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Saturday, March 27, 2010

Do not tell aggressive psychiatric patients to calm down. It will not work. They may attempt to whack you upside the head, as my partner may or may not have discovered.

If they think they're perfectly fine, smile and nod and treat them like they're perfectly normal. Agree that they have every right to be perfectly upset about the situation. They want to bring a stack of bibles? That's fine, but advise them they might get lost in the ER. They want all six of their baseball caps? Sure. You'll even make sure they don't fall off. Let them rant. They think the doctors are out to get them? Reassure them you'll make sure the ER doctors are good.

This would also be how I got my patient to hand over his belt, shoes, and the aforementioned stack of bibles when we got him to the psychiatric holding room at the ER. For safekeeping, of course. Totally normal.

Because yes, paranoid schizophrenics do present a danger to the long term care facilities they reside in when they become agitated and aggressive.

But they have every right to not be reprimanded to control behavior that they literally can't control. At least for the ten minutes that they're in the back of my bus.

For all you know, on some deep level, they themselves might be terrified at what they've become. Imagine being trapped in a mind that you can't control.

They're still human. You just reason with them a little differently. And you may have to repeat yourself a few times, cause it won't sink in at first.

Totally normal.

Friday, March 26, 2010

80% Of Nitro Prescriptions...

F.D.A. Says Millions Got Unapproved Nitroglycerin-NYT

Check what's on your bus. It's not being recalled, but that doesn't mean you shouldn't take initiative. If it doesn't say Nitrostat by Pfizer, there's no guaranteeing that it's going to be as effective as it should be in the field.

And what I didn't know? Nitroglycerin prevents heart attacks in 3-4% of patients with chest pain. So that other 96-97%? It decreases blood pressure and strain on the heart, of course. That's what happens when you take a vasodilator. But how exactly did they get that number?

And how many states allow BLS to use Nitroglycerin?

Massachusetts BLS crews are allowed to give up to three Nitroglycerin with five minute intervals between each dose, so long as the patient's systolic remains above 100. ALS is activated if needed.

New York City BLS? We don't even carry Nitroglycerin. We can assist the patient with one tablet or spray of their own prescription, if ALS is enroute to us either while we're on scene or while we're transporting AND if the patient's systolic is above 120.

The confusion of being licensed in two states. :P

Wednesday, March 24, 2010

PEG Tubes vs. Jejunostomy Tubes

For those of you who may have been curious. I had a patient with a sub-total gastrectomy recently, and that was not a PEG tube. Looks similar. Different placement.

PEG = Percutaneous Endoscopic Gastrostomy. It's for gastric tube feeding. see: PEG Tubes - Wikipedia

No stomach (or an unsuitable stomach) means no gastrostomy. Therefore, the Jejunostomy tube goes directly to the jejunum (the middle section of the small intestine). see: Jejunostomy - Wikipedia , Jejunum - Wikipedia

Yay lower risk of aspiration!

And then, just because it's in the picture, too, see: Nasogastric Intubation - Wikipedia

(Credits for the pic go to nutritioncare.org)

Tuesday, March 23, 2010

Definitely almost threw up in the middle of a hospital lobby with a patient on the stretcher ready for transport to rehab.

I'd like to send my appreciation for today to dimenhydrinate, ibuprofen, and ice cubes.

Because sticking it out to the end of shift meant hearing a life story from an ex-heroin addict recently paralyzed patient who really needed to talk.

And who thanked me and my partner for our kindness and professionalism.

Because sometimes you just need someone else to hear your story, to orient yourself. And the more you tell it, the more you can put it in perspective. Sometimes you need to call for back-up, for someone to help you sort things out, when they get too complicated for you to sort out on your own.

Knowing yourself is seriously something to aspire to. Once you've got that down, you know where you want to go. And then you find a way to get there.

But sweetheart, you've made it this far. Keep going. Even if it's out of sheer orneriness, to show the universe that they can't hold you back for anything. You intend to live, and you intend to live well.

Go kick some ass. You'll make it through.


Monday, March 22, 2010

1198, 1198, can I get a Code 1 to 9999 99th Ave., in Queens? 20-something female, severe abd. pain and uncontrollable vomiting, suspected food poisoning. That's a Code 1. Oh, and 1198? That's going to be a one-flight carry-down.

Ahaha, oh wait, that's me. And I'm uninsured. So don't worry guys, no stairchairs today.

I did however set a new personal record today. Vomiting 10 times in less than 8 hrs. Water, you are not my friend. But at least you're not too bad to see a second time.

Also, hypothermia via dehydration is not as attractive as it sounds.

However, 2 hrs in a hot bath and 2.5 trays of ice cubes later (because I can chew on ice but not drink water? wtf?), I'm feeling a little bit human.

But unless I make a spontaneous full recovery overnight, I'm going to have to call out again. And there goes half my paycheck for the week. Oh, 90-day probationary periods and the lack of sick-pay therewithin.

(Also, please note: Private companies use Code 1 for emergencies and Code 2 for non-emergencies. So our Code 1 is like the FD's EMS Code 3. It's all about the lights and sirens, baby.)
Got my tax refund a la e-filing.

Only $12,000 left to pay off on my student loans. :D


House Approves Health Overhaul, Sending Landmark Bill to Obama-NYT

Who has a happy? I has a happy.

...I can has insurance now please?

Sunday, March 21, 2010

C-diff. Offically scarier than MRSA.

My last MRSA patient was firmly bandaged, blanketed and bundled before we even arrived. There were multiple decubitus ulcers involved, but only one that we had to be a little scared of, and that was in the sacrum/buttocks region. Definitely nowhere we needed to be involved with at the time.

I still wanted to fill a swimming pool with Purell, jump in, and stay there for a very long time.

My partner had to burst my dream, of course. Compliments of C-diff. His only advice? You'll know it when you smell it.

"...the rate of hospital-acquired C-diff infections was 25 percent higher than MRSA infections." -NYT 3/20/10

Alwaysalwaysalways use your PPE/BSI.

(Purell is still my best friend, though.)

If you're not scared of narsty spores transmitted through diarrhea, please, continue reading:

Infection Know as C-diff Seen as Growing Hospital Threat -NYT

C. difficile -Mayo Clinic

General Information about Clostridum difficile Infections -Center for Disease Control

Tuesday, March 16, 2010

Waiting 2.5 hours for a suicidal psych to actually be admitted to a hospital? When you knew they were coming?

Can you tell I was in a not happy mood for the rest of the day?

Patient not happy = me not happy.

I watched all that optimism they'd managed to muster about getting somewhere to finally get help crash and burn by the 45 minute mark.

Dear dispatch, if you send me there again, I will be admitting myself as well as the patient. I cannot deal with incompetent people. They make me want to throw things. But, being the professional that I mostly am, I have to sit and make small talk with a patient who's getting sadder and sadder as I watch. And I can't fix that.

Monday, March 15, 2010

Type II Diabetes, Heart Attacks, and Blood Pressure Medications.

Bits and clues to connect when treating. :)

The short and sweet of it is:

In Type 2 diabetes, the body is resistant to the hormone insulin, leading to abnormally high blood sugar levels that can cause eye, kidney and nerve disease. But heart disease is what kills most patients. A quarter to a third of heart attack patients have diabetes, even though diabetics constitute just 9 percent of the population. And 25 percent of heart attack patients are on the verge of diabetes, with abnormally high blood sugar levels. -NYT

What this means, girls and boys, is that roughly half of your heart attack patients may have diabetes or something close to it.

Now, why you should look at your patients' medicines:

Diabetes Heart Treatments May Cause Harm-NYT

Because all those medications that are supposed to be keeping their blood pressure down? Those may actually be increasing their cardiac risk factors due to severe side effects.

Now, what I really want to know is how Nitro would factor into this. Or does it only apply to long-term daily medications?

Sunday, March 14, 2010

Private ambulance companies are preferred over fire department ambulances by skilled nursing facilities because:

a) They don't like the drama of the fire truck showing up and the entire station tromping around the place.


b) They don't want the city seeing all the health code and safety violations.

I like option a, because I think it's funny in a "well, at least we do something better than you" sort of way. :)

(Your buses are definitely prettier. Because you know, my dream car is a bright red Ford F350. And that's what you drive. With an ambulance on back. Jealousy? I think so.)

But someone very tired and very grouchy at the end of a shift pointed out option b the other day.

Now, I've got my opinions regarding the many, many places I visit every day (see previous post). I have opinions about where I would send the people I care about, and my expectations of the staff and facilities for them. But I've never had an issue with the essential structures and mechanics of a facility. Maybe I didn't like the architecture, or the paint scheme, or the fact that they lock the front door to keep residents in. But most of my impressions of facilities were made up by the nursing staff. Even the most untrained lowly health aide can go a long, long way in my respect by caring about their patients. The more you care, the more you study. The more you study, the more employable you become (and the more money you earn).

You and your patients can have a mutually beneficial relationship. Remember, you signed up for this. Make the best of it.

I don't think I'll be outraged about option b until I run into a facility that doesn't have an AED on the floor where it's needed, or is incapable of treating a complicated case that they in fact said they were capable of treating (ie: patient with wound vacs transferred there from hospital, when the facility doesn't have any wound vacs or trained staff).

All of my issues with facilities come down to human error. Apathetic humans are one of the few things I cannotcannotcannot stand. I would never verbalize my opinion of you in front of a patient. There may be a lot of history involved that I'm not aware of during the ten or fifteen minutes that I'm on scene.

However, I can't promise I'll be able to control the need to frown meaningfully in your general direction. I might even go so far as to raise an eyebrow.

Though mostly I'm concentrating on smiling at my patient. Because even the worst dementia case will brighten up and smile back. It's human instinct. And sometimes the simplest forms of communicating are the best.

(No small non-verbal children were harmed in the development of this theory. Other than wetting their diapers from giggling. But they probably had to go anyways.)

Friday, March 12, 2010

Didnotdidnotdidnot want to transfer that totally awesome retired superhero to that rehab facility. Nor was said retired superhero at peace with the situation. That was for real the hardest to watch. One of the original superheros from waywayway back in the beginning of EMS going to a place like that for post-op rehab.

But I cannotcannotcannot turn to said retired superhero and inform them that their doctor is an idiot and reccommend they transfer to one of what I consider to be the two best rehabs in the city.

Not when said retired superhero is worried enough that they may never be walking again. As in legit scared that said rehab is the end of the line.

Ladies and gentlemen, do not leave your parents alone in those situations. They need someone to hold their hand, and I'm not a very good liar. They need someone to advocate for their care in the long term. I have to leave them once I finish my paperwork. Even if that means leaving them alone, in a strange room, with a plastic bag of their belongings, being straight out ignored by the attending staff.

Because no lie, I left that place wanting to cry. Or punch several medical professionals.

Thursday, March 11, 2010

Full-term pregnant lady with a stab wound = not how you want to arrive in the ER.

Wasting half an hour on a transfer call trying to find parking because a little girl fell and/or jumped in front of a train at the station right next to the hospital = also not attractive.

Coming home from a ten hour shift to find your roommates haven't cleaned since their party last night and your kitchen has been overrun by roaches = not okay in any way shape or form.

Finding out that the medic involved in that little girl's death in DC is being investigated for homicide... How could you not do your paperwork? You didn't even file a PCR, let alone get the mother to sign a release. No lie, you deserve the hell you're about to get.

Or maybe I'm the sort of person who would trek through a blizzard to get my patient. Even if I had to put a bariatric patient on a longboard and rock it like Balto.

You like that mental image, yes?

Tuesday, March 9, 2010

Reasons not to take the keys to your ambulance home with you:

Waking up ass crack early to bring them back so the next crew can have them and you don't get written up.

Oh, overtime. The things you do to my competence.


Monday, March 8, 2010

Good morning. Have a five flight carry down.

In other news:

Hello, tax refund. Goodbye, ACS student loan.


Thursday, March 4, 2010

Coming home from the late shift:

Two EMT's (from two different companies), two MTA bus drivers, and a USPS guy in the back of a bus.

Welcome to blue collar NYC.


Tuesday, March 2, 2010




So here's my issue. I've re-opened negotiations with the financial aid department at my chere college, and they seem disposed to hearing me out now that I have lots of paper-y things to prove that I do, in fact, support myself.

So.. packing up my life again and moving back to Massachusetts? I like this whole driving really fast with lights and sirens thing. That would involve buying a car, so I can commute to nearby urban centers for employment. Our little college town has approximately one fire station within walking distance. With one ambulance. I think they're at employment capacity. :P

I can afford a car, post-tax refund. But then there's insurance, and registration, and it might be easier to wait 'til I move back up there to buy one. Nevermind that they're probably more snow-inclined up there.

It's a half hour commute to said urban centers. Can I fit shifts into my class shedule? Could I clear Fridays and weekends for shifts? Can a private company even guarantee me a schedule like that, when they've probably got other students working for them who need the same hours? Would I be willing to pull overnights in the middle of the week? Would I be sane enough to drive home afterwards? In a blizzard?

Are they even hiring?

Because I have to support myself at school. I have bills to pay that won't simply disappear. And a car involves car insurance. And gas. And other fun things.

I qualify for health insurance in nine weeks with my current company. Do I want to trade that and start all over again? Will my school make me buy insurance? And dental?

What about CME credits, to maintain my license? My current company offers them regularly. I need 28 by the end of the year. Will those even transfer back to MA? Or will I have to do everything in NY and then have MA reciprocate my renewed license? Or can I use the same credits to renew both licenses? And if I'm not working in EMS up in MA, how will I finish my CME credits?

Do I want it this bad?

I could transfer to a school in NYC. But anything with an education equivalent to my chere college would look at my transcript and laugh. I'd have to submit my resume to even get their consideration, and then I'd have to have the insane negotiations with their financial aid department. At least my chere college understands that situation.

I missed a year in my friends' lives. They're graduating a year ahead of me now. I can make more friends, but DUDE I'm going to have a chip on my shoulder when it comes to graduation and all. For reals, I'm gonna be pissed.

Seriously, I'm going to be twenty-three when I graduate. Chere college, you messed up my five year plan. For reals.

But this is coming from the girl who contemplated selling organs to get back to school.

I guess I'm up-ending my life again?

Oh, but I am going to have no patience for people whining about school. Like punch in the face no patience. Like you're getting a free ride from your parents so shut it or drop out status.

I LOVE EMS. Will on-campus volunteer stuff be enough to satisfy that addiction? Could I deal with a desk job for bill paying? I'll be chasing CME credits all over the state. I still need a car.

If you lasted this long in the post...welcome to my thought process? ;P