Saturday, December 17, 2005

You mean he's really sick?

Well...I had my first real kinda live sick patient in two months. In the past two months I have been dealing with flu-like sympotoms times three days, fevers, sore throats, bullshit chest pain secondary to crack intake, spitters, depressed suicidals, ABD pains from too much egg nog, drunks, and anything that the police department calls us for. The poilce seem to think drunk is a medical emergency. Hell, I was drunk three days ago and I didn't need an ambulance. I needed a taxi and Advil. Anyways, back to my sick man. He was a fairly young veteran, 52 years old. The call had come out as Respiratory Distress secondary to Asthma. We were met outside by several police officers, a young male officer I have known since my days working the the ER comes up to me while I grap the airway bag and computer and says "B, He's got some kind of growth on his neck, I have never seen anything like it and he's bleeding...bleeding alot."
"So this isn't a Shortness?"
"Shortness, where the hell did you get that?"
"Our dispatchers told us this was asthma."
"Well I 'm not the meidcal expert you are, but I don't think this is asthma."
So I put the airway bag back and grabbed a trauma box and a D-tank. My partner was already in the house. The front door is a peice of plywood and there is another door to the immediate left. The doors swing in the oppisite directions so you have to close one door to open the other. (this detail about the doors is important in the extrication od the patient from the residence) It is a tiny one room apartment where these two best friends live together. It reeks of cheap booze,cigars and the metallic scent of blood. A small black and white TV blares on the floor. The paient is sitting on the blood soaked bed being supported by his buddy. He is damn near dead, unresponsive with no radial pulses. He friend tells us what happened. The large tumor on the mans neck had split open and had started squirting blood. The man was covered in it, as was his buddy. His friend had tied a tee shirt around the wound and was holding pressure on it. "M..M..Miss ambulance lady...It just started bleeding...I...I...I Put this on it, but it just wouldn't stop. Y..You help my friend? I felt for my patient and I felt for his friend who even though was somewhat intoxicated knew to call 911 and knew to put pressure on the wound. He had a look of sheer panic in his eyes. I gathered all the infomation I needed from the buddy while my partner called for the fire ddepartment. The extrication from the house was gonna be tough because of the way the doors lined up. And the fact he was COVERED in blood. So the fire department showed up and we wrapped him up in what is refered to as a "Shit Taco" ( a huge fluid proof yellow sheet) And carefully carried him out of the house. We get him in the back of the ambulance and he is still only alert to pain. I lay him back and throw his legs up in hopes to bring his pressure up somewhat. The wound had quit activly bleeding for the most part. It was still slightly oozing. The first offical Blood Pressure was 72/44. He had shit for vascular access. I tried 6-7 times for a line my partner tried twice. My second pressure since putting him the trendelenburg was 92/50 and he was starting to wake up a bit. If you hollered his name he would look up at you. After trying for several lines I just look up at my partner and tell him to just get me on the road. He needs a central line and blood. Cat Two, please and ER's channel. High flow O2, High flow diesel is all I can give him. By the time we arrive at the hospital he is more awake and starting to fling blood around the box. I learned from the hospital that the tumor had started out dime size about six months ago and he had refused all surgery. It was now the size of a large grapefriut.
The rest of the night was uneventful, a broken leg, a drunk and a weak all over.

Also of note I had my court date for the speeding ticket. Reduced to two points and $77 fine. Accoding to the judge I could have just called, I didn't have to drive all the way out there to get it reduced. Apparently the arresting officer had told him that he had told me that. Which he hadn't of course. I couldn't even get the courts phone number out of the officer....damnit

1 comment:

Anonymous said...

Interesting case. Nice work. Someplace along the line it dawns on you that you didn't do the pt. any favors by saving his life since he has been refusing lifesaving therapy right along. I try not to think too much abou that.