Jedediah Joe Capps: October 2012

Tuesday, October 23, 2012

Last week of day shifts

Recently finished my day shifts with my first Preceptor Brittany. The last week with her we had some good calls. We had another cardiac arrest and a GSW (Gun shot wound) to the chest. The cardiac arrest was another 450 + lbs. person, and she went down in her bathroom. I don’t know why, but it always seems like extremely obese people live in really tight quarters and have lots of stuff through out their house. The doorway into the bathroom was the size of a coat closet door. (That’s like 2/3 the size of a regular door!) It is not uncommon for the Fire Department to beat us to the scene, and for some reason they decided to start working the lady right there in the bathroom!

Now, I will give a little EMS perspective here. When we arrive on scene of a known cardiac arrest or Full arrest (No breathing & No pulse/heart beat) we want to move the patient to an open area so that we have the space to work and move about the patient. This may seem a little rough, or rash, but it is for the patient’s best interest. Another thing that has to be taken into consideration is that the first EMS crew on scene may not have the man power to actually carry the patient and so that patient may be pulled, pushed, rolled, etc. to get them in an open area. It’s not a pretty site, but what part of EMS is pretty?

So, back to the cardiac arrest call. The Firemen decided to start working her in the is small bathroom, which her head was right against the edge of the tub so any attempt at placing an airway (like an ET tube or King airway) was going to be extremely difficult. In fact, there was a Fireman in the bathtub reaching over the side attempting to place an airway. Now, I would’ve loved to make an attempt taking care of the airway, but that would have been a huge circus act trying to climb into the tub with the Fireman and take over bagging the patient while he would have to climb over me to get out, so I just left the airway to him. I instead, placed an IO (a needle drilled into the bone) in the patient’s right leg and started pushing meds. It was my 3^rd successful IO. We also ran out of the 1/10,000 concentration of Epinephrine, so I had to mix 1/1,000 into Normal Saline to make the 1/10,000 concentration. We ended up giving Epi (Epinephrine) 11 times! We never resuscitated the patient and I believe the ER pronounced her dead a few minutes after we transferred care to them.

The GSW call started out with Dispatch telling us that shots had been fired within the residence. As we are driving to the call, dispatch says, “PD is on scene and says the scene is safe to enter.” As we arrive, the Fire Department is also scene and as we walk into the residence the patient is laying on the floor, no treatment of any sort has been initiated. The woman was on her hands and knees and would not work with us whatsoever, so that we could examine her wounds, but we could tell that there was an entry and exit wound. She had shot herself clean through the right side of her chest; the exit wound was proximal to the scapula. We quickly got her onto the cot and loaded her into the ambulance. This woman would not work with us at all. I was lucky to get an IV. She kept rolling around and finally my preceptor just decided to let her lay/kneel however she wanted. We had prepared to dart her chest because her lung had collapsed, but she would not hold still and we had a short transport time to the hospital.

When we arrived at OU’s Trauma Center, their trauma team was ready to go. I stuck around and watched them insert a chest tube into the side of her chest to drain the blood and fluid from her thoracic cavity. Watching them place the chest tube made me feel sorry for the lady. It was obvious that the patient had an extensive history of drug abuse. As we were transporting her to the hospital she kept saying that she was sorry for shooting herself and that she knew she had made a mistake. (Uh, Yeah! That would be a huge mistake!) I don’t know if I mentioned that she had used a .22 caliber pistol. I think she just wanted some attention, but then again, maybe she was sincere in her attempt to end her life. Hopefully, she won’t ever make the same mistake again.

Wednesday, October 10, 2012

Week 5 or 6? I am losing track

Well, unfortunately I don't have any really exciting calls to write about this week, but I can tell you a little bit about the many un-emergent calls we are called to on a daily basis. The other day, I believe it was after the second or third call that (what do you know!) was non-emergent! I begin contemplating about the area I come from, I guess some would call it the sticks or redneck country, hick-town, what have you. Anyways, I was thinking about how things are done and about the life we tend to live (or the way of life) in a rural area. Many, of us would not think of calling 911 at the first sign of a child choking. The times I can recall one of my younger siblings or a niece/nephew choking someone always runs to the child and either picks them up or leans them forward and begins to slap them on the back. Thanks be to our Father in Heaven they have always regurgitated what was in their mouth or throat and have been okay.

I wonder, at what point would you call 911? Do we wait until the child or adult is no longer breathing or making an attempt to cough or gasp for a breath of air? I think many of us would wait to call until that point. I am not saying this is right or wrong, but simply stating the mind frame I would have to wait until I thought it was an actual emergency to call. Would it be an abuse of the system to call 911 in the moment your child begins choking? Not at all! I cannot tell you of the relief I (and many other EMS personnel) would have, to arrive on scene and see that the child no longer has an airway obstruction and is alert and breathing. In fact, again.... where I come from if the child spit out whatever they were choking on I believe the caller would make an attempt to call 911 and cancel the ambulance if they (the Ambulance crew) were not already on scene by the time the child was Ok.

With that I preface, my argument or comparison of different types of people I encounter here in OKC. We are often called to a home/apt for a person that has been sick for the past 2 or 3 days and has come to the decision that their illness is an emergency and they need to go to the hospital by ambulance. Whether they are ill with nausea/vomitting or have been experiencing hot and cold chills, they call. Did it ever cross their mind that they could go to a clinic and see a Doctor that would charge them a lot less than what an ER visit costs? Oh wait! If they do that they would have to find a ride to the clinic, and if their only option was a cab, they would have to pay for it out of pocket. Instead, they would rather just call 911 and have an ambulance rush to their address, pick them up, and take them to the ER where we will either put them in triage (I should start practicing this more) or get them directly into a room. So, who's pocket does that come out of? Your's and mine! The Taxpayers of America, The land of the free! :) Did we lose the original and honest meaning of what "The Land of the Free" actually means? Our lovely welfare system contributes more and more to that demographic of society.

Now, this might make some of you sick, so I will forewarn you. This is an actual statement that was documented by our dispatcher from a caller who dialed 911.
REASON FOR CALL: and I quote, "They (the Hospital?) told me that if I took him/her myself they would just make us wait."
(Yes, I see that would be a huge inconvenience for you, I see how this makes your situation an emergency.)
HAHA! (I am not really laughing, are you?)
Wait it gets better!
One of my fellow Paramedic students had a patient say this to them.......
Patient: "I want to finish my cigarette before we go."
Paramedic: "Ok, obviously this is not an emergency and if you need a ride to the hospital, you can just call a cab and get a ride."
Patient: "I can't do that cause I don't have the money for a cab."

CHAA CHIING!!
And a $1500.00 Ambulance ride is charged to someone other than this uh? umm? (do I call them a patient or do they deserve their own special title or category?)

I won't bring up the expenses that go along with an ER visit. I am sure you can find that out if you really want to know.

One memorable call I had was a woman that called 911 for her 4 y/o daughter who had grabbed a bowl or cup of hot syrup off the table and spilled it on herself. Now, my first impression is "Poor child, I hope that she is not severely burned."

We show up to find the child playful and in no pain at all, no burn marks to the skin (HER SKIN WASN'T EVEN RED!) The mother is trying to point out burn marks on the child's skin.
So the mother said, "I knew it was time to call 911 when she started talking about rainbow colors on the ceiling."

Ok, your daughter is 4 years old, she is playing around and not worried about whatever took place with the syrup 30 minutes ago and because she has a bit of an imagination, YOU CALL 911! ???

The best part of this story is that the mother claims to be finishing her nursing program soon. HAHA!

She pulls out this medical dictionary as I am giving my call ahead report to the receiving Emergency Department. I am guessing to look up words I was using to politely explain to the ED Nurse that the child has no signs of trauma and is completely fine. Or maybe she was just studying up for one of her tests coming up? Don't know, but if she becomes a nurse.... I don't know what to think!

Well, I do love to serve those in need and it is a bit refreshing to help someone who is truly experiencing an medical emergency!

Thursday, October 4, 2012

Week 4

Sunday, Bloody, Sunday....

Well, this past week was quite an experience. I had a different preceptor each day because my usual preceptor was out of town for the weekend. It was especially an adjustment because the average age of the Paramedics covering for my preceptor was probable 50 years old, which is twice the age of my normal preceptor, Brittany.

Anyhow, I should just get to the nitty gritty of the calls. Sunday morning began with us getting a call as soon as we left the base station. We arrived on scene at 4:45 a.m. to find the police next to an apartment building with their flash lights pointed toward a woman sobbing and uttering incomprehensible speech, wearing only a shirt, which apparently came from a tenant who had found her and called the police. The woman was in her 20’s and was hunched over in a flowerbed holding her abdomen like the contents within would fall out if she were to let go. The police stated that no one knew who she was or where she had come from. The only item she had in her possession was a cell phone.

Did I mention that it was raining? This woman was lucky if she were to register 100 lbs. on a scale. You would’ve of thought she would be hypothermic wearing no clothes and being soaked to the bone. My first impression was that she was jacked up on Meth, but as we got our first set of vitals she was not tachycardic and her blood pressure was on the low side of normal. The medic, Preston said he thought it was a psychotic break and we immediately started to prepare for IV access and a regimen of sedatives.

The woman started using recognizable words, but still didn’t make much sense and seemed to be in a panic that “they” would hear her and come back to do her harm. Our attempt at peripheral IV’s failed so Preston decided to do an EJ (external jugular, IV). He had given versed IM (Intramuscular injection) a few minutes before so the woman was slowly becoming more and more flaccid and relaxed. Once the EJ was in he administered Haldol and the woman was out! We transported her to the ER and headed to our next post.

We barely made our next post and received a call for a stabbing. Dispatch confirmed that the assailant had fled from the scene and that police had secured the area. As we approach the address I notice that we were entering a nice apartment complex (much like the one that we live in currently). I began recalling the past calls I have been on, and not in a million years would I have guessed that my first actual serious assault would occur in a nice, well-kept community. We arrived on scene the same time as the Fire Dept. At this point, I am a little leery of just jumping out of the ambulance, so I take it slow and I am in total condition red, waiting for some lunatic to come running at me with a knife. As I step out of the back of the ambulance Preston comes to the back of the ambulance just as a black SUV quickly pulls in about 15 ft. away from us. A man jumps out and approaches us asking where his brother is. In a split second, Preston goes into defensive mode telling the man to stop right where he is at. The man continues to approach him saying, “the Dude is his brother!” With the use of some colorful language, Preston tells the man to stop where he is and to get back in his vehicle.

At this point I am trying to decide if I should continue to stay with Preston as both men are now seriously agitated with each other (I can see another assault about to take place). Just then another police officer pulls up and Preston points to the man and asks the officer to deal with him. I grab the trauma bag and follow Preston to the scene. As I approach the victim I see firefighters kneeling down beside the young man, they are holding pressure to the victim’s chest with a shirt that is soaked in blood. A girl is sobbing and walking away from the victim with blood on her shirt. The Firefighters say they need a HALO (Occlusive bandage) and ask me for a stethoscope to listen to lungs sounds.

Preston is not interested in staying on scene for long, so he directs the firemen to put the victim on a backboard and get him to the ambulance. The victim (a 21 year old male) is crying and screaming he can’t breathe, while the veteran EMS personnel assure him that he can because he is able to scream and tell them how much pain he is in (Not much for consoling the victim). The young man becomes more agitated and starts swearing at us. As I kneel beside him and help move him to the backboard I find another stab wound to his lower abdomen with minimal bleeding.

We get him in the back of the ambulance and the young man continues to yell in agony that he hurts and can’t breathe. I step up into the ambulance and Preston tells me to get an IV started. I apply a constricting band to the guy’s arm and Preston hands me a 16 gauge needle. (Now I was a little disappointed that he didn’t hand me a 14 gauge, but I haven’t stuck a patient with a 16 yet, so I guess I am working towards a 14). I get the IV and start a bag of fluids. Next I move to trying to calm the guy down and grab a NRB (non-rebreather mask) and tell the guy that he his breathing OK and that his vitals are looking good. We drive code to Oklahoma’s Level I Trauma Center (OU Presby). I continue my assessment and look for other stab wounds that we might have missed. The young man begins to tell us about the assault and that “The Dude” who stabbed him was a guy he worked with. (Talk about working with bad people!) All in all the young man had a 3 inch laceration to his left lateral chest (which I am sure it may have been from multiple stabbings to his chest) and one stab wound to his left lower abdomen, his lung sounds were diminished mainly because he wouldn't take a deep breathe due to the pain it caused.
We got him to the ER and it was pretty amazing to see the trauma team go to work, I am estimating that they had him into surgery within 20 minutes of our arrival. Upon there assessment and x-ray they confirmed that his left lung had collapsed. I spent the next 5 minutes or so trying to wash the guy’s blood out of my pants. Later, I asked Preston what you do if a patient won't take a deep enough breath for you to hear lung sounds and he said that he just pressed his thumb in the guys wound to make him gasp and take a breath. "Do no harm", except when necessary. We left the hospital with 8 hours left in our shift; it had been an exciting morning.

Jedediah Joe Capps