Wednesday, January 17, 2007

Baby it's cold outside.....

Oh, yeah.

At 4:45PM EST, current temperature is 17.8 degrees Farenheit outside my door. Not windy right now, but there was a good breeze outside earlier. I normally have Wednesday's off, and I had errands to do so I had to go out. The first sign that it was going to be a trouble-filled day was that I found my car door locks to be frozen. And I do not have the luxury of a remote key, so I was sort of screwed. Same thing happened last night when I left work - locks were frozen solid. I decided to leave my car unlocked and take my chances. What's the worst thing that could happen? My car could get stolen, but so what! There could be worse things, and if someone wants it that bad, they can have it, as long as they steal my payment as well.... Apparently, snow is in the forecast with continued cold, and at this point I'll believe it, simply because winter is finally here.

Yesterday was a busy, and particularly bad, day. We did 6 calls in 10 hours, which doesn't sound like many (and it really isn't; there've been shifts where we've been 10/10 or 7/14 on a Sunday night), but most of these were bad calls. We started the shift with a call for a fall, and when we arrived, we found our patient at the foot of her stairs lying on her back with her right foot out at a bad angle. It wasn't well lit, so when I got closer to her and had a better look, I found that she had a compound fracture of her right tibia. There was active venous bleeding, and with the bone sticking out we figured we'd better get some help. In addition to ensuring that her ABC's were okay, which they were, we got her leg immobilized and worked on getting the bleeding under control, and as soon as the engine company arrived we packaged her and got her out of her house. Her vitals were all good, but she was starting to have muscle spasm around the fracture. The big problem I had was she had no vasculature to speak of, therefore, no IV access. I wanted to at least give her a fluid bolus and some medication for pain. She was allergic to morphine, and the only other narcotic we carry is fentanyl. It would have been a good thing if I could've gotten a line started, but it was not to be. Fortunately we had a relatively short transport time. I checked on her a little later on, and the orthopedic surgeon was with her - she was on her way as soon as they got all of the consents signed.

The other call of those we had that was notable was a 2 month-old male that we went to for difficulty breathing. This call was at one of the local clinics, and when we arrived we were notified by the lieutenant on the engine company that he'd been diagnosed with RSV (for Respiratory Synctial Virus - very nasty in infants and children) the day before, and the mom and brought him back because he was vomiting and not able to feed, and it had been going on for 2 days prior to this. I thought to myself pretty immediately that perhaps this kiddo should have been admitted when he was initially seen, but I bit my tongue. On top of this, the mother was a non-English speaker; she spoke Spanish only. Not a humongous problem, as I can get information in Spanish as I need it, and I work on it a lot because I want to be able to at least communicate as necessary. Manchester has a fairly large Hispanic community now, so in my opinion it's important to at least be able to have some tools to figure out what's going on. My next project after I get my Spanish skills where they really need to be is to learn either basic Somali or Bosnian; I haven't decided which. Anyway, I got a look at the kid, and my first thought was that he was in trouble. He was breathing between 60-70/minute and shallow, he had a heart rate of about 160, and he was pale,warm and dry. Mother told me the vomiting started on Sunday morning and he hasn't fed to speak of since. Fortunately, his lungs were clear; that was about the only good thing he had going for him. We had big time trouble getting IV access, too; he was also somewhat turgid, which was another thing that got my attention quickly. Both my partner and I made attempts to get access, which failed miserably, so I asked him to get us on the road and not to go slow. Well, about a minute into the trip to the hospital, baby decided to stop breathing. At that point my sphincter muscles tightened up noticeably, and as I was pulling the infant AMBU bag out I was yelling at my partner to PUHA (pick up and haul ass, for those of you who were wondering). And he did - I lost my balance, fell on my bottom (I was on my knees at this point), and hit my head on the cabinet behind me as we pulled G's. So I started bagging the baby, and 3-4 breaths into it he started breathing on his own again. He opened his eyes, got a good look at me, and started screaming. Thank God for that.... We got him into the ED and the team looked at me like I was from another planet when I told them what had happened. I checked on him about a half-hour later, and he was feeding like nothing had happened, momma was crying but with a smile on her face, and the Doc that took care of him squeezed my shoulder and said to me, "close calls suck, don't they?" Enough said.

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