Tuesday, March 20, 2007

Sleepless in Vegas

Well, not exactly. It's just after 2:30AM here in Land of Non-Existent Dreams, and I can't sleep. But there is a good reason for that. I worked my normal 14 hour overnight shift Sunday into Monday and did not sleep there, either. We did 6 calls overnight, one of them involving an injured Manchester firefighter on the scene of a three-alarm building fire that was rocking and rolling when the first alarm arrived. The firefighter suffered an ankle injury because he went down on icy pavement while he and his crew were advancing hose toward the three-family house that was burning. He was the second casualty from that incident, and fortunately he was the lesser injured. The other was a 19 year-old male (not my patient - thank Christ) who suffered severe smoke inhalation and had to be flown from the Elliot Hospital to the Massachusetts General Hospital in Boston to be treated in their Hyperbaric chamber. Why he went to Boston, I don't know for certain; Manchester has Hyperbaric chambers in each of the hospitals. Perhaps it was due to the severity of his condition and the strong potential for secondary injury - that's all I can think of.

The reason for my sleeplessness is because when I finally got home at 9:00AM yesterday, I climbed into bed and slept. And slept. And slept some more. I finally woke up at a little before 11:00PM, almost 4 hours ago. I've tried to go back to at least sleep a little bit before the alarm goes off in 3 hours and I have to get up and do it all over again. And I'll make another attempt after I post this, but I'm not certain if it will work or not. We'll see.

Ironically, I'll be going to 24 hours Sunday into Monday starting April 1. That may actually help, as when I get off work at 5:00 Monday nights, I'll actually be able to fall into bed (probably reasonably early) and sleep until Tuesday morning when I can get up at the time of my choosing, since I won't have to be back until Thursday. However, that could be an issue as I do work for 3 other agencies, and I could have work scheduled with them on those days that I'm "off", for lack of a better term. But I'll still be able to get at least 8 or 9 good hours of sleep.

Unofficially, it looks as though I will be able to get into the Critical Care Transport course scheduled in July of this year. When we get our tax refund back I'll be able to use some of that to pay the up-front tuition cost of the course that my employer requires me to do. That way if I blow it, they won't be obliged to reimburse me the cost of the course. With that said, I expect to be able to get a check sent by the end of this week to MCG in Augusta so that I can get my books and start reading ahead. When I do go, I will be ready, as it is touted as being a difficult 17 days of school. Ultimately, I have no intention of leaving Georgia without CCEMT-P certification.

Last week, as I mentioned in an earlier post, I took Neonatal Resuscitation, otherwise known as NRP. It was a good class, but I was a little disappointed; there was not as much content as I expected there would be. Rather, it was a replay of PALS but with emphasis on newborns and preterms, and a lot less pharmacology. The only drugs we had to be concerned with were 1:10000 Epinephrine and Narcan. Both of these drugs are staple drugs that both in-hospital and pre-hospital providers use to treat patients with regularly. Epi is used to deal with a number of different problems depending on the concentration - the 1:10000 concentration is used to treat cardiac arrest, and the 1:1000 is a high-dose concentration used primarily to treat respiratory emergencies, mostly asthma attacks and anaphylactic shock. Narcan is used as an opiate antagonist - with a known overdose of an opiate or opioid (heroin, morphine, methadone, dilaudid, fentanyl, and others) Narcan displaces the opiate molecules off of the receptors in the brain it latches on to, reversing respiratory depression and ruining the "high" that the patient is experiencing. It can cause withdrawal and seizures either in higher doses or if it is given too quickly.

I can say from personal experience that there is nothing like giving Narcan to someone in respiratory arrest and then watching them sit up like they've risen from the dead and projectile vomit all over you. Nothing at all like it. But I've learned a lot since then, and I make sure that I give it much more slowly or position someone I don't like at the patient's feet. Enough said.

It is now just after 3:00AM. Time to go back and attempt sleep for a couple of hours before I have to get up again.

No comments: