Friday, May 18, 2007

Slogging Onward


Another end of the week. But it doesn't matter because I have to work tonight anyway.

I'm not in the best of moods as I write this mainly because I'm looking out the window in front of my desk and it's cloudy and gray, and it's only 45 degrees F in my corner of the world right now. This is May - it's not supposed to be like this. It should be at elast 20 degrees warmer and the sun should be shining. I should have glare! But I don't. I only have clouds.

Nothing special to report about work, in terms of calls. When I worked in Goffstown Tuesday night we didn't turn a wheel, which was good, but I couldn't sleep, which was bad. I got to Tri-Town Wednesday morning and found out I was going to Hooksett instead of staying in Pembroke, which is what I was scheduled to do. My relief had asked me a day earlier if I could stay a little later than the end of the shift because she was going to be stuck coming off of ALS-9 in Manchester. I agreed to do it - not a big deal. Besides, I was on ALS-9 for just over 2 years and I know what a difficult truck that can be to work on. Well, she got out late from there, and while I was in her place we got two calls. The first one was for a "possible code gray", which is parlance for a DOA. We got to the scene and discovered this 53 year-old male, down, unresponsive, not breathing. He had a history of seizures and a cardiac history. There was a puddle of vomitus on the floor next to him. He was cyanotic and had dependent lividity from his neck down to the back of his knees. No way of telling how long he'd been down for, but it was long enough that on the cardiac monitor he was in asystole in all 3 limb leads.

Because of the lividity and that he had been alone for approximately 6 hours prior to being found by a family member, there was nothing we could do for him. The lividity and the cyanosis gave it away; those two signs told me that he'd been down for at least an hour if not more. Nothing more we could do except turn control of the scene over to the police while they waited for the medical examiner or a funeral director to come.

I hate calls like that.

The second one was for a 17 year-old male who was having an allergic reaction to a bee sting. When we arrived we found him in his bedroom, lying with his upper body elevated on some pillows, having difficulty breathing and some swelling around his eyes. His mother told us he'd been stung on the inside of his right calf - she'd iced it prior to our arrival, and the swelling there was gone, but the only evidence left was the mark from the stinger. He was working hard to breathe, not a good sign. We'd brought the drug box into the residence, and from there I gave him 0.4mg of 1:1000 Epinephrene subcutaneously, followed by IV access and 25mg of Benadryl and 125mg of Solu-Medrol. We got a quick set of vitals and got him out of the house and onto the ambulance for transport. On the way I put him on 2LPM of Oxygen and the cardiac monitor with a 12-lead ECG as a baseline. Secondary assessment showed a decrease of his work of breathing with clear lung sounds, he was pink, warm, and dry by this time, and the only real complaints he had were some shivering, both because he was chilly and he was having side effects from the Epi, and he had some tightness in the area of the sting.

We arrived at the hospital and turned care over the the ED staff. Parents were pleased, the doc was pleased, and I was pleased. Nice to be able to go from not being able to do anything to having a positive effect on someone's life.

Yesterday was not a bad day - I had a student on my truck, and we had a couple of weird calls. One of them was for an unconscious male. We arrived at the location at the call and we had Fire with us. We had no access to the residence, so the firefighters had to force entry. We found an 81 year-old female sitting on a chair on the phone with 911, and her 56 year-old son on the floor in the hallway. He had an AICD (a pacemaker/defibrillator) implanted a year ago along with 2 cardiac stents, and he apparently had a near-syncopal episode. His mother, God bless her, tried to help him up before we got there and likely injured her hip. So we ended up having a "twofer", which was just weird. But they were both okay otherwise; he didn't want to go but we persuaded him to at least be evaluated at the emergency room. Once we got him seated upright he got to his feet on his own (before we could slow him down - he was pretty spry). His vitals were all within normal limits, and I put him on the monitor once we got him on the ambulance. He had a sinus rhythm with no visible ectopy. He denied pain/dizziness/nausea/difficulty breathing, etc. His mother likewise had no complaints other than pain to her left hip and groin and the inability to stand on that leg. She said she had no problem prior to attempting to help her son stand up. So we transported both of them uneventfully to the hospital.

It was just really a strange call. Kind of funny, but strange.

When I get out of work tomorrow in Brentwood, I have to go to Salem for noontime. Tomorrow is the first qualifying day at Rockingham Park. Might be kind of muddy on the track - we'll see. I'll talk about that next time.

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