Some needs to call the paramedics, Oh crap I am the Paramedic

So this morning I was sitting at the light in front of my house, waiting for it to turn green. Which sometimes it doesn't because it sucks and it stays red for ever and I have to call The Voices, who then call the city police voices, who then call traffic, who then fix the light. Well this particular morning, I was waiting for the light to turn, enjoyin my morning coffee an the new Death Cab for Cutie album, when I heard sirens and lots of them. I first think, how odd, I don't remeber Sirens in this song, them it dawns on me, its coming from outside. I see a fire truck, then another, then a ladder, the two squad cars. Phew, something big is going down. I cut off the car in front of my that won't turn and continue on my way. I find out when they were going in such a hurry.
I turn down the road on mu normal route and they are all clutered in front of the school with a bunch of cop cars, but no medic unit. I see the vehilce smashed all to hell and a man with all the fire guys franticly doing stuff over a man with lots of blood around the head area. I fly past all the chaos, and pull into the school parking lot, jump out of my car, barely remembering to put the damn thing into park and rush over. I am stopped by a police officer, mind you I am in uniform. "Can I help you?" He asked in that I'm a bad ass cop voice, even though he looked like my seventeen year old cousin. I look at him thn look down at myself, and go "Well I thought I might be able to help you, I'm a medic"
"Oh...OH....yeah...YEAH, go see what the fire guys need!"
I go walking over. "Hey yall, I was on my way in to work, thought you might need some help." I hear from behind me someone yell "Hey capt, he's CAT 1!" (Damn near dead) I turn around and he is guppy breathing, clamped down, blood everywhere. One of the fire guys, goes "We got a medic!, She needs a pair of gloves!" I get a pair of XL gloves thrusted at me from somewhere (I wear a small normally) And right at that moment I had a oh fuck moment. I was the only Paramedic. With nothing but a BVM and a pair of gloves. No drugs, no ambulance, no monitor. And at least six men turn to ME (gulp!) and go "What do YOU need us to do?" WHAT THE FUCK DO YOU MEAN "WHAT DO I NEED YOU TO DO" Oh Jesus Christ and all that is holy, I am now in charge. I am the senior Medic on this scene now. And All I could do was Bag this man. Breath for him. He still had pulses. We did have CSpine stuff, so we were starting to CSpine him when the medic unit pulled up. And never in my life have I been so happy as to see an ambulance. That 3-5 mins it took the medic unit to get there felt like an eternity. But when it did show up. I was happy to turn over care.

But I did have a Oh Fuck Me moment. A someone needs to call a paramedic, Oh shit! I am the Paramedic moment. When everyone, even though they were completly able and competent, turned to you. Because You have Paramedic in front of your name and goes, "Hey, what do you need?" I was alot of responsiblity that hit me all at once. I wanted to run away. But of course didn't. I had My fire guys taking care of me. And they did a wonderful job. So again I thank them too.

Gut feelings

My last post was about assessment. This one is about gut feelings. I get them. I know when I'm about to walk into something bad. And it's usually when I get it, very bad. I got it on the way to the Airport and when we walked in to a cluster of a cardiac arrest. (We brought him back, not only brought him back, but had him walking and talking, CAOx3 by the time we got to the hospital, they were doing CPR when we got there, he was D-E-D dead. and very much alive when we dropped him off at the hospital) I got one when we forced entry into a house and found a pt laying prone on the floor who looked up at us and took her last breath. I got one when I listened to that kids lung sounds from the last post. And most recently got one with a pt who called us after a syncople episode in his backyard. Pt was SOB and passed out. Even out in the heat pt was pale, cool and diaphoretic. You know how they teach that kis are either sick or not sick. Well this works on adults too. They are either sick or not sick. And this pt was very much sick. S-I-C-K. Cardiac sick. Pt had that look. Had a gut feeling. So pt got high flow O2, and a 12 lead. which came back normal. So pt got two more 12 leads 5 mins apart. Also normal. But something was not right. Pt was sick. Pt was hypoxic, fighting to breath. SPO2 was normal. But Pt was fighting the mask, and skin condiction never improved. Then as we were pulling into the hospital, pt respiration increased from 26 to 38. SPO2 dropped and near syncope. One more 12 lead. HUGE ST elevation in inferior and anterior leads with some slight elevation in lateral leads. The pt infarcted right in front of me. nearly arresting. I RAN him into the ER waving 4 12 leads in my hands. "Doctor! Doctor!, you need to come with me, He's literally infarcting right now! right as we pulled in. the bottom two are the first ones I did, the top one is the one I did right now like 30 seconds ago"

So gut feelings. Listen to them. They are normally right

Assessment

Don't you love it when nothing else is wrong, but there is one thing, one symptom, one minut finding that make you sit back and go, "Self, something is totally fucked up about this." You look at your patient, who looks fine, whose vitals are stable, but that one finding, that one thing is signifigant enough that your gut is screaming at you. I had that the other day. A young pt who had pain in inspiration "right here" and he pointed to a point on his chest on his right side. "A rubbing sharp pain?" I ask. "
"Yep. Excatly."
Pluresy. His vitals are ALL stable. Normal Sinus on the EKG, 99% SPO2 on room air, I put him on a canulla. respirations 16 non labored. Not fighting for oxygen at all. I listen to his lungs with my handy dandy stethescope. High tech little tool we have, not really, but very important peice of equiptement on the ambulance. So I instruct him to take a deep breath and hear very clearly breath sounds on the Left, but nothing on the right. Whaaayayayyttt? Okay do it again dude, Deep breath. And again, nothing on the Right. I look at the monitor and everything is normal. So ONE more time, deep breath, and once more....nothing on the right. But still vitals stable and pt not working to breath. I ask again any shortness of breath. No. None. Just a sharp pain and he can put his finger on it. He doesnt want to go to the hospital. I explain that I can't hear air moving on the right side, thats strange. I have a gut feeling that something is funky. But how do you explain to someone about gut feelings? I convince him to go. and we take a easy ride to the hospital.
When we get there, I tell the staff. "I know I sound like a crazy person, his vitals a completly stable, SOP2 is 99-100%, respirations are 16, and he denies SOB. But I swaer his has almost no lung sounds on the right. I know all I have in the feild is a stethescope, not exactly a chest xray. But I swear, I listened 8 times, my partner listened. neither of us could hear. So we brought him to ya'll. So you tell me...can this be a spontanous pnuemo even though no other signs and symptoms piont to one?"
The doc told me that I was thinking the more deadly Tension Pneumo, a small bleb wouldn't show up so seriously. SO I did what I could do in the feild and brought him to the hospital. So good job. They would do a chest xray and figure it out. He wouldn;t try an diagnose a pneumo in the feild.
Yesterday, I stopped by the ER, it was not only a pnemo, but a big one. Needing a chest tube.
This my friends is what you find when you do a good assessment.
Listen to Lungs, know what the sounds mean, do the 12 lead on that 78 year old whose only complaint is weakness ( I found a huge anterior MI once that way, again, pt was very stable, vitals, only complaint was weakness x 3 days, but there it was staring back at me plain as day). I have had several medical mysteries recently, where the patient was absolutly stable, but something told me, put them on the monitor and then caught the 2 degree heart block or the stable Vtach (yep, had that too) don;t put them with you EMT basic partner, as competent as he is, he can't give amiodarone or interpert a 12 lead. CHeck the drunks BGL. Oh shit it's 567. Thats why he altered. Yes there are times that sometimes a fall is just a slip and fall. Listen to your patient. They can tell you many things. And also listen to what they are NOT telling you. Sometimes that can tell you more.