Thursday, May 10, 2007

Bad Calls, Another Edition

Miserable day today - when I left for work this morning it felt like someone put a wet blanket over my head. Just trying to breathe was a real workout because of the humidity and the pollen. I love the spring - after all, hope does indeed spring eternal - but I wouldn't object to a little bit of rain.

My regular partner (for two of four shifts) is back as of today. We worked together and had what I thought was a really good shift as a crew. The calls we did today, however, weren't so good. We did 5 calls, and one of them in particular was really messed up, of for no other reason than for the circumstances of the call, not the care provided. It was for a fall, and we had no information other than that on dispatch. We arrived at the location (not in a particularly nice neighborhood), and as we were walking to the front door of the building a voice called down to us from the third floor to come up. We got there, and we found this 21 year-old female who was hysterical. Her legs were covered with bruises as was her abdomen, she had swelling to her right ankle and deformity to her right elbow. All she would say was, "I want a cigarette", and when we told her she needed to wait until we had a chance to figure out was going on she told us to get out of the house.

At about that time two Manchester police officers showed up. Between the friend who called 911 (the person who waved us up), the officers, and my partner and me, were able to figure out what had happened. It turns out the boyfriend of our patient had taken off with the cache of drugs (we suspect) that was in the apartment. And at approximately 8:00 last night our patient either fell, jumped, or was pushed out one of the third floor windows of the house and her friends carried her back up to the apartment. We were told that the boyfriend was laughing as she went out the window, but the problem with that is that it is hearsay - no way to prove it.

Did I mention that in addition to the injuries I listed she was also complaining of neck pain? In addition, she told us that she just found out that she's pregnant with her second child.

As my partner and I assessed her injuries, it became clear to me that she wasn't going to be taken out on a stair chair, much less walk out. We had to put her on a long back board and immobilize her cervical spine. It didn't help that she was a rather chunky person, either. At that point I called for, and got, and engine company to come out and help us get her extricated from the apartment.

While we were dealing with this situation, the city of Manchester was going to hell in a handbasket; within 4 or 5 minutes of our being dispatched out three other calls had come in and two of the other three trucks were already out. This meant all 4 city-committed 911 trucks went out in the span of 10 minutes, and the two ALS transfer trucks were committed to calls. So we got help from Bedford and Goffstown.

Anyway, during this call our patient finally found a cigarette - I told her the only way she could smoke it was if she did so before the firefighters arrived or all bets would be off and she'd have to wait. Then she started moaning and groaning about being thirsty and wanting a drink. That presented a problem for her as we couldn't let her have anything by mouth. With her injuries surgery was a real possibility, and we didn't want to make things any more complicated than they had already become. She started to become combative, and my partner got into her face and told her to stop or she'd end up in police custody. I never saw anyone settle down so fast.

Fire got on scene, and we had her boarded and collared just as they were walking through the door. I went out to them and filled them in on what was going on. The captain on the engine is a friend of mine, and I could see the look of utter incredulity on his face as I talked. Things changed, however, once we got inside and he and his crew had a look at the patient.... We got her out of the apartment (no mean feat) and down to the ambulance. Loaded her on board, assessed her further, got IV access (she was also pretty dehydrated, which explains why she wanted something to drink) and gave her fluids. We got her to the hospital which was about a 2 minute ride up the street and brought her into the Trauma room.

Last I knew she was having a complete set of radiography including a head, neck, and abdominal CT done. I don't know what the outcome of the pregnancy is; usually radiography is proscribed when a fetus is involved. However, with scope of this patient's injuries I think priorities need to be considered. I also suspect she'll end up in the OR at some point. More as I find out what happened.

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