fluid and wiper blades. it ended up that JS was not a psychopathic nut job, it was actually radiator fluid that was flying up onto the windshield and he was trying to keep the old beast on the road. we have a lot of overheating ambulance fails in the summer down here. also, the turbo on the Fords like to pop on these hot days.

4,202...

that's how many calls we had in the month of May. we average 8 ambulances on the road at any one time (around 12 during the day and 6 at night) and only one hospital. we take people to BJ and the army hospital but that is probably only less than 10% of our calls. gonna be a warm summer and it's gonna only get worse. any medics out there need a job?

Adventures in Vehicle Maintenance

on 5/26 we were going emergency traffic to a call when our right front tire broke off and bent into the engine causing us to slide across into the on-coming lane. luckily it was late at night and there was nobody driving against us. we have a beat down fleet and are in dire need of new trucks. the Fords we have have over 200,000 miles and the suspension in all of them is a joke. it is getting embarrassing to explain to the pt's why the ride is so bumpy. you just can't run trucks like we do, hard and with no rest in a 24 hour period. something needs to change. also, my partner that night, JS, had just eaten a cupcake and that was 60% of the blame for the broken axle. junk. in. the. trunk.

I call her Blackcloud...

worked a little overtime on Friday (5/14) and got to work with Angel (AA). every time i get to work with her we run the crap out of some calls. and this day was no different. we had 10 calls in 12 hours with one cardiac arrest, a code medical and a dislocated hip. the cardiac arrest came out as a 33D, cardiac/respiratory arrest at a facility with health care providers on scene. we pulled up to a well known local doctor's office and went in to find this tiny African man (Dr. O) doing chest compressions on a tiny older lady on the floor. there was about 2 gallons of coffee ground emesis on the floor and coming out of her. there was a poorly educated "home health provider" that had brought the pt in and she told the doc that the pt was vomiting blood last night. i asked the person for the pt's history and she stated she did not know. i asked her how old the pt was and, again, she did not know. i then asked her to leave the room and she did without hesitation. AA and i worked her well, very difficult airway (very anterior) and after numerous suctioning our QRV lead medic arrived and was able to intubate her. a firefighter and i lifted her arms straight up which lifts the shoulders and hyperextendeds the neck (this was done after ruling out a fall) and has worked wonders in the past. unfortunately she was in asystole the entire time and was pronounced at the hospital. we then got a call for a 30B2, traumatic injury, where a lady had recent hip replacement and was getting out of her car and twisted wrong and it popped out as she sat into her wheelchair. we arrived to find her in her wheelchair in the heat. she did not fall so we ALSed her there, gave her fentanyl, used a KED inverted to stabilized the hip and took her to the hospital. later in the day we went to a 6D2, breathing problems, and found an elderly man with shortness of breath (SOB) and an impending sense of doom (not good, ever). did a 12-Lead in the house showing his pacemaker was firing but not producing a profusing beat. his heart rate was in the low 40s and his b/p was 80/P. placed the pacer pads on his and got him to the stretcher using a stairchair. we were only a mile away from the hospital and i told the guy that if he relaxes and stops responding to me i was going to have to "light him up" (i know, i know...but it worked. i don't like to shock or pace someone who is talking and fully awake. don't get me wrong, if his b/p was a couple ticks lower i wouldn't think twice about pacing and sedation) which worked. called a code medical and had to take him to the blue zone due to the fact that our recess room was completely full. it was like back in the old ED when we would bring a code medical or code trauma just straight past everyone and into any number of regular rooms to be worked. old school style.

...and I drove too fast.

this is part two of the last post. when last you read us CC and i just had our first cardiac arrest together and CC got his intubation. well, the next day was a busy day and by the end of it we came to the conclusion that we were douches. we were supposed to be done at 7 pm. around 1700 we got a 27D, GSW. some crack head/heroin addict was walking down the street and some peeps drove by and shot her in the ass and back of the legs with a shotgun. it was my call and we got her fat ass off the scene and to the hospital in nice time. we were on top of our game that day, after having such a good day the day before. so we check out of the hospital and right at 1825 we get another call. ok, no big deal i guess. yeah, it sucks but what can we do. so we go and pick up this old guy and take him to the hospital on base (he's retired military and gets a choice between the two in our county). we check out of that hospital at 1945 (45 minutes over our scheduled time) and now we get to go back to base with no chance of getting another call. unless, of course, a bad call comes out and we are the closest. BAM! 9E1, cardiac arrest comes out. we are kinda far from it but when we hear the only truck available for it is coming from base we have a choice to make. i look at CC and he goes "ok, let's do this" and i get on the radio and tell the other truck, medic 13, to keep going and we'll MEET them there. fully thinking (wishing) they will get there a couple minutes before us and CC will get another tube and then we can just help out until they take off for the hospital. but what does my dumb ass do? i drive to fucking fast and smoke the other ambulance. now WE are the first on scene and this is now our call. i couldn't believe it when i came around the corner in the neighborhood and saw just a fire truck. and on top of it all the firefighters placed a BIAD/King airway! so we load the guy up because he was outside in his car at the time. the fire dept had him on the ground and it was cold out so, without thinking, we put him in our ambulance. WRONG. he was in asystole at our first contact and according to our protocols we can work him for another 30 or so minutes (with numerous other caveats on top) and call it there on the scene if he doesn't improve (even getting him into a VTach/VFib i consider an "improvement"). but now we have him in the truck and we aren't just going to stop and take him back out after 30 minutes and lay him in the grass in front of the neighbors. so we take off for the hospital (after setting him up) and en route the King airway is sliding around in the guys mouth due to all the puke. CC notices the SPO2 dropping and d/c's the King and intubates the guy. so it all worked out in the end. at least until it was 2245 and we were still at base writing up the report into emscharts. we both were so tired and we could only laugh at how stupid we were.

Chuck got his tube...

i have been training CC since 12/23 and we have seen just about everything in the entire protocol book (CPAP, SVT, Afib w/ RVR, STEMI, etc.) but we couldn't buy him an intubation. we would try and jump cardiac arrests and someone would be closer or we would get there and the dude would be dead for days. we tried switching up stupid things, trying to drum up a cardiac arrest. and finally on 2/17 CC finally got one. we were at base and a 6D, respiratory distress, came out for medic 10 and the dispatcher stated possible cardiac arrest. CC and i were very close so we advised dispatch we were going to it too. we figured that we would pull up a minute after medic 10 and CC could still intubate (and we would just steal the call from them and run it in). the two units met at an intersection and CC was on the phone with medic 10. we were at the exact same intersection near the call and they stopped their lights and siren and gave it to us. we rolled up on scene and the fire dept. was already there (it happened to be one of the guys mother-in-law). she was on the floor with CPR going and we took over. she was in asystole on the monitor and after the next rhythm check she was still in asystole. we had IV access and intubated her and cardiac drugs on board. our QRV was there, as well, and had pulled the family into the kitchen and explained that we were going to work her for another 25 minutes and if she didn't get out of asystole we were going to call it here in the house. the family was ok with that and were very understanding. the pt just was released from the hospital with pneumonia and when we tubed her thick, white phlegm was all in the tube. she was altered and short of breath (SOB) for most of the day and she just collapsed on the floor. 24 and a half minutes into it she gets a strong femoral pulse and we scooped her up and took off to the hosptial. 24 1/2 minutes exactly. asystole to pulse. strange, very strange. she stayed alive for most of the day and CC went into the room to see the family (they had already signed a DNR for her and were sitting by the bedside all day) and CC literally saw her go into PEA and he called for the doc to come in to the room. CC brought her back and was there the second she died, again. strange day. the next day was even stranger....

I must be dreaming...

this was a couple years back. i was working a shift with SA and we were in line to get breakfast at Bojangles and a 10D, chest pain, came out and we both got out of line and set off to it. usually when interrupted from breakfast a crew may make snarky remarks about the pt we are going to (of course, once on scene that all goes away) but this time i remember we didn't say anything we just took off. we got on scene and the first responders were already there with the pt. this was in a bad area of town on one of our worst streets for drugs and violence. we walked into the house and the pt was a black male about 42 years old, he looked younger. he was wild eyed and clutching frequently at his chest. right away we could tell there was something going on and we placed him on the stretcher. as we were pulling the stretcher out of his house, he was only 2-3 minutes from the hospital and we decided to do everything in the truck, he said something about "spiders". his house was dirty and i started to look at my shoulders and arms and get that feeling like stuff was crawling all over me. as we loaded him into the ambulance he said it again "is it the spider?" and i crawled into the truck looking at my clothes for spiders. SA placed him on the monitor and right away, i think without even a 12-Lead she just said "let's go, i'll do everything en route". the pt was very anxious and had that text book "impending sense of doom" going on, looking back in hindsight. i took off for the hospital and i could hear him asking SA "is it the spider" and finally she asked him what he was meaning. he started to say he was watching a hospital-type show the other night and heard about a spider. SA asked him "you mean a widow maker?" and he goes "yeah, that. is it that?" and i just mashed the pedal a little further into the floor. as i pulled up on the ramp of the old ED i could see SA in the rear view mirror start yelling at the guy and she pulled the head of the stretcher down, moving him from sitting to supine. i ran around to the back and pulled open the doors and jumped up and the pt looked to be having a seizure. SA was at the monitor and she had placed the pads on him earlier and the monitor was showing V-tach. but the pt was shaking so violently i told her to hold on and i checked for a pulse quickly and after 5-10 seconds of not finding one she gave him a nice shock at 200J. as i was pulling him out someone came out and i yelled to them to tell the ED our pt coded on the ramp. we ran him in and i was doing CPR and SA was pushing the stretcher and we got him into the old orange zone and the nurses and MD were there and i moved around to lower the head of the stretcher and the doc yelled out shock him again. the monitor was in between the pt's legs and the doc could see the V-tach plain as day once i stopped doing compressions. BAM! we hit him again and began to move him to the bed. within a minute of his first shock on the ramp the pt was shocked a second time and he was on the hospital bed, biting a female ED tech in the hand and screaming "i'm dreaming!!! i'm dreaming!!!". hell yeah he was dreaming. and sure enough he WAS having a widow maker. we later found out he had an extensive cardiac history from abusing cocaine and had had a mild MI in the past. "i'm dreaming!!! i'm dreaming!!!" crazy town.

lesson in common sense #36...

we are going through some changes over the last year and a half in our system. our new boss, appearing at first to be a big talker, has has come through with some very needed changes. but occasionally there are a few knee-jerk reactions to ANY type of "bad press", no matter how poorly sourced and one-sided the editor of the Cheers and Jeers section happens to be. the inability to attack weak local journalism is a shame for such a politically oriented boss.
today i wish to examine a lack of common sense by the Yes-Men he has surrounded himself with. according to our new state protocols we need a blind insertion device (BIAD) for adults AND pediatric pts. a quick explanation of the use of a BIAD:

in case we are unable to perform an intubation via laryngoscope, after 2 attempts we have the choice to throw in a Combitube and go from there. easy to do and has worked perfectly everytime i have used one. it is so easy to use i can show some 18 year old country hick first responder just once, and he can do it right everytime. the majority of times i have seen failed airways is on TALL, heavy black guys who naturally have large tongues (see: Mallampati airway classification)and no necks.

as for a pediatric BIAD, no big deal there. King Airways makes a wonderful product (see above photo) easy enough, just purchase a size #3 and done. keep our tried and true Combitube and add the King #3. but Sadly, No. our system (and now all the city fire stations) go and throw out the Combitube and buy King #3 and #4. the #3 is for persons 4-5 feet tall and the #4 (our NEW adult BIAD) is for persons 5-6 feet tall. notice anything? of, course you did as did every fire fighter i have talked to....what about a person over 6 feet tall?!?! as medics this is sorta a moot point, we now have numerous other choices in case of a failed or difficult airway (Bougie, AirTrack, surgical, etc.) but the first responders now have to bag (using an OPA/NPA, of course) and try and keep a person oxygenated while they wait for us to get to the scene to intubate. a lack of common sense can result in death in a busy system like we run. and it is funny how the people who make a lot of the major decisions in our system are the people farthest from running on an actual truck. not that i think the regular paramedics have the time to sit in all these meetings, but at least try and get their opinion occasionally about product use and need. oh, and to just show how easy it is to place a Combitube in an adult i'll let this crazy German doctor show you....

1/2 a baby...

i have delivered one and a half babies in the field (so far). this is the story of my 1/2 baby. i think i was with JH at the time and we got sent to a 24D, baby on the way. we pull up on scene at like 3 am and walk into a back bedroom and there is a lady with a newborn baby on her belly, umbilical cord still attached. we missed it by seconds. the lady's 18 year old sister delivered it and tied off the cord with shoelace per EMD (EMD are the people you talk to on the phone if you call 911). the baby was great, a little tiny naked little baby. mom was fine and sister did a great job. the baby had its first crap and my partner was helping mom clean up some of that oily messy stuff while i clamped the cord closer to the belly button. i noticed him at first but now i had the time to take it in. the mom's 5 year old son was on the bed with her and by the shock-and-awed look on his face he was there for EVERY THING. he had these wide eyes and was just silent and taking every thing in. i finished clamping off the cord and took out the scalpel and looked up at the boy and said "come around here". he jumped down and ran around to me and i put the scalpel in his little hands with the blade up and told him to hold tight. i slid the cord in a sawing motion across the blade and he got to cut his little sibling's cord. as i got the last of it over the scalpel a burst of blood spurted onto his hand and he looked at it, looked at me and threw down the scalpel and ran into the bathroom and i could here him washing his hands. he came back out and we cleaned up mom and the baby, mom hadn't passed the placenta yet, and we loaded them both onto the stretcher and into the ambulance and off to the hospital we went. the lady had gone to L and D earlier in the night with labor pains but they sent her home at midnight with some percocets...oops. the mom was joking with us in the ambulance and was in a good mood right up until we walked into L and D and she got the greatest pissed-off-black-lady face i ever saw. the nurse saw her and said "did we just see..." she trailed off as she looked down at the baby. that was a funny site.

baby octopus and the surgical site...

im with CC lately, he's "bluedotting" with me, and we get a call, 26A, a lady is having problems with her surgery site. i had just ate way too much food. i went to a Chinese food buffet place that is one of the best in town and got a to-go box. i put a lot of baby octopus in it and some fried sweet plantains. my stomach was full. we walk in to her house and she was easily 400 lbs, sitting on the couch. she had a bowel obstruction on 12/12/09 (she went to the ED that day vomiting feces) and over the last month she has been in the ED 4 times having "electrolyte problems". about 30 minutes prior to calling 911 her surgical site on her belly, which was cleared a couple days prior by the surgeon, burst open at one end and massive amounts of puss flowed out. i noticed her pants were wet in her crotch area and just assumed she pissed herself. CC said "let me look at it" so he began to pull her pants down to look and i could see right away from how tight her pants were, she was presenting with a distended abdomen. her belly was very tight and rigid. as CC pulled her pants down to expose her scar/site there was a towel there. he pulled the towel down and immediately a sound like "blub, blub" occurred and bubbling puss flowed up and over the top of the towel. i'm not kidding, a crap load of puss came out, that was what had wetted her pants in the front. i spun around and stepped right outside. luckily the puss didn't smell but i was way to full to even attempt to stay in that room. i stood out in the carport and called for Engine 12 to come and give us some "lifting assistance". as we were waiting for them i just stood outside and talked through the door asking her name, history, meds, allergies, family doctor, etc. and then i just walked out to the truck and typed in all the stuff until E12 showed up. CC stayed with her in the house and got a set of vitals, he could tell i was fighting to keep my food down. i'm usually very good with smells and sights but i was just too full at that specific time. the only thing that makes me dry heave at work is smelly vagina, the kind that is so rotten the smell is seeping through the persons jeans. i have never puked on scene or in front of a patient....yet. we loaded her onto the stretcher and took her to the ambulance and took her to the hospital. i told the doc what was going on and we both agreed we may have found the source of her "electrolyte problems". CC was all gung-ho about seeing the puss again so when the doc looked at it he helped her but i stood outside the room, behind the glass door and watched. it didn't come out like it did at the house and her belly looked less distended. i would have loved to see what her CT-scan would have looked like had anyone in her previous visits done one. lesson learned for when i become and PA in an ED, if someone comes in with a recent surgery and they have electrolyte problems maybe i should take a peek under the scar.

clarity in policy...

some of the times i have directly affected policy in our system.
.....1)no fire personel, even the ones who work part-time for us, cannot drive an ambulance in when on the clock at the fire dept. this was 'cleared up' in the summer of '07 when DC and i were riding together. we had just came out of paramedic school in Dec. and they had faith in us to ride together (this was so awesome because we didn't have to be embarassed as we 'worked things out' with pt's and could correct each other). we got called to a respiratory distress, 6D, and arrived on scene without first responders, we later learned they were accidently not dispatched. the pt was sitting in a chair, outside in the dark. as we approached him his wife stated he has congestive heart failure and we could hear the fluid in his lungs as we walked up to him. we quickly got him to the ambulance and his SPO2 was above 90% with a NRB at 15 liters so we weren't sweating it and i placed him on the monitor while DC looked for IV access. but once on the monitor things got a bit different, V-tach with a pulse, confirmed with a 12-Lead. by this time first responders were re-dispatched and coming to us. i worked the v-tach/cardiac issue and DC started running down the pulmonary edema protocol, they actually start out very similar. the pt was not able to talk in complete sentences but he was very calm and was actualy joking with us and we all were smiling as the fire dept arrived. both DC and i were dealing with v-tach with a pulse for the first time and when one of the firemen opened the door and said 'what's up' i didn't hesitate when i saw who it was. i said 'drive' and he jumped up in the front and took us in emergency traffic. the fireman was DM and he works part-time for us so i just assumed it was no big deal to have him take us in. it was very helpful for DC and i and the pt got great care (just an aside, the amiodorone didn't convert him and since he had a semi-good b/p and was c/a/o x4 i called med control. they advised to cardiovert him and after some sedation and electrical therapy he, needless to say, did not want to joke around with us anymore). but within a couple days a new, clear, written policy arrived to let us know that firemen who are responding with the city or a county fire dept. cannot drive us in anymore, and if needed we could call a QRV to drive.
.....2)this year i was driving with JM and we got a call to a child, like a month or 2 old who was very feverish. we got there and the child had something like a 102 fever axillary so we took him and mom out to the truck and slowly started some passive cooling and i thought 'how about some motrin'. so i looked it up quickly because of his age and it said nothing in our little policy/protocol book. JM's wife is a pharamacist and they have some kids, i don't have any. he said they have given their kids motrin at this approximate age, so i thought, no problem. but when we got to the peds ed the PA there said 'don't give kids under 6 months motrin'. ok. as per the norm in our pediatric ed she was snotty towards me, but hey, nothing new. listen, they deal with babies ok? ok!?!? so within a couple days an IM appeared to not give kids under 6 months motrin and a new 'fever' protocol form took the place of the old one.
.....3)this is a bit different but one day i came in and was told to go out a take 103. this is a lead medics area and it is a QRV. working alone, jumping only the serious calls, getting there first on scene, intercepting intermediate crews when they need an ALS intercept, etc....it's all gravy on a QRV. so i go out and in the morning the other shift comes in and i get a sour look when they see me out at 103. by the next night crap is hitting the fan because (in a whining little voice) 'he's not QRV qualified' whatever the fuck that means. i guess back in the day, good medics were rewarded by getting to go out on QRVs sometimes but only after becoming 'QRV qualified'. my supervisor has complete trust in me and is laid back anyway, so i got to go. i even got to be 102 for a couple nights and that really had the other shifts heads spinning. the sad thing was a lot of my fellow FTOs on the other shifts were talking shit, but it was just jealousy. so now CH, DC, LC and i go out to the QRVs whenever there is an opening and other FTOs have come to our shift to work QRVs (if we are all blue-dotting new employees) and no one says anything anymore. the lead medics in our system are a strange lot and i don't have the next 10 hours free to write about all that bullshit.

got my hair did....

looking back at '09 and found this: on April 21st was sent to a severe allergic rxn, 2D. walked into the house to find a black girl, a little plump, early 20's sitting on the floor up against the couch with major swelling to her face and neck and hives all over her arms and legs. the firefighter/first responder alerted me to the fact that he just hit her with an epi pen (one of the only 'drugs' a fireman carries so he was amped up that he got to give it). we quickly loaded her on the stretcher and bolted to the ambulance, the pt did not eat anything new today and did not have any new meds. the only thing she did differently was go to a different hair stylist and got a weave about an hour ago. i looked at her head and saw her scalp was bright red, bam...there's the culprit. got her on the monitor and she was the first person i have ever been able to go down the entire length of the anaphylaxis protocol. gave her 50 mg benadryl, solu-medrol, albuterol neb and she was still swelling and her airway was getting restricted. called med control and gave her epi IV...that was the trick, damn did that not work fast. had never given a person with a pulse epi IV before. the entire time i had a fireman with me and all he did was use shears to cut out chunks of her weave. we walked in to the recess room and the staff felt so sorry for her they made us stop and one of the nurses got very tiny scissors and cut the rest out. lets just say up until we got into the ED we weren't too worried if it was half her hair and half weave.

capitalism and the police state

I am a medic on both the city SWAT/ERT and the county SWAT/SRT. Went on a raid late one night with the city to a ‘gambling establishment’. the guys on the team said that they normally would never raid a place like this, but certain situations were forcing them to act. The main one was that some of the local soldiers, that have returned from Iraq and Afghanistan, have been losing big money at this place and some of their wives had followed them to the establishment. Now the wives are demanding the city to stop the gambling. I may not be the biggest supporter of capitalism, some have jokingly called my a ‘commie’, but when you are making a choice to gamble it should be on that person not the person who is providing the service. And let me tell you, this guy had a beautiful ‘service’. I am so glad I did not know about this place because I would have loved to play cards there. We rolled up and after the 2-3 minutes of action I walked into paradise. The dude who was running it was in his late 20’s, tall, skinny white dude and his mother was running the door. The ‘owner’ had his brand new 250Z parked right up next to the door. Of, course the old lady was having an anxiety attack and after checking her I went inside. The location was half of an auto body shop with a garage door and a large main shop/room with an office area in the rear with a storage closet and bathroom. The owner had the place straight decked out. There were 6 professional card tables with a dealer for each, a pool table in the middle for guys who bust out or were waiting to get on a table, 8 flat screens on the walls, a convenience store cooler with beer and soda in it and a place in the back to buy chips and snacks. It was wonderful, a man’s playground. There were about 40 guys and gals in there playing cards at the time of the raid, a lot of them soldiers (I could tell by all the military ids turned in). The cops zip tied them and searched them and they were all given tickets and sent on their way. If they had a small amount of drugs that was taken and they were given another ticket. Now, this took awhile to go through each person and while it was going on this big thick white dude was sweating at one of the tables and told me he was having chest pain. He was a good guy, he wasn’t giving me any crap, he just was refusing all treatment and stated that he was going to be fine, so I just stayed by him. Eventually he let me check his b/p, he had a hx HTN, and as he began to calm down a little his b/p dropped and he stated his chest pain went away. Now, when the cops gave you your ticket and you were going to leave they walked out with you and checked your car before letting you go. It turned out that the big man had coke, weed and pills (a lot of all) in his truck and that was the reason for his worries. Poor dude. This is a service economy and he was just providing a service to the community. Like I said, if your husband is out gambling all the money he got fighting in Iraq (yes, yes, yes…I know, the wife is at home worried and watching the kids, blah, blah, blah) then as a wife you need to stomp them balls. My fiancé would NEVER let me get away with that shit, she would stab me in my sleep. So, to the wives of those soldiers who stopped a wonderful illegal card game…..shame on you (I know, harsh words, but hey medicine tastes bad sometimes).

pooped....

poor Medic 9 got sent on a 26A, sick person, today to the rest area on I-95. the pt info was as follows "6 year old male, constipated, sitting on the toilet inside". how sad a story to tell of your family xmas vacation. billy couldn't poop. :(

GSW

2009 recap: on Feb. 5th RVC and i got sent to a 27D, GSW. the guy was in a very poor part of town that is also crime ridden and violent with a lot of prostitution. he was shot in a drive-by on his porch, but he didn't have a phone so he crawled across the street, maybe taking 10 minutes, to his neighbor who called the police. we arrived on scene and the pt was standing on his good leg on a porch, it was very dark but i could see he was very ashen and moaning. the police and fire dept. were just standing in the dark, below him on the ground, just looking up at him. i yanked the stretcher to the steps and walked up and grabbed the guy, we need to be off this scene in 10 minutes or less, he was a definite 'load and go'. as i grabbed him all the fire fighters groaned and yelled he was bloody, too late, i pulled him down to the stretcher and he covered my shirt in blood. we checked him quickly and noted that he was not shot above the waist but the pt's femur was crunchy and obviously destroyed and a large compartment injury was happening. the thigh can hold a fatal amount of blood in it and he was walking that line. we loaded him in the ambulance and his b/p was crap over crap and he was very cold and ashen. he was ALSed and rushed to the hospital. one of the worst femur injuries i've ever seen. i remember he told me who shot him, i seriously don't remember the nickname he gave me, but i told him you can tell that to the cops at the hospital. i don't need some thug life fag comin' after me for snitchin'. word life.

13 in 12...

looking back at the year (in my day-at-a-glance) i see that DB and i worked on July 19th and had 13 calls in 12 hours with 11 transports to the hospital. the 13th call was a 9E, cardiac arrest, that we worked to the hospital but she did not make it. i remember her family telling us she was a diabetic and that recently she had not been taking her insulin and had stopped eating.

chewing on fentanyl patches....

looking back at this year in my day-at-a-glance. on Jan. 6th i was working some overtime on Medic 12 with JM. called to an overdose, 23D. arrived on scene to a beat up trailer in a crappy trailer park that butts up against a major roadway, this was the trailer right up against the road. as with most trailers there was no way to get the stretcher up in there without some major shucking so we grabbed the bag, suction and monitor and entered the mad house. there was a dude and a chick, both obvious young meth heads. the guy walked us into the bathroom and laying on the floor, soaking wet, fully clothed, pale, cyanotic, and breathing about 4 times a minute was a skinny white chick. her boyfriend stated, after hemming and hawing until we said "we are not police, we don't give a shit just tell us what she took", he finally stated she was "chewing on morphine patches" and he was trying to wake her by soaking her in the bathtub with cold water. we pulled her freezing cold body straight out onto the living room floor, i cut her shirt off and placed the pads on her chest, she still had a pulse but was bradycardic, and JM began to bag her with a BVM. it was my call, we are both paramedics so we switch each call, and i started an IV and got the narcan out. JM checked her mouth for patches but they were not there anymore, pupils pinpoint and sluggish. while i was getting the narcan ready her dumb friend was on the couch behind me and was crying and asked me "should we have called?". since they are all youngsters i was able to swear at her and fully let her know how stupid she was for 1) asking that question and 2) not calling sooner. bam! 2 mg narcan and she opened her eyes and gasped for air. within 30 seconds she was crying and talking to us. she was about 5 minutes away from death and then the narcan snatched her back to the toilet bowl that is her drug addicted life. narcan is such a cool drug. one ED MD asked out loud once why they can't make a "narcan for alcohol". if you can develop one you could make millions.

Cadillac and crab legs

(straight away...i had a fever and was delirious when i went on this call and my BS guard was down) went to some guy in his late 20's, call came out as a sick person (26A), pt has a hx of HIV. this call was in a trailer park, not one of the bad ones, but still a trailer park (this damn one has like 200 speed bumps and takes almost 12 minutes to get about 4-5 blocks). the dude is sitting on the couch when we walk in the house. his mother is very upset and begging him to go to the hospital with us, she is the one who called 911. the pt obviously has a fever and a bad cough but since he can answer all our questions we can't kidnap him. plus, he's a real asshole and very stubborn, but since he has HIV/AIDS an infection, like this, is not good. after numerous times asking him to come with us i turn to the mother and tell her that he needs some ibuprofen to break that fever and maybe later she will be able to talk him into going with her, or us, to the hospital. she starts to cry and beg him to go and says that she doesn't have any money to get him any Motrin. so i go out to the truck and get some children's Motrin that we carry and i give it to her. now while i'm out getting the stuff my partner is outside of the house talking with the mother. so i give her the medication and as we are leaving i finally notice that in the only parking spot for this trailer is a Cadillac STS, brand new, backed into the space. and then my partner tells me that when he asked the mother if the pt was eating well recently she said that he didn't have any of the crab legs she made tonight. she has a Cadillac in the driveway and crab legs for dinner BUT can't afford Motrin!?!?

V-tach with a pulse...upstairs, of course.

this call happened in the early morning hours of 8/17/09. i was working that night on medic 14 stationed out of city #7 with another paramedic RVC. call came out and it was just around the corner from the station and we beat the first responders there. the call came out a 10C (chest pains, hot call), we arrived and the wife escorted us to the second floor of a very nice, well kept home. the pt was a 54 y/o male who was laying supine in bed and c/o chest discomfort, pt had a strong radial pulse that was irregular with gaps noted by me upon palpation, i just assumed we would see some PVCs on the monitor and the pt's b/p was good and he was talking to us fine and not in distress. the fire fighters arrived and slogged up the stairs rubbing the sleep from their eyes and i turned and told them we were good and that we would just use the stairchair to get the pt down to the stretcher (we recently got new stairchairs that work wonderfully). they left as my RVC was placing the electrodes on the pt. i was kneeling next to the bed writing down the pt's hx, we were going to do a 12-lead in the house and give some ASA and then move the pt, when i heard my partner ask the pt "do you have a pacemaker" and it immediately said "oh, shit". and there it was, v-tach with a pulse on the monitor. my partner placed the 12-lead cables on the pt while i ran down and stopped the FD from leaving and asked them to grab our stairchair. i came back up as the ECG was printing and it was upright in V6 to confirm, without a doubt, v-tach. again the pt was c/a/o x4 and was hemodynamically stable, if had not been it would have been some cardioversion. an IV was established and amiodorone was mixed in D5W with a 60 gtt. set and administered. we kept the pt and his wife fully aware of what was going on. after the 10 minutes the pt converted into a NSR with occasional runs of PVCs/V-tach but the pt stated he was feeling much better and stated something like he wanted to run down the stairs, but of course he was helped to the stairchair and brought down the stairs still attached to the monitor. the compartment the stairchair is in is very cluttered and i just had the FD place it in the passengers seat. so our new stairchair rode shotgun as my partner ran us emergency traffic to the hosptial. below is our activity log and after is the narrative found on our run chart.

08/17/09 02:30

226

140 / 90

107

97

16

Wide Complex Tachycardia (IRR)

4/5/6

WCT - S

4

Manual Cuff

Normal

08/17/09 02:34

Cardiac

v-tach with pulse12-Lead EKG performed by RVC. was successful.

08/17/09 02:35

159

132 / 90

104

99

16

Wide Complex Tachycardia (REG)

4/5/6

WCT - S

4

Auto. Cuff

Normal

Initiate IV

Peripheral IV initiated by RVC with 18 ga. at Left Antecubital. Attempts: 1 successful

08/17/09 02:37

Medication

Amiodarone,150 MG via IV - PUSH given by ParamedicX mixed in 100 cc D5W flow with 60 gtt set ran over 10 minutes

08/17/09 02:42

122

126 / 84

98

100

16

Wide Complex Tachycardia (IRR)

4/5/6

WCT - S

0

Auto. Cuff

Normal

Cardiac

runs of v-tach, irregular, perfusing on normal beats with strong radial pulse, non-perfusing during v-tach runs12-Lead EKG performed by PX. was successful.

08/17/09 02:50

118

130 / 84

99

100

16

Wide Complex Tachycardia (IRR)

4/5/6

0

Auto. Cuff

Normal

pt moved by stairchair and stretcher to ambulance, pt on monitor at all times, paddles attached to pt since before medication admin

08/17/09 02:55

100

110 / 70

83

100

16

Wide Complex Tachycardia (IRR)

4/5/6

WCT - S

0

Auto. Cuff

Normal

Medication

Normal Saline,150 MG via IV - PUSH given by PX fluids given enroute

08/17/09 03:00

106

136 / 68

91

100

16

Wide Complex Tachycardia (IRR)

4/5/6

117

0

Auto. Cuff

Normal

bsl checked at this time

08/17/09 03:05

98

140 / 66

91

100

16

Wide Complex Tachycardia (IRR)

4/5/6

WCT - S

0

Auto. Cuff

Normal

54 y/o male woke from sleeping with heart palpitations and slight chest discomfort and called 911. pt laying in bed at first EMS contact, FD arrived at same time as EMS, pt c/a/o x4 and talking well without resp distress, pt radial pulse irregular but strong with gaps of non-perfusion, pt placed on monitor showing v-tach with a pulse, pt hemodynamically stable and on second floor of home and decided by EMS on scene to treat on scene. pt given 12-Lead, confirming, and IV est. pt given 150 mg amiodarone via 100 cc D5W over 10 minutes with 60 gtt set. pt converted out of constant v-tach on the monitor to runs of v-tach and pt stated he was feeling much better and that the discomfort in his chest was gone and when pt was moved to stairchair pt stated he would be able to "run down the stairs" if we wanted him to. pt moved by stairchair and stretcher to ambulance with constant monitoring. pt with rare skin disease and prolonged admin of prednisone and lasix with constant fluid retention in lower legs and periodically into abd. pt legs wrapped in bandages due to pressure ulcers in lower legs. pt in good spirits during entire EMS contact and pt transported emergency traffic to CFV and taken to the recess room upon arrival where ED staff and ED MD were waiting.