back.

Yes, I know its been a while. But before you all go yelling and hollaring, I do have a very good reason for no posts. NO INTERNETS. My internet has been down since the crazy hobbit med student moved out of the apartment. But I am now in my own place, complete with TV and cable internets. So I am now setting up my new place, with a short break to type this post. Other than moving haven't been too busy. Work is still the same. Actually our system has had a few bumps, but nothing I want to comment on really. We all have our problems. So we will leave it at that. But in my work life, everything is smooth. I work hard. No death, but now extreme life saving either. I haven't shocked anyone back to life in recent weeks. And the most notiable thing that has happened was I got threated by a drunk, mentally hadicapped man who told me "Unhand me you crazy woman or else I will fuck you up!" But my partner and the cops kept any fucking up from happening. But not before he let loose a lugie the size of my fist in my general direction and then he just cackled at me. Oh well it happens. well I will make this short a sweet as I have more boxes to unpack.

Okay here it is a new post

Phew, I know I know I know. Been a long time. But I have good reason I promise. Had a bout of writer's block. Then I found out my lease is up alot sooner than I thought so I had to find a place to live otherwise I was gonna be living at the women's shelter that I have grown to know and love. But I have found a wonderful place to live. A place that is ALL my own. My first place that is mine all mine. I don't have to share with anybody. More rent and I have to work a little harder to actually afford it, but a space that is all your own is worth that extra two shifts a month I think. And it has a pool. So seriously, yeah, two extra shifts is worth a pool.

Man, yall...we were crazy busy this weekend too. That full moon thing is so true, and all but one was some BULL-shit. The one was one of our frequent flyers that everytime you see she is actully sick, but because of crack. You just go "Goddamnit!, You were doing so good! What the hell happened?!" and she shruggs, all while fighting to breath. You CPAP her, load her up with NTG and haul ass to the hospital, go any slower and you will be tubing her. You just pray the whole way that she didn't wait too long to call you, because you can't get a line so you can't RSI her and you for damn sure don;t want to nasally tube her, she doesn't care for the CPAP, so you know she ain't gonna like that tube shoved down her nose.

The rest were all just alot of uncooraperative people who thought that EMS were either taxis to downtown or "unresponsive" who were gonna "faint" everytime we tried to stand them up. And every one of our "fainters" were a good 3 bills give or take. i've already has back surgery once, I'm not having it again. so I' not gonna catch you. You can faint. Not one of our "fainters" hit the ground. They all somehow made it to either a sofa or a chair or somewhere soft. One even made it clear across the room to the sofa. It was a fucking miracle.

Then there was the drunk college kids. How do you drink that much? No Seriously? How? I've been drunk, really drunk. I broke my foot in five places I was so drunk. But I have never been so drunk that I was unresponsive and EMS had to suction vomit out of my airway.

Holy Crap Batman! I can raise the dead

So I thought that my streak of death was still following me. But apprently the EMS gods had other plans for me today. We get called to a near syncope...oh and can you also first respond to the Seizure too, it's at the same place, we have another unit coming, they are just 20 minutes out. Sure thing my dear dispatchers.
Medic on scene...Are you fucking kidding me, you didn't tell me the seizure was in fact in cardiac arrest! I can't give too many details about the call because this being the internet, a a very public forum and I would like to keep writing and this is the kind of call that walks the line of "can I write about it without reveling too much in this kind of setting" but I can say the pt was in fact in cardiac arrest, meaning he was not breathing, nor did have a pulse, he was...in not so many words...Dead when we got there, but my dear readers, do not fear, by the time we dropped him off at the hospital, not only did he have a pulse, not only was he breathing on his own...but he was sitting up, talking, conscious, alert and orenited x3 and holding a conversation with us. And when we left him at the hospital, he was on a nasal cannula, and they were trying to find a reason for why he went into cardiac arrest in the first place. Yes...We did some "Third Watch", "Emergency", "Baywatch", "only shit you see on TV" kind of Paramedic Magic today.

I have no idea what happened to the near syncope, the other unit came...nor frankly do I care. I was to busy saving a man's life. With a little help from my friends.

I would also like to say a BIG thank you to the First Responders. Without them sometimes our patient would not walk out of the hospital, like our cardiac arrest today. They started CPR right after he dropped and frankly, played the biggest part in saving their friend's life. So thank you. Without them we'd have nothing to work with. Just want you guys to know that the Paramedics, we do apprciate what you do. We may not say thank you all the time. But here's mine.

THANK YOU FOR ALL YOUR HARD WORK GUYS.

Sick and Tired of the BS

Now we all should know by now I am a very laid back medic. Rarely getting worked up over much of anything. Sure, my hands tend to shake through bad calls, not out of nervousness, but because the adrenaline makes me. I can usually work through it by just sitting back for half a second and saying to myself "Self...Honey...It' ain't your emergency" On the outside I'm cool medic. I'm Eh...It's just VTach Medic. On the inside I'm going "Someone should really call the paramedics... oh crap I am the paramedic." But Thats another post on another day. Today, whoa, was let's see what else we can find to bitch about day. And to top it off I have whatever the respiratory crud from hell is going around. I bought my partner three bottles of cucumber foaming hand sanitizer and a tube of Airboure and a can of Lysol that I made him use every hour today because damnit if he's gonna get sick too. Anyways, Bitch at the Medic day...good Lord, seriously. I have other things, more important things to worry about than where my partner's name plate is. Like where are the Narc Keys and are they still attached to my hip? Seriously we have already discussed that fact that it is missing and that it is getting remade. I sometimes feel like I'm in the movie Office Space...Yes, I have seen the memo on the TPS reports and no... I don't need another copy. I have 8 bosses, Bob...EIGHT. Okay, so we are out of 20 gauge INTs. I didn't;t get by our supply cabinet this morning. It's cool really. Everyone will either get an 18 Gauge or a 22 gauge or just won't get an IV. The world is not crumbling or coming to an end. Chicken Little, my friend, the sky is not, in fact, falling. We have plenty of oxygen and all the ways to deliver it, drugs and all the ways to give them, and the monitor/difibrillator is still sitting on the bench seat so I'm cool. I have all I need. My boots are a bit scuffed and my uniform shirt has a few drops of coffee on it leftover from a little spillage when we hit that bump at 45mph, but I still am ever the professional. I still speak to you, my patients with kindness and confidence. I may have no idea what's wrong with you (as what was the case the other night with my actually unconscious/ unresponsive 18 year old with perfect vitals and no reason to unconscious) but I will treat you as to the best of my ability and haul ass to the hospital if needed. So With all that being said...Very few things piss me off or get me worked up as rudeness. Don't yell at me unnecessarily. Don't speak to me like a child. Don't hang up on me. And don't EVER call a supervisor without talking to ME about what I did wrong first. It's childish and like tattling. I hate getting a phone call at home several hours or even days later from a white shirt bitching...er, discussing... that I am not allowed to be at a station when the other crew is home when I have forgotten all about staying that extra ten minutes at a station because I was shooting the shit the with crew and fire guys. I'm very respectful to you on the phone, I expect the same respect to be shown to me thank you very much. I state again, Chicken Little about the sky..NOT falling. We can all get along. Just show me the same kindness, patience, and respect I show you and we will have no problems.

Smile.

Smile.
Originally uploaded by artist in the ambulance 190.

Distract and play

We as paramedics get caught up sometimes in the swirling around us. Lots of people yelling at you from all directions from your 2 year old patient to the patient's freaking out mother to the fire/ medic first resonders who were on scene first to the other kids who saw the patient fall and then subsequently started seizing. HOLY SHIT PEOPLE QUIT YELLING AT ME! Okay one at a time. FIrst Thing...Mom... your little one is alert, awake and now telling me that she is two years old and her favorite color is pink. I can't go anywhere until I find out what happened. Quit yelling at me to start driving I have a Fireman hanging on to my bumper. Quit freaking out because when she sees you freaking out...she freaks out...now hold this oxygen mask right here.
Now...Fire Guy...Give me the short story...
Now Partner...Drive before this mom starts to yell at me some more that I'm not moving fast enough.
Phew...
This is what I had to deal with today. This 2 year old fell and hit head...HARD on the concrete driveway. Had what sounded like a seizure following fall and breif LOC. But on arrival of us, kid was CAO to normal mental for age. ANd did tell me she was 2 years old and in fact her favorite color was pink. She did not like me for about 30 seconds following a BGL check until I redememed myself with Elmo stickers, which she kept a death grip on in her little hand for the rest of the trip. Mom at one point asked why I wasn't doing anything "You know? medical?" Thats when I looked at her and go "I know it looks like I'm doing nothing, singing and talking and asking your daughter stupid questions like what color is my stethescope, But as I ask them I'm checking her mental status. She has no idea what day it is or who the president is. But she know who Elmo and Big Bird is and that who on these stickers. And she know who you are. And she knows her favorite color is pink. So if she answers those questions, she has a normal mental status for a 2 year old. And that is a very good thing. Means that there is a a very slim chance of a head injury. Also her Heart rate is right where it should be and her pupils are equal and reactive. I'm doing more things "medical" singing with her than you think. I can't do a exam with her screaming crying now can I?" That got mom to shut up. I was more than just an "Ambulance Driver" at that point. We got the child to the hospital. Gave turnover to the nurses.

You have to learn that with kids...distract. Play. Sing. Clap. Anything to get thier minds off the fact that you have needles. I particularly like stickers. Elmo Stickers are a huge hit with the under 5 set.

roamers

System Status Management. I haven't decided if I like it or not. I'm on one of our three "roaming" trucks. Meaning I have gotten to know alot of parking lots and street corners. Now I don't mind the street corners. In fact, if it keeps the non roaming trucks in their station instead of driving around and out of parking lots...I say...Send me to the parking lot of the WalMart on Main, I'll sit. I've got an iPod with the entire second season of No Reservations and the seventh season of The First 48. Plug that bitch in the cigarette lighter and I'm good. Thats what I'm here for. I'll even pick up the radio and remind dispatch that "Hey Y'all, we are right here!" when they lose track of where they put us and sends the downtown truck to the island we are sitting on. But what I don't get is they whole we can't be at the station when the truck that is STATIONED at that station is home. Take today for instance...We were sent to way out there..then that truck came home. The dispatcher called the station and goes..."Is the roamer there? If they are tell them they have to leave." When the crew asked where to send us, the reply was..."Anywhere in your district is fine but just not your station." Are you kidding me? Really? So we left, and went two blocks away to the local pizza joint and got a couple slices and cherry cokes. Its ridiculuas really. But So goes it.

Other than that one issue though...I think I do like it. We drive around. I've seen alot of the city that I might normally miss because I'm stuck at a station all day. Last shift we drove to the waterfront and sat and ate lunch there. You just don't do stuff like that when you work at a station. So its not so bad I guess. Could be worse...I could be working INSIDE. ::shudder::

oh and PS...

Steve Berry thinks I'm Cool.

Love your stuff. You are one sick medic and I respect that
Best Regards,
Steve Berry

4:13 PM

did nothing

So I was back to the streets today. The back problem was short lived, fixed with a couple of flexarils and lortabs. Thank God for that. Not too busy today, just one call. A seizure at a local supermarket resulting in a calm ride to the hospital with a postictal man who kept repeating himself. The rest of the day was spent sitting on various street corners discussing with my partner, who eats more discusting stuff, Andrew Zimmer or Anthony Bourdain. (I prefer Tony B. to the other but I just happen to like his crass, cynical attitude towards everything) Everyday can't be filled with lifesaving shocks to the heart. So there we sat for 12 hours, breathing disiel fuel, talking about fermented shark, pig entrails, and slaughtering goats and how I would never put half that stuff anywhere near my mouth. (I have been watching WAY too much of Anthony Bourdain's show on the Travel channel) Boring day really. One needs days like this though. You can't have balls to the walls days every shift, or else one would go nuts in this line of work. You gotta have sparatic do nothing days. Where you sit. And do nothing. And talk about...well...fermented shark, and pig entrails, and goat sluaghtering

The Beach

The Beach
Originally uploaded by artist in the ambulance 190.

Twisted Tree

Twisted Tree
Originally uploaded by artist in the ambulance 190.

oh crap

"Are you fucking kidding me!" Was the thought that went through my head as I paced outside the hospital. Over and over that one phrase. I had just got done moving over this fat ass bullshit "I got rear ended because I was talking on my cell phone, wasn't paying attention, had to slam on breaks so in turn caused the car behind to do them same and they still hit me but now I have bullshit neck/back pain, so I'm now going to sue the ass off those poor college kids who hit me" MVA patient from my stretcher to the hospital bed. Now as many of my faithful readers know, I am very conscious of my body movements because of my history (I have had back surgery at the ripe old age of 27). Well, this time even though I was very aware of what I was doing, I still strained my back. I knew it the second I did it. I felt that pain. That pain I was once very familar with. Now thank God it was not pain the shot down my leg. Thats Disc, you need surgery pain. This was muscle tighting and screaming at me pain. So I took the stretcher outside and paced. And this is where we came in "Are you fucking kidding me?" So I called my supervisor and Safety officer. And went in to get seen by the county doc. I'm getting better the Flexaril has helped ALOT, which is a very good sign. That means its muscle, not disc or nerve. So I get a couple days off rest the old back. I have the spine of a 60 year old. So I sit and I rest and I enjoy the drugs. Until monday when I go back to the Doc and hopefully get cleared to go back to work.

We rock.

I was a good little paramedic today. Actually, make that a damn good paramedic today. I saved a life. Yep, my friends, I, The Angel o' Death, saved one. Really and truly saved 'em. I pulled some great paramedic magic outta my ass and brought one back. So here's the story. Got called to a chest pain. Pt was sitting up, Talking, CAOx3. Looked fine, skin pink, warm and dry (we are all about skin condition). Tachy at 140s was our guesstimation. not working hard to breath, lungs clear, BP at 130/88. Got [the pt] out to the truck put [pt] on the 12 lead EKG (was c/o of CP pain earlier, now only generalized weakness). The EKG showed....VTach. The pt was so very stable, had a great blood pressure, no SOB, and was still sitting up talking. So I moved the 12 Lead stickers and started putting the defibrillator pads on [the pt] And started explaining that the heart was doing some funky things and that we are doing everything, but its going to be alot of stuff all at once....and that we might have to shock [pt]. I was gonna try to aviod the whole shocking thing and go with anti-arrythmics, but Versed and Cardioversion could work too. anyways... My partner starts working on an IV line and I hop over to the O2 cabinet to get a non-rebreather mask on [pt] As I'm doing that I'm also getting the hospital on the radio to let them know we are coming with a very stable but very much in VTach pt that I'm about to give Amniodarone to. Because at this point with [the pt] as stable as [pt] is, cardioversion is not first line. Until [the pt] looks at my partner and goes "I'm going to go unconscious" to which my partner responds "Are you really now?" Just as the pt flutters and in fact goes unresponsive. To which we both look up and see that [the pt] is now in V Fib. I now throw the radio mic down, mid sentance, grabed a BVM, threw that to my partner and then leaped over the pt, landing on the bench seat next to the monitor. I hit the charge button, looked up, CLEAR! and lit em' up. and then quietly prayed....please don't go into Asystole please don't go into asystole please don't go into asystole. Not Asystole...don;t know what it was...strange looking rhythm, but not asystole. [The pt] then opens eyes looks up and goes "I blacked out there for a second" Ah, no... darling you just DIED there for a second. But we saved you. The rest of the ride was uneventful. No more shocks, no more "I'm going unresponsive"s I made sure of it. [Pt] closed eyes for a second and I yelled, "Don't you be closing your eyes, you keep talking to me [M.P]!" Oh and hile all this is going on, I had forgtton all about the hospital I had on the radio, so I kept hearing "Last unit...advise...Last unit?" Sorry, Miracle Hospital, we were busy shocking our pt back to life. We got 'em back we are stable again. Here's what we have. ETA's less than 5mins. Any more questions/ orders?

So we rock today. My first day back after an 11 day vacation and my first call had to do actual paramedic work. Thinking like a real paramedic is hard. I love my job. I saved someone. We so rock.

Chaos and assholes

Do ER Docs go to special classes to learn how to be pricks to the medics? I think some do. I think some forget what we have to work with on the streets. I think some forget that we are not glorified taxi drivers and most important I think some forget that not all of us are paragod idiots. Some of us do in fact know what we are doing. I am in fact a good medic, despite my faults (I can't add and I can come off as a dingbat sometimes) but I am, so I've been told, a good medic. I have even been told by a seasoned ER nurse who I have known for a very long time and love and respect that I am a VERY good medic. So when I have an asshole doc tell me during a hectic call over the radio in a very condecending tone "Did you think to give your unconscious, only breathing 4 times a min Pt that you're are assisting ventalations with a BVM with Narcan?" It makes me want to be a total smart-ass back. Which I kinda was. My response was "I would be glad to give my unconscious only breathing 4 times a min Pt Narcan, do you have any other obvoious orders for me Doc? I am 3 mins away from you guys I was trying to encode you before we got there since I am assisting ventilations, We actually just got the line" ASS.

What these ER docs Have to remember is this...I am working in a 4x6 closet on wheels with an EMT Basic who may be a very good Basic, but they can only do BLS. Meaning no Lines, no drugs, no intubations. Thats all on me and me alone. And I may have Fire too...but again...BLS...If I'm lucky I might have another Medic, but usually just one. So One more pair of ALS hands so four ALS hands. I'm doing the same job that the ER doc is doing with several veteran RNs, a respiratory thereapist, an ER tech or two, maybe a resident, a PA maybe all in a cloest with deisel engine. Going down the road at 60 MPH. Do you know how hard it is to hear lung sounds with a crappy stethescope with a siren going and a turbo desiel going at the same time? It's tough. I have even had a ER doc tell me "I don't know how you people get anything done in the back of those things." I just laughed and said "That's why you're a doctor and I'm the kick ass paramedic"
"That you are my dear, you fixed the Patient, now can you take him back to the shelter?"
"Nope, I am 911, strickly one way babe, he belongs to you now"
That happened to be one of the ER docs I like. One who understands what we do. What truly goes on in the back of a truck. That is really is oranized chaos.

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

http://truluc.myminicity.com/">truluc.myminicity.com/indtruluc.myminicity.com/ind">

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.