Wednesday, November 12, 2008

An (Attempted) Substantive Post

Let's see if I can write something that has words of my own in it for once....

It's been a long time since I've been able to write about something even remotely work-related. Yesterday - while I didn't actually do any work per se - I had to go to Chelsea for some mandatory in-service training on some equipment we're going to be getting on our trucks. As of 12/1 we are going to have the Rusch QuickTrach for needle crichothyrotomy, and 12 of out 911 trucks will have the Zoll Auto-Pulse on board for use on a cardiac arrest. I've worked with the Auto-Pulse in the past; RRA had two of them on evaluation last summer, and I used on two codes. It was impressive; unfortunately, both patients were too far gone for it to actually save their lives.

One of them had a huge steak bolus in his airway, and the medic I was working with didn't expect to hit a wall with the ET tube. He just looked at me and said, "WTF? Take a look at this, willya?" I did, and I just started pulling meat out of this guy's airway with a set of Magill forceps..... He did pink up with the Auto-Pulse, but he'd been down way too long. The other crazy thing I remember about that call is that when the family found this guy, they dumped a bunch of ice down the front of his pants. I know why they did that; Hispanic family, non-English speakers for the most part, and this guy had a drug habit. They tried to wake him up with the ice, thinking that he'd overdosed on his drug of choice. Well, even if he did (Narcan didn't touch him and he had a CBG in the 200's) it still wouldn't have mattered as he was asystolic in the house. Multiple rounds of drugs and no changes to his rhythm (or lack thereof) basically told the tale. But he did get great pulses with the Auto-Pulse; that much was certainly true.....

I'd never seen the QuickTrach before, but it looks like a pretty easy device to use. Plus, the lumen on it is much bigger than a 14 gauge catheter connected to the jet adapter. Plus it has a piece of tubing that comes with it which can connect between an ET tube and an Ambu-Bag.

I like it.

It was also nice to see some of the people that I work with. I got teased about my injury, but I didn't care about that. And it wasn't mean-spirited in any way, either.

I went in to see the surgeon today - actually, I saw his PA. It wasn't a planned visit; I've been seeing some changes around the incision site that I got concerned about, and I wanted to get it looked at. He saw me this afternoon and was able to reassure me that what I have going on isn't a problem but pretty normal changes that are, on the whole, positive. First one is a hardened area above the top of the incision site, about an inch square. This is fibrous tissue which, in my understanding, forms at the top of the area of repair and it ultimately strengthens the tissue that had been compromised. Second, I'd noticed some decrease in capillary refill to my foot overall and some significant redness to the perimeter of the heel wound. Apparently, because my vasculature has decreased in size globally around my foot, my lymph nodes have taken over and increased the amount of lymph that I'm producing there. This would also explain why my foot is shedding skin like a rattlesnake that is molting. As for the heel wound itself, he doesn't see any sign of infection; he actually think it looks like it's healing on schedule, but he also, for the most part, is going to defer to the wound guy, and I'm seeing him tomorrow.

The only negative that came out of the visit is that I'm dealing with muscle atrophy in my left calf. This also is normal, and it is likely that I will not recover all of the muscle I had before the accident once I'm functioning again. Basically, this is a by-product of an injury like this, and all I can do is the best I can to recover what function is available. One thing is certain: when I do have the ability to work the lower part of my leg, I will be doing lots of leg curls and lots of bicycling work to get it back. Even if it is smaller in appearance, it's critical for me to get as much function back as I can. And I will do my best....

As days go, this has not been a bad one. In fact, probably one of the better days I've had in quite some time. How often does that happen?

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