05 March 2006

Circling the Drain

First call, right off the bat, was a return to a nursing home. The lady was the cutest little thing. She had a blast on the ride there; she was harassing my partner the entire ride. When we got to the nursing home, she asked me, "what the hell happened to you?" I said, "um...I don't know." She said, "when did you get so tall?" I told her that possibly I grew on the way over. The lady's daughter piped in, "mom, you're only 4'10"." She just said, "Oh."

Next call was in Northbrook for an "arrhythmia." Wierd. On the bottom of the screen it also included vomiting and diarrhea. Okay, that doesn't sound too good. It was screaming cardiac problem to me. We got on scene and saw the patient. She had been vomiting for two days, not eating, and, according to the RN, had an abnormal heart rate. I put her on the monitor and did vitals and I wasn't able to figure out how she discovered the abnormal rate. She didn't have a radial pulse. Her blood pressure was about 80 systolic, and her heart rate was around 160. She had a history of A-fib. To add to the problems, she was diaphoretic, dizzy, short of breath, had a blood glucose of 372, and I couldn't get a line. She also had stroke-like symtoms of sudden onset during transport-she had slurred speech and one of her eyelids started to droop. She had a history of a CVA, but the RN said she didn't have any deficits. The patient wanted to go to a far hospital, but I was diverted to the closest for obvious reasons.

I couldn't believe what I was hearing when I got to the ER. Our patient was a DNR, but that doesn't mean do not assist, or do not try to help. I was doing everything I could to help her and make her comfortable. I gave my report to the nurse, emphasizing my concerns. This is what the nurse replied, "It's not necessary to get all worked up. Maybe it's just her time to go...her blood pressure is 80 systolic-that's okay...we'll just give her some fluids." I was pissed at the nurse. Besides that it was completely unprofessional to say that it "might be her time," my patient was A+Ox3, and could hear, and understand, everything that was going on. I almost wished I had taken her to the farther hospital. The nurse completely dismissed my concerns, even the possible repeat CVA that could have been critical-and treated right away-considering they didn't start until we were en route to the hospital. This was my first diversion of the day.

I got a call for a patient in respiratory distress at a local nursing home. Once I saw the name of the place on our pager I knew we were in for a treat. The lady was gasping for breath, unconscious, diaphoretic, and pale. She was a full code-a ward of the state. We got her moved into the ambulance and did the rest of our assessment. Her blood pressure was a little low, her heart rate in the 130s. Her respirations I counted at 40. Her spO2 was okay-around 93%. Staff said when they found her it was 46%. Her arms were contracted and we were unable to get a line. I gave her a neb treatment because she was wheezing. She also had crackles, but without her being alert enough to use CPAP, and without a line, I was shit out of luck. I checked her gag reflex while my partner continued his search for a vein. It was there. I checked it one more time before we left the scene-not there. Crap. We got the intubation stuff ready and were set to go. My partner inserted the blade and she started gagging. She had tons of phlegm in her throat that we suctioned. At least she had a gag reflex. Now that my rig was officially trashed-we were ready to go to the hospital. Another desired hospital about 15 minutes away. I called medical control, and big surprise! I was diverted again. She did okay on the way to the hospital. We got her into a room right away and I gave my report. All I had to say was the nursing home I got her from and the nurse was shaking her head. The last I heard she was in the ICU, clinging to life. Or, rather, circling the drain.

There were five other squads at the hospital while I was doing paperwork. One squad alone brought four in.

Another transport for a psych patient. I had taken him before. He was alright-very quiet.

While we were there I noticed another lady, whom I predicted would be our next psych. She stood in her doorway for a few seconds. Then she turned around and went back in her room. She returned dragging a chair and holding a bottle of saline. She put her arms up in the air, as if she was blocking someone. She said, "hello, officer friendly," to a police officer that was standing in the hallway. She tipped the bottle upside down and unopened, and then declared, "oops! I fell." A nurse approached her and tried to get her back in her room. The nurse tried to take the bottle of saline away from her and the patient told her she was thirsty-it wasn't for drinking. The lady proceeded to sit down on the chair, the nurse took the bottle of saline, and the woman spread out her arms and declared, "give me back my normal saline!" I was trying to disguise my laughter as a coughing fit, but I don't think I did a very good job.

Our last call was for a patient with a fever-on a priority. The nursing home is about 15 miles form my station. We got down there and the nurse said the patient had a fever of 102.8. After seeing the patient, I had her take it again-103.2. The patient had wet herself, and soiled herself, she was flushed, diaphoretic, had a low blood pressure, was lethargic, and was oozing copious amounts of greenish brown phlegm from her stoma. Nice. We actually got a line on this lady, which surprised the hell out of me considering my track record for the shift. There really wasn't much I could do for her but wipe the phlegm off that kept running down her chest every time she coughed. I also noticed that she had gotten her stool all over her hands as if she had been playing in her diaper. Yummy. I gave the hospital a two minute ETA. We got her settled in her room. I'm not sure she will pull out of this one.

I was held over again. I got back to quarter around 0830, but it was a good shift. I had a paramedic student with me, so he got some good calls. It's always nice when I actually get to use some skills.

I was off until 0900 (a whole 30 minutes). I got my rig checked out while my partner ran home. He had forgotten his wallet. It was the same partner I just did my 24 hour shift with. We went out to breakfast at IHOP with two other crews and then we were sent to post a local hospital. We sat...and sat. Everybody in the county was busy except for us. We watched a movie about a psych facility called Madhouse. Very scary-I don't recommend it. I was especially stupid to watch it because my quarters are actually at a psych facility. We stay on the second floor of the hospital. Thank God I didn't try to watch it last night. The hospital is all shut down except for two floors. The psych floor is right above us. We were wandering around last night for a bit and ended up in the surgery area. There was mold growing across part of the floor, old beds and tools lying around and even the machines that anesthesiologists use. Very creepy. It looked like an old hospital from a war movie that had been deserted. Anyways, we finished the movie, I fell alseep for about a half hour or so, and then we got our first call-a psych going across town. Isn't that convenient. He was alright, the transport was uneventful and I was glad to finally run a call. We told dispatch we were clear and they told us to hit the pumps and have a good night. It was 1600-I wasn't due off until 1900. Oh well. I was hoping to have a repeat of yesterday, but no such luck.

I am back on shift tomorrow. Another 24. I am dead tired. I barely had the energy to eat dinner when I got home. All I did was throw my uniforms in the washer to prepare for the next round-hopefully a good one.


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