Friday, February 22, 2008

Normal - What' s Up With That?

Yesterday was, for all practical purposes, a normal day. It was steady - we did 5 calls during the shift, which isn't bad at all - and it was a mixed bag. Nobody terribly sick or dying, but enough to make it interesting. I also had a second medic student for the day, and it's possible he'll be with me again but I don't know that for certain. His name is Jamie, and he's from one of the area programs. He's gotten all of his time in but he didn't get a lot of experience while he was riding with the other services he was with. Because of this, he felt he needed more time with a service that at least has something going on. So he spent the day with me, and I believe he's spending today at our place again - I'm told he's going to be with The Asian, but I'm not sure of that.

The Asian is one of the good guys - he's a Chinese Redneck. His father is of Chinese descent and his mother is a White American, and he is originally from Kentucky. I've known him now for going on 6 years, and he is one of the nicest guys I know, plus he's a really good, no-nonsense Paramedic. He's married to one of our other medics (who also is really good), and they have an 18 month-old daughter who is absolutely beautiful. I'm glad I know them; they are people I would turn to in a minute.

So the day consisted of the normal rounds of B.S. as well as a couple of sick people who we transported. The sick ones were a 47 year-old female with a history of liver cirrhosis and esophageal varices, and she'd been vomiting blood for probably 6 hours before she called for help. She looked rather unwell; she was pale, conscious but lethargic, and bruised up on both arms and legs. She told us she'd had an episode similar to this one a couple of weeks previous to this and she'd received multiple blood transfusions at that time. Finding her was a challenge as the house she lives in had multiple entrances on two different streets, but we ultimately located where she was.

There were a couple of things that, even though she was obviously sick, seemed a little bit sketchy. First, her pupils were pretty dilated, up to 5-6 mm, and her speech was slowed as were her responses to questions. Second, she wouldn't give up her list of medications to us. I don't know why she wouldn't, and it set a tiny bell ringing in the back of my head. I can't help but wonder whether or not she had over-medicated herself on some prescription benzos and didn't want us to find the empties. Call me cynical, but it did cross my mind....

Once we got her on the truck and started assessing her, it was clear, though, that she was in a bit of trouble. She was mildly hypotensive with a pressure of 90/40, but her heart rate was only in the low 80's and she had a decent Oxygen saturation. She was pale and a little cool, however, which can spell hypovolemia in most cases. She was a difficult IV stick because of this; my student tried twice and got nothing. I took a look and decided it was better to let the IV team at the hospital do their thing. She was conscious, breathing, and stable, so we transported with what we had. Once we got her to the hospital, I went to see her probably 15 minutes later and they still didn't have access on her, so I can only surmise that they weren't so worried about her status, either. But she did need more blood products, at least in my view, so I'm thinking that they'd have her accessed soon.

Another call we had was for an unconscious person at one of the local nursing facilities. We arrived and found this 78 year-old male, history of a stroke with right-sided hemiparesis, having periods of unresponsiveness. At the same time his Oxygen saturation would drop dramatically. He was on a non-rebreather at 15 liters/minute and I watched him become somnolent twice over 3-4 minutes. The nurse on the unit told us that he normally is awake, alert, and oriented appropriately, and his Oxygen levels are usually in the high 90's; we were seeing maximums of 85-86 percent with the high-flow Oxygen on him. So we packaged him and transported him to the Elliot, which was extremely busy yesterday but he got into Trauma-1. He's also being treated for thrombocytopenia, and because of this he was a massive bruise; we had no way of starting IV access on him because we couldn't find vasculature. He was stable during transport, and when we brought him in they started looking with no success. Another one for the IV team.....

I am watching it snow. Again. When will winter be over? As far as I'm concerned, it won't be over soon enough.

No comments: