D for Danger

Our last nightshift started straight at the begin of shift, no time for a vehicle check. I hate having to head out before having given everything the once over.

We arrived at the scene of some recent domestic violence. We had a face vs. fist (our customer), and an alcohol fueled face vs. fence (coppers customer).

Both parties were intoxicated, one scared, the other violent. Even the neighbours were drunk, aggressive and threatening to join in. The whole situation was touch and go, so we did just that, and stopped around the corner for some treatment.

• Note to self: If you don't feel comfortable, just leave.

Ooooh you know it sounds so obvious, but you kinda feel paralyzed in the first-of-a-kind job. Won't happen again, next time I'll be in and running out of there like a good curry...

A few transfers down the track we get called out to someone who requested an ambulance, but then hung up (so our communications centre told us). Then some further information seeped through, apparently our patient was having seizures. And surely, there was something going on neurologically, something in her brain was not quite right.

On arrival she was quivering, like a mountain of jelly, not communicative, and apparently with a known hypersensitivity to Midazolam, which is a drug which may be given to those unfortunate enough to suffer from prolonged seizures.

Not much we could do, but get her to hospital, due to her size we needed another ambulance for lifting.

What did I learn out of this? Not much, but I did see my first pseudoseizure, and realized that if you really want to, you really can. Can tolerate a semi rigid 15 cm tube stuck down your nose. Can tolerate a 10 cm rigid piece of plastic stuck in your mouth. And even tolerate this down your throat...even if only for 10 seconds at a time (the video get's interesting at ~1:30) Pretty impressive, and every mans dream :-)

The night ended with two call outs, just lifting elderly gentlemen off the floor. Easy, especially in this case due to the fact that a) they both refused hospital, b) they were in palliative care and wanted to die at home, c) their doctors were going to see them the following day anyway.

We got offered a cup of tea at both jobs, very nice - but I don't drink tea and we did have to pop ourselves back in to bed (it was 2am and 4am).

On a side note: a couple of us met up for drinks on the weekend, was good seeing people out of uniform and being able to talk without having the next call in the back of my mind. Even some of the ED staff came along and turned out to be pretty cool people. I must say this job (and related professions) attract some really interesting people.

But they all figured out that I have a background in IT. I am, and always will be, a bit of a geek :-)

Things that make you go *cringe*

My current paramedic Kath thinks I make awful jokes. Kath thinks they are getting worse by the minute. Kath seemingly does not appreciate such humour.

Zoom back in time to this morning.

Station: "BEEP BEEP BEEP BEEP BEEP"

We walk, half asleep to the van. I am driving, Kath is attending. I grab the street directory to look up where we are going.

Me: "OK, map reference 186 K9"

Kath: "That's a nice name for a dog"

Me: "Hmm?"

Me: *blank stare*

click

Ouch . That was bad.

not much going on

No really, it's quiet. Currently I am keeping my stuff up to date.

I carry a A4 bright green file (my fave colour) around with me, with plastic sleeves inside. I collect heaps of good information (about drugs, experiences from past jobs, CPG's etc etc.) and keep them in that Folder. I also fill out my PCRFs (Patient Care Record Forms/Run Sheets) out with it. It follows me everywhere. It is my second brain.
So it is being restocked now with updated info.

Didn't pick up any good info whilst driving the last shifts, but I did do a Paediatric Transfer the other day, with doctor and nurse escort. Things to remember:

• A Head Box is a see though plastic box where a Kiddies Head goes in, the rest of the body is exposed. Used for Paeds in respiratory distress to give them O2 (30-60%), the Oxygen is blown from the top down, which has the great effect of a) blowing the CO2 away from the kiddies airways, and b) not drying out their eyes (hence why little wee ones shouldn't be put on O2 masks for prolonged periods). Picture.
• Kiddies don't breathe through their mouth until they are around 6 months old. Good to know for suctioning and choking.

On a side note, went to the local childrens hospital the other day to bring in a stable patient. Took a while to get him seen, as they had a status epilepticus in on of the resus areas, and another child with a severe, and I mean severe asthma attack. It was interesting to see it, but one look at it (without ever having seen a child like that) told me it was at deaths door, knocking, but the Reaper hadn't decided whether to let it in or not.

Education in this job is invariably linked with suffering from others.

Reunion

The new station I am at has not brought much excitement yet - but I'll give it a few more shifts before I give it the stamp of boredom.

Second last shift I was driving, not much to grab from there, but I did pick up a great story from an older lady:

She was a war widow, and had lost her husband (who was in the navy) in WWII. He was on a battle ship when it got hit, and sunk somewhere in the middle of the Pacific Ocean.

Midway through her grieving process (after three months to be precise), an american sailor walks through her door and greets her.

Well... after the initial shock of "Who the hell are you to walk in to my flat!?" turns out that it was her thought-to-be-lost husband.

"What the?" I hear you ask.

The Background:

The ship he was serving on sunk all right, but he was luckily rescued by a passing american battleship, which was on its way to America. Having lost all his clothes, he was fitted out with some spare american uniforms (naked would have been awkward).

Arrives in the US, sends a Telegraph to his wife stating that he is alive and well, and proceeds to jump on the next ship back to Oz.

The said telegraph arrives half an hour after Mr Presumed Dead does.

Funny things that life brings up sometimes.

First Day, Second Roster

So, on Saturday I finished my first 8 weeks on the job with my fist "On Road Tutor", an experienced Paramedic who is supposed to show us newbies the tricks of the trade.

Well, in a massive stroke of luck I got teamed up with probably the keenest medic on the job. Which suits me fine, as I strive to be the keenest student on the job :-)

To sum it a in a silly little rhyme:

The 8 weeks flew

my confidence grew

And now I'm with someone new.

Gotta get used to working with my new crewmate, the first shift seemed OK, I'm sure we'll get used to each others working ways.

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Things I picked up:

• Went to a broken tib/fib, sporting injury. Never really done one before, and I openly admit I've always felt that I am rubbish at bandaging, and the calls that come with having to bandage people limbs. Must remember to expose the limb (in this case, cut his socks off).
• Broken bones (legs, in this case) can interfere with peripheral (in this case foot) circulation. I was damn proud of myself to remember to check for a cap refill less than 2 seconds, also checking for warmth and neurological deficits (with I damn well forgot to write down on my form). What I did forget was to check for a pedal pulse. If you want to find a pedal pulse for yourself, check this out (from http://meded.ucsd.edu/clinicalmed/extremities.htm).
• Whilst on the subject of exposing - remember to expose bilaterally. It was only en route that my paramedic reminded me to take the other shoe of, to be able to compare colour etc with the healthy foot.

The other two jobs were nothing special - a chest pain (getting good at these, but still not quite there yet) and a transfer from airport to hospital with a grumpy doc accompanying us.

Nightshift tonight...I wonder what awaits us?

Overheard in ED

Triage Nurse: What is your name?

Patient: *stutters, looks frustrated, mutters something incomprehensible*

Triage Nurse: What language do you speak?

Patient: Inlisch

Triage Nurse: No you don't, otherwise I would understand you.

Patient: Inlisch

Triage Nurse: What day is it today?

Patient: *stutters, looks frustrated, mutters something incomprehensible*

Triage Nurse: What is your name?

Patient: Inlisch.

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After that brief but very amusing conversation, I went to restock my ambulance.

Trauma in the elderly

Went to a lecture today at one of the major hospitals in town about "Trauma in the elderly".

Turns out that calling people elderly is now deemed ageist, go figure. Certainly not going to stop me, personally I think this whole politically correct movement has gone way too far for far too long.

Anyway, here are a few key points I picked up:

- Physiological Changes in the Elderly include

• Cardiac
• Pulmonary (decreased mucociliary clearance)
• Neurological (the brain shrinks with age)
• Renal (less nephrons available)
• GI tract
• Immune systems
• Musculoskeletal

- Meds: May mask problems (more on that later)

The elderly often take

• Antihypertensive drugs
• Antiplatelet/Anticoagulants
• Antideressant and other related psychiatric drugs

- Beware of Co-morbidities in the elderly

- Most common site of injury for elderly patients:

• Head
• Pelvis
• Lower limbs
• Wrist

Older patients have 2x the risk of sustaining c-spine injuries

- each rib fracture increases mortality around 19%

- Patients with >2 rib fractures should be admitted to hospital

- ABCs

• Reduced Airway Reflexes
• Difficult Airway
• Less sedative doses
• Higher vent rates
• Diagnosis of shock difficult (antihypertensives, Beta Blockers...)

- Many elderly patients have a Vitamin D deficiency. Vit D plays an important role in bone strength, and can be obtained from sunlight exposure.

- Adapted for us ambulance staff: If a patient has had a fall, or is likely to have a fall (regardless if they refuse transport to hospital), get a Falls Risk Assessment done. This may vary wherever you are, but it's usually linked to social/community/other government service.

- Another prehospital tip: document on your case sheet how the patient lives: 'independent', 'independent with support' etc. Important for the hospital and further treatment, if any intervention is needed (stairlift, rails, ramps etc).

- Some definitions:

• older: >65 yrs
• oldest: >85yrs

In Australia, an indigenous (aboriginal) person is classed as 'older' above the age of 65. This is due to their shorter average life span (~19yrs les than the typical white population).

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All in all a great seminar, with a few good hints and background information that I picked up. I'll keep those in mind the next time I have an ELDERLY (sorry, couldn't resist) patient. Which will be soon, as they always seem to have a tumble here and an ache there.

I don't mind, hey, I signed up for this job well knowing what it's all about!