Thursday, December 17, 2009

The Freezin’ Season

Yup – it is very cold up this way.

I’m not sure what the temperature is, but I can’t help thinking that it’s not 10 degrees F outside. I do know there is also a wind chill, and that is adding to the discomfort.

It’s a funny thing how we as humans complain about extremes. We know they will occur and we expect them at different times of the year. Yet we still complain. I suppose it is in our nature, but I still think it’s pretty funny. And I will readily admit that I am as guilty about that as anyone else.

I’ve been working off and on this week getting ready for final exams. We have a written exam (available on-line from about 6:00 this morning until just before midnight tomorrow) and a practical tomorrow evening. I’m not stressed about the written; it is open book/open notes, and if I don’t know where I can find information I need by now, I’m sunk. The practical, on the other hand, is a different story. I am worried about that because of how poorly I did on the first one. But it’s like anything else: don’t look back at what’s happened. Try to be ready for what is to come and do the best job possible.

I’m trying to make that happen. Plus, I’ve had well-wishers, both on-line and in person, and that helps a lot. Makes it a little less stressful and motivates me to do the best I can.

Had a call yesterday while I was working in Goffstown that makes me definitely not want to be in a nursing home. Called to the county nursing home – usually gets above average marks in my book – for a sick person. Now, you never really know what you’re going to get with that kind of dispatch; the illness could be absolutely anything. So we arrived to the unit we were dispatched to for a 59 year-old female who has a diagnosis of right lower lobe pneumonia and hospitalized until Monday for this. Since being sent to the facility she’s had a gradual increase in respiratory distress as well as changes to her mental status. Plus she’s had a moderately high temperature to boot.

We found her in her bed lying at about a 30 degree angle with a simple mask on her face giving her 5 liters of Oxygen. Her saturation was at between 77 and 84 percent, so our first move was to get her on a higher concentration with a non-rebreather mask. This brought her up into the 90’s, but she still was having a lot of respiratory difficulty, including accessory muscle use and grunting. This was not a good thing. She also had expiratory wheezes in both lungs, which were hard to pick up because her effort was rather shallow and rapid. But they were there; it made me suspect that the pneumonia spread across to the left lung. I also suspected maybe the beginnings of respiratory failure were setting in, but I couldn’t be sure. She’d gotten both Acetaminophen and multiple nebulizer treatments before we arrived, so there wasn’t much we could do for her chemically.

My partner, also a medic, was able to get access on her before we even got out of the room. And we pretty much scooped her and ran. Patient is also an insulin-dependent diabetic with a glucose of 348, up from 266 prior to our arrival. I have no doubt the increase in her glucose level was due to her metabolizing her own glycogen stores because of the fever, among other things. When we arrived at the hospital she went to Cardiac 1. The trauma bay was full, and probably 10 minutes after we arrived a Rockingham crew brought in a STEMI. So at 6:00 yesterday morning, CMC’s ED was rocking.

On that note, back to the books for a while until we get work to do.

Stay warm, wherever you are.

1 comment:

Medic7 said...

Good luck on the practical Walt...but, ou know yluck really has nothing to do with it. I think you'll be amazed at how much better you do on the second practical. Mine was the same way. Our A&P prof gave us abysmal scores on the first, and by the time the second practical rolled around, we were all on our game. In A&P, you just seem to suck up information by osmotic pressure.

Have a great holiday break, all the best to you and your family!