Toothpicks

Yeah.... Right..... I need some of those for my eyelids right now, I think.

Fatigue is setting in pretty fast. I worked 36 hours over the past two days at three different places. Sunday morning I evaluated one of the airway management stations at the Fire Academy for the monthly ALS exam. From there I went to Rockingham Park and worked the race day, and when I left there I went to my 24 in Manchester.

Fortunately it wasn't super busy in Vegas while I was on, but I am still fatigued after 24 hours on with not too much sleep. Only 8 calls over the shift, and half of them were non-transports. Of the others there were two that were interesting: the first was a 58 year-old female with a history of liver failure and obvious ascites showing that had changes in her mental status. Blood ammonia levels, perhaps? The second was a 67 year-old male, status/post AAA repair 12 months ago having bi-lateral flank pain in the area of the bases of his lungs with radiation to his upper abdomen near his epigastrium. I'm not sure what was going on with him, other than he's had intermittent symptoms over the past 7 days. Vitals were all within normal limits, and he was in sinus tachycardia at a rate of 110 with a non-diagnostic 12-lead ECG. We had a three minute transport time, but his pain levels were high. I debated pain medication, but by the time I would have had the narcs box opened and the meds drawn up we would have been at the Emergency Room doors. I felt bad, but I turfed that to the hospital to initiate. I don't think it was an AAA-related event as he had no pulsatile activity in his abdomen and he was not hypotensive.

I started my summer reading this past week. I'm currently reading "The Historian" by Elizabeth Kostova. It is historical fiction, story about this young woman who's father, a diplomat, and his mentor while he was in graduate school, are all trying to find Vlad the Impaler, otherwise known as Dracula. It is a well-written story, and I am having a hard time putting it down. I had the same problem with Steve Berry's "The Alexandria Link", the latest of the Cotton Malone series. Also very well written, and quite suspenseful. I have been finding the the best reads have unpredictable endings. I like that.

More to talk about tomorrow. For now, it's time to find some sleep. Otherwise, those aforementioned toothpicks might snap, and that could be ugly.