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A Student Paramedic of the Uni Variety
Ambulance from a student paramedic's perspective.
28 August 2009 @ 10:22 am
21 June 2008 @ 07:30 pm
Life has been busy... work life that is... I've moved to a new station and started on a brand new roster. I hated my new station in the beginning but I have to admit that I have come to adjust to it and starting to feel really quite at home and a lot less resentful about being there. Like always, life worked itself out and I now have a line to call my own... I knew it was a gift opportunity. I knew that I'd be surrounded by the best and most educated in the field. I knew it would be closer to home. I knew HJs was on the way home... I knew that if there was a chance of landing a line, then this would be the place to do it. But I still felt disturbed by it all the same but indeed it has come good. :-) Now with a Subway open round the corner... my life is complete! Haha!
The new roster is hard. 12 hours makes for long days and really really long nights. Being at a priority station we're not kicked around quite so much but when we do... boy it is hard. 12 hour nights are a killer. Especially two in a row. I'm facing five weeks straight of day, day, night, night - something I've been dreading. I'm trying to look past it.
From a clinical perspective it has been a time when i've really been taking a good long hard look at myself and I feel that I'm growing yet again. The introduction of CART has made me a lot more aware of my paperwork and ensuring that it is up to the standard in all cases. I'm always working harder to make myself a good clinician. It has been a challenging time and I've had much benefit from chatting with some of the ICPs around the station with their years of experience.
Today I had another one of those path changing experiences. For the first time, I had a rather healthy looking patient go from GCS 15 to GCS 3 and nearly bottom out entirely...unexpectedly.
We had been called to a 76 y/o gentleman who had been complaining of fever, nausea, vomiting and diarrhoea over the past three days. He'd also been experiencing dizziness on standing up. Although the food intake was nonexistant, he said he'd been keeping up with his fluids. What he didn't tell me was that what he meant by that was tea drinking.. Anyhow, he was a good colour and everything checked out. The only number out in my head was his blood pressure which was sitting at ~100 systolic. He said his blood pressure was always really good and I reasoned that with a reduced food intake he'd probably be a tad dehydrated. After having his options laid out, he opted to stay home even after I'd outlined my concerns given his hx of heart failure.
My partner had taken some gear back out to the truck while I had been chatting with him. When he returned I asked for a second set of vitals as was the requirement for the paperwork. This time his blood pressure came back at ~80 systolic. I said "are you sure?" which is a dumb question given that my partner never gets it wrong. He repeated but the second time came back with ~60 systolic. Having difficulties understanding where such a drop came from, I did one myself and came back with the same result. My head clicked into action mode and suddenly it was all on... The alarm bells were starting to go off given a drop of 40mmHg in such a short time. My partner went out to grab the gear back in and I started to explain the need to go to hospital. He started to complain of dizziness and began to get rather pale. I ordered my partner to whack on some oxygen and get the monitor back on fearing that there may have been some underlying cardiac involvement. I prepared for cannulation with the mind to give fluid. On went the torniquet and out an 18G w/ bung and opsite. But I never got to the cannulation as I became aware of my patient starting to gape like a fish before making that horrible gurgling noise and the sound of lot of incontinence. It wasn't good. Gurgle passed and he was grey, unconscious w/ no palpable pulse.
My cage is rattled. I wasn't mentally prepared for an arrest even though it had crossed my mind. I'm nervous and even now the exact order of events is sketchy....
Defib pads go on, screaming down the radio for ICP backup code 1. We are looking at a rate of 20... junctional rhythm. Just as quick as it had happened he's back.... like it never happened. Pale as anything but conscious and alert.... sinus rythm of 60 and BP of ~80... Priorities shift again and I regain control. My partner talks to him while I get a high flow mask on his face. Legs elevated even higher... I'm back on cannulation and working towards the maxolon as my patient dry reaches (thank goodness there was nothing to vomit). Maxolon goes in and now I'm torn as I want to get a 12 lead ECG before I consider giving fluids in case of cardiac failure. My partner primes a fluid line and I look to make a start on the ECG when the gold shoulders walk in... I give a somewhat scrambled handover (seeing the last information they got was an "our patient has just arrested"). then my brain gives out.... I give an idea of a treatment plan and then take a backseat and try to calm down after a lot of reassurance about how I've done the right things.
12 lead is normal. Fluid is a go and we end up giving him 800ml which brought his BP up to 110/55... and also made him look quite rosy. I'd refocused myself by the time we had departed.
After an hour's worth of paperwork, my patient was sitting up an looking in perfect health - better than even when we first walked in. He thanked me like I was awesome.
In one way I was happy because we managed to get back on track despite such a fall in the patient's condition. By the time the ICPs had turned up I had an 18G in his ACF and maxolon down with a line ready to go.
But there is a lot to be learned from in that case in regards to my ability to remain calm, clear headed and systematic.
I'm not sure I believe in karma as such but for some reason things just worked out for this gentleman and for me. We were there at just the right time. 20 minutes earlier and we would have left him... he probably would have died and I would have to answer for his life in coroner's court. Had he come with us, which was what I had prepared for, we would have assisted him to the stretcher outside where he might have collapsed out the front of house and possibly died. As it was, his granddaughter who had been with us, stepped out and missed the entire sequence of events and never had to see him in an arrested state. It was just the best possible outcome.
I feel now that I can look at a similar situation a bit differently and having experienced the sudden arrest first hand, I can be better prepared in future for the possibility and how to handle it.... I love this job... it makes me so angry sometimes but I love what I do and I love that I've got challenges and am learning. I wanted a big job today and I got what I asked for but not at a time when i wasn't ready to handle it. Things can only continue to improve.
The new roster is hard. 12 hours makes for long days and really really long nights. Being at a priority station we're not kicked around quite so much but when we do... boy it is hard. 12 hour nights are a killer. Especially two in a row. I'm facing five weeks straight of day, day, night, night - something I've been dreading. I'm trying to look past it.
From a clinical perspective it has been a time when i've really been taking a good long hard look at myself and I feel that I'm growing yet again. The introduction of CART has made me a lot more aware of my paperwork and ensuring that it is up to the standard in all cases. I'm always working harder to make myself a good clinician. It has been a challenging time and I've had much benefit from chatting with some of the ICPs around the station with their years of experience.
Today I had another one of those path changing experiences. For the first time, I had a rather healthy looking patient go from GCS 15 to GCS 3 and nearly bottom out entirely...unexpectedly.
We had been called to a 76 y/o gentleman who had been complaining of fever, nausea, vomiting and diarrhoea over the past three days. He'd also been experiencing dizziness on standing up. Although the food intake was nonexistant, he said he'd been keeping up with his fluids. What he didn't tell me was that what he meant by that was tea drinking.. Anyhow, he was a good colour and everything checked out. The only number out in my head was his blood pressure which was sitting at ~100 systolic. He said his blood pressure was always really good and I reasoned that with a reduced food intake he'd probably be a tad dehydrated. After having his options laid out, he opted to stay home even after I'd outlined my concerns given his hx of heart failure.
My partner had taken some gear back out to the truck while I had been chatting with him. When he returned I asked for a second set of vitals as was the requirement for the paperwork. This time his blood pressure came back at ~80 systolic. I said "are you sure?" which is a dumb question given that my partner never gets it wrong. He repeated but the second time came back with ~60 systolic. Having difficulties understanding where such a drop came from, I did one myself and came back with the same result. My head clicked into action mode and suddenly it was all on... The alarm bells were starting to go off given a drop of 40mmHg in such a short time. My partner went out to grab the gear back in and I started to explain the need to go to hospital. He started to complain of dizziness and began to get rather pale. I ordered my partner to whack on some oxygen and get the monitor back on fearing that there may have been some underlying cardiac involvement. I prepared for cannulation with the mind to give fluid. On went the torniquet and out an 18G w/ bung and opsite. But I never got to the cannulation as I became aware of my patient starting to gape like a fish before making that horrible gurgling noise and the sound of lot of incontinence. It wasn't good. Gurgle passed and he was grey, unconscious w/ no palpable pulse.
My cage is rattled. I wasn't mentally prepared for an arrest even though it had crossed my mind. I'm nervous and even now the exact order of events is sketchy....
Defib pads go on, screaming down the radio for ICP backup code 1. We are looking at a rate of 20... junctional rhythm. Just as quick as it had happened he's back.... like it never happened. Pale as anything but conscious and alert.... sinus rythm of 60 and BP of ~80... Priorities shift again and I regain control. My partner talks to him while I get a high flow mask on his face. Legs elevated even higher... I'm back on cannulation and working towards the maxolon as my patient dry reaches (thank goodness there was nothing to vomit). Maxolon goes in and now I'm torn as I want to get a 12 lead ECG before I consider giving fluids in case of cardiac failure. My partner primes a fluid line and I look to make a start on the ECG when the gold shoulders walk in... I give a somewhat scrambled handover (seeing the last information they got was an "our patient has just arrested"). then my brain gives out.... I give an idea of a treatment plan and then take a backseat and try to calm down after a lot of reassurance about how I've done the right things.
12 lead is normal. Fluid is a go and we end up giving him 800ml which brought his BP up to 110/55... and also made him look quite rosy. I'd refocused myself by the time we had departed.
After an hour's worth of paperwork, my patient was sitting up an looking in perfect health - better than even when we first walked in. He thanked me like I was awesome.
In one way I was happy because we managed to get back on track despite such a fall in the patient's condition. By the time the ICPs had turned up I had an 18G in his ACF and maxolon down with a line ready to go.
But there is a lot to be learned from in that case in regards to my ability to remain calm, clear headed and systematic.
I'm not sure I believe in karma as such but for some reason things just worked out for this gentleman and for me. We were there at just the right time. 20 minutes earlier and we would have left him... he probably would have died and I would have to answer for his life in coroner's court. Had he come with us, which was what I had prepared for, we would have assisted him to the stretcher outside where he might have collapsed out the front of house and possibly died. As it was, his granddaughter who had been with us, stepped out and missed the entire sequence of events and never had to see him in an arrested state. It was just the best possible outcome.
I feel now that I can look at a similar situation a bit differently and having experienced the sudden arrest first hand, I can be better prepared in future for the possibility and how to handle it.... I love this job... it makes me so angry sometimes but I love what I do and I love that I've got challenges and am learning. I wanted a big job today and I got what I asked for but not at a time when i wasn't ready to handle it. Things can only continue to improve.
Current Mood: 
sick
sick20 March 2008 @ 08:54 am
I had been dreading these two nights. Four days on (two day shifts and two afternoons) followed by one day off, then two night shifts, a day and afternoon shift. The nights were not looking good because I was to be floating and as usual could end up anywhere working with anyone. However, I have to say that I really did strike it lucky.
Tuesday night I was instructed to go over to the bayside with one of our units. I thought that was unusual and didn't like my chances of getting there. Rightly so, as the minute I logged on I was dispatched as a single response to abdo/chest pain. As a student I had been looking forward to running by myself for the first time. As a qualified I was still excited by the prospect but very nervous. Driving code 1 in a vehicle on your own is a different experience and despite my worst nightmares, I arrived well before the backup crew! Hooray for advanced map reading skills. ;-)
Anyway, I pulled up and was feeling nervous. I wondered why... I don't feel nervous about jobs when working with someone else regardless of the level of clinical experience. It did all go well though. The adbo pain was an epigastric pain which the patient had experienced before and the specialist felt was related to the gall bladder removal a while back. It is a bit of a different experience having to ensure you get a full set of vitals, process the story and ask all the appropriate questions at the same time. I actually found this to be easier than I expected and I attribute this to the little time I've had working with students. It only really took a minute for me to calm down and I got through without a problem. The backup crew arrived and I gave a handover before packing up and heading on my way.
It wasn't to be my only single officer response for the night however, as I got sent code one to another chest pain that was a bit closer to my target destination. The transport crew ended up only being a minute behind me so I only really got a chance to lug my three bags in, introduce myself and find out roughly that the guy had chest pain and numbness in his right arm. It made for a smooth transition for the new patient care and I stayed around to help treat and load the patient. It turned out to be one of those really odd could-be-anything-including-cardiac type cases and I was kind of glad that I didn't have to try and work out what was going on and get everything organised at the same time.
The rest of the night was quite relaxed with a transfer from the islands to the local hospital to finish off before a couple of hours sleep - something unheard of these days.
Last night was equally good. I spent an hour and half at station waiting for my second officer to pick me up and again only had two jobs before a good couple hours of sleep and returning.
I got slapped with one of those could-be-anything-including-car
The guy said he suffered fibrositis which affected the muscles around his heart and gave him headaches. However, I had not heard of this condition and didn't really know what to expect which made things a tad difficult given that he couldn't really elaborate about what exactly the problem was. He described the pain as being an ache on his left side of chest w/ some numbness down his left arm. The crew on scene had treated him as cardiac and given an aspirin and GTN and his pain (I think more coincidentally) went away. A little bit of further investigation revealed that the pain was aggravated by movement and cough. He said he'd had the pain for years but normally managed it with panadol or aspirin. This episode was three days long and much worse than ever before. He also happened to mention feeling nauseas and had been upset in the stomach of the last week and had some kind of upper GIT hernia or ulcer.
As soon as we went to put him outside his pain returned and then he started dry reaching. He denied ever having angina or cardiac problems as such and his pain just didn't match up with the typical presentation of ischaemic chest pain. The first crew had already put a line in so I generated a plan of attack. I decided to initially persist with the GTN to see if that was going to make a difference again and then throw in some morphine and maxolon (he quite handily had a hx of GIT upset with morphine) if the pain continued. I gave a GTN and his pain eased a little and then I put in some morphine + max to see if that would knock it off. (Should mention all his vitals were within normal limits and ECG was unremarkable). But instead of making it go away, it seemed to get worse and he was suddenly rolling around in agony. That was when I got to see the thing come and go of its own accord. One minute he'd be near crying and the next able to focus on me and talk to me. By this time I was pretty well satisfied that it was not an ischaemic pain and dumped GTN in favour of the morphine. So, by the time we got to hospital he had 3x GTN, 1x aspirin, 5mg morphine & 10mg of maxolon on board and was looking worse for wear than when I'd first picked him up. I handed over and watched the fellow yack his guts into an emesis bag. Confusion +++
Having written all this I've actually had a chance to find out that fibrositis is actually the old name for fibromyalgia. Suddenly, it all makes sense... The term fibrositis must have come from a time well back because noone at the hospital seemed to know what it was either.
So in hindsight, I was right that it wasn't ischaemic as such but I don't think it was a bad thing to treat it like so given that it can't be a good thing to have that happen to muscles around the heart when it causes pain like that. Plus a bit of CYA never hurts... I was glad that I managed to keep things cool despite the guys' pain level. My student appeared to be largely more anxious but I was glad that I was able to keep just that little bit distanced and manage it calmly with a clear plan.
The second and last job for the night was a polypharmacy on 40x Xanax, 3x seroquel, 1x valium & 8+ shots of bourbon. Hx of same three days early and only just been released. Got to fill out my first EEO...
Other than that, managed a few hours of sleep and then returned back home. :-)
Interesting two nights and a great learning experience!
Tuesday night I was instructed to go over to the bayside with one of our units. I thought that was unusual and didn't like my chances of getting there. Rightly so, as the minute I logged on I was dispatched as a single response to abdo/chest pain. As a student I had been looking forward to running by myself for the first time. As a qualified I was still excited by the prospect but very nervous. Driving code 1 in a vehicle on your own is a different experience and despite my worst nightmares, I arrived well before the backup crew! Hooray for advanced map reading skills. ;-)
Anyway, I pulled up and was feeling nervous. I wondered why... I don't feel nervous about jobs when working with someone else regardless of the level of clinical experience. It did all go well though. The adbo pain was an epigastric pain which the patient had experienced before and the specialist felt was related to the gall bladder removal a while back. It is a bit of a different experience having to ensure you get a full set of vitals, process the story and ask all the appropriate questions at the same time. I actually found this to be easier than I expected and I attribute this to the little time I've had working with students. It only really took a minute for me to calm down and I got through without a problem. The backup crew arrived and I gave a handover before packing up and heading on my way.
It wasn't to be my only single officer response for the night however, as I got sent code one to another chest pain that was a bit closer to my target destination. The transport crew ended up only being a minute behind me so I only really got a chance to lug my three bags in, introduce myself and find out roughly that the guy had chest pain and numbness in his right arm. It made for a smooth transition for the new patient care and I stayed around to help treat and load the patient. It turned out to be one of those really odd could-be-anything-including-cardiac type cases and I was kind of glad that I didn't have to try and work out what was going on and get everything organised at the same time.
The rest of the night was quite relaxed with a transfer from the islands to the local hospital to finish off before a couple of hours sleep - something unheard of these days.
Last night was equally good. I spent an hour and half at station waiting for my second officer to pick me up and again only had two jobs before a good couple hours of sleep and returning.
I got slapped with one of those could-be-anything-including-car
The guy said he suffered fibrositis which affected the muscles around his heart and gave him headaches. However, I had not heard of this condition and didn't really know what to expect which made things a tad difficult given that he couldn't really elaborate about what exactly the problem was. He described the pain as being an ache on his left side of chest w/ some numbness down his left arm. The crew on scene had treated him as cardiac and given an aspirin and GTN and his pain (I think more coincidentally) went away. A little bit of further investigation revealed that the pain was aggravated by movement and cough. He said he'd had the pain for years but normally managed it with panadol or aspirin. This episode was three days long and much worse than ever before. He also happened to mention feeling nauseas and had been upset in the stomach of the last week and had some kind of upper GIT hernia or ulcer.
As soon as we went to put him outside his pain returned and then he started dry reaching. He denied ever having angina or cardiac problems as such and his pain just didn't match up with the typical presentation of ischaemic chest pain. The first crew had already put a line in so I generated a plan of attack. I decided to initially persist with the GTN to see if that was going to make a difference again and then throw in some morphine and maxolon (he quite handily had a hx of GIT upset with morphine) if the pain continued. I gave a GTN and his pain eased a little and then I put in some morphine + max to see if that would knock it off. (Should mention all his vitals were within normal limits and ECG was unremarkable). But instead of making it go away, it seemed to get worse and he was suddenly rolling around in agony. That was when I got to see the thing come and go of its own accord. One minute he'd be near crying and the next able to focus on me and talk to me. By this time I was pretty well satisfied that it was not an ischaemic pain and dumped GTN in favour of the morphine. So, by the time we got to hospital he had 3x GTN, 1x aspirin, 5mg morphine & 10mg of maxolon on board and was looking worse for wear than when I'd first picked him up. I handed over and watched the fellow yack his guts into an emesis bag. Confusion +++
Having written all this I've actually had a chance to find out that fibrositis is actually the old name for fibromyalgia. Suddenly, it all makes sense... The term fibrositis must have come from a time well back because noone at the hospital seemed to know what it was either.
So in hindsight, I was right that it wasn't ischaemic as such but I don't think it was a bad thing to treat it like so given that it can't be a good thing to have that happen to muscles around the heart when it causes pain like that. Plus a bit of CYA never hurts... I was glad that I managed to keep things cool despite the guys' pain level. My student appeared to be largely more anxious but I was glad that I was able to keep just that little bit distanced and manage it calmly with a clear plan.
The second and last job for the night was a polypharmacy on 40x Xanax, 3x seroquel, 1x valium & 8+ shots of bourbon. Hx of same three days early and only just been released. Got to fill out my first EEO...
Other than that, managed a few hours of sleep and then returned back home. :-)
Interesting two nights and a great learning experience!
Current Mood: 
exhausted
exhausted17 March 2008 @ 08:18 pm
It has been an interesting couple of weeks. Two weeks ago I got work with an absolutely brand new students. This was indeed a memorable experience. The first day was a bit difficult and I wasn't quite used to having to think for the other person. There are things that you would assume would get done but just don't happen with new students without the experience. But the second time around it was a whole lot easier and I was able to collect a set of vital signs and pay attention to how the case was progressing to pick up where I needed. I found myself calling out QFRS for a car accident and single handedly managing a scene for the first time. I look around and see all those flashing lights and the complexity of what is happening and I can't help but wonder if I was over reacting. I understand some of the crew dynamics that used to bug me or I found unusual when I was a student. I am seeing things from a whole new angle.
I found myself with one of the current final year uni students for a day last week. It was interesting to see myself in what they were doing or not doing as the case was at times. I also found myself confronted by decisions and being all too aware that it was only going to be me who made them... no advice and noone to bounce ideas off.
Managed a pretty serious (but not quite pre-arrest) asthma this last week and did a good job of it. Finally pretty comfortable with the idea that I'm not going to kill anyone and I can manage a sick patient. Had a few learning experiences in terms of hyperglycaemia and small children.
Tonight I went to my first clinical night. It was about 12 lead ECGs and really was recapping old information for me but was good to cover it again and get a different take. Feeling really inspired and enjoying things more than ever. So good to be here. :-)
I found myself with one of the current final year uni students for a day last week. It was interesting to see myself in what they were doing or not doing as the case was at times. I also found myself confronted by decisions and being all too aware that it was only going to be me who made them... no advice and noone to bounce ideas off.
Managed a pretty serious (but not quite pre-arrest) asthma this last week and did a good job of it. Finally pretty comfortable with the idea that I'm not going to kill anyone and I can manage a sick patient. Had a few learning experiences in terms of hyperglycaemia and small children.
Tonight I went to my first clinical night. It was about 12 lead ECGs and really was recapping old information for me but was good to cover it again and get a different take. Feeling really inspired and enjoying things more than ever. So good to be here. :-)
Current Mood: 
optimistic
optimistic21 February 2008 @ 09:01 am
I was happy last night because I was actually able to stay at my station and work with the partner I'd had for the previous five weeks. 
First job for the night was a big one... in more than one way. QPS were doing a patrol of an industrial area and noticed a truck alone in a block of industrial buildings. They found a 30 y/o guy who was AT LEAST 160kg, unconscious on the ground, having overdosed on Endep (TCA). He'd taken a total of 2.5 grams (50x 50mg) and washed it down with a can of V and suicide note to boot. Had he been a smaller man or the police not been patrolling the guy would surely have died.
He had rapid shallow resps, was blue in the face and snoring. VSS: GCS 8, BP 120/90, PR 130 ST, Sp02 92%, RR 30, 36.2C & 6.8 mmol/L. I whacked in an OP straight away but it was too small so I got the big horse one out and still he was snoring. He barely had a neck and his face was fat so it was impossible to get a jaw lift happening into my BVM and head tilt was useless. Even with an NP, he was still sounding nasty but at least with a bit of IPPB his Sp02 climbed up to 97%.
We were lucky we had two police officers there and an ICP to help us get him up. It was a marathon and we had to use every belt we had to contain the body mass and fit him in our vehicle. At least in the back I was able to pop a pillow under his head and get a good jaw lift so only an NRB at 15lpm was required.
The Endep had been issued at the pharmacy that day. A few calls to family and friends revealed that our patient had a hx of depression and had a previous suicide attempt 2 years earlier. The long thing scars running from his wrists up his arms confirmed. His suicide note was written in a somewhat erratic and irrational frame of mind (even without alcohol) and resembled the selfish angst of a teenager.
We later had to transfer the patient to an alternative hospital for ICU admission. That was an even greater challenge than the first time.
Anyhow, one of the nurses who was doing the transfer was also there for our suicide attempt that morning. Much to my surprise I found out that he'd been extubated and come out sitting up and GCS 14 and now in the wards. I was shocked. I had fully expected him to die or to be very unwell. What I also realised though was that for the first time I had been responsible in my actions for contributing to saving the guy's life. I was able to manage him and extricate him in such a time and fashion that he didn't end up brain dead and when he did arrest, he did so in the best environment possible - at hospital. Realistically, if he'd arrested in the ambulance, our CPR protocols would have demanded defibrillation and it probably would have killed him. It feels good to have that knowledge. This was MY job and it wasn't some other ACP or ICP who saved him - it was me.
First job for the night was a big one... in more than one way. QPS were doing a patrol of an industrial area and noticed a truck alone in a block of industrial buildings. They found a 30 y/o guy who was AT LEAST 160kg, unconscious on the ground, having overdosed on Endep (TCA). He'd taken a total of 2.5 grams (50x 50mg) and washed it down with a can of V and suicide note to boot. Had he been a smaller man or the police not been patrolling the guy would surely have died.
He had rapid shallow resps, was blue in the face and snoring. VSS: GCS 8, BP 120/90, PR 130 ST, Sp02 92%, RR 30, 36.2C & 6.8 mmol/L. I whacked in an OP straight away but it was too small so I got the big horse one out and still he was snoring. He barely had a neck and his face was fat so it was impossible to get a jaw lift happening into my BVM and head tilt was useless. Even with an NP, he was still sounding nasty but at least with a bit of IPPB his Sp02 climbed up to 97%.
We were lucky we had two police officers there and an ICP to help us get him up. It was a marathon and we had to use every belt we had to contain the body mass and fit him in our vehicle. At least in the back I was able to pop a pillow under his head and get a good jaw lift so only an NRB at 15lpm was required.
The Endep had been issued at the pharmacy that day. A few calls to family and friends revealed that our patient had a hx of depression and had a previous suicide attempt 2 years earlier. The long thing scars running from his wrists up his arms confirmed. His suicide note was written in a somewhat erratic and irrational frame of mind (even without alcohol) and resembled the selfish angst of a teenager.
We later had to transfer the patient to an alternative hospital for ICU admission. That was an even greater challenge than the first time.
Anyhow, one of the nurses who was doing the transfer was also there for our suicide attempt that morning. Much to my surprise I found out that he'd been extubated and come out sitting up and GCS 14 and now in the wards. I was shocked. I had fully expected him to die or to be very unwell. What I also realised though was that for the first time I had been responsible in my actions for contributing to saving the guy's life. I was able to manage him and extricate him in such a time and fashion that he didn't end up brain dead and when he did arrest, he did so in the best environment possible - at hospital. Realistically, if he'd arrested in the ambulance, our CPR protocols would have demanded defibrillation and it probably would have killed him. It feels good to have that knowledge. This was MY job and it wasn't some other ACP or ICP who saved him - it was me.
Current Mood: tired
tired20 February 2008 @ 09:30 am
I haven't been very motivated to post since I've been qualified. (Late November). I finally got clearance for independant practice last week and have finished my consolidation phase. Last night was my second shift as the community spare. It was also my first shift working with a student. I've had a few pretty good jobs since I've been qualified e.g. a conscious bradycardia at 24bpm and hypotensive internal haemorrhage post multi organ failure. Nothing however, has really inspired me to write here. Heck, I've not even fixed up the pics that went awol from my ambo graduation (oh and I finally graduated from uni too in the break). But I've had a little inspiration this morning.
The last two months have been really good. I am really starting to enjoy my job and look forward to doing big jobs. I'm not really afraid anymore - it is all exciting. I like that I don't have to answer to anyone else and that I am free to practice as long as it is safe and within our guidelines. I still have some learning to do and I still feel quite young but I can't say that I dread work or want to get away from it.
As I said, last night was the first night I've worked with a student. We had it pretty easy until about 05:30. One heel lac on warfarin, one pseudo muscle spasms/contractions, one insect bite of which there was evidence it ever happened and a transfer for a guy with a ruptured spleen. We had assumed he was going to be our sickest patient. WRONG!
I've been pretty lucky. It is like the universe has been looking after me. I get jobs in order that I can handle them but at appropriate times to test me and help me to grow. This was one such case. We were dispatched code 2 to a job that even after query wasn't upgraded for another 5 minutes. All details unknown except that an 82 y/o M had left a suicide note on the bathroom door and his wife couldn't get in after being told his emphysema was terminal and not much more could happen. We were upgraded because the wife made it in and found her husband collapsed and they thought it might be a DOA. HELLO!!! What part of suicide note + locked door + no response does not = dead or near dead???
Anyhow, we get there and have a look and realise the guy is still moving. He was lying in a drizzling shower in the R) foetal position with some degree of blood and clots around. Initially I could not see what had happened. He told his name and said that he'd been waiting to pass out.
My partner went to jump in to do a fore and after lift but got distracted and went down the path haemorrhage control. For a moment I got lost in that and forgot I was in control. It only took a moment for me to remember that I WANTED the patient OUT. The shower was about 1m squared and there was about a body width path between the bathroom door and the shower and less than a body length. The bathroom door opened to completely obstruct the shower entry. That was a problem. As we sat the guy up he immediately became unconscious and started making a pretty unhappy sound respiratory wise. Then the sergeant major side came out and for the first time and most importantly, I WAS IN CONTROL. I demanded we get him out and somehow with a whole lot of gymnastics we managed to get this guy out into the house hallway. In hindsight we could have probably taken him around the corner a bit but we managed all the same.
I ordered the student to get the defib pads on but in doing so obstructed my access to the airway and had not appropriately moved the monitor so more orders were issued. I was relieved when QPS turned up and lent a hand. I got my OP in and started IPPB supporting his ventilations. He did have a carotid pulse and it was pretty good at the time. He was however, GCS 3. I could see at last that he'd used the blade to slash his wrist down to the bone and even had a go at his throat although it was entirely superficial. I got my blood pressure which came back at 50/30 and bandaged both wrists. He was on a scoop in no time and we were out and loaded within 20 minutes. I impressed myself. I even managed to get ICP backup code 1.
My radio sitrep had been a bit shaky, more because I was feeling a tad stressed.
This has been the first real case where I had been in charge and I had to make sure that everything went right. It was important that I stayed in control and got everything I needed done in the right order. The ICPs calm presence helped bring things down and I could get a sense of humour.
In the back the ICP tried to cannulate while I continued ventilations. Unfortunately it wasn't a successful attempt but we did elevate his legs as high as the stretcher would allow - causing the scoop to slip down a fair way. His blood pressure was 40/18 at one point and his carotid pulse started to become very difficult to palpate. I also noticed this respiratory drive had become quite depressed as we approached hospital (which took us less than 10 minutes).
Fortunately, just minutes after handover he arrested into VF and the ED staff were busily trying to get lines in everywhere (with limited success) on his body to give to drugs while CPR was commenced. However, by the time I'd done my paperwork, he'd returned spontaneous circulation and ventilation accompanied by a few drugs and 1.2L of fluid.
I felt sorry for his wife who was ambling down the driveway and picked up the newspaper, really upset and barely able to speak. I was glad that she didn't hang around to see us pulling her husband around the way we had to in order to get him out. Obviously, the dx was not what he'd wanted but he'd not thought of her enough when he did what he did.
The prognosis was poor and as we were leaving the doctors were trying to work through the ethics associated with letting the gentleman die.
I hope that I might be able to follow up on him at some point....
I was proud of myself in this job. I got in control and got exactly what I needed and when I needed it. I moved quickly and got the patient extricated completely in good time. I was a little bit rattled but that will get better in time with more experience. I feel like I can handle even more now and I can do it when I am the one with the responsibility.
I love this job!
The last two months have been really good. I am really starting to enjoy my job and look forward to doing big jobs. I'm not really afraid anymore - it is all exciting. I like that I don't have to answer to anyone else and that I am free to practice as long as it is safe and within our guidelines. I still have some learning to do and I still feel quite young but I can't say that I dread work or want to get away from it.
As I said, last night was the first night I've worked with a student. We had it pretty easy until about 05:30. One heel lac on warfarin, one pseudo muscle spasms/contractions, one insect bite of which there was evidence it ever happened and a transfer for a guy with a ruptured spleen. We had assumed he was going to be our sickest patient. WRONG!
I've been pretty lucky. It is like the universe has been looking after me. I get jobs in order that I can handle them but at appropriate times to test me and help me to grow. This was one such case. We were dispatched code 2 to a job that even after query wasn't upgraded for another 5 minutes. All details unknown except that an 82 y/o M had left a suicide note on the bathroom door and his wife couldn't get in after being told his emphysema was terminal and not much more could happen. We were upgraded because the wife made it in and found her husband collapsed and they thought it might be a DOA. HELLO!!! What part of suicide note + locked door + no response does not = dead or near dead???
Anyhow, we get there and have a look and realise the guy is still moving. He was lying in a drizzling shower in the R) foetal position with some degree of blood and clots around. Initially I could not see what had happened. He told his name and said that he'd been waiting to pass out.
My partner went to jump in to do a fore and after lift but got distracted and went down the path haemorrhage control. For a moment I got lost in that and forgot I was in control. It only took a moment for me to remember that I WANTED the patient OUT. The shower was about 1m squared and there was about a body width path between the bathroom door and the shower and less than a body length. The bathroom door opened to completely obstruct the shower entry. That was a problem. As we sat the guy up he immediately became unconscious and started making a pretty unhappy sound respiratory wise. Then the sergeant major side came out and for the first time and most importantly, I WAS IN CONTROL. I demanded we get him out and somehow with a whole lot of gymnastics we managed to get this guy out into the house hallway. In hindsight we could have probably taken him around the corner a bit but we managed all the same.I ordered the student to get the defib pads on but in doing so obstructed my access to the airway and had not appropriately moved the monitor so more orders were issued. I was relieved when QPS turned up and lent a hand. I got my OP in and started IPPB supporting his ventilations. He did have a carotid pulse and it was pretty good at the time. He was however, GCS 3. I could see at last that he'd used the blade to slash his wrist down to the bone and even had a go at his throat although it was entirely superficial. I got my blood pressure which came back at 50/30 and bandaged both wrists. He was on a scoop in no time and we were out and loaded within 20 minutes. I impressed myself. I even managed to get ICP backup code 1.
My radio sitrep had been a bit shaky, more because I was feeling a tad stressed.
This has been the first real case where I had been in charge and I had to make sure that everything went right. It was important that I stayed in control and got everything I needed done in the right order. The ICPs calm presence helped bring things down and I could get a sense of humour. In the back the ICP tried to cannulate while I continued ventilations. Unfortunately it wasn't a successful attempt but we did elevate his legs as high as the stretcher would allow - causing the scoop to slip down a fair way. His blood pressure was 40/18 at one point and his carotid pulse started to become very difficult to palpate. I also noticed this respiratory drive had become quite depressed as we approached hospital (which took us less than 10 minutes).
Fortunately, just minutes after handover he arrested into VF and the ED staff were busily trying to get lines in everywhere (with limited success) on his body to give to drugs while CPR was commenced. However, by the time I'd done my paperwork, he'd returned spontaneous circulation and ventilation accompanied by a few drugs and 1.2L of fluid.
I felt sorry for his wife who was ambling down the driveway and picked up the newspaper, really upset and barely able to speak. I was glad that she didn't hang around to see us pulling her husband around the way we had to in order to get him out. Obviously, the dx was not what he'd wanted but he'd not thought of her enough when he did what he did.
The prognosis was poor and as we were leaving the doctors were trying to work through the ethics associated with letting the gentleman die.
I hope that I might be able to follow up on him at some point....
I was proud of myself in this job. I got in control and got exactly what I needed and when I needed it. I moved quickly and got the patient extricated completely in good time. I was a little bit rattled but that will get better in time with more experience. I feel like I can handle even more now and I can do it when I am the one with the responsibility.
I love this job!
Current Mood: 
accomplished
accomplished29 November 2007 @ 08:19 am
Well the big day finally came yesterday and I it did go really well.. I'm impressed.
The whole ceremony only went for about 30 minutes and the rest of the time was devoted to pretty fancy morning tea with sandwiches, fruit, vegies, cheese (brie, camembert and swiss), crackers, spring rolls, party pies, rice paper packages, tempura prawns and free drinks! Absolutely to die for!
This is one of my favourite photos of those that I had taken on the day. It was even good enough to bump my grading photos as display picture!
Can you see my big blingy shoulders?? We were given the formal epaulettes! Mind you, that had me feeling a tad concerned as I couldn't imagine having to go out on round wearing those! As much as I am happy to be a QUT graduand, I also just wish to fit nicely in to the service without a big sign above my head making a point of the fact that I came from QUT. So I was somewhat relieved to be given a set of the normal cloth ones too! They are actually the old style without the embroidery around the edges.
Anyway, it was an absolutely great day and I got a whole load of pictures which I've uploaded to Facebook. Got to spend some good time with a friend that afternoon and we turned all the pictures into a slide show with captions and music to the song of Heather Small - Proud. It is just so aweomse to look at that picture of myself and see red! It has been a long time coming!
Funny moments for the day:
1. Watching how awkward we all felt about being stuck up on a stage with the Minister of Emergency Services and the QAS Commisioner.
2. Listening to the "top graduating student" talking about living their dream and always wanting to be in ambulance when knowing he is about to dump the whole thing to study medicine next year.
3. Finding myself wiping my food covered hand on my other arm in an effort to clean it to shake the hand of the Minister who was trying to congratulate me during the morning tea!
This is what life is about...
The whole ceremony only went for about 30 minutes and the rest of the time was devoted to pretty fancy morning tea with sandwiches, fruit, vegies, cheese (brie, camembert and swiss), crackers, spring rolls, party pies, rice paper packages, tempura prawns and free drinks! Absolutely to die for! This is one of my favourite photos of those that I had taken on the day. It was even good enough to bump my grading photos as display picture! Can you see my big blingy shoulders?? We were given the formal epaulettes! Mind you, that had me feeling a tad concerned as I couldn't imagine having to go out on round wearing those! As much as I am happy to be a QUT graduand, I also just wish to fit nicely in to the service without a big sign above my head making a point of the fact that I came from QUT. So I was somewhat relieved to be given a set of the normal cloth ones too! They are actually the old style without the embroidery around the edges.
Anyway, it was an absolutely great day and I got a whole load of pictures which I've uploaded to Facebook. Got to spend some good time with a friend that afternoon and we turned all the pictures into a slide show with captions and music to the song of Heather Small - Proud. It is just so aweomse to look at that picture of myself and see red! It has been a long time coming!
Funny moments for the day:
1. Watching how awkward we all felt about being stuck up on a stage with the Minister of Emergency Services and the QAS Commisioner.
2. Listening to the "top graduating student" talking about living their dream and always wanting to be in ambulance when knowing he is about to dump the whole thing to study medicine next year.
3. Finding myself wiping my food covered hand on my other arm in an effort to clean it to shake the hand of the Minister who was trying to congratulate me during the morning tea!
This is what life is about...
Current Mood: 
happy
happyCurrent Music: Heather Small - Proud
12 November 2007 @ 09:20 am
Gosh I'm tired... 
Things just seem to change. I didn't even quite realise they would. I worked last night for the first time since OSCEs and I am not sure that I was quite ready. I felt quite nervous and my mind was in overdrive after having vigorously explored all the different avenues for each patient during exams... and out loud too. I'm still in a student mode and yet I'm feeling so much more aware of my own accountability. I think I've inadvertantly placed a whole lot of pressure on myself to perform and perform well. 
I am looking forward to flying solo but at the same time I'm a little scared. I'm a little bit scared about who I will end up working with and how they will treat me and I'm a little bit worried about breaking out of the student role and thinking like a leader. I've been a student for so long and I have been made to believe like everyone thinks that we are all lessers because we are QUT students. 
The learning curve is going to be very steep because not only will be catching up on a mammoth amount of experience, I will also be having to convert mindset.
I guess what I am also concerned about is where I am really at... The surveys say that we are all so bad... Are we really? Are we really competant and safe? I spend the time leading up to OSCEs speculating what the scenarios will be and this alters as it gets closer to time. Then there is OSCE day itself and the insane nervousness that accompanies. There is so much pressure because this is the final exam and we have to pass and we will be the first group out etc. I sit there stressing and wondering if I am about to be discovered for being a fraud all along and that I've passed everything previously by luck, fluke or pity or something like that. Then there is the OSCEs themselves and they go as they go. I came away on a good one and felt reasonably confident. The days after that become an intense reflection on everything that happened and all the things that were not done correctly or well enough. The good feelings fade and the doubt starts to set in... Then there is an email that says:
"Well done!
You are not required to undertake a supplementary OSCE exam."
The initial feeling is elation... the hard part is done and I've done nothing that has earned me a return to uni. A few of my friends are not so lucky and I try to imagine how they must be feeling... Perhaps that total apprehension like they are down to the last straw? A resignation? A confidence because we have decided that they aren't just going to let us fail? I wonder if that will be the case or if I am going to get some nasty text message at the end of the day saying that something about them not graduating or the likes. But in between all these feelings there is a part of me that wonders about how well I passed. Did they take pity on me? Did I get through because I didn't do anything wrong technically? Was I a borderline case for a return? Do they really believe that I am competant or has my subject coordinator done a remark and decided that I am competant against the recommendations of the folk who assessed me? I don't know. 
I'm not sure I want to know. At the same time I would... I'd like some feedback even though I am not sure how that would benefit me.
With all these thoughts come the next questions about where I fit in the larger scheme. Do I compare with a newly qualified officer of the diploma stream? I've had one experience that says yes and I've had one that say no. My partner reasoned the "no" case out and I feel that it makes sense. I'd just like to know that I am good to do this job and that I am ready to wear those red epaulettes.
Anyhow, that night panned out well. I got to chat with one of the freshly qualified guys and my partner also did wonders with coaching me. The night was nice and light with no jobs until 00:40 in the morning and two jobs all night. I drove myself into a wall with all my self doubt on the second job. I guess I am also concerned of the expectations that others will have of me. The whole world of QAS will be watching to see if we fly or we crash. 
Can this new education system work? Will they survive with so little time on road by comparison? I wonder about the people that I will work with. At some point, I am going to be doing casual work and I am going to be the relieving qualified officer turning up. I feel my guts ache like diarrhoes and flutter in my chest at the thought. Will I be able to stand up for myself if they give me trouble? Will I be able to think in terms of being THE qualified officer? It is such a truely bizarre feeling to feel so good about reaching a destination and yet be so scared.
Perhaps in the future I will look back and read this in the same way that I looked back recently to the stuff I wrote towards the end of first semester this year and laugh. Wouldn't it be nice to skip a year or two from now....
Current Mood: tired
tiredCurrent Music: The Baileys Ad...
10 November 2007 @ 05:31 pm
This last week has been huge. It has been full of stress and lots of disturbed sleep. But on the bright side, I think it is all over.
Monday was the written exam. Unfortunately, the three hours exam got scheduled into a two hour block which meant were left in a mad scramble just to get to the end of the paper. I knew exactly how to fill out the exam in great detail but couldn't do that otherwise there was no way I'd get it done. In the end I only missed the last question and half of the second last question.
Some of you may be familiar with the experiment on spider web building and drugs.
I think the spider on chloral hydrate or caffiene probably could have written a more coherant exam than the one that we were given. This may be related to the fact that more than one person wrote it. For example, there is a question about a patient who is in cardiac arrest with CPR being performed and no cardiac output. The questions that follow were "identify these rythms and state the next to priorities in treatment". All except for one were PEA. The other was VF. To me it didn't make sense other than to write PEA of underlying rhythm X... and then to make things more complex a 12 lead ECG is thrown in of an antero septal STEMI... in PEA. Why??? Why???? Can someone tell me why we would be doing a 12 lead ECG on a person in cardiac arrest just in case they were in a PEA that would suggest the location of their infarct??? I get that we were being asked to identify the rhythms and whether we would shock them but really.. the 12 lead ECG.
Okay, rant about that over...
Thursday was OSCE day. I was unfortunate enough to be placed in the second group which catered to an extraordinary amount of stress time. 
It is not the most pleasant feeling to be assigned a random number and being locked in a room with other students who are gradually being removed at random to the unknown of whatever practical component lay ahead.
I got through it all okay and was glad that my second scenario was the better performed of the two so I left feeling good rather than bad.
I received the email to say that I was not required for Monday's resit so I am very happy. Now just waiting to hear about my exam results. If that pans out then I will adopt a new email address and head on the war path towards setting up life outside of university. 
Looking forward to tackling the world as a qualified officer. I have a feeling things are going to be a bit different and it will be good for me to have to get up and just make decisions. Bring on the 28th...
Current Mood: tired
tired26 October 2007 @ 09:23 am
I have had an absolutely awsome night. This morning I have come away feeling so confident and happy. 
This really is what it is all about!
We had three jobs last night and two of them were good ones... one was damned good!
We'd just logged on when they sent us code one to a fifty year old with chest pain. On our way an update came through saying the patient had vomited. Two thoughts went through my head, one was that our patient had a belly upset and the other was that the patient could be really sick. It turned out to be the latter.
Our patient was very pale and diaphoretic. The first thing he did was apologise because he said he'd vomited all over himself. It didn't quite realise that he really meant it until a little later down the track when we started uncovering towels. They guy had virtually powerchucked all over his shirt, pants, chair, table and somewhat into the bucket that his son had provided. 
Our patient had been exercising on a treadmill and approximately thirty minutes later had a sudden onset of severe central chest pain while at rest. He said it was about 8 or 9/10 pain and felt like a burning sensation. There was obviously some nausea and vomiting but he also stated feeling dizzy. Nil radiation and NIL CARDIAC HX!! 
I should have felt for a pulse straight away... that is what I am taught to do but have fallen a bit out of the habit. If I had, I would have realised that he barely had a radial pulse.... because his blood pressure was roughly 70-80 systolic , bradycardic at 37 bpm and saturating at 84%. The ECG showed ST segment elevation in both leads II and III. I actually have a strip where it shows the elevation increasing within a five minute period!
We had oxygen on him and my partner is preparing to cannulate. He is a bit peripherally shut down but we managed to get an 18 guage in his L) ACF. I realise that I can't give him a GTN or give morphine because his systolic blood pressure is below 100mmHg. I also want to give an aspirin but my patient is far too nauseous. 
I am proud because my brain works and I figure that I can give him IV Metoclopramide to stop his nausea and then give him the aspirin.
This ICPs arrive and I am able to provide a really good handover as to what the patient's condition is and what I have done with treatment. I am again feeling proud because I have a voice and am in control of the situation. I have even remembered to tell the son what is going on.
Having placed him in a supine position in the recliner, his blood pressure rose above the 100 systolic mark and the first lot of morphine is given. I can see the patient is starting to look a little less pale but is not well enough to provide a whole lot of information and spent a lot of time with his eyes closed, hardly caring about what we did or the fact he was covered in vomit.
Everything was coordinated so well. I drew up Morphine and a flush, my partner replaced the oxygen tank, I retrieved the stair chair and my partner cleaned up the gear. In the meantime the other ICP did a 12 lead ECG (showing a right sided inferior infarct) and drew up some Atropine and Adrenline in case it was required. In my overzealouness, I managed to slice my thumb on the morphine ampoule... hoping that the remnants of sweat and vomit that would have been on my gloves didn't contain anything too nasty. 
Extrication was the fun part because it was absolutely pouring down with rain outside the two story house. We ended up having to stair chair this guy holding the monitor, down his back stairs to go under the garage and out to the ambulance. His wife came home halfway through and I get the idea that nobody really told her too much of what is going on... something that I should have done when I went back upstairs to check we'd not left anything behind. After some almost dramas with the stairchair and slippery paths we transferred the patient and were away. The two ICPs in the back, my partner driving and me following in the ICP car. I did get lost on the way so I didn't get to do the handover but did get to see the final ECG.
The patient was thrombolysed at hospital. Ironically, just as the ICP was telling the comms operator that everything had turned out well, the red light outside the resuc bay started flashing and doctors, nurses and wardsmen came rushing in... Apparently he'd suffered two or three screens worth of asystole while his wife and son were still in the room. That was one very sick man....
It was a job that left me feeling good because I got things done and thought for myself. I was in control of the situation and was able to provide an appropriate handover and help out competantly. Everything ran so smoothly - the coordination was brilliant. This was a guy who would have died if he'd stayed home. This is the stuff that we train for and makes a difference. 
We had an easy middle job but our third and last job for the night was also pretty good. Our patient was a 58 year old female who'd had a sudden onset of central chest pain while reading in bed at 2200. However, she didn't call an ambulance until 0300 and hence got a little bit of a gentle talking to by her nurse daughter.
She described her heaviness like a giant rock on her chest and it radiated up to both shoulders and into her neck too. A little bit sweaty to the touch. Her pulse was a little bit weak but 110/70 which gave us more room to move when we found that our rhythm read elevation in II and III yet again! We got the ICPs rolling into action for the second time that night. This time our patient had a little bit of a cardiac hx with a previous dx of an enlarged R) ventricle. She was also due to have a stress test done the next week because she'd had some pains on and off for a little while. The previous similar episode was at Christmas last year and resulted in dx although there was a suspicion of an AMI.
Our patient felt it somewhat painful to breathe but her pain started to dissipate with oxygen alone. We gave a shot of GTN which dropped her blood pressure down to 100 systolic so after an Aspirin, I used the 20 guage that I'd popped in to administer 2.5mg of Morphine to help reduce the pain and provide a mild vasodilation effect. This helped to further reduce her pain and she felt she was able to breath again.
In the back of the car I found her blood pressure to be 105 systolic. I was reluctant to give GTN because it was a little bit too close to 100 systolic for comfort and I didn't want her to crash. My mentor made the arguement that GTN was treating the problem where as morphine only relieved the pain. I understood his point but felt it was too risky. Even so he still insisted so I administered the GTN... only to have the ICPs arrive and say that we should have withheld... Clinical judgement is that word...
On the way to hospital the ICP crew did a 12 lead ECG which showed more significant elevation in V2 and V3 instead. We popped her another 2.5mg of Morphine which made her feel very happy and afterwhich she was pain free except for deep inspiration.
Again I was in control of the situation and was able to provide a good handover. 
The provisional dx at the hospital was actually pericarditis.
Overall the night was fantastic. These were the type of jobs that we train for and make a difference. I felt like I had really made a difference and more importantly, I felt happy with my personal performance. There are still things that I could have done better but I was happy with my treatment of the patients. I feel like I am really ready to start doing this for real. My confidence is getting right up there and I feel in control and full of a voice. I'm not scared any more and don't shy away from things like cannulating a sick patient. I had been dreading the night shift for days but I am now just so glad that I had the opportunity to be patient care on these jobs tonight. I really feel like it has consolodated my learning and made me an even better paramedic. I want to be able to hold on to this feeling forever.
This is a great job! 
Current Mood: 
enthralled
enthralled06 October 2007 @ 02:43 pm
C/T – 1 m/o F SOB ALOC – Code 1C
The pickings were slim in terms of acute cases however, I’ve chosen this one over the age old lesson about how people develop some sort of affliction to providing forewarning of the potential for impending reverse peristalsis. I learned that lesson a while ago and my vigilance continues.
Anyhow, our patient’s mother called because baby had a chesty cough and seemed to have some difficulty coughing. She was also delayed in waking up for the morning. Baby did wake up as we departed and she was happily looking around and doing all those random active motions that babies do as normal. Mum had become a little bit over cautious as three weeks earlier, baby had caught the flu, stopped breathing and developed encephalitis, earning a week intubated in Mater Children’s ICU.
What struck me when mum had first answered the door, was just how young she appeared to be. We talked in the back about a variety of things, mostly related to her child however, at one point she asked me a question about something relating to baby’s skin v. body temperature, one of those “mum” questions. I baulked and told her that I didn’t have a clue as no amount of babysitting my niece would ever have provided me with motherly powers of knowledge. She said something about how she thought that I’d have children which left me wonder just how old she thought I was. We continued to talk for the remainder of the journey.
Afterwards, my mentor told me that she’d just turned 16. Her assumption about my potential parenthood made sense. Remembering back to her age, the seniors at school looked to be so much older and anyone who was at uni was just so adult! In my own world, I still consider myself to be 18 and just starting out in uni, despite the fact that I’m about to finish my fifth year of uni and turn 22. Obviously, she sees me how I saw uni students when I was her age.
Current Mood: tired
tired06 October 2007 @ 02:41 pm
C/T 7 y/o F # leg – pt has brittle bones – code 2A
I don’t think I could have prayed harder that we might get diverted away from this job. Nothing scares me more than children in pain. I don’t care what anyone says, knowing that causing them pain to help them feel better does not make the experience any easier.
The child had inherited osteogenesis imperfecta from her father and had extendable rods in both femurs and tibias accompanied by 10 previous fractures in various locations, caused by simple actions such as jumping up and down on the spot. With a 50% chance of passing on the illness, I could understand these parents wanting to have a shot at bringing a child into the world. However, after seeing one healthy older boy in household, I found myself having some serious ethical struggles with the couple’s decision to have another at such odds.
Regardless, our patient had tripped over a toy in her room and appeared to have dislocated, if not also fractured her knee joint and surrounding bone. She was very intelligent and a high level of communication skills, a marker of the trial gone by. She answered all my questions and began and I began her on methoxyflurane in hope to completely intoxicate her on the stuff and off we’d go. Unfortunately, I mentioned the taste in trying to coach her into taking some bigger deeper breathes and then the dam burst with a million tears and cries of “I can’t take it anymore Mummy, it is really horrible!”. Subsequent efforts to negotiate needs were unheard and down crumbling came any semblance of self constructed confidence to get me through the job. Hooray for mentors with children, I step into the back seat while we worked some magic. I then got to bleed my heart with 4mg IMI Morphine and watch her scream being transferred from lounge to stretcher. Fortunately, some time after departure the Morphine kicked in and she was babbling away happily with Mum.
I don’t like dealing with kids in pain. I find it difficult to reason with an absence or skeletal child logic. I have enough trouble bargaining with an adult who doesn’t wish to be part of treatment, let alone a child whose way of shutting me out is just make more noise than I can talk over. Less do I enjoy feeling like an axe murder while I put them through even more grief in the name of help.
Current Mood: tired
tired06 October 2007 @ 02:35 pm
I generally like to believe that I am not one to pass judgement quickly and like to keep an open when it comes to other people’s thoughts, beliefs, actions, behaviours and social situations. Occasionally, the one track mind sets in and I find myself drawing conclusions based circumstantial evidence that may not even be related to the reason we’ve been called. This was one such case.
We’d been called to a middle aged lady who appeared to be of Aboriginal decent, within a less than quality housing commission neighbourhood. She was suffering a bout of renal colic and needed to go to hospital for further management. My interaction with her had been limited as she’d been uncommunicative during the obtaining of vital signs and then I spent some time moving our gear and setting up the stretcher. She came out dosed up on methoxyflurane and raving about alcohol and behaving like a drunk. I assisted with the loaded and then proceeded to hospital.
At the other end, we were placed at the bottom of a queue of vehicles still waiting to offload their patients. For the next hour and a half I got to know the patient better and I have to admit to being surprised at what I learned. This particular patient had been suffering renal colic for a number of years and which began with 24 hospital admissions in one year. She had learned how to be proactive and take steps to hydrate in effort to break down and pass the stones at home with early identification of onset. She’d attended numerous information sessions on the condition to learn about diet modification and general home remedies. Hospital was her last port of call if all else failed and the bout proved to be unmanageable.
Current Mood: tired
tired06 October 2007 @ 02:33 pm
C/T 72 y/o F SOB Hx of lung infection – transport crew Code 1B
We were called to act as the transport crew for an OIC and two ICs who were treating a patient in respiratory distress. The patient had been diagnosed with an unspecified lung infection which did not seem to be easing with treatment from a recent hospital visit. The patient became extremely dyspnoeic and developed an altered level of consciousness. The patient had a history of asthma. On departure to hospital:
GCS | 3 |
Resp | 40 |
Pulse | 105 |
Saturations | 95% |
BP | 130/80 |
Auscultation of the chest revealed a generalised lack of air movement with expiratory and mild inspiratory wheeze. IC paramedics had administered IV Salbutamol and Hydrocortisone. IPPB and PEEP were being used to support her efforts in ventilation.
I had to consider myself lucky as the way things worked out, I ended up in the patient care seat and got to actively participate in management and reassessment of the patient. It was interesting to watch the two ICs in action as their approach was very calm and systematic, verbalising each action and thought. Their demeanour inspired absolute confidence in the condition of the patient and the treatments they were giving. Working with them really emphasised how a calm and steady paced approach was beneficial to being able to effectively manage a situation and prevent unnecessary anxiety.
Unfortunately, by the time we reached hospital her oxygen saturation levels had reduced to 75% and her respiratory rate and effort had decreased. She was intubated and ventilated at hospital.
Current Mood: tired
tired27 September 2007 @ 04:26 pm
For our last job of the morning we were dispatched on a code 2B to a business in the Rocklea area where a gentleman had lacerated his leg on a piece of steel. The haemorrhage had been controlled by others on scene. The job itself was relatively straight forward as the injury had been bandaged well and the patient was only complaining of a minor dull ache at the injury site, stating that stubbing his shin on the steel had been many times more painful. He stepped up into the vehicle and rode in the dummy seat on the way to hospital, chatting with my partner.
We had some difficulty in locating our patient, despite being provided with a street number and business name. After travelling up and down the full length of Sherwood Rd, we were unable to find an establishment that matched either the name or number we were looking for. It was by chance that we noticed a staff member from Rocklea markets waving us down as we headed into the business across the road to try our luck. Unfortunately, upon pulling up the staff member was immediately abrasive, suggesting that we didn’t know what we were doing and that the patient could be bleeding to death! His manner was incredibly sharp and patronising and refused to give any credit to any friendly suggestion that we’d not been provided with accurate information.
The street number we had been looking for was the Rocklea Markets however, that information was not given to us. The business name provided was the name of the business within the markets.
As we followed the security car to the patient’s location, I found myself feeling quite bothered by the staff member’s behaviour towards us. The way he’d spoken to me was as if I was a school child who had been told to do something important and failed to act in timely manner. Being the first time I’d experienced this from someone who was unrelated to the patient and also being a young person acting in a professional role, I was a lot more disturbed by the encounter than my mentor who had quickly dismissed it and moved on. This negative experience really substantiated the fact that it is hard to predict who is going to be involved in any case, how they are involved, the way in which they will respond and as a result unless it directly impacts on our ability to treat the patient, it is best to remain friendly, polite, distanced and focused on the task at hand.
In this case the staff members was misinformed as to the patient’s severity and ambulance operations, not to mention aggravated at waiting outside for ~45mins. I was happy to be able to understand the response with some thought although it will serve as a learning point and hopefully I will not be quite as surprised by such a reception and move on quickly.
Current Mood: 
okay
okay27 September 2007 @ 04:25 pm
C/T 29 y/o F Chest Pain, patient has chicken pox – Code 1C
The patient was diagnosed with chicken pox on the Monday and that night had developed a bit of pain in their back radiating to chest and associated with some numbness and tingling in the left arm, aggravated by position and inspiration. Patient called the ambulance after a phone consultation with the RN at the local hospital as patient’s concerned due to extensive cardiac history. All vitals returned within normal limits and ECG showed a strong healthy sinus rhythm and hence, provisional diagnosis was shingles. Patient care and provision of information proceeded as standard.
At the hospital, the triage nurse asked the patient a question which well and truly rocked me out of the 2am fuzz. “Are you contagious?” The reply was affirmative. It was at that point that I realised how I had forgotten to take a step back and look at the bigger picture in terms of infection control. Having not had the chickenpox, I put myself at risk by using the same gloved hand that applied ECG dots and felt for a pulse to pick up my pen and scrawl all over the other gloved hand as well as carry the tough book around. Although the skin to glove contact was minimal and the patient was not coughing, a risk of infection still existed and I had managed to completely neglect it with one of the most common and contagious diseases. Unlike my mentor, I wasn’t immediately able to identify the contagious state by the spots on the patient’s face however, I should have asked that one simple question or a few about the state of the spots at a minimum, as well as change gloves after investigation.
Hopefully, without having to learn the hard way, I will remember that just because a patient isn’t outputting fluids from all orifices or doesn’t have a dangerous disease like meningococcal, it does not mean that they are not contagious and able to pass on disease!
Current Mood: okay
okay20 September 2007 @ 03:07 pm
We were dispatched to an elderly lady suffering shortness of breath with a history of asthma. She’d been generally unwell in the days prior and using her Ventolin nebuliser every four hours. On this particular night she had awoken to run some more salbutamol however, was not getting relief. She was tachycardic, extremely hypertensive, saturating at ~84% while on the nebuliser but able to speak in sentences despite a noticeable increase in respiratory effort. Her ECG produced a normal sinus tachycardia. Auscultation of her chest revealed very mild baseline crackles, full field wheezes and a lot of upper respiratory noise.
She was placed on a nonrebreathing mask at 15lpm during extrication which brought her oxygen saturation levels up to 96% however, the exertion involved increased her respiratory distress and she became quite anxious. My partner administered 5mg of salbutamol to the patient upon departure. Approximately five minutes into our journey I noticed that the distressed moans coming from the back of the vehicle had quite suddenly ceased as our patient’s condition started to deteriorate. By the time we reached hospital our patient was only able to grunt, extremely diaphoretic, pale, slumped with exhaustion and saturating in the 80s again while my partner had attempted some IPPB.
In hindsight, perhaps the use of a stair chair during extrication would have delayed the progress of the patient’s illness. Although the distance travelled from the room to stretcher was short, the exertion would have been minimised to standing and sitting twice. However, the benefits may have been lost if the patient felt anxious with the loss of control associated with being wheeled, as I have found in previous cases.
The rapid deterioration of the patient meant that I was able to do my first code one drive to hospital. It is more challenging with a patient in the back because one needs to be aware of just how bumpy it can be in the back and therefore, choose the route to hospital carefully. I was lucky to have an easy introduction as there was very little traffic at that particular time of night and could avoid some of the particularly degraded sections of road more easily.
Current Mood: exhausted
exhausted20 September 2007 @ 03:05 pm
C/T 44 y/o M Severe SOB, cardiac hx.
Patient is complaining of sudden onset of extreme generalise weakness, tingling down left arm, cold sweats and abdominal pain. One family member has the flu and one has croup. Patient has history of silent MI and angina with similar presentation with the addition of a fluttering sensation in chest. Patient also found to be obese with gross oedema in both lower limbs secondary to cellulitis. Past medical history includes angina, silent myocardial infarction, diabetes and hypertension.
Due to patient’s history, treatment and monitoring was based on the assumption of a cardiac event.
Extrication and loading of patient proved to be quite difficult as the patient stated feeling too weak to walk and had to be placed on a wheelchair to move to the front door. Once on the stretcher we proceed to elevate to full height with the assistance of a few family members. As usual, the patient’s legs were raised first however, when attempting to raise the patient’s body, the other end of the stretcher collapsed violently back to half height. We concluded that the legs must not have locked out fully on the first attempt. In ambulance, nothing happens in slow motion quite like the moment you realise the stretcher has refused to defy gravity and there is nothing you can do about it. It was like being in the scene of an ambulance horror movie – one of those things that you hear about but are never supposed to experience because you learn from other people’s mistakes. Yes, up until now I have never forgotten to unlatch the trigger that allows you to drop the stretcher to half height and I have never allowed a moment to bypass when I haven’t heard the second click when exiting the ambulance. Given the circumstances however, I don’t think knowing about the possibility could have avoided what happened. Subsequent transportations showed that without a rapid rise, a definite clicking sound did not occur – a fete not possible with a patient of such a size. Although I wasn’t physically involved with raising the foot end, I feel that I should have been more vigilant and noticed the absence of locking sound, particularly with such a large patient.
Current Mood: blank
blank20 September 2007 @ 03:03 pm
C/T 92 y/o F Collapse, ? Not breathing – Code 1B
A 92 y/o dementia patient was found to have an altered level of consciousness by the community health workers who were transporting her. The workers stated they were unable to feel a radial pulse but did find a slow, irregular carotid pulse. The patient was stated to be unresponsive to voice, touch or pain, very pale, clammy and extremely bradypnoeic. On arrival, the patient’s condition had improved as she was able to respond to some questions, had a radial pulse and breathing normally although cool to the touch. She was still quite bradycardic at ~45bpm.
This was another case where the job itself was reasonably straight forward. With a little bit of oxygen and regular observations we trundled away to hospital and the patient become substantially more awake. Our arrival at hospital heralded the start of a two hour wait for a hospital bed. Although the experience was intensely unexciting, it did prove to be a learning experience as it wasn’t long before my patient was fully recovered to a state considered normal for her.
Up until this case, most dementia patients that I’ve attended to have been less than vocal or tended to be preoccupied within their own realm of existence. This was different as my patient would ask me repeatedly how she got to be sitting on a stretcher in the hospital. This was intermittently substituted with unexplained crying or positive comments about my general appearance or how young or nice I was, assuming that she didn’t try to speak to me in Polish instead. Occasionally it seemed as if she would realise how long she’d been there and gesture or look at me in an exasperated fashion. Of course, this would soon be followed by “How did I get here?”. It seems almost as if dementia patients live in a semi-timeless existence which under these circumstances would have made a trying experience far less difficult for both patient and paramedic. An officer I once worked with told me always to leave dementia patients smiling because even though they won’t remember why, they will know that they feel good. :-) I can see now why this could be true.
Current Mood: 
sad
sadCurrent Music: Ian Van Dahl - Castles in the Sky
20 September 2007 @ 02:58 pm
As part of my assessment I am supposed to write a reflective blog on two cases per shift, outling my personal learning as well the details of the case. Seeing I've spent so much time on these buggers, I thought I might as well post them here too. Most will be public but I may switch to friends only under some situations depending on content.
So... here is my first one...
Shift 1 Chest Pain 30-07-07
So... here is my first one...
Shift 1 Chest Pain 30-07-07
69 y/o male c/o central chest aching and heaviness with some shortness of breath.
Patient stated having a sudden onset of the chest heaviness while returning inside from his ute and said that it was different from angina pain he used to have. The patient had an angiogram in 1994 and has been event free ever since. Patient had taken 3x Disprin prior to QAS arrival.
Pulse | Irregular @ ~180 bpm | GCS | 15 |
BP | 110/60 | ECG | Sinus tachycardia / SVT |
RR | 18 | Temp | N/A |
Sp02 | 98% on 15lpm NRB | Pain | 5/10 |
Initially, I proceed to treat the patient as a regular chest pain. If my partner had stated the patient’s pulse rate, I did not hear it and assumed that it had been within normal limits. I stated my intention to administer GTN and my partner acknowledged while he continued to set up the ECG. Immediately after delivering one dose, I turned to look at the monitor only to discover the excessively fast rate! This would become a point of discussion later. Altering treatment paths, I tried the Valsalva Manoeuvre four times using two different methods, but was only able to revert the rhythm momentarily each time. My next option was to administer morphine which would serve to ease the pain, vasodilate and slow AV node conduction with the hope of reverting to a normal sinus rhythm. However, by the time I’d cannulated the patient his pain had dropped to 1/10 with his blood pressure ~90 mmHg systolic, heart still rocketing away. He also stated the headache, which he’d neglected to mention earlier, had eased. It wasn’t until departure that his blood pressure restored enough to give 2.5mg of morphine IVI, which after five minutes only seemed to increase his pain to 4/10 as we pulled into hospital.
Had I been aware of his heart rate, I would have assumed that the pain was rate related and would not have administered GTN unless specifically directed to do so by my clinical instructor. In discussion, he seemed to conclude that the rate problem came after the pain and hence, the administration of GTN was fine. Indeed, the GTN did reduce his pain and didn’t cause him to crash, as I had been taught would happen. In fact, not only did the GTN reduce his pain, it eased his headache and reduced his heart rate to ~160bpm. When I shared what I had been taught about “rate related chest pain”, he stated that he’d always given GTN and not one patient had crashed. I am now a bit confused as the logic explained for why we don’t give GTN made perfect sense but it proved to be a positive treatment in this case. I am also unsure why his pain increased after the administration of morphine or whether it was unrelated. What I am sure of is that if I’d been the qualified officer with a student, I would not have allowed GTN to be given based on what I had previously learned. Perhaps I have not yet learned to be a clinician rather than technician.
Current Mood: blank
blankCurrent Music: Ian Van Dahl - Castles in the Sky