Thursday, February 25, 2010

Something Every Man Fears

Today I pulled at the Campus EMT squad, for lack of a car. I slept there last night, so as not to miss my 0830 midterm this morning due to inability to get there on time...and just stayed, because we're kind of having another snowstorm, and why not.

Our first call of the day was both wince-inducing and possibly a real emergency. It was called in to us from the student health center as an "abdominal pain" which turned out, when we got upstairs and got accosted by the questionably skilled nurses, to be TESTICULAR pain, possibly a torsion. A testicular torsion is A Bad Thing. In fact, it's a surgical emergency that has to be corrected pretty damn quick, or you lose the testicle involved to ischemia. The poor kid was really scared, and I don't blame him. I DO blame the nurse, who kept us outside the room for a minute, telling us "dont ask him any questions or examine him, just take him to the hospital. He's embarrassed".

No. If you want a TAXI, you call a TAXI. If you call an AMBULANCE, you get asked questions, vital signs taken, and assessed for any immediate problems. Can you imagine if an ambulance pulled up at the ER, and just unloaded the patient to the ER nurse saying "well, we dont actually KNOW what happened, because we didn't want to embarrass the patient. No, we didn't look at it either, cause the nurses at school said not to!"

The patient himself was quite cooperative, although he did refuse a physical genital exam- two women on the crew, i'm not sure I blame him, it's only a 5 minute hospital transport. i DID manage to elicit a possibly important history though- when he was a baby he had an inguinal hernia repair on the OTHER side...maybe this is just a hernia, not a torsion! I do feel sorry that he was embarrassed, our driver S is a guy, and he was practically wincing the whole way to the hospital, in sympathy. Still, better a little embarrassment NOW than a bigger problem later.

So there you have it. EMTs DO try to assess their patients. If you want to just get a ride, call a friend or a taxi. We're better than that. We'll try to help save your life if you give us a chance.

When it rains...

Yesterday afternoon my car decided to stop working. I was planning on being home by now, up in the Frozen Northlands, but I decided to make a food run for road supplies, and my car stopped shifting gears. I drove my poor little Civic straight to the dealership down here, and they diagnosed my brave little car with having her wires chewed through by mice. It's going to be 500 dollars to fix. Dammit. I really don't have the money to spend on it, but no choice. I need my car to work, so...there you have it. Really hoping I can pull some calls as soon as i get home, to earn some money to make up for it. Grr...

Wednesday, February 24, 2010

Done With Pediatrics

Today was the last shift of pediatric rotation. I learned a lot about human development, I played with some cute kids, and World's Greatest Children's Hospital was MARVELOUS as a placement- the equipment all worked, the kitchen was stocked, the staff was top-notch- but I'm glad to be done with it. Floor nursing just isn't for me.

Today I had a mixed bag- one GREAT patient, one Exorcist patient. The great patient was a 10 year old girl, one day post-op for a splenectomy, who let me get her out of bed (in spite of some serious pain) to help her to the bathroom, let me take her to the play room (she needed to sit up straight for a while to prevent Acute Chest Syndrome), and basically coped pretty well with her treatment, said please and thank you, the whole bit.

Her roommate, a 10 year old girl, needed FIVE NURSES to restrain her to take ONE ORAL DOSE of a not-bad-tasting medication. she simply did not wish to take it. she took it yesterday, without a problem, said it didn't taste bad, but today she was clearly possessed by DEMONS. she spat at the nurses, tried to bite, and basically was AWFUL. her mother just stood by the bed saying "she likes to play". Clearly this is where she gets her fabulous attitude. I asked the mother to either help us get the meds in, or leave the room. She refused to do EITHER, and just stood there laughing as I got spat on and kicked, and the doctor got punched in the chest. He had shown up when the kid started screaming, to lend a hand.

Next is OB. Hopefully less kicking.

Monday, February 22, 2010

Conversion Disorder

Conversion disorder is when someone (usually an adolescent, and female) takes some sort of outside stimulus (school bullying, or puberty, or nerves, or whatever) and manifests it as physical symptoms.
ALL nursing students suffer from a bit of this, when we worry ourselves sick, or we give ourselves headaches, convinced we're failing a course. This is not a disorder.

A patient today DID have the disorder. Breaking the odds, he was male, 13 years old, good student, all that. And he was dizzy. REALLY dizzy, especially when he stood up, or was made to do anything he didn't want. Suprisingly, even sitting up or standing or walking, he had NO problems, as long as he was goofing off, or talking on his cell, or looking for snacks. Assess him, or let anyone in a white coat enter the room, and suddenly he was "super dizzy, weak, and unable to stand on his own".

I feel bad for the kid. If he had an organic problem, there'd be an easier fix...with this, he's got to use meditation and biofeedback, and possibly wait to grow out of it.

Modern medicine mostly sucks at behavioral conditioning...except when it involves training people to take medications...

Monday, February 15, 2010

Age Differences

The strangest thing about pediatrics is the developmental difference between our patients. In adult medicine, even if two patients have ages 15 years apart, their care remains pretty much the same. A 65 and and 80 year old heart attack patient are treated with the same drugs, in the same approximate amounts, with predictable effects.

In pediatrics, on the other hand, it is possible to have EXTREMELY different patients. Today, mine were 2 years old, and 18 years old. One pulled at my earrings, and tried to RUN AWAY from the blood pressure cuff, the other was worried about missing his chemistry class.

It's actually kind of amusing, once you get past the shock of going room to room and adjusting speech patterns and priorities by age. For the teenagers, you need to emphasize (against the express dictates of Very Catholic University) sex education, good decision making, and independence. For the toddlers you focus on SIMPLE choices: "do you want the BP cuff on your ARM or LEG?" or "temperature BEFORE or AFTER I count your pulse?"

All in all, I like pediatrics, except for the teens in Status Dramaticus. They drive me NUTS! After all, if your pain level doesn't CHANGE after you've received a MASSIVE dose of painkillers that makes you REAAAAAALLY high, and you STILL rate your pain level as "the same! 10!", what would the point be of me giving you any MORE pain meds? If you're breathing at 6 when you sleep, due to the sheer amount of narcs, we CANNOT give you more! Plus, don't think I didn't notice that when I was not within view, you were giggling, laughing, eating a FULL lunch, and chatting with your friends about how you were SO getting "the whole week" off from school. Yeah. I told your doctor. :-p

Thursday, February 11, 2010

My So-Called Snowpocalypse

I spent an unintended 24 hours on call yesterday afternoon into today at the ambulance. I left my car at the squad building Tuesday night, intending to pick it up Wednesday and return it to my apartment building after we were plowed out, walked the mile from my apartment to campus yesterday afternoon aaaaaand...promptly got told NOT to walk back, as it was quite windy and snowy out.

Since I only had half a change of clothes (so that I'd be dry after I got there), I had to run upstairs to the student health center and borrow a set of scrubs from the nurses (they keep a supply for sick students to wear) to wear as pjs. Then we realized that the ambulance was grounded (only allowed to move in an emergency) which meant WE were stuck in the building too...except for me, as I wasn't officially ON I wound up tramping across campus to a dining hall, and scrounging food for the whole crew. They were WONDERFUL, and gave me about 5 POUNDS of chili-mac and apples, crusty bread, and dessert. FABULOUS.

We only had one patient, in spite of the massive amount of partying expected on campus, due to classes being canceled for today as well. We attribute the LACK of mayhem to the fact that everyone drank heavily TUESDAY night, in anticipation of having classes canceled WEDNESDAY....except that YESTERDAY, the liquor stores were closed. This meant no-one could restock on alcohol, so, being an intemperent bunch, most of the students were OUT OF ALCOHOL! OH NO!

Friday, February 5, 2010

A Guide for College Drunks

Hi, drunk college students! In the interests of making all our lives easier, here's a little advice:

1. When you decide to go out in the middle of the week, go EARLY in the evening, so that you can get wasted, stumble back onto campus, get picked up by public safety and taken to the hospital in time for the rest of us to get some sleep.

2. If an EMT tells your slightly LESS drunk friend to "please just stand over there and put on a coat, it's freezing", cussing the EMT out and muttering snarky things under your breath will NOT endear you to either Public Safety officers, or the other EMTs. Hint: either you dont mutter as quietly as you think, or you might want to remember that when you're drunk, you tend to lose inhibitions. I hope you enjoy the 500 dollar fine.

3. If you're going to lie and give us the birthdate from your fake ID, show a little spine and give your fake AGE too. If you give us a REAL under-age age, and a FAKE birthday, a little simple math makes you look even MORE like an idiot.

4. I know it's a cliche that you should wear clean underwear in case you get into an accident, but really, EMTs dont WANT to look at your underwear, so a skirt that is wider than your average belt would be great

5. If you're worried about a friend who cant hold their liquor, don't worry. We WILL come out and get you in the middle of the night, and do whatever it takes to keep them safe. Just...try not to let it get that bad. You guys might swear at us, and hate us, and think we're all out to get you busted, but really, we just want to make sure that all of you who go to bed get to wake up tomorrow, hangovers and all.

Tuesday, February 2, 2010


Yes, I know I've already posted today, but this was getting to me.
This evening, Very Catholic University (VCU) was playing a home game against Some Other University (SOU). This meant that the parking lot next to the Student Health building was PRIME parking real estate. Now at Collegiate EMS, we dont actually HAVE our own garage, we have a lovely set up with a massive parking space on the lower level of this covered garage, which we have marked off by cones as well as flourescent parking lines saying "NO PARKING- AMBULANCE" all over them.

Needless to say, as we are near the Home Stadium, the Health Services lot becomes "The VIP lot" during games, and VIPs tend to be...well...asshats. I spent AN HOUR AND A HALF this evening kicking people out of the CLEARLY LABELED ambulance spot. Once, I even had to go yell at a guy who made his 10 year old kid get out and start MOVING OUR CONES so he could park in the spot. I bounced out the door, ran over, and knocked on his window: "Sir! You can't move the cones! They're there to help you notice the 'NO PARKING- AMBULANCE' sign!"

"But..." says he, irritably, "all the other spots HERE are TAKEN!"

"The ambulance needs to plug in to this plug here, sir, or the epinephrine we keep on board freezes, and the next kid with a nut allergy dies in agony" I replied. Entitlement to VIP parking is one thing. Believing that you have a god-given right to park in an emergency vehicles zone? That's a whole NEW level of evil. Next time I'm not going to warn him, I'm going to tow his car WITH THE AMBULANCE...into the dumpster.

My Kingdom For An Accurate Dispatch!

Today was another episode of Fun And Games with the collegiate EMS dispatcher! This time, I was OVERJOYED to have a call for a -gasp- actual medical complaint! "College EMS, please respond to On Campus Nursing Home for a Really Old Dude with a witnessed syncopal episode!" 'WHEE!' I thought, 'an actual call! where I might be able to perform interventions! And help fix someone!'

No such luck. Upon arriving at On Campus Nursing Home (seriously. It's a nursing home, on campus.), we find Really Old Dude (ROD for short) sitting up in a chair, looking really lousy. "Hi, ROD!" I said with my best jaunty EMT grin, "I'm Little D, and I'll be your EMT today! When did you faint?" And that's pretty much when it all went pear shaped.

"Oh no, he never FAINTED!" Piped up the nurse at his side, "ROD got sick last night, and hasn't gotten better!" "Define 'sick' for me" I asked, warily. "Oh he's been vomiting, and having diarreha, isn't that right ROD?"

Oh great. Here we go AGAIN. "Ho ho ho!" Replied ROD, perking up a little bit. "Sir, how are you feeling?" I tried again, "You've been a good little girl! I'm feeling fine! Merry Christmas!"

Yes, ROD thinks he's Santa Claus. "ALTERED MENTAL STATUS" I wrote. "Um...ROD always thinks he's Santa Claus" interjected my partner. Peachy I thought to myself- nausea, vomiting, NO syncope, AND he think's he's Father Xmas. This is SO my day.

We dropped ROD off at the hospital as requested. This may be his last visit, as people with "Alphabet Soup" rarely do well. A SMALL sample of his PMH revealed the following: BPH, COPD, HTN, CHF, NIDDM, GERD, and PEs, and multiple DVTs, as well as at least one CVA.

This time the dispatch mixup was not all the dispatcher's fault. Apparently the nurses called in for a "Sick Episode". Seriously? A SICK EPISODE? What's next? A HUNGRY episode? This has to stop.

In other news, my morning at the Greatest Pediatric Facility In the Galaxy went extremely well.