Yes, we had one last night. Not that it was totally eventful, but I think I got a whole three hours sleep - WOO-HOO!! One other thing I got hammered with, though, is the start of allergy season. I'm miserable, and I had to back out of a commitment I had today because I feel like utter crap. The allergy meds aren't doing their job just yet, and I keep feeling like I got run over by a city bus. So between the relatively steady night and the onset of allergy symptoms, I'm a little bit wrung out. On the other hand, I do have this coming week off, and although I have things to do, I'll at least get to spend a fair amount of time in my own bed. I can't wait for that.....
I don't remember all of the calls we did last night (I think we did either 5 or 6 during the shift, which isn't really bad for a Friday night) but I do remember a couple of them. One that's notable is a call we got for a Psychiatric problem. A 16 year-old female with a history of schizophrenia and a history of anxiety, having what appeared to be pseudo-seizures. We got inside the residence and discovered complication number one - nobody speaks English. All of the folks who live in the house are Spanish speaking with limited English knowledge at best. Well, I can deal with that as my Spanish is pretty limited, so between all of us we were able to at least talk to each other somewhat.
It was interesting; this girl was unresponsive but would have these intermittent episodes of gasping for air and spasmodic movement followed by about a minute of intense sobbing, then back to being unresponsive. The onset was sudden, and it was paroxysmal in nature. My partner and I were mystified as to what the cause could be. A little bit more investigation on our part found that the girl had been seen at the Massachusetts General Hospital in Boston back in January for this, and nobody has an answer as to the cause.
We originally thought that perhaps she'd gotten into something that was opiate or opioid, so we did a rule-out with 0.4 mg of Narcan. No change. Then the intensity level of the activity climbed for a bit, which made us think that maybe there was something to this - Nuh Uh. Pretty much the same as before with a little bit more of a respiratory challenge. So I gave her 2mg of IV Valium to calm her down, and that worked at least until after we got to the hospital and it started over again..... I found out from one of the nurses that the symptoms self-resolved probably a half-hour after we brought her in.
I'm still scratching my head over this, but I suspect that she does have some sort of neurological issue of some sort. Not knowing enough about her history and the findings of her last visit to Mass General, I wouldn't know where to start looking.
We got called at 4:00 this morning to one of our local nursing facilities for a resident having chest pain. An 89 year-old female with a history of 2 previous MI's as well as Hypertension and Diabetes. Great.... I talked with the charge nurse - he was totally without clue - and found out that the symptoms started about 2 hours earlier. They'd given her 2 0.4 sub-lingual Nitro tabs and her symptoms subsided. About an hour later they started back up again, one more Nitro with no relief. They called her PCP who told them to call us. So we got there and I got all of this information, and my first question to the nurse was, "with her history and the fact that you gave her all of this Nitro, why didn't you folks call us sooner?" I guess my tone of voice rubbed him the wrong way because he got rather upset with me, and I thought he was going to try to rip my face off of something like that. All I said after that was that with 3 Nitro, continued symptoms, and no changes, we had better be on our way. So we packer her out of there.
Her blood glucose was a bit high in the truck (280 mg/dl), and a 12-lead ECG showed the signs of an impeding problem: she had a left bundle branch block and left axis deviation. In my mind, those were certainly a harbinger of trouble. She got 325 of Aspirin, but she told us that her pain had managed to resolve itself, so she got no more Nitro. However, after we brought her in (a 0.5 mile transport) within 20 or so minutes her pain returned and she got both Morphine and a Nitro drip. And the Morphine not only relieved her pain, but it also gorked her out. When I got a chance to stop in and see how she was doing, I found her sleeping rather soundly. Pretty amazing, in my view. I know if I was on a Nitro drip, it would probably feel like my head would explode.
One time I was setting up a Nitro drip on the back of my ambulance (I was a baby medic at the time) and I wasn't wearing gloves. I never, ever made that mistake again as I had a problem with the Nitro solution getting onto my skin. Within about 30 seconds I was sitting on the floor of my ambulance with a splitting headache and the spins. My partner at that time got my blood pressure, and it had dropped substantially, from normally about 116/70 to 94/40-ish. It got his attention, but I kept going because the patient we were dealing with at that time, it turns out, had a head bleed, so time was not our friend. I sucked it up and felt better a few minutes later.
Lesson for the day: don't spike a Tridil bottle without gloves. You will get wet, and you will go down. Never a good thing to have happen to anyone.
I don't remember all of the calls we did last night (I think we did either 5 or 6 during the shift, which isn't really bad for a Friday night) but I do remember a couple of them. One that's notable is a call we got for a Psychiatric problem. A 16 year-old female with a history of schizophrenia and a history of anxiety, having what appeared to be pseudo-seizures. We got inside the residence and discovered complication number one - nobody speaks English. All of the folks who live in the house are Spanish speaking with limited English knowledge at best. Well, I can deal with that as my Spanish is pretty limited, so between all of us we were able to at least talk to each other somewhat.
It was interesting; this girl was unresponsive but would have these intermittent episodes of gasping for air and spasmodic movement followed by about a minute of intense sobbing, then back to being unresponsive. The onset was sudden, and it was paroxysmal in nature. My partner and I were mystified as to what the cause could be. A little bit more investigation on our part found that the girl had been seen at the Massachusetts General Hospital in Boston back in January for this, and nobody has an answer as to the cause.
We originally thought that perhaps she'd gotten into something that was opiate or opioid, so we did a rule-out with 0.4 mg of Narcan. No change. Then the intensity level of the activity climbed for a bit, which made us think that maybe there was something to this - Nuh Uh. Pretty much the same as before with a little bit more of a respiratory challenge. So I gave her 2mg of IV Valium to calm her down, and that worked at least until after we got to the hospital and it started over again..... I found out from one of the nurses that the symptoms self-resolved probably a half-hour after we brought her in.
I'm still scratching my head over this, but I suspect that she does have some sort of neurological issue of some sort. Not knowing enough about her history and the findings of her last visit to Mass General, I wouldn't know where to start looking.
We got called at 4:00 this morning to one of our local nursing facilities for a resident having chest pain. An 89 year-old female with a history of 2 previous MI's as well as Hypertension and Diabetes. Great.... I talked with the charge nurse - he was totally without clue - and found out that the symptoms started about 2 hours earlier. They'd given her 2 0.4 sub-lingual Nitro tabs and her symptoms subsided. About an hour later they started back up again, one more Nitro with no relief. They called her PCP who told them to call us. So we got there and I got all of this information, and my first question to the nurse was, "with her history and the fact that you gave her all of this Nitro, why didn't you folks call us sooner?" I guess my tone of voice rubbed him the wrong way because he got rather upset with me, and I thought he was going to try to rip my face off of something like that. All I said after that was that with 3 Nitro, continued symptoms, and no changes, we had better be on our way. So we packer her out of there.
Her blood glucose was a bit high in the truck (280 mg/dl), and a 12-lead ECG showed the signs of an impeding problem: she had a left bundle branch block and left axis deviation. In my mind, those were certainly a harbinger of trouble. She got 325 of Aspirin, but she told us that her pain had managed to resolve itself, so she got no more Nitro. However, after we brought her in (a 0.5 mile transport) within 20 or so minutes her pain returned and she got both Morphine and a Nitro drip. And the Morphine not only relieved her pain, but it also gorked her out. When I got a chance to stop in and see how she was doing, I found her sleeping rather soundly. Pretty amazing, in my view. I know if I was on a Nitro drip, it would probably feel like my head would explode.
One time I was setting up a Nitro drip on the back of my ambulance (I was a baby medic at the time) and I wasn't wearing gloves. I never, ever made that mistake again as I had a problem with the Nitro solution getting onto my skin. Within about 30 seconds I was sitting on the floor of my ambulance with a splitting headache and the spins. My partner at that time got my blood pressure, and it had dropped substantially, from normally about 116/70 to 94/40-ish. It got his attention, but I kept going because the patient we were dealing with at that time, it turns out, had a head bleed, so time was not our friend. I sucked it up and felt better a few minutes later.
Lesson for the day: don't spike a Tridil bottle without gloves. You will get wet, and you will go down. Never a good thing to have happen to anyone.
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