Friday, January 25, 2008

A Bright, Frosty Day

I have no idea what the outside temperature is as my outdoor thermometer is located in a bad spot - it gets direct sunlight because its back faces south. When I looked at it a few minutes ago it said 46 degrees F. I don't believe it. According to the folks at accuweather it is 22 degrees outside with a wind chill that makes it feel like it's 13. Now that sounds more like it!

Kind of a nice day at work yesterday. We had a class in the morning about Vascular Access Devices. My understanding is that we have three patients in the local area here that have them and we have to know how to deal with them should we have to transport one. Basically, the device itself supports the left ventricle on someone whose is in failure. The input and output for blood flow to the tubing is surgically implanted, with one opening in the bottom of the left ventricle and another in the aorta so as to allow blood which would normally be ejected out of the LV to go into the pump and be transferred that way. Anyone, by the way, who has one of these devices is on the list for a heart transplant.... Should the patient go into arrest or some sort of failure, the method of CPR is not to do chest compressions but to assist the pump manually with a device that looks like a bicycle tire pump. The patient carries a bunch of stuff with them when the travel, including one of these pumps. There is also documentation that the patient has, including contact information for their cardiologist. And the ultimate place they need to be is on the cardiac ICU at the Brigham and Women's Hospital in Boston. So at least we have no surprises with that.

Otherwise it was a relatively slow day in Manchester, at least for us. We only did 4 calls, compared to ALS-4 which did 7. I felt bad for them, but Jenn, the medic on the truck, had a partner that was sort of new to the system status management platform and wasn't aware that he shouldn't be taking his time at the hospital. They got stuck outside a bunch because of that.

One of our calls yesterday was for a very drunk patient passed out on a Manchester city bus. He'd been at CMC overnight for being extremely hammered, and we ended up taking him back for the same thing. He was extremely uncooperative (big surprise there, huh?) and he wouldn't move - totally dead weight. In any case, we got him off of the city bus and onto the ambulance with the help of one of the engine companies. His blood glucose was 114 - rule out of hypoglycemia - and he didn't respond to Narcan. The ETOH odor was quite strong anyhow, and it was enough to make me want to be on the bus parked next to the one he was on. He got a fluid bolus on the way back to the hospital, and he ended up parking in Cardiac-1 after we brought him in.

Waste of a bed, in my opinion - he should have been put in a less acute room. If a true cardiac emergency had come in, he would have had to be moved out anyway.

Now, I don't want to sound callous. I know that alcoholism is a real disease and a true problem for a lot of people. However, the repeat offenders are the ones who are in the system for other reasons, i.e., they're homeless. If someone like this patient (who I know is a repeat customer) has this problem, why can't he follow the recommendations that he's been given to get help? Good grief - there are numerous public programs as well as some that are taxpayer-funded (another story for another day, of course) that he and other could be taking advantage of. Why can't they just do it and leave emergency resources alone so that people who really have medical emergencies can get help when they need it? That it totally frustrating....

On the other hand, I was working in Goffstown this past Tuesday night, and we got a call to go to St. Anselm College and stage. We were also asked to call Base 100, our dispatch center at Goffstown PD. They told us that there was a suicidal student on the top floor of one of the residence halls and they wanted to have us wait until the scene was safe. When we finally got to the scene, there was a whole host of people, including St. A's security and their Rescue Team (affectionately known as "the rescue kids") as well as three police officers. It took about a half-hour to talk this guy down, who was really huge - about 6'6" and well over 300 pounds. He'd taken an overdose of multiple medications that were his prescriptions: Lamictal, Triaxifen, and Ativan. Plus from what I was told afterward, he had a noose hanging on his overhead light fixture that he attempted to hang himself with as well as a knife, as evidenced by a number of superficial wounds to his neck. Not a good situation, all the way around.

In any case, we were able to walk him out with great effort (he was slurred in speech and he was a bit unsteady on his feet) as there was no way to carry him out without a myriad of help, and the folks that were on scene weren't people I was willing to use if I had to go that route. We transported him to the hospital, and from there I know he ultimately got admitted to the Psychiatric Institute there.

As I was writing this I got a phone call from my station manager, who is also our clinical director. I've written before about issues with new paperwork that we have since we've got new forms from Medicare. Up until now, I've not had paperwork returned to me, but it seems I have a stack coming my way and he wants to talk about it before I go on shift tonight. He also seems to think I've been giving medical staff at the ED's bad information about their need to sign off on these forms. I haven't done that in any way, so it will be interesting to see what he's been told. As far as the returned forms, I can't think of what I would have overlooked as I try to be thorough to the extreme. But we'll see what's up when I get there.

More this weekend, and I'll talk about the continuing paper saga then....

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