Lethargy
I slept for the first couple hours of shift. We got our first call around 1200. It was a priority for a lethargic patient. I have had more calls for "lethargy" in the past two weeks than I have in the past year. Anyways, it took us about 15-20 minutes to get on scene. The nursing home that we were going to can only be accessed from the north-bound lanes. Unfortunately there is a concrete median, so you have to pass the nursing home, go to the next intersection, due a U-turn and head back north to the place. I feel pretty stupid every time.
We got on scene and found a 75 y/o female with a history of mental retardation that was usually aphasic, that was now "more lethargic." Okay, I'll give them that. They had her on four liters of oxygen on a simple mask, and they had tried to get a line twice and failed. Of course they used all the good veins and left me with nothing. The RN said that the lady hadn't eaten in a couple of days. She was diabetic. The lady's glucose was 71 at 1200. I took it again and I got 59; borderline, so I gave a unit of glucagon IM. We got her packaged and down to the rig. Her oxygen sats were in the low 90s, so I put her on a non-rebreather, and they went up to about 95%, which I can deal with. I took her glucose again-54. Okay, that's not supposed to happen. Her blood pressure was also only 80/42, and without a line all I could do was put her in Trendelenburg.
The hospital is south of the nursing home, and there is the same problem with the median. On the way to the hospital you have to go north about 1 1/2 miles and do a U-turn to go right past the nursing home again and head towards the hospital. We got about 1 mile from the hospital when things started to go downhill. I didn't even have time to call the hospital back with an update. Her sats started dropping into the 70s and she started breathing rather slow and shallow. I switched over to a BVM and she was back up in the 90s. Whew. I wanted to check her glucose again, but I didn't have enough hands, and we were pulling into the ER. The staff freaked out when we came in. From my report, they knew that her blood pressure was low, I didn't have a line, but other than that, her problems were taken care of for now. I had about three nurses and two doctors in the room with us. We moved her over to the ER bed, a nurse took over bagging the patient while I gave my report, and I got out of the room so that I could finish my report and get out of the way. They took her glucose again-32. Yikes. No wonder she didn't feel like breathing. They got a central line on her, and about 5-10 minutes later her glucose was about 100; they stopped bagging her and she was doing good. Talk about a good first call of the day.
We did a transfer to a nursing home out of the same hospital right away. We got back to quarters around 1600. I did one more call around 2100 for a return to a nursing home from a local ER. It was a boring call. I was just ready to transfer care over to the nursing home staff because he wet himself, probably several hours before we got him, and he reeked of urine. Oh well. Hopefully a quiet night ahead.
We got on scene and found a 75 y/o female with a history of mental retardation that was usually aphasic, that was now "more lethargic." Okay, I'll give them that. They had her on four liters of oxygen on a simple mask, and they had tried to get a line twice and failed. Of course they used all the good veins and left me with nothing. The RN said that the lady hadn't eaten in a couple of days. She was diabetic. The lady's glucose was 71 at 1200. I took it again and I got 59; borderline, so I gave a unit of glucagon IM. We got her packaged and down to the rig. Her oxygen sats were in the low 90s, so I put her on a non-rebreather, and they went up to about 95%, which I can deal with. I took her glucose again-54. Okay, that's not supposed to happen. Her blood pressure was also only 80/42, and without a line all I could do was put her in Trendelenburg.
The hospital is south of the nursing home, and there is the same problem with the median. On the way to the hospital you have to go north about 1 1/2 miles and do a U-turn to go right past the nursing home again and head towards the hospital. We got about 1 mile from the hospital when things started to go downhill. I didn't even have time to call the hospital back with an update. Her sats started dropping into the 70s and she started breathing rather slow and shallow. I switched over to a BVM and she was back up in the 90s. Whew. I wanted to check her glucose again, but I didn't have enough hands, and we were pulling into the ER. The staff freaked out when we came in. From my report, they knew that her blood pressure was low, I didn't have a line, but other than that, her problems were taken care of for now. I had about three nurses and two doctors in the room with us. We moved her over to the ER bed, a nurse took over bagging the patient while I gave my report, and I got out of the room so that I could finish my report and get out of the way. They took her glucose again-32. Yikes. No wonder she didn't feel like breathing. They got a central line on her, and about 5-10 minutes later her glucose was about 100; they stopped bagging her and she was doing good. Talk about a good first call of the day.
We did a transfer to a nursing home out of the same hospital right away. We got back to quarters around 1600. I did one more call around 2100 for a return to a nursing home from a local ER. It was a boring call. I was just ready to transfer care over to the nursing home staff because he wet himself, probably several hours before we got him, and he reeked of urine. Oh well. Hopefully a quiet night ahead.
posted by Ambulance Girl at 21:07
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