On Rope.

I am now a Level I Rope Technician. Hells Yeah!. So Below are a few photos from our Technical rescue class we had this weekend. A Three day intense as hell class which ended with the building of not one but two massive Highlines over the harbour. we made Anchor points out of nothing in mid air. We did change-overs and pick-offs. We made all kinds of cool shit that my brain can't even wrap itself around right now. But it is the coolest thing I have ever done is to ride a high lie 100 feet in the air. If any of you fire, medical people ever have a chance to take the OnRope courses (www.onrope.com) Fucking do it. It is AMAZING. and you will leave knowing things you never though you would ever understand. I had my AhHa! moments in this class.

Thumbs Up!

Thumbs Up!
Originally uploaded by artist in the ambulance 190.

The Whole Shebang

The Whole Shebang
Originally uploaded by artist in the ambulance 190.

Building the Anchor

Building the Anchor
Originally uploaded by artist in the ambulance 190.

I made a city Yall

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Kinda Cool. Not quite sure what to do now...

Holy Crap, I actually saved one.

The Angel of Death saved a life. Yep. I know hard to believe but I did. Converted them right outta SVT (SupraVentricular Tachycardia AKA really fucking fast heart rate) with a little prayin' and a little drug I like to call "this is gonna make you feel reeeeeal funny" or Adenosine. Now Adenosine basicly is a drug that stops the heart, causing it to reset and start back up at a normal rate, the patient can have anywhere from a few slow ectopic beats to a period of asystole (flatline). It causes the paramedic to have a breif period of "Oh shit don't stay in Asystole". which they normaly don't, but given my track record, I wasn't taking any chances, I had the difib pads ready, the intubation kit out and fire department on the way. None of which I needed, but like I said, wasn;t taking any chances. So this is how it started. Got called to Chest pain on a young patient. now young CPs are normally bullshit...or crack induced, so when we go the address my partner and I were taking bets on whether it was anxeity or crack. Pull up to this trailer, go inside young pt sitting on sofa, CAOx3, looks fine, complaing of chest tightness. I grab the pt wrist to get a quick pulse, but it was a kind of half-assed gesture so I didn't think much when I didn't feel anything. They was about four other people in the room and I didn;t know if [the pt] knew any of them closly so I didn;t want to go over [pt's] whold medical HX in the house. Pt looks fine so we ambulate to the truck. I sit pt on the stretcher and start with the questions as I put the monitor on [pt] and get the 12 lead cables out. Still haven't looked up at the screen yet. The blood pressure beeps that its done cooking and I then look up. and Holy fuckballs [Pt's] heart is just tachying along at 212. Pretty little narrow complexes. Well I know why your chest hurt darling and why I couldn't feel a radial you got a pressue of 80. Lets just lay back and put so oxygen on you. My Partner god love him got a line for me, the only one he could, a 22 gauge IV in the right wrist. Not the best but it was gonna have to work. Which is where the prayin came into play. So I hit her with the 6mg. Which everyone knows 6mgs of Adenosine never works. Then I hit her with the 12mgs. Which worked goddamnit. Even through a 22g in the wrist. I had never given Adenosine before. I have been there to see it work. Be never been the one to push it. And it worked. I fixed her. I saved her. I'm a pretty good medic.

Okay People...Here's a Medical Lesson

A few days ago a local news crew did a story on a local County EMS system on bad response times and high employment turnover. The story, while had some vaild points, was for the most part, and for lack of a better term, Bullshit. And while I have lots to say about all of that today I'm gonna talk about something that one woman they interveiwed said that made me want to shoot my own television. Her daughter had dislocated her shoulder, which , from what I understand, she has done many times before. While I understand this injury is very painful. It is not life threating. It blows the big one. And I am very generous with pain medication for my patients show that dislocated or broken a bone. But will you die, not likely, unless you have massive multi-system trauma like bliteral femur fractures and a broken pelvis. Then we start to worry. Anyways, Im getting off track...So Mom's being interveiwed...blah...blah...we waited three days for an ambulance to show up...blah...Then she said it...a statement all Paramedics cringe at..."She could have gone into SHOCK!" What the fuck!...Come again...So here it is a lesson on what is and isn't SHOCK.

Shock is defined in most if not all medical textbooks as: A state of inadequate tissue perfusion. Now there are several types of shock.

Hypovolemic: a reduction in cardiovasular volume AKA bleeding to death or Plasma loss such as the case with Severe burns or Fluid and electrolye loss from massive vomiting/diarrhea.

Distributive: Shock that results from mechinisms that prevent the distribution of nurtients and removal of waste products. The blood and other fluids can't get were they are going due to either poor vascular tone or other reasons such as infection
Anaphylactic: A severe...SEVERE alleric reaction that results in the bloodvessels dilating and movement of fluid in to the interstial space AKA the vessels a too big and fluids are going where they don't need to be.
Septic: Massive Infection were toxins crompromise the vascular's systems' abilty to control blood vessels and distribute blood. AKA the blood vessals are to sick to work right so blood can't get were it needs to be

Obstructive: shock resulted from interference with the blood flowing through the cardiovasular system. AKA...Something plugging up the pipes and/or the pump

Cardiogenic: shock resulting from failure to maintain blodd pressure due to inadequate cardiac output AKA they be having the BIG ONE causing the heart to fail therefore it's not able to pump blood through the body

Neurogenic: shock resulting from an interuption in the communication pathway between the central nervous system and the rest of the body resulting in decrease peripheral vascular resistance. AKA spinal cord injury...brain can't talk to the rest of the body so it can't control the blood vessels below the injury. so they dialte resulting in shock.

Okay thats the types of shock...and they are all bad. If you are in shock you are DYING. Let me repeat that IF YOU ARE IN SHOCK YOU ARE DYING. Shock does NOT happen in the following circumstances: Dislocated shoulder alone, minor MVA in the drive thru of micky d's, during a posticatal state of a ETOH induced seizure, a fall from standing height with no injury, being placed under arrest for DUI/ public drunkeness/ or beating your wife with a chair leg, being filled with the holy spirit, being assaulted by another drunk asshole and the only injury you have is a busted lip. I could go on, but I think you get the picture.

These are examples of shock...Auto-pededestrian with massive facial trauma, large avulsion across left side of chest and amputated arm with a blood pressue of shit over squat. Man with tombstoming ST elevations in fucking every lead with a blood pressure of shit over squat. Female with 8 GSWs to the chest, legs, and Abdomen who is remarkably still alive when police clear the scene for us to come in with a blood pressure of shit over squat. Old guy with a temp of 105, Respiratory rate of 40, heart rate of 140 and pnemonia with blood pressure of shit over squat. These are all shock. So for fuck sake people quit using this word to descibe...well I'm not quite sure what you are trying to descibe. But unless the person is in an ACTUAL state of shock as explained above, just fine some other word to use. And it ain't shock.

People Suck.

Wow, the Delta Bravos were out in full force last night. But god bless the City Cops, for they kept me sane. One Delta in particular I wanted to assault myself. He gave me the Hold On a Minute Finger...then said "You...Can JUST WAIT a DAMN minute." Uh...No, I can't, you my friend can walk your happy ass to my truck so I can get a better look at the laceration above your eye. I looked at the cop that was standing there who told the guy "Um I would go with her...so she can check you out, plus she alot nicer than us" The guy then proceeded to not give us any of his personal information like medical history or allergies or home address because "he didn't think we needed that" So I kicked him out of the back of my ambulance told his sister that he needed stitches and then stormed over to one of the cops I knew who immediatlly went "B...B...breath..."

"Fuck breathing, J...I'm gonna kick that kid's ass myself. You know you come to assaults going Man I feel sorry for him he just got his ass kicked, then you talk to em and go...I would have kicked his ass too. Fucking Delta. He can bite my ass. His sister's taking him, he's not going in the back of my rig"

And thats the kind of patients we had all night. Fucking assholes. All night, just wanted to be assholes to the paramedics. And I'm a Kind person. Even the cops were like, what the hell? You were nice at the beginning of the shift. I was but you get beat down and by the end you are like all you people suck.

Are you !@#$ing kidding me!

I sometime wish my internal censor button was just a little less sensitive. I had a a patient last night I just wanted to go "Are you fucking kidding me!?, FUCKING SERIOUSLY!, You are calling me at 0430 for this! REALLY? You do understand you are putting an ambulance out of service for 30 minutes for your fucking superficial laceration...no...wait...abrasion... on the side of you leg that you got...what... three days ago from falling up the stairs thats not even bleeding... What do you want me an EMERGENCY MEDICAL TECHNICIAN to fucking do about it...tonight...right bloody now!? FUCK!... I am not...I repeat...NOT...louder please...NOT! taking you to the Emergency Room. At all...not tonight...or ever. Quit smoking crack. Have a nice night and thanking for choosing us for your health care needs.

And people wonder why our response times are extended sometime. It's because we are dealing with bullshit like this. And when a real emergency drops like YOUR grandmother is having Shortness or your father is having a heart attack the next nearest truck is 20- 30 minutes away.

Also, think about this people who aren't EMS, Police and Fire...When you see an Emergency vehicle driving down the road, with lights flashing and sirens blaring... slow down and MOVE TO THE RIGHT. Don't get pissed. Don't flip us off. Don't honk at us. Don't think we are getting in your way, you are getting in ours. You are just slowing us down and we could be going to YOUR family member. Don't be that Asshole. Really. Just don't.

Didn't Break Nothing this Year

Regular Readers of my blog may recall this time last year I was layed up in a hospital with my left foot propped up secondary to an unfortunate run in with a flight of stairs after several bottles of wine and all while wear fishnets and 3 inch heels. Well, this years birthday had no such run ins, infact no bottles of wine and no fishnets. For I was working. I spent the night picking up drunk assaults and psych patients from my fair coastal city. The doc that was working the night of my "accident" was working tonight also. She was happy to see my sober and using both of my feet. All night I was asked "Why didn't you take the night off?" Well, my friends there are two answers to that question. One of them is the paragraph above. I didn't want a repeat of last year's hospitals stay. I can find much less painful ways of scoring Dilaudid. And answer number two is this is my weekend off so I got the next three days off, which I'm spending in Asheville, NC. So really, whats another day, honestly? So I worked. I picked up drunks. I saved the sick and the stupid, because thats what I do. I even was there when Lil' Kim was having her 3rd child. She wanted me to call her cousin Beyonce, but her baby daddy didn't like Beyonce, so we thought it better we wait until the baby was born. So that was my birthday night. No broken bones, no hospitals stays by yours truly, no killer staircases. Just a bunch of crazies, drunks, and respiratorys to show for it.

I signed up on Halloween for drunken debauchery in costumes. What I got was blues hairs falling in the middle of the night and arm tingling. ARE you KIDDING!. Damn it. Oh well there's always next year.

an EMT made me look good

Ok, we all know the saying Paramedics save lives, EMTs save Paramedics. Well, I always tell my EMT, you job is to make Me, your Parmedic, Look Good. Ok, well my EMT, who I had been having problems with for 4 months, did both on our last shift together. We aren't gonna go into why I had problems with them, thats not the story. The story involves a patient that presented with totally random symptoms that turned out to be a big ol' bad CAT 2. So he we go...

Get called to a "sick party" Now this could be anything, this anything turned out to be inconsolable crying. Really. Pt in a mentally handicapped pt, non verbal, who's family calls this the pt's "pain cry". Pt not eating. HX of bowel obstruction. Fever. Ear infection. Tachy at 130. Hypotensive at 90/60s, but pt is also 80lbs soaking wet. BGL at 200. But Pt is compleatly stable. skin is warm/ dry. Pt will focus on you when you speak. I felt perfectly fine putting this pt in the back with an EMT who is also a paramedic student. But then the family wanted the pt trasported to a hospital who is notorious for asking for an IV for even the most mundane of symptoms and this was a borderline BLS/ALS pt. so I said to my EMT partner "I'll ride this in, but I want you to continue to assess as if this was your pt, do a BGL, put pt on monitor, everything but the IV, oh an get a manual BP the monitor been fucking up" SO he does what I say. and as he put pt on monitor I glance up for my seat as I type my report and I see little Normal sinis complexes marching across the screen. little funning looking, but I'mm get up in a minute when we get going and really look at it when i go the start the IV. from where I'm sitting there's a P wave and an upright QRS so we are golden. I go back to typing. Just then my EMT shoves a strip in my face..."Hey!!B!! is that ST elevation?!?"

"Noooo..Thats just a funny lookin...Well fuck me...
I get up and start flipping through the leads on the monitor and get to Lead I and goddamnit if there ain't huge ST Elevation. Well...get em on the 12 lead...we have elveation in leads I, II, aVL, V2, V3,V4. And BIG elevation. And pt had pressure of 90 and can't swallow, so no Nitro, or aspirin so I just placed em on high flow O2 and high flow disel and off we went. Pt didn't like me neither I had to stick em like 6 time for an IV because {the pt} kept trying to bite me.

That just goes to show you paramedics sometimes need them lowly basics.

So I yelled again.

People never stop amazing me. I know it's human nature to gawk at an accident scene. To stare at it from the car window as you dive past and imagine the carnage that may or may not be unfolding. To be mezmerized my the flashing lights of the emergency vehicles. To watch as the Paramedics, Firefighers and Police Officers run around on scene in seemingly aimless patterns, with equiptment and notepads and oxygen tanks and stretchers. To even watch as a helicopter lands in the middle of the highway blocking traffic. I can only imagine what this looks like from the outside looking in. As opposed to being right smack in the middle of it.

So as we pull up to the scene there is a small truck, roof caved in. Looked to have rolled several times. Firefighters at the side two criticals laying in the grass. Another across the highway at the side of a family of three sitting up in the grass, not bleeding. They will be care for in a few minutes. I need to see the two laying supine bleeding all over the place first. Just as we were about to pull up a man with a Nikon around his neck leaps in front of the ambulance and snaps off a few shots. I look up and see where he came from. A goddamn fucking tour bus had stopped in the middle of my fucking accident scene. So not only did I have 5 patients (two of which who were critical) but I had a bus full of fucking tourists snapping pictures. Oh and ONE COP. Who sends ONE COP to a multi car MVA? So ever the professional, I get out of the truck and begin my triage. I go to the first patient. Severe SOB and pain on inspiration, bilat, yet dimin breath sounds, several head Lacs, crushed hand. Place him on High Flow O2, Got a trauma RN on scene to hold Manual CSpine while I go see my next patient. CAT 2, trauma center criteria. Run into some tourist who goes, "You just gonna leave him with that fireman?"
I give the stank eye and go "You gonna tell me how to do my job? Or you gonna move so I can triage all my patients? MOVE!"
Next patient...Partner's got him...Altered Mental, repeating questions, weird looking pupils, neck/back/chest pain. Also CAT 2. CSpine. High Flow 02. Trauma Center Critera. Move him to unit.
GO across highway to triage family...All CAT3 facial pain 2nd to airbag deploy. Can wait on 2nd unit. Firefighter stays with family until 2nd unit arrives.

Thats the run down. Now I walk back over to where my criticals are. Where now ALL the tourists from the bus are now off the bus and all have their cameras out and snapping pictures. I have now had it. This is not a show. This is real life. This is not entertianment. There are two people laying in the grass actually bleeding, actual blood from a actual car accident and these people are treating as if it's an episode of "Grey's Anatomy" So as I walk up, I start yelling. "ANYONE WHO IS NOT PART OF MY ACCIDENT, BACK THE HELL UP AND GET THE HELL OFF MY ACCIDENT SCENE." I then think to myself I'm gonna have to call a supervisor later. I'm gonna get complaints. But right now I don't give a damn. And I got back to my original patient. He looks up at me and says "You tell 'em girl" Then the man with the nikon that jumped in front of the ambulance as we pulled up tried to get up close to me and my patient. "If you don't get that camera out of here...you see that cop over there...I will have him cofiscate that lovely little memory card from you lovely camera because you breaking all kinds of HIPPA laws right now, BACK OFF!" I was pissed. This guy felt he had the right to barge in on the lives of my injured and bleeding patients... and on mine for that matter. But I could fight him off. My patients could not. They lay there exposed to the world, both physically and emotionally. So I was angry and I expressed it and not just at this one man, but at the whole bus load of people who treated the whole thing as entertainment. So what if I end up with several tourist complaints in my file. They acted more inapproriatly than I did.
And so we load both our critcals in the back of our unit and too off.

Our patients made it to the trauma center alive and in one peice. And I only pissed off a bus load of tourists. Welcome to our fair city.

phew glads thats over

Holy mother of god I'm tired. 48 hours on an ambulance will do that to a person. 48 hours and 22 calls later and suprisingly an Angel of Death, such as myself didn't kill any one. (Refer back to a an earlier post for how I earned that nickname) In fact, I might have very well saved one. Woman having the tingling of an Inferior MI. Just the beginings, ever so slight ST elevations in the right Leads (which are ??? my Paramedic students out there) Bradycardic and slightly hypotensive. II did have to laugh at myslef for just a second as I go "I gonna give you a spray of...wait no I'm NOT going to give you nitro, I'm going to turn you fluids up a bit more my hypotensive friend" Its so ingrained, so banged into our heads that EVERY CHEST PAIN GETS NITRO that sometimes we forget that not ALL chest pain pts should get a spray of Nitro.

I do also forget how much fun it is working when you work with someone you get along with and work well together. My partner last night, we have very diffrent styles. Very diffrent. Both of us are laid back type of medics, but I tend to be, well... very sweetly southern. He's from a whole diffrent side of the country and well isn't. He's a no bullshit do you want to do the fucking hospital get in the truck now lets go quit bleeding on my fucking boots type A, but in a way that you like. He lets me be sweet, all while pushing them out to the truck. So it works. Its gets the job done. I get to be sweet and he well...covers me when the shit hits the fan. Plus, he's a good medic with strong medicine. And doesn't look at me funny when I yell at the crackheads who complain of chest pain at 4am (QUIT FUCKING SMOKING CRACK AND YOUR CHEST WILL QUIT HURTING DUMBASS!)

But now I'm going to bed. Sleep is good. And then The Shins concert. I love The Shins. The make me happy.

Keeper of Keys

Back to nights I go. Its time for our 6 month switch, and I get my nights back. Thank god. I'm getting frustrated on these 24 hour shifts. I'm getting downright mean. Not to my patients, but to my partners. I did have a difficult partner this time around, which is why I haven't been writing as much as I used to. I am afraid of what I might type and to be quite honset I haven't been enjoying the job enough to really write. The frustration had taken over and made it difficult to find the interest to sit in front of my laptop and tap out a post. I hate the managing part of my new position. Sometimes on my 12 mile bike rides I think of ways to get demoted back down to crew member. The best solution I came up with was to look up porn while on duty. It's not hurting anyone, nobody dies and after a while everybody forgets about it. As long as you don't do it again. and you let you friends in on the secret (I'm not really a dirty girl, I'm just tired of being bitched at at 0130 because I put the patient on 12LPM as opposed to 15LPM via NRB masK, does 3 LPM really make that big a fucking diffrerance really?) Or maybe making out with that cute City officer in the back of the unit while on duty. Again...not hurting anyone, not killing anyone. But still against policy. I just want to come to work, pratice medicine and go home. I don't want to have to worry if my EMT partner is going to try and push Narcan on MY patient if I wasn;t there to stop them or writing evals or having to sit my paramedic crew member down and tell them that this is not how we write our reports here when they have been doing EMS since before I was born. But here I am in charge. Keeper of the keys, overseerer of medic units.

Put my Penis in my Pocket

I yelled at a fireman yesterday. I went all bitch mode on his ass. But it was for a good reason. I was fighing for my patient. I had a bad call. An MVA on a back road. Car wrapped around a tree the only access I had to my patient... the only part I could even see was a wrist. A wrist with no radial pulse. Now the way the car was crushed, mangled around the tree I knew in the pit of my stomach that the person was no longer of this earth. But there was no way I was going to call someone based on just a pulseless wrist. So I wanted the car off the tree. I wanted access to my patient. And I wanted it ten minutes ago. So when the fireman came up to me and goes "She's dead...you got no pulse in the arm. you calling it now? I need to know now before we start pulling on that car and tree" I went off..."I most certianly am not calling based on a pulseless wrist...GET THAT GODDAMN CAR OFF THAT GODDAMN TREE...I need access to my patient, then we can talk about calling...not sooner" I paced a three foot radius around that car for 25 mins while they cut and pulled and yanked the vehicle off the tree. I do not do well with being inactive, with not helping. I'm a paramedic. I am trained to help. I don't watch very well. So I paced, waiting my turn, every so often going "Capt! You got Any activity from the patient?"
"No Baby, Nothing. But I'm still cutting"
"Thats good Capt, keep cutting!"
Then they got it off the tree. A mangled peice of metal. I got access. I was able to pronounce properly. To put my hands on the patient. To see that there was nothing I could do for her.

I broke down later. I couldn't get to her for almost 30 mins. Then I didn't want to leave her.

My supervisor came by after the call to chat. I needed it. I felt bad for getting all bitchy with the fireman. My supervisor told me that being a female paramedic in charge sometime you have to. You have to "Put your Penis in your pocket and fight like hell for the best of your patient, which you did...now you can go away knowing that you did everything you could for her...even if there is nothing you could do for her"

Lessons learned today
You can't save them all.
sometimes you have to put you penis in you pocket...and be a bitch...if it's best for your patient.

I'm being a very slack medic recently

So I have been productive in some aspects of my job and so slacking in others. To be quite honest, my day to day responsibilities, like washing the truck and making sure that we have all six tires I'm slacking. Because who really care how many transfer needles there are in the IV tray. All I really care about is if there is plenty of oxygen tanks to get my through a shift and if the narcotics and RSI drugs are safely under lock and key and tucked away in the fridge. Is the CPAP machine sitting on the actionary and the laptop plugged in in the back...then I'm going to go take a nap. Those 15 reports sitting in my EMSpro box can sit for a few more hours. I haven't worn civilan clothes in a month and a half. I haven't put on lipstick and masacara for two. I Pay rent for an aparentment I haven't slept at since I moved in three months ago. So forgive me if I don't count the 4x4s(If I you are grabbing more than say 6 4x4 for one wound, you need something other than a 4x4 I might add) nor I'm I going to polish my boots...so there.

But what I have been productive in is reasearching Versed as an alternative for Ativan for contolling Seizures. I recently got an order of IM versed for a 3 year old Status Seizure. This is an order I cannot follow becausse per our state I cannot giver Versed to Pediatric patients. After the call I spoke to the doc, some RNs and other medics and most will agree that Versed is becoming the drug of choice for seizures management. Works faster, higher serum levels for longer (meaning it's longer lasting) and ICU admissions post arrival to hospital are shorter. So if it works better, lets change it. I wouldn't mind hearing from fellow medics who use Versed as first line...what are your thoughts...are the studies true? or are they just blowing smoke up my ass.

Doh!

In the immortal words of Homer Simpson, all I have to say for myself is DOH!. Yep that was the statement of the night. we were called to an assault, ended up with a non transport which was good because as we were trying to manuver the ambualnce through the maze of police cars that lined the narrow winding street we made contact. Actually, let me back up a bit. To when I hopped out of the truck and started toward one of the officers to go "Hey lets move either this car or this car a bit either this way or that way so we have room to get by" Now keep in mind there are like 9 crusiers on this street all with the blue lights flashing and a large group of people all around...and no street lights. So our mirrors are useless...we can't see shit. While I'm talking to one officer another is guiding my partner from the front of the unit through the maze. He forgets that we are much bigger than a Crown Vic. Wider. With a very large box. So I turn around just in time to see the back corner of the box crack the headlight of a police car. What's even better is that the cop that was spotting us, that was HIS cruiser. My partner didn't find the humor in it. I, however, thought it was hilarious. I mean if you can't laugh at something like this, what can you laugh at. he guided an ambulance into his own police car. Comeon! That's funny. EMS comedy.

So there we sat for about two hours waiting on the sheriff's office to come to do the traffic report. No big deal. Kept us from running sick and stupid calls for a while. I could use the down time.

What have I told you people about lying to the medics?

I've been getting these weird calls in the middle of the night. Last shift was the assault that we thought was bullshit drunk guy that turned out to be bleeding internally going into shock guy. This shift was it was running from the cops got tased refused to sit up and talk to us guy, but not because he was that beligerant, but because he had a blood pressure of 70/squat and was tachy at 120. What the hell? He was intermitently responsive. The type of resposive that you had to fuck with all the way to the hospital to keep awake, but as long as you kept fucking with him, giving him a good sternal rub or hollar at him when his O2 sats dropped he came right back up to 100%. I did feel kinda bad when I first got him in the truck and kept yelling at him to talk to me "If you can run from the cops, you can sit up and talk to me, quit fucking around" then his pressure was 70. SON OF A BITCH! "What the fuck did you take?"
"mumblemumblemumble...nothingman...mumblemumblemumble...nothing"
"No really, what the fuck did you take!"
"mumblemumblemumble...nothingman...mumblemumblemumble...nothing"
"How much you been drinking?"
"I ain't been drinking man?"
"yes you have I can smell it, what esle you been doing"
"mumblemumblemumble...nothingman...mumblemumblemumble...nothing"
well knock me over I got a fucking angel in my possesion. So he bought himself a ride to the hospital with bilateral 16 gauge IVs a liter of fluid, some Narcan, and was going to get to meet a bunch of very nice nurses with a very large foley catheter at the ER. I also found out that I am getting very good at sliding in 16 gauges into handcuffed patients. Its a strange angle but it can be done.

With it being so hot here are some tips from your friendly paramedic. Because I don't want to pick your ass up.
1.Stay in the AC
2.Stay in the AC
3.Stay in the AC
There's plenty of Law and Order reruns on to enjoy, there is no reason to go outside in this heat, to run, play tennis, mow the grass or really do a damn thing
4. if you must go outside, you crazy bastards. Drink water. not Budweizer, not PBR, not vodka, WATER. or gatorade is fine too or my personal favorite, Revive VitaminWater.
5. Wear light cothing, both in weight and color. This does inclued the lowcountry favorite of searsucker. I didn't say it had to be flattering.

If you becaome unresponsive, stop sweating and your temp gets above 103 you are offically in need of my assistance. And I will be glad to come and get you but I do reserve the right to fuss at you if you do not follow the simple steps listed above. Because it's your own damn fault.

Balmy nights makes for miserable Medics

Hot, humid nights brings out two things here in the south. CHF and assaults. It was 93 degrees last night with 110% humidity. The air was also very still, nights like this are more bearable with a sea breeze, but last night there was none. So the sweat just sat on your skin. It made all who worked last night move a little bit slower, almost as if the air was so thick held us back. It also make people more mean I think. We got called to a stabbing. No when we got there, it was not a stabbing, well...it was, but it wasn't. He got cut with a knife and had an avulsion on his finger. Now it didn't raise flags when we saw him and he was all sweaty, we were all sweaty. It didn't raise a flag when he was slightly altered, he reeked of ETOH, it didn't raise flags when he kept saying he was thirsty, it was hot, he reeked of ETOH, and to be honest I was wicked thirsty myself. It even didn't raise flags when the blood pressure on the monitor said his blood pressure was 60/30. That damn thing had read a correct blood pressure all night. But when niether me nor my partner could find a radial pulse nor ausultate a blood pressure for ourselves was when we both looked at each other and then at the cops that were standing outside of the back of the truck and say at the same time "Fucker's actually sick!" I put in a 16 ga IV and threw him on a high flow oxygen my partner gets an 18 ga IV and gets him on the EKG (tachy as hell at 130) and We haul ass to the trauma center. He kept saying he was beat with a board in the abdomen (again no flags raised because ADB was soft, flat, non distended) But sure enough, according to the FAST scan at the Trauma Center he had a large amount of blood in his abdomen. I don't know how it works in some systems, but in mine we can, if they don't meet transport criteria, choose not to transport. The finger injury alone does not meet transport criteria. But the altered sensorium 2nd to what We initally thought was ETOH (which did in fact turn out to be shock) did. So you can say, being drunk saved his life.

The other thing we look fotward to on these balmy nights is CHF. This weather really exacerbates it. We gave over the night, 200 mg of Lasix, CPAPed just about everyone who got into the back of our ambulance, and gave more Nitro that even we of that bitter/ sweet orange nitro smell that all medics should be very familar with. I also went through the supply reqs for the night when I restocked after my last CHFer, and every single sheet listed the same thing Lasix and CPAP circuits. Every single one. Thats was all we did last night. But at least it is easy one you get it under control. It's just CPAP, NTG, and Lasix...CPAP, NTG, and Lasix...lather rinse repeat...