Monday, July 28, 2008

Weekend Recap

I have to say that the shift I worked this past Saturday was probably one of the best shifts I've ever worked as an EMS provider. Not that it was chock full of calls - it wasn't; we only did 4 during the shift - but the calls we did were all legitimate, high quality, and either ALS or critical care, depending on the call itself.

My truck had the "team coverage", at it is known, for the Boston Children's Hospital on Saturday. Usually this happens if the Critical Care Transport Team doesn't have a Paramedic on the truck, and this was the case from 7:00A-7:00P. We took the team (it consisted of a pair of CCRN's that are also EMT's - a requirement to be on the team) out to the Framingham Union Hospital (now known as the Metrowest Medical Center; I'll always call it the Union because that's what it was when I was a kid) for a 29 week emergency caesarean section who was anoxic at the time of birth, and probably prior to being delivered, but that was an unknown at the time. When we arrived, the on-call pediatrician was working on putting an umbilical arterial line in but was having trouble. Some 5 attempts to confirm by X-Ray showed that it was coiled up in the artery and had to be removed. They also attempted to intubate this baby prior to our arrival, but they were also unsuccessful at that. It was close to an hour before the team got to actually assess this baby because of all of the fiddle-farting around that the pediatrician and the nurses assisting her were doing. Ultimately they put this baby on CPAP, which it turns out he probably really didn't need - he kept on pulling the prongs out of his nose, which I personally thought was pretty funny. Plus, I can relate well to the discomfort of those nasal prongs as I wear them when I sleep due to a really severe case of obstructive sleep apnea (I can't remember the number of times I've been threatened with intubation when I haven't had it on).

When the team finally was able to get in to package the baby for transport, they needed hands, and my partner Greg and I were very happy to oblige. We gave them all kinds of scut-type help, and they were really glad we were there, I suspect. When we got back to Children's, they let us know how happy they were for the help and the smooth ride back to Boston. And we were happy that they involved us. Most of the time, the team's Paramedic is basically in the mode of "I Paramedic - I drive." It was really no different with us, but it was an ego boost to both my partner and me that we were able to assist them.

The other really notable call we did was early evening. We got sent to the Somerville Hospital for an intubated patient going to the Cardiac ICU at the Mass. General. We arrived and were met by one of the BLS crews out of the Somerville district. I found out when we got there that we were the only available medic truck in the area - all others were either committed or out of service, which is why we got the call. We found a 76 year-old male, status post cardiac arrest. He was resuscitated by one of our crews earlier in the day and he'd been in the Somerville ED ever since. He was bradycardic with a rate in the high 40's, was in a first-degree block with occasional lapses into a junctional rhythm which would resolve spontaneosly, and he had a decent, perfusing blood pressure with a mean arterial pressure, or MAP, above 80 mm/Hg. Because of this, Atropine was proscribed as the sending physician didn't want to see his pressure go any higher and risk another arrest. He was indeed intubated and sedated with Propofol (also known as Diprivan or the "milk of amnesia", because of it's white color and milky texture which gives it a high lipid count). He was on a ventilator, so I got the settings and moved him on to our portable, which he tolerated amazingly well.

We packaged him and loaded him aboard our truck - both Greg and I were in the back and one of the EMT's from the BLS truck drove us down. Greg took care of monitoring the pump and the patient's vitals and I managed the vent and his airway. It was an extremely smooth ride, the patient was stable and tolerated the movement with not too much change in his status. His heart rate went above 60 for a short time and he flipped into the junctional rhythm for a couple of mimutes, but it sponaneously resolved itself shortly thereafter. We got him inside and up to Ellison 11, which is where the CCU is located. Upon bringing him in, the portable Oxygen tank attached to the vent went dry, so we got him on hospital Oxygen and started ventilating him manually until we could get him moved onto their ventilator. Thank goodness for ambu-bags.... Once we got him situated, the attending doc started to ask us questions. I think he was rather amazed (and, I suspect, impressed) with our ability to respond quickly and accurately to his questioning. He was looking for a fair amount of information related to the junctional issues the patient was having, and we gave him the answers he was looking for.

The other thing that happened that's worth writing about is that we got sent to Logan Airport at 3:00AM to meet the Coast Guard aircraft coming in from Nantucket. They had a patient on board suffering from a laceration to her spleen and internal bleeding, cause unknown to us. It had to be a pretty massive trauma, however, but we'll never know. When we got to the air terminal we were sent to, an AMR crew was there waiting for the same patient. After many phone calls and trying to get sorted out who was going to assume care for the patient, it ended up going to AMR. Apparently the family had the Nantucket Hospital ED staff call AMR to set up transport to the Mass. General, while the Coast Guard called Boston EMS, who then turfed it to Cataldo. In my experience, family preference in instances such as this tops anything else that is going on, which is why AMR got care. Frankly, it didn't bother either Greg or me that this happened. We would have gladly done the call if it had gone our way, but we were both happy to be able to get back to quarters and finish out the shift sleeping. That doesn't always happen, but it's good when it does.

Yesterday I got home and spent a quality day with my wife and my kids. We were all in the same place at the same time - amazing in itself. But it was really good. Overall, a pretty decent weekend.

Today is a catch-up day, as far as chores, tasks around the house, etc., are concerned. And away we go.....

No comments: