Thursday, October 16, 2008

PVC Challenge

Clinicals continue to entertain.

I'm way behind in my clinical paperwork... as soon as I finish posting, I've got to work on my charts for my ED shift last week, as well as my prehospital shift on Sunday. If I get all caught up, there is paperwork from the L&D rotation to do, too.

Anyway... the other night was a pretty busy shift. Started off with a major trauma after an MVA. BLS onscene called for us to assist. Patient had a femur fracture and signs of a head injury... so he got himself a ticket for a helicopter ride to the nearest trauma center.

I had a few other calls, but the last one was the most serious:

Dispatched for a CVA (Stroke). On arrival, the usually calm cop was a little panicked. PD said that the patient had just gone unresponsive on him after exhibitng sudden-onset, stroke-like symptoms.

The patient wasn't breathing well... fast, shallow, irregular respirations. We laid the patient down and he wasn't moving air and had signs of a brain injury, so we went for the airway.

After ventilations with a BVM, the patient started to look better. Gag reflex was intact, so I intubated nasally. I'd always head how easy it was... but I didn't really believe it. I had a little trouble at first, because I had to remember to push the tube BACK, not up. I was using a BAAM (a whistle that fits over the end of the ET tube), and all of a sudden, it started whistling. I checked lung sounds and secred the tube.

I was a little protective of the tube... because I didn't want to lose the tube.
Part of that reason was that I'd pulled a medic's tube out on my last prehospital shift... the tube just popped out... and I wanted to make SURE it didn't happen to me.

So... I got another first in the class. Someone else got the first oral tube... but I'm the only one with a nasal tube.

Tuesday, October 14, 2008

Tuesday - Post 1

So... I'm sitting at work. Working 2 hours overtime to cover a hole in the schedule. I'll take the money.

I'm about a month into medic school - and we've got some form of mid-term tonight. There is a study group gathering before class... and I might stop by.

I've been running myself ragged between work and school. I need sleep. I need a day off. I'm also sick - had a sore throat start last night during clinical, runny nose today, and I feel miserable.

I had 3 calls so far today at work - 2 were cancelled before getting to the scene, and the third was a moderate MVA - high speeds, limited injury.

Last night at clinicals was cool. I had the first shift of the class in Labor and Delivery. That meant that I was the guinea pig. I stood around looking a little out of place (6'3" big guy in gray shirt and blue pants surrounded by female RN's in green scrubs. Then they realized that I needed to get into scrubs - which I did.

I don't like wearing scrubs - at least not in public. My scrubs at home are reserved for around the house and use as pajamas. I'm used to having pockets, and thicker fabric. I feel so out of my element in scrubs. No trauma shears, no key ring, no glove pocket.

I got to observe a C-section last night. C-sections are WAY out of the paramedic scope of practice, but it is intresting to watch. Because I went through a different paramedic program already, but now get to start over from scratch, I'd actually already done a few shifts through L&D, but at a different hosptial, in the City. So I actually had seen one before... but it is still intreesting to see. I also spent a lot of time talking with a medical student doing his mandatory OB rotation. I learned some from him... and even more from watching the attending teaching him. I also spoke with a PA in the OR.

I've been in OR's before. I understood what was sterile, and what wasn't. I had to ask where I would be able to stand out of the way... but otherwise, stayed back and watched. The procedure seemed to go without any trouble, and the NICU folks were there to resusitate the baby, but didn't have to do much. Initial APGAR was 9. I had a discussion about that, too. Although the perfect score would be 10, they only usually get 9, loosing a point on color.

Anyway - it was a good experience. But I really hope to keep my rig "life-neutral"... no one dies in my truck, and no one is born in my truck. I've done pretty good on the second half, lately. OB was a great change for me - in my previous 2 clinical shifts, I'd worked 3 codes... 2/3 were unsuccessful. The 3rd one we actually got ROSC (Return of Spontanious Circulation)... AFTER we started working the code, the nursing home gave my preceptor the patient's living will, which called for no heroic measures. By the time we got this, we were transporting - so we kept going, consulting with the hospital staff. So we walked in the door and got a pulse back - but the patient didn't want to be there... now what? I'm not sure if the ED staff continued mechanical ventialtion, as the patient had no spontanous respirations. I'm going to guess that that patient died, too... making me 3/3.