Monday, July 06, 2009

Tri-Town

Working at Tri-Town Ambulance today. Tri-Town is headquartered in Pembroke – for those of you not familiar with Southern and Central New Hampshire, Pembroke sits just south of Concord and north of Allenstown. Tri-Town services Both of those towns as well as the town of Hooksett, just north of Manchester. Normally, Tri-Town runs a 24-hour truck based in Pembroke at the Fire Department and a 10-hour truck that stations in Hooksett during the business day. This will only last for about another year, however as the contract between Tri-Town and Hooksett will only be in force for about another year. At that time, I don’t know what will happen, but I suspect at the very least the conditions (and the name) will change.

I came in the morning at 5:00AM as the medic on the 24 needed to leave early to go to another job. I know how that feels as I’ve had to do that myself more times than I can count. And it was really funny, though not necessarily in an amusing way, because 10 minutes after I arrived we got a call. For a person not conscious and not breathing.

Heck of a way to start the shift – first one here since prior to my getting hurt.

Anyway, we arrived on scene just after the Fire Department, and when we got through the doors they were already with the patient, a 54 year-old male with an extensive history of cancer. Lungs, lymph system, and Leukemia. He was anorexic with a considerable amount of excoriation and deterioration to the skin on his torso. Cool, pale, diaphoretic, constricted pupils. Not responsive. Breathing on his own but not effectively – one of the firefighters was assisting with ventilations. He had lots of scarring on his extremities, likely due to the chemotherapy he had been receiving.

His vital signs were not good. Profoundly hypotensive and tachycardic. Blood sugar was slightly high, but not alarmingly so. The status of his pupils was interesting – something we tested on the way to the hospital.

Patient was extricated from the residence and loaded onto the ambulance. Continued his ventilatory support. Attempted to obtain IV access times 2 – only one stayed because he was tensing and flexing the other arm and blew the line in place that was there. After 0.5 mg of Narcan he started to become more responsive and able to interact with us a little bit. Seeing that result, my partner and I hypothesized that either he took too much of his prescription Vicodin or he somehow became intolerant of his regular dosage. When we asked, however, both he (and his wife a little bit later) denied that he’d been taking it.

I thought that was interesting – makes me wonder if this had happened before and they thought we would pass judgment on them. Considering the issues he has, however, I wouldn’t blame him if he did have something happen. I can’t help thinking that perhaps he’s approaching end stage and having pain issues that are becoming more difficult to manage. I could be wrong, but I’m not so sure.

We arrived at the hospital and got him into one of the treatment rooms. In the middle of my giving report to the nurse, one of the docs walked in. Turned out that it is one I know who used to work in one of the Manchester hospitals. He got one look at me and just sort of exhaled while he said, “figures it’s you.” He did say it with a smile, however, and it was good to see him too. I filled him in on what was happening, then we got out of there.

As I said – it was a great way to start a shift. Since then my partner and I have migrated to Hooksett and done one call – an MVC with no injury.

I like that better.

4 comments:

TOTWTYTR said...

I used to kid my friends up in New Hampshire that there are only about 20 paramedics in the state. Each of them has about four jobs to make ends meet.

Even though I was kidding, there is a lot of truth to that.

Walt Trachim said...

There is. And it's part of the reason why I do. Although I do okay in Boston, I'm catching up because I was out for as long as I was. And I'm going back to school in the fall.

I must be out of my mind.

Here's hoping you enjoy your vacation.

TOTWTYTR said...

Thanks, we will. I understand about being out for all those months. Nursing school?

Walt Trachim said...

I'll be taking prerequisites - I'll be applying to the direct entry MSN program at UNH sometime between now and the end of this year for a 2011 acceptance. Goal is to get them done (A&P I&II, Microbiology, Statistics, and Psychology by the end of next summer. When I go back it will probably be full-time and all but the job with Cataldo and my slot on GFD will have to be put aside. And I'm doing things I have to get done now (my medic refresher - online, and FCCS in August) so I'll be freed up for the fall.

It's a good move, and I'm nearly ready. And I've been looking for an excuse to go to grad school anyway.... :)