Vroom Vroom Or Ding Ding?

Day one. First call goes out as a cva then a full arrest I was like oh snap is this real life so we walk in and the patient is laying there moaning turns out it is not a full arrest. So we get her hooked up to the monitor I start the IV we load her up. The monitor shows a fib with RVR and the patients states no history of irregular heartbeat. From the time we left the patients house to getting her to the hospital she was now throwing frequent PVCs and then they went trigeminal and then she was having couplet PVCs. She was confused the whole time with us and wasn't quite sure of anything going on. Our next call was for a fall I walk in this very pristine vintage home and this patient fell from being dizzy and split the back of her head open. I start going through my assessment and she is very snippy with me. Okay rude I'm just trying to help you out and I want to make sure I don't miss anything. So anyways her snippiness continues and at one point my medic almost had to step in but it was all good. The patient didn’t mean to be. Next call was for another fall and this little lady went to sit down in her office chair and she just missed it and kind of hit her back. She was the sweetest thing but she ended up not coming with us. We get a call for a seizure 16 year old. I'm thinking okay good. Well we get there and fire already started an IV and the patient had a seizure while in fires care so we load her on our cot get in the truck and she fights us a little bit, we wrap that IV so we don't lose it and she starts fighting us more so I start holding down the legs and my medic gets the top half and patient was going crazy. It was like that all the way into the hospital. My hands would slip because the patient was so sweaty which made it tough. We pushed 5 mg Valium in hopes it would help just as she started relaxing we sat down and she went at it again this time we start getting the restraints out and we give her another dose of 5 mg Valium and then we pull into the hospital so we never got the restraints on we are trying to wheel her in while we strapped her legs down good in hopes she doesn't get out of the buckle again and my basic has the foot of the cot I am holding one arm down and pushing the back and my medic is on the other side holding the other arm down and pushing the cot. Dude it was a big mess! That patient was mad strong too and also like two of me! Next call was for a diabetic emergency hyperglycemic. Hey guess what. He was combative too. Awesome! So we wrangle him on the cot strap him in and this time we pulled the kerlex out and restrain him before we left and once we got in the truck we pulled out the soft restraints. Cause me and my medic were not about to fight back again. Next call was for short of breathe history of COPD. So we get on scene and I'm like well hopefully not combative with our luck he will be so I start hooking him up to the monitor an I put the bp cuff on him and he made some statement that he will slap me I thought oh no here we go again but he was a little disoriented. He was not combative thankfully. Load him up and do the whole work down.

Day two. We get a call for shortness of breath and abdominal pain. The patient recently had a colon resection. She really just wanted to get out of the house though. The next call was for a fall. Turns out this patient had drunken about a gallon of listerine and was just a tad drunk also he had broken his hand two days prior an had since taken the cast of himself. His hand did not look too good. And from his fall he had split his head open. We were finally able to talk him into getting everything checked out. A listerine drunk patient is quite the smell! Third call was for a suicide attempt overdose. This patient would only respond to painful stimuli and we were unable to figure out how much of what she took and when she took it. All her vitals were stable and she was breathing adequately. She wasn't in any need of narcan because she was stable and it's no fun dealing with a patient who has narcan on board but as we were pulling into the hospital my medic said the hospital likes when we try it so we gave it when we were almost there. There was not much change. It slowly started to show a change and by the time we were leaving the hospital she was talking some at least. We got a call to transfer a cancer patient on a few drips. After that we got a call for an assault in a sketchy sketchy apt complex! So we stage for a few minutes then get cleared to go in and we have two patients who got the snot beat out of them. The guy was knocked unconscious so we had him back boarded we get him in the truck I do my assessment and start the IV then they bring the other patient in back boarded as well so I do my assessment on her and an IV and we bring them in. They both had swollen faces and it looked pretty painful. We get this call for a patient who fell off his bike ( mind you it is like 1015 at night ) my medic tells me what the call is for an she goes we don't know if it is his bike vroom vroom or bike ding ding. We get on scene and fire says he left we were about to go start looking for him. So we start driving around the neighborhood looking for this patient. But clearly he must not be that hurt. We never found him. The last call was for a fall and this elderly lady was found on the bathroom floor. She was not very enthused we were there she did not like me touching her. She complained of pain everywhere but it was not believable. I finally get somewhat of an assessment done and only found a big bump on the back of her head which was painful to her. We couldn't take her to the hospital until her daughter got there and decided. So meanwhile I had to put up with her repetitiveness and fighting every time the bp went off and if I tried to put the little spo2 clip on her finger she would freak out that it hurt so whatever. Her daughter finally gets there and after 5 minutes they finally decide she will ride in the ambulance. Now that that is figured out we are able to get the show on the road. We were unable to get a sugar or IV on her, which wasn’t a big deal. Needless to say we got off a little late.

Day three. First call was for "man down" that's all we got. So we show up and fire is just all standing around. So apparently this patient was just lying on the sidewalk and fire drove by and stopped. Her blood sugar was low so they gave her some glucose we get there I check her level again and it stayed the same so we try to give her more but by this point she was all sorts of frustrated and angry. We had called her mom and she was going to get picked up. We had to wait for the mom and the patient just yelled at us the whole time she eventually just made herself comfortable on the sidewalk and just laid there till the mom came. Ridiculous. We get a call for a CVA so we show up and this patient is just so antsy and can't stay still and delirious. Since called in as a CVA I go to do a stroke assessment and have him squeeze my fingers with both hands and he had equal strong grip and would not let go. We load him up fast when we saw he was a fib with RVR at 180 a minute. Get him in the truck and I start an IV give him fluids and he won't sit still and trying to take his seatbelts off and he was just all sorts of crazy. He felt warm to us but we don't have a reliable thermometer to check it so once at the hospital they check it and got 103.7 yikes! They give him some Tylenol and started giving him haldol before we even left the room. The last call was just a transfer for chest pain. A whoopin 12 hours and only three calls. Impressive.

Day four. It's a PINK truck day so of course I had to get the pink gloves too! It's fun but it's an old truck so it rides TERRIBLE! So our first call is for short of breath. The patients sats were 84% on 5 liters of oxygen we put him in a duoneb with 6 liters of oxygen and get his sats up to 99% super. He sounded pretty gunky. Poor guy. So after that we were headed to post and a car broke down in the middle of the road so we blocked off the road and pushed the car out if the way and we got a call so once the car was out of the road we booked it back to the truck. Got my exercise man. The call was for a diabetic emergency. Patients’ blood sugar was 31. We ended up giving him an amp of D50 (through a 22gauge unfortunately) and 100mL of D5 and got him up to 159. Apparently this happened last night as well so we said it’s probably time to get him looked at. We get a call for a fever for a patient at the dialysis center who had just had a fistula put in a week prior and the swelling from that has gotten worse. Being that we were right across the street from the hospital we did not have much time to do anything. Next call was for a seizure at a college nearby. When we got there we were talking to the patient and from the way that the patient was responding we don’t think it was a seizure but more of a syncopal episode. We started questioning her and find out that she hasn’t eaten in 24 hours and she had just got home from soccer practice. Crazy I tell you crazy!! So we start attempting for an IV and im sure everyone can guess that didn’t go well because she was so dehydrated. I think after 3 or 4 tries we got it. We gave her fluids on the way in. Our next call was for a possible stroke we get there and this patient checks out fine but she did have an episode where her speech was garbled and confused so at that point we stepped it up a little. We get her to the hospital in that 3 hour window for a stroke patient but to our surprise the family neglected to tell us that they woke her up when this started. What we got from the family was that they had gone in to talk to her and it started and then resolved. So then the real time of her last time seen normal was passed the 3 hour window which was a bummer. We go ask the nurse about that syncope pt we brought in and turns out that patients electrolytes were all sorts of screwed up. Her potassium was 2.48 and normal range is 3.5-5.0 so that is pretty low. No wonder she felt so crappy! Anyways last call for the day and week was for abd pain with n&v. Ongoing pain for the past 6 weeks and tonight was just unbearable therefore we got the call.

Good week. My preceptor keeps telling me I am improving more and more each day, which I like to hear :D

Unicorns and Angels

This week is shift change. I now work from 1245-0045. New week new shift new crew new ways. I now have to adjust and make a system as a new team. I am now able to attend part of church before going off to work which is nice. So my crew has given me a few tips and warnings about how they are and how they do things. Just some good to know tid bits. Our first call was for a possible fall and low blood sugar by the time we got there the nursing home didn't need us anymore. Next call was for an assault. The patient got maced. Sweet. We rinsed her eyes out for a good while and then she didn't want to go to the hospital so we left. Next was for a MVC but nothing significant.  Then we get a call for a fall and this pt had fell like an hour before calling us and her story just seemed fake. She was complaining of a headache from hitting her head. But she just seemed a mess so we took her in. Our next call was for a suicide attempt. Probably my FAVORITE CALL yet! So when we get on scene she was sitting on the curb still somewhat alert but she was deteriorating pretty fast. She said she had taken like 30 muscle relaxants and boy let me tell you she was relaxed! Haha. So we start hooking her up and just from the time she was in FDs care to walking in the truck her heart rate went from 60 to 39 so we were like oh crap. She was at the point of barely responding to us anymore and we rushed her in hot. We were so close to the hospital we didn't have much time with her. We get her in the hospital and on to their bed and I'm think eh we are done with her now they start there work up I ran to the bathroom and then my medic was like they are going to intubate you can go in and I hear my basic say she has had a white cloud since she been here and the dr looks at me and says ill give you one shot. I was like wait for real!? Legit! So then I got all nervous and I was like no pressure and there were like 10 nurses and 2 doctors in the room and then here I am just a lowly paramedic student about to intubate this patient. So we get all the RSI drugs in and the dr goes whenever you are ready and so I did my thing lift up and would ya just look at those chords! Glorious. Slide the tube down and they listen for breathe sounds and they go present bilaterally! I was like boo yah!! I wanted to jump up and down but I refrained. It was the best thing that happened all day! The last call was for an elderly patient that felt lethargic. Oh good.. But overall a freakin amazing day! I feel so accomplished since I got my first tube here!


Day two. We get a call for a MVC but again nothing significant and both were no cares. Next call was a possible DVT but when we got there my medic was leaning more towards possible cellulitis. Our next call was kind of a joke. Patient went home on her break at work and drank a cup of vodka and took her Ativan came back in to work a little loopy therefore we got the call. Her story was long and it was hard to get what we needed cause she would interrupt us. She started leaning forward out of her chair and nearly fell out and busted her head we had to catch her. It was a mess. We ended up sending her home with her friend to go straight to bed. So lets hope. Next call was for abd pain and that was a sticky sitch as well. Apparently her and her daughter are frequent flyers which is very unfortunate. So we take her into triage. All the hospitals are getting slammed today and so are we. Gotta love it! A call to an assisted living facility for a fall. This was the cutest old lady ever. She was just sitting on the floor content and we start assessing her and her legs are uneven. We start poking at it to she if he has some pain and she says she does but she just sits there like a champ. We load her up and give her some pain meds for all the bumping down the road. But the pain meds and bumps kind of balanced out and the pain stayed about the same. We got a call for a psych/inappropriate behavior turns out she is on a new medication and he body is still adjusting to it. Our last call while others were getting shootings I went up to Guthrie and picked up a DKA to bring back down here. That took us awhile.


Day three. So we get this call for a fall and I was like alright but ten tey tell me it's a 24 year old. I was like for real. We get this and he is laying prone on a bed an says his back hurts real bad. Apparently he fell into the coffee table and bumped his back. There were no deformities just some tenderness where he hit we told him he should probably take some Tylenol or ibuprofen and ice it. He was worse than some of my older patients wow. Next call was for low spo2 at a nursing home. We all know how those go. Like I was taught in school "treat the patient not the monitor!" We did another transfer for chest pain but patient was completely stable. We get a call for a traumatic injury which entailed the patient knocking her head on the corner of the mantel with a little laceration that bled quite a bit. It was on the head so not surprising. She did not want to go to the hospital. We get a call to a nursing home for a stroke we get there and the patient is actively seizing. We load him up but by the time we got him in the truck I had started an IV he began to seize again. We then called it status epilepticus because he had no in between lucid state. We gave him some Valium to stop the seizure. He also had a code brown. Smelly yuck! When we got him in the hospital he began to seize again so we tried another dose. Newt call was for chest pain we pull up to a corner and find this man lying there all sprawled out and wouldn't do much to help us out or even answer our questions. Did the whole work up and found out he overdosed on his meth. He was definitely tweaking out with us. Our last call was for back pain dude to kidney stones. Her prescribed meds were not kickin it so she called.


Day four. When I was headed to work I noticed it was way windy outside and thought to myself I'm going to blow over. Well so we get out first call and it is for a fall. While headed there we are driving down the highway and pull over and a cop pulls over as well and was like everything good. Turns out they thought we blew a tire but it really was just the mud flap falling off. So we get back to headed to the call and we show up and fire almost had her backboarded so start questioning her an she was walking out of the restaurant and the wind just knocked her over and she split her head open. Rough day. After we drop her off at the hospital we are heading to post and see an accident so we stop and they were no cares. Next call we get was for another MVA minimal damage to the vehicle but the patient was complaining of pain so we do the whole work up. C collar KED and back board. We get a call to a middle school for someone who passed out. Turns out during basketball practice she was running and passed out and hasn't eaten today. So that's that. We get a call for suicide attempt we show up and the patient doesn't want anything done to her said fire so I get in and tell her I jut have to check her out since we are there. She doesn't want to go with us and then she decides she wants to get out if the house so we take her and once in the truck she admits to having taken a bunch of pills. We give her some activated charcoal and she downed that like a champ. Next call was for a MVC and the patient didn't suffer much her car did though. We get a call for a shooting woot woot. Once we get cleared to go in we come up and all that happened was maybe a bullet case bounced off the patients back. She was fine. She had quite the bullet holes through her door and window. We get a call for a fall and we show up and this drunk guy greets us at the door and says he doesn't need us he says he is fine so we call it good. So our last call for the week was for an elderly lady at the nursin home. We walk in and walk right past her due to no one telling us where she was we come back to her and I start talking to her and she doesn't really know what's going on. The nurse called for increased confusion but she doesn't know the difference. So I'm asking the patient some questions and she is answering them as if she is trying to cover something. I tell her we are going to take her to the hospital but she isn't quite sure why so I explain that the nurse was a little worried about her increased confusion ad that she should get checked out. She says okay and we get her loaded up. She was in no type of distress for us just a little confused which isn't normal for here. Busy day nothing too exciting. My crew has a very white cloud as do I so therefore we like to say our white cloud has unicorns and sparkles and angels cause we never get anything good.

{[ sorry about missing last weeks update, i cant even remember those calls anymore, but nothing too exciting sticks out]}

Get Me A Coca-Cola!

Here is another week in the truck. 

Day One: My normal basic is gone today so we just have a sub in. She is a funny little cookie, should make for a fun day. So I was talking with my medic and he asked about my weekend and I had said I went grocery shopping and he said at Target with the dead guy? I was like ha no but I did hear about the shooting. He goes apparently the dead guy was just in the parking lot for awhile before anyone came. Oh boy. So the first call goes out as breathing problems but we show up to the jail to this man complaining of leg pain. History of arthritis and it is a crappy day out so nothing to worry about. He apparently was just getting released from jail. We drop him in triage and mousy on our way. My medic says he just wanted a place to go. ( as we were walking out of the jail some other guys walked out and said do you have a cigarette my basic goes yes cause we are an ambulance and carry those! Gotta love it ) Second call was for a fall at a nursing home. Third call we get was kind of fun. We show up and the patient yells at us to leave she had called her guy to take her to the hospital for back pain and he had called us. Patient refuses as she is laying on the couch under a blanket and just continues to yell at us to leave we have to get her to sign refusal because we made patient contact and we need some basic info. Her an her boy start fighting and he says I'm done and leaves. She won't give us info but finally tells us her birthday is "kiss my @$$" so my basic goes wow really we are done and then someone who knows them comes by and he signs as a witness but we try again to get her to sign and the other guy says stop messing with her your just trying to make her mad and my medic looks at him and goes you need to stop telling me how to do MY job I got you to sign as a witness but I still need her to sign and he was getting mad telling us what to do an my medic had to put him in place and we left. The patient tried yelling at us the whole time as we left and such. Whaterr. Car accident in the parking. Those are the best calls.... Sike. Usually they aren't bad enough to injure anyone as long as they are in the car. Anyways these patients all seemed fine and didn't want to be transported. So this basic I have been working with today is basically just awesome. Every time we get a call she will be like you gonna follow us or we will see you there. Haha I'm right behind no worries. Next is for another fall and this patient injured her ankle she was so nice but nothing too fun. Next call was for a little boy who fell on the playground at the mall and injured his arm. Him or his mom didn't speak English so it made it a little hard to communicate. Our last call was to a funeral home. Weird huh? Patient was not dead just complaining of chest which subsided as we arrived. At the end of the shift the basic I worked with told me I was her favorite because I could occlude a vein when I did the IV. She was like that's why the first IV you did I hovered so bad because others I have worked with seem to practice blood letting and that is not cool cause I have to clean it up so thanks for your great skills. :) Yay

Day Two: First day of October! Yay and it was cooler this morning. I got it my car and the low tire light comes on I was like ah man. super way to start my morning but none of the tires were obviously flat. I check the pressures and they were all borderline fine. Anyways.. I get to work "late" but I was still there "early". Our first call is a fall. Wow don't worry I'm a professional at those. Although this guy had a bloody nose as well that had resolved by the time we got there as we were about to pull into the hospital he says he needs to spit but he is back boarded so not so easy. We hand him some paper towels but that wasn't cutting it so we pull the suction out. And let me tell you I do not do suction. It was all I had in me not to not gag. The next call was for a "stroke". When we showed up the patient had no s/s of a stroke and things had resolved. So after we drop him off we were about to leave the hospital when they dispatch us a transfer from that hospital clear across town. This patient had textbook perfect Wenckebach but was not symptomatic. That was an easy transfer. We then ran on a patient with breathing problems but did not want to be transported so we just have her a breathing treatment and went on our merry little way. The last call was a car accident. And you never know whether to be excited about it or not. Most of the time they are just back/neck pain and nothing fun and others are more fun. So my medic tells me to grab the vest and so I was thinking maybe it's a little more serious we pull up and the firefighter opens the side door and this little girl walked in. All she had was a little bump on her head but she was fine. No transport there either.

Day Three: So today marks my one month being in Oklahoma. I still don't feel like I'm here it's so weird. I'm sure ill get used to it soon one could hope. My medic today keeps asking me if we are going to get anything good today I just keep saying one could hope! First call of the days is for breathing problem aka an asthma patient who didn't get their inhaler filled yesterday as he should have. So our second call was for the same thing. Short of breathe. We walk into this motel and it was the same patient we picked up from the jail on Sunday. This time he had a nice bottle of vodka on the night stand empty and boy you could smell it on him. He was not a fan of us this time he thought we played to many games with him. We take him to a different hospital from Sunday and we walk in and the whole staff knows him name. It's a dang shame! Our next call was for a seizure. Shocker it's not a breathing problem. She seems pretty alert you just couldn't understand a word she said we got her in the ambulance and she starts "convulsing" but is telling us at the same time that she is having a seizure, we said most people when they have seizures don't talk and she stopped talking. Weird how that happens. So she kept saying four different hospitals so we just take her to the closest one again the staff knows her by name. Aye yie yie. Fourth call was for palpitations. We show up and she is in a fib but has no history of it. She was waiting for her grandson to get home but then she had to call us as we were in the truck he came home so needless to say he found out and he came with us. We took her in nothing too significant happened. Our last call was a GSW (gun shot wound) but it was a transfer from one hospital to the level 1 trauma center. Apparently this guy was walking down the street minding his own business when he heard 4 or 5 gun shots and felt something hit him and he stated that his body went numb for a minute. He had his parents drive him into the hospital. We then transferred him. But this patient was completely alert and oriented x 4 and the bullet was still in his head. They are guessing it was just a little gauge bullet. I felt bad for him if that was a true story of how it happened. We aren't too sure if there was more he wasn't telling us.

Day Four: My Friday!! First we start by sitting at a post for 3 hours. Then we get a call for a fall and this patient was so adamant that she was fine and did not need to go. After hearing the same story for 20 minutes we finally get her to talk to the supervisor and clear the refusal with him and then we got her the coca cola she had been asking for and put her to bed. The whole time we had to listen to her say y'all are just so nosey. Why thank you I will take that as a compliment it is my job :) Next call was at a doctors office for short of breathe aye yie yie. Literally the office building was connected to the hospital. We show up and her sats were 82% on room air. Not good so we finally get her up to 96% on a mask with 10 lpm of oxygen. She is also in A Fib with RVR and no history of it. So we do our two minute transport and be done with her. Next call my basic goes its another fun one. So this guy "broke in someone's back yard and is drunk and high" we show up and he is a little wasted off his butt hard! So he doesn't want to go to the hospital but he is too drunk for us to leave him. We get him in the truck and start and IV and hang a line. My medic just messes with him but we start down the road and he is just staring at me. Gosh. So finally I say do you need something he responds you I said excuse me no you can't have me. My medic kicks the cot and yells at him to behave and that that was inappropriate. He was a mess. We get him in the hospital and two of the nurses that were help checking him in he looked at the blonde and said "you ugly" she took it as a compliment and didn't care and was like thanks that made my day the other nurse was brunette and he looked at her and said "you pretty lord that blonde hair mmm I love you" and she was like ha thanks he makes his rounds to me and says "you ugly" I said thank you. He goes from wanting me to thinking I'm ugly awesome. I hate drunk people and how they are abusing the system using his social security/disability check to buy alkeehol and get so wasted that he is a potential threat to society to where we have to take him in. We get another call for a patient who drank too much alcohol but now wants help and wants to sober up. What is it with these people today it's mid Wednesday sheesh. The cop ends up taking him in to get sobered up. Next call was just for a transport. Last call for the week was an elderly lady unconscious. We load her up and she is only responsive to pain. So of course when I stick her with a needle she flinches. That's all well and good. By the time we arrived at the hospital she started talking to us.

Overall a good week. My medic keeps bugging for something good instead of all these little bs calls. Stupid white cloud. Maybe next week!