Wednesday, April 09, 2008

Training

I worked in Goffstown last night. Tuesdays are reserved for department training: the first Tuesday dedicates training to the fire side of the house while the second dedicates training to EMS. We also do trainings on the third Monday night and the third Wednesday morning, or something like that; I can never get it straight. In any case, we were supposed to have the director of the Cath Lab at CMC come and talk to us last night. Through some scheduling faux pas, he didn't show, but he will be with the day crews next Wednesday. That sucks for me - I'm scheduled to have the second half of my occupational health physical that day.

So Mike, one of our guys, also does our training. He is an EMT-Intermediate with probably a million years of experience as well as knowledge. However, he has never been able to pass the National Registry medic exam because he has test takers block. He also has ADHD (just like me) and takes the same medication I do. But that's for another day.... He did a class on the basics of cardiology, ECG rhythms, and 12-lead ECG's. Not a bad class, but a number of our EMT-Basics and Intermediates approached me after the class was over and told me that I should have taught it.... I can't imagine why they would tell me that, but it may have to do with a class I taught back in January. It was a refresher review for all levels, and I covered some of what was touched on last night. Some of the people in last night's class were in that class as well, and they told me that I made the information understandable at any level. That made me feel a little bit humbled. Also resolved to get me to keep doing that, just because of how important it is to understand why we do what we do, not just how to do it.

About this occupational health physical. The department contracts with one of the national companies that does this sort of medical certification, and we are required to have one every year. I have no idea why, unless it's a liability issue for the department of some sort. It's a two part process: part one is all of the preliminary stuff: lab work (both blood and urine), a chest X-ray, a 12-lead ECG, a vision and a hearing test, and a pulmonary function test. Since I had blood work done when I had my annual physical with my PCP, I expect to not have to go through that again. The second part is the actual visit with the physician where he asks all of the questions and does his exam. The only major differences between the visit with my doc and with this one is that my doc didn't do a prostate check - told me I didn't have to worry about it until my 50th birthday. The occ health doc, on the other hand, will indeed do one. I am not happy about that, but since we have a history of prostate cancer in my mother's side of the family, I don't complain. All of that said, I had a Prostate Specific Antigen (the dreaded "PSA" test) drawn last year, and my level was near zero. The levels are measured in ng/ml (nanograms/milliliter), and most men usually are at between 0 and 4. It becomes more worrisome if the levels go above 4, and is a problem if it is at 10 or higher. The other problems that aren't related to cancer are Prostatitis and Benign Prostatic Hypertrophy, or BPH. I've had Prostatitis before; it is extremely uncomfortable. Usually it is treated with anti-biotics and an analgesic called Pyridium. That's actually a funky drug; it eliminates the discomfort while turning your urine a nice shade of orange. Not a visual I want to think of myself....

Yesterday was a transfer shift in Manchester. I worked with an Intermediate who is also a RN - she works at Children's Hospital in Boston. An awesome person to work with, knows her business, great sense of humor. We did almost more city calls than transfer calls yesterday, but not quite. Actually dealt with some pretty sick people, the most notable was a 18 year-old female that got into her father's Phenergan - took 20 25mg tabs, followed with a handful of 20 mg Lipitor tabs, all chased down with a bottle of wine.

She was still awake and talking when we got there. Very lethargic, pupils dilated at 6mm. Got IV access in her left hand as that was all she had to work with. She had a heart rate of 78 with a sinus rhythm on the monitor. She had decent color and good skin temperature, and by virtue of her being awake and talking to me she was protecting her airway. We got her to the hospital, and my guess is that they were going to charcoal her, but sometime after she'd been there - maybe an hour, I'm not certain - we had passed through with another patient, and I looked in on her. Something happened as she ended up on a ventilator. I wasn't able to find out more because of time constraints, but I will try tonight when I go into work.

I know that drugs like Phenergan, and any other Phenolthiazine, are pretty toxic in large doses. They can do damage to the liver, and they can wreak havoc with the central nervous system. That may be why she was knocked down and intubated. I'm just glad she was still conscious when we got her; no telling what could have happened otherwise.

On another note - we almost have our driveway back. It's only a matter of time before the snow at the far end melts. More to follow.

3 comments:

Sean said...

The physcial is an OSHA requirement for fire departments if part of your job description requires you to wear a respirator (ie SCBA or APR). ;)

manchmedic said...

I figured it had to be something like that. And I just love to put SCBA on....

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