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.

80% Of Nitro Prescriptions...

See:
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

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)

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.

<3

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

Also,

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

Who has a happy? I has a happy.

...I can has insurance now please?