Mucho Dolor?

The nurse at the doctor's office gave us his history, but we still had to ask.

Yo hablo un poco español. Un poco poco.

He smiled and nodded, explaining as simply as he could that he had pain in his lower back and down his left leg, and he couldn't feel his left foot.

O.K.? got him comfortably situated on the stretcher, and O.K.? made sure he was still comfortable after we loaded him into the ambulance.

He replied that he was fine, just the pain in his back.

Two minutes later, at the triage line at the ER, I asked for the two things missing from the doctor's transfer sheet.

ID? Driver's License? accompanied by a finger outline of their size.

He passed me his Medicaid card and learner's permit. I jotted the insurance and his address onto my paperwork and grinned as I handed them back.

Only a learner's permit? I teased, tapping the big words at the top of his shiny new ID.

He laughed and grinned back in understanding, then pulled a picture from his wallet.

His great-grandson.

Medication Caution: Revatio

I'm being lazy. Here's the text from the REMAC website:

Revatio® (Generic Name: sildenafil citrate)

Revatio (re-vah-tee-o) is a fairly new drug on the market used to treat pulmonary hypertension. Pulmonary hypertension causes increased blood pressure in the blood vessels of the lungs. Because of this, patients are not able to tolerate physical activity and exercise as they used to. You may find patients with COPD that also have pulmonary hypertension. It is very important for all EMS providers to be aware of Revatio because it is made of the same drug as Viagra. The generic name for Viagra and Revatio is sildenafil (sill-dena-fill). Patients on Revatio are contraindicated from receiving Nitroglycerin the same as those on Viagra, Levitra or Cialis. Administration of nitroglycerin to a patient on Revatio could cause a sudden and severe drop in blood pressure. This is an important thing to remember because oftentimes the patient is on a generic form of a drug rather than the brand name. Look for patients with a history of chronic breathing problems—especially when brought on by exertion, to be on Revatio. If you encounter a patient taking Revatio that has indications for nitroglycerin (chest pain), document that the patient is on Revatio and therefore, is unable to receive nitroglycerin. As a reminder, the State and Regional protocol for withholding nitroglycerin has been increased to 72 hours in the presence of Viagra, Levitra, and Cialis (erectile dysfunction drugs). You can find additional information at: http://www.drugs.com/pro/revatio.html

Current and Updated Protocols can be accessed at the Regional EMS Council website: www.nycremsco.org.

More on pulmonary hypertension later...

Recertification

So it's that magical time of year where I realize my EMT license expires next spring, and I ought to get a preemptive start on doing my refresher.

Obviously, this involves an epic choice between recertifying in Massachusetts vs. recertifying in New York. :)

New York EMT licenses last for 3 years. Refreshing in New York City involves Challenge Exams (similar to the normal state practical), and then 3-4 months of classes. You're required to attend the ones regarding the sections that you did badly on during the Challenge. Then you get a final exam.

Massachusetts EMT licenses last for 2 years. Refreshing requires 28 CMEs and a 24 hour refresher class. You can do all of the CMEs and 18 of those 24 hours online.

The 3 year thing is really tempting. When I got my original Massachusetts license reciprocated by New York, they went according to the date on my Massachusetts license. So both of my licenses expire in the spring of 2011, 2 years after I got certified.

But I'm moving back to Massachusetts in 28 days, so a refresher class in New York isn't exactly practical.

And, little known fact:

I LOVE ONLINE CMES. Even if I didn't need them to recertify, I'd still be doing them.

EMCert.com, my personal favorite and the place where I have a 1 year subscription :)

MedicEd.com

EMInet.com

WebCME.com

Going Home

A month ago, he was fine.

He was finishing rehabilitation after a total hip replacement, getting ready to go home.

Then the dyspnea began, and they found the clots in his lungs.

Medications solved that.

But during the follow-up exam, the doctor found rigidity in his abdomen.

A week later he was in the ER with severe jaundice and lethargy.

Cholangiocarcinoma. Cancer in the bile ducts.

Inoperable. They did one dose of radiation before the family made their decision.

He was going home. No one knew if he had a few days or a few weeks. I had a copy of the DNR in my paperwork.

And so we traveled across two states, with his wife of fifty-two years holding his hand and his grown children following in the station wagon behind us.

We gave them most of our extra linens.

No one was ready. They'd only had a month.