Tuesday, September 16, 2008

Disorder In My Office

Here I am, sitting at my desk, looking at the clutter that surrounds me. I have a huge pile of paper to my left, and a similarly huge pile of electronics and power connections to my right. Even further right is a fan, a container of index cards (unopened and unwrapped), two containers containing pens, pencils, and highlighter markers, and to my left is my newly-connected All-In-One. It is now capable of printing to all of the computers in my house as well as sending and receiving faxes. Again.

My point is that I am utterly beside myself as to where to start cleaning this mess up. I've been doing a lot of different things, including going back to the gym (I've needed to do that), doing the grocery shopping (that needed to happen anyway), and reading. I've started re-reading, for probably the fourteenth time or so, J.R.R. Tolkien's "The Lord of the Rings" trilogy. Right now I'm about halfway through the first book of "The Two Towers"; I just finished the sequence where Aragorn, Legolas, Gimli, and Gandalf made their way back to Rohan to see Theoden the King. And Wormtongue was an utterly nasty human being if I do say so myself.

Currently I'm listening to some music I haven't heard in a while, and it's giving my great pleasure to listen while I write. The harpist Andreas Vollenweider has had a place in my personal music library for approximately the past 20 years. He is quite eclectic; not what you would expect from someone whose instrument of choice is the harp. Also not the type of music that would make one think of the traditional Celtic music mostly associated with the harp, or of what passes as popular music covered by harpists. His genre is mostly New Age, but the mix of jazz and classical is in along with it. Plus, there is a decent amount of world mix in with what else he does, and the results are really quite good to listen to. I've actually got a number of his albums, and I am listening to "Dancing With The Lion", one of those with considerable eastern and oriental influences. I highly recommend the vast majority of his music. It is definitely worth giving a listen to.

While I was working in Boston this past Sunday morning, we got sent to the Signature terminal at Logan Airport's North Cargo area to meet the Coast Guard. The patient was a 75 year-old male with a subdural hematoma. When I got report from the Paramedic who accompanied the patient from Martha's Vineyard Hospital, she told me he had a 1 centimeter shift to the left, affecting the left cerebral ventricle. His main complaints were dizziness and a headache, and the onset event was a fall he'd suffered 5 weeks prior. His family was really concerned (as they should be) about changes he was having in his mental status as well as some issues he'd been having with balance. When he got to me, his main problem was a headache plus some unrelated cramping to his legs. That wss understandable; he'd been transported on a long backboard with a stretcher pad on the top of it. This made our ability to transport him more challenging as he was constantly on the edge of falling off of the stretcher. So, the first thing to go was the pad, and the backboard immediately followed. He had no cervical spine precautions in place, so there was no need of him being transported on it. I also had orders in hand for pain medication, so I wanted to do everything possible to make him comfortable. Fortunately, the ride from the airport to the Mass. General was only about 10 minutes. So the comfort issue was easy.

His neurological function was intact, as was his mental status. I was a little concerned about his blood pressure, but it turned out to be not the problem I expected it to be. As for pain, I only had orders for 2mg of Morphine; not enough to be effective, in my opinion. Plus, it was not taking the edge off of his headache, which was constant at 6/10. If I'd been in NH, I would have gone for a higher dose, probably closer to 5 mg. But I would have had to keep a closer eye on his respiratory status, his mental status, and his blood pressure, as they are all affected to a degree by opiates. But even 5mg probably would have had minimal effect on all of these factors. And it might have done a better job on controlling his pain.

Personally, I like Fentanyl more, as it doesn't have the effects on blood pressure and respiratory effort that Morphine does. But our resource hospital doesn't issue it, plus in looking at the list of approved pre-hospital medications in Massachusetts, it isn't there. I personally disagree with that simply because I have access to it in NH. Plus, I know it works. But who am I? Nothing more than a simple Paramedic, I'm afraid.

So now I have to look at this sorry excuse of a desk. The problem is figuring out what to do with all of this stuff. But I'll get to the bottom of it somehow.

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