Sunday, October 21, 2012

More stories

This has been awesome!!!  So many interesting calls, that going through the assessment has just led to more details to why they might be acting or feeling the way they do.  It's just been fabulous!!  We've had plenty of hypoglycemic pts., hyperglycemic pts., bradycardic, tachycardic, drunk, stroke, seizures, breathing problems, asthma pts., lots of syncope, tons of chest pains, abdominal pain... The list goes on and on.  Some of the more interesting calls though I'll write here, then try and be better about posting more regularly for my own sake!

We we're called to a 56 yo F not acting right.  We get out of the ambulance and there is a crowd of ppl sitting on the back of some cars. (everyone is african american btw) They just look at us and say "ya'll gonna need a mask."  Precep. says "well we'll go inside and check it out.  Thanks though."  I didn't want to go check it out, if these ppl say I need a mask I want a mask!  They obviously know something that we don't!  At this point I was just thinking the person was extremely sick or had some infectious disease.  We grab our bags as fire pulls up and walk into the apartment.  Just from the door open I could smell poop.  Walk into the apartment it gets worse.  The apartment is like a pre-hoarders house.  Papers all over the counters, clothes in piles randomly on the floor, broken glass on the floor, garbage all on the floor.  They tell us the lady is around the corner in the tub.  So we make the turn to the bathroom and it's like a wall of stench hits me.  Smell of diarrhea/vomit/crap/urine... everything disgusting.  Cockroaches climbing up the walls; of the hallway and once in the bathroom even more and bigger roaches!  She had old hospital vomit tubs on the counter in her bathroom that had mucus looking vomit in it.  The toilet has crap all over it, and we see the 280 lb. naked woman stuck in the tub.  Sitting in 3 inches of her own urine and crap.  Her head was down by the faucet so her back was clogging the drain.  She couldn't talk, she was just slapping her right thigh with her left hand over and over again.  At this point we know we just need to get her out.  So we talk to the fire fighters about the plan of attack.  In the meantime we get masks and chew gum to try and mask the smell.  DID NOT HELP at all.  Some of the firefighters couldn't even walk into the apt.  I was watching one of them just walk in try to breath start dry heaving and run out!  Then he'd make it in a few steps further before turning and running out, and a little further and further.  haha it was so funny!  So we decide to use a sheet and one of the firefighters lift mechanisms to get her out.  When we pick her up we notice tons of sores on her back and on the backs of her legs.  We wrapped her in sheets and put her on the cot.  We'd found her medications to try and get a history on her.  Turns out she has MS and has had a stroke in the past. :/  Then I really felt bad for her.  Neighbors hadn't seen her in about 4 days so they are guessing she'd been in the tub for that long.  We started 2 IVs in her en route and got vitals.  Took us 20 minutes after dropping her off at the hospital to decon. our ambulance and it still stunk for the rest of the day.  We talked to one of the doctors the other day about her and said she started coming around after she had some fluids in her.  They ended up sending her up to the burn center to get the sores on her backside cleaned.

Another awesome call was to a shooting.  We got there maybe 2 minutes after the call came out and by the time we showed up, the police had this intersection spider webbed in yellow tape in a mile perimeter.  It was insane how much tape they had going everywhere in such a short amount of time.  All we knew to the story was that it was a domestic dispute, and the guy had shot up the leasing office.  While police showed up to stop him he decided to just shoot himself.  Meanwhile across the street from this going on was a drug deal or something.  Those guys heard shooting and saw the cops outside and assumed the cops were there for them!  So they took off in a car driving through the apartment complex and started shooting at the cops.  We are parked in the middle of this intersection when we show up.  we can see the dead guy up on the hill, fire wasn't doing anything so we figured it was an obviously dead call.  The paramedic says he'll go check it out while the EMT and I get the cot and bags just in case.  We're about to pull the cot out when I see the cops behind the EMT start bookin it, and he's looking at the cops behind me start booking it in the same direction.  He just warns me "If you hear any shooting be prepared to just jump in the back of the ambulance and lay down."  One cop then comes and stands by us, saying there is rumor of another shooting over there (where the cops were running, also where the drug deal thing was going down).  They say they have a man in custody so we're alright to keep going.  The paramedic comes back and says he's dead, so there's nothing we can do.  Meanwhile the cops bring back someone in handcuffs and put him in the back of the police car right next to us.  That makes the whole black community watching angry.  Some guy starts yelling at the cops "you can't take my brother" he starts running under all the yellow tape towards the cop car.  Luckily the cops run towards him and distract him away from the scene.  Crazy.  They still want us around in case something else goes down.  Oh and a helicopter was circling the scene!  So cool!  Well waiting around the cops tell us someone is having breathing difficulty up by the dead body.  So we got to go up there to check her out.  I start asking her questions and applying the BP cuff, the girl was bawling!!  She could hardly talk to me becuase she was crying so much.  One of the detectives then leaned over and whispered to me "She's the girlfriend of the guy that just shot himself."  ahhh eye opener, that's why she's crying!  So I continue to ask her questions.  She had been hit on the head and had a big goose egg already that was turning purple.  She had a bullet grazing on her leg too that we put a band aid on.  Probably needed a little more, but we just did a band aid.  Vitals checked out so we called it good and left.  It was such an exciting call, even though we didn't get to save the guy shot. darn.  You can check out the news clip for details of what went down.

Walked in on a dead lady face down on her bathroom floor with her pants down.  She was about 85, poor old lady though, had been dead for a couple days like that. 

Another dead lady we walked in on had a trickle of blood coming from her mouth.  She wasn't showing signs of levitity, so we were about to try and work her, until we rolled her to her side to check her back.  Tons of blood came pooring out of her nose.  Turns out she was on a bunch of blood thinners she was on and the dosing was wrong.  Must have had some kind of hemorrhage in her sleep or something.  She was about 80, the family was pretty heart broken about it.

Had a 24 year old that had a collapsed lung 2 weeks ago and the hospital gave her oxygen to make it better.  3 days prior she started having extreme pain on the same side as her collapsed lung and was having difficulty breathing.  Listened to her lung sounds and they were absent!!  So weird to hear lung sounds on one side and none on the other.  We were pretty close to the hospital so we just started an iv.

Had a 26 yo M who got hit by a car.  He got pulled over on the south side of the freeway and thought he could run from the cops across all the lanes going north, about 5 lanes of 55+ MPH.  Got hit on his trek across.  He was hit by a small car and rolled over the top.  He had a closed right tib/fib brake, and road rash on all his extremities.  He wouldn't answer most of our questions, we think he was on some kind of drug.  We started 2 large bore IV's in each arm.  He kept complaining about his bum hurting so once at Grady in the Marcus Trauma Center he received the Grady hand shake. :)  a nice poke in the boo hole, and he had a cut on his butt cheek.  As soon as they spread his cheeks apart he started freaking out and saying how it was his upper leg and not his bum. haha.  It was great.

More for later!

Sunday, September 30, 2012

Catch up on the experience

Ok since I've been horrible at this a quick catch up.  I think my favorite part of the internship is all the people we deal with.  Everyone is so unique and interesting.  The things people say and do just cracks me up.  :)  So one lady we picked up for heartburn was talking about how she had her grits for breakfast "country style."  My preceptor knowing I"m not from the south mentioned how I probably didn't know what country style grits were, or grits for that matter.  She looks at me in disbelief and disgust; in her southern country accent then says "You ain't never had grits before?"  I respond with a smile "nope, never had em."  Her jaw drops open!  Then my preceptor says I've probably never had okra or fried green tomatos or something else, that I really don't know what he was tlaking about.  This much information pushed her over the edge.  She was going into shock. Not really, but she just started going off "You ain't never had grits or okra or...."  I reply no.  Then she just shakes her head, "mmm, you need to go to the store and buy some aunt jemima.  Yep aunt Jemima is ma favorite grits.  Hers are real good."  She still can't get through her head that I've never had so much southern food so she starts asking about more food.  "You ain't never had fried chicken?" I say I have had fried chicken.  Still wondering she asks "You ain't never had pork?" I agian inform her that I"ve had pork.  Then she tells me again to get some aunt jemima. :)  She was funny.

Those of you've that have seen my hand writing will appreciate this.  I hand my preceptor my sheet to sign and he looks at it and respons; "Holy S*** your writing.  What's wrong wit you?  You're a woman!" :) Yes I know that, thank you.

We went to a call for a lady who just needed help getting on the toilet to use it, then back in her bed.  So we put her on the toilet and ask her if she'll need some more time, like if it's a #1 or #2, she replied "oh I just gotta deposit a quick one." Cute.

After dropping our patient off at the hospital another grady ambulance pulls up with a lady who was switching from asystole to NSR w/ pulse.  So we stayed to watch them come in.  She was fine in the ambulance, soon as they pulled her out she went into asystole again.  The extra firefighter that was with them just jumped on one side of the cot standing and put one hand on the handle bar across from him and with his extra hand started chest compressions again.  Then rolled them into the hospital like that. :)  I'd never seen that so it was interesting to me.

We picked up a bum and took him the the hospital.  Go on some more calls and after about 6 hours we see the same bum at the ambulance bay.  He just needs a ride closer to home.  So my preceptor allows him to catch a ride with us back to Grady.  Tells him to make up something that's wrong with him and that when we got to Grady he was to walk in and say he doesn't want to be treated.  We asked what the doctors had said about his illness from previously and anytime he would talk about what the "Doctors" said, he called them the "Ders" So he'd say "The ders told me I has pneumonia..."  So funny!! :)

Another funny lady we picked up...  She's sitting next to me on the bench and after doing our assessment and it's time to casual talk she looks at me and says "you're so pretty. You have a great smile."  Few moments later "I like your size!"  Once inside the hospital I"m standing with her and she just keeps repeating. "I just love your size.  Must be real comfortable huh?" She was a little overweight with a cute southern accent. :)  Love these people!

Finally picked up a patient that had "da shakes and da shivers!" :)  When they said that I just smiled, since Dallen introduced us to the term.  Glad I had one!

When we ask patients what hospital they want to go to they either refuse to go to grady, or they reply "Well Grady!  I'm a grady baby!  All my doctors at Grady, always go to Grady."

We've picked up lots of purely psychotic patients!  So weird talking with them. One lady thought she'd been kidnapped and had to get back to the french consolate.  She was smart tho.  She would play with her words and with what we'd say to her.  She was crazy. 

There is one tall guy we've picked up twice now.  Says he has a 19 yo wife.... he's 48.  HIs name is George and I think he's developed a little crush on me.  The second time we went to pick him up we were asking ppl if they called an ambulance and he said no.  I smiled at him tho, cause I'd picked him up only a week prior.  After I waved at him he perks up and says uh yes I did.  So my preceptor says alright well let's get in the truck.  I don't sit next to him this time, last time he kept touching me and almost threw his smelly jacket over my head b/c of the story he was telling.  (he's very eccentric) So I sat at the captains chair this time.  He told the same crazy stories about his favorite movies.  In the hospital I avoided geting close to him, but it didn't work.  He still walked up to me and said "I like you, I can trust you." Then proceeds to give me a side hug.. Blah! Gross!! Smelly guy, homeless... blah!

Everyone smells down here.  Always a mixture of black skin, being homeless and not showering, not brushing teeth, drinking alcohol, and smoking.  I wish I could capture their smell in a jar so people could understand what a REAL stink is.  Crazy how they live wiht themselves.

Sunday, September 9, 2012

Day one

First day was Thursday.  Todd is my preceptor and Matt is the EMT/driver.  Both of them are really nice and helpful.  Our day consists mostly of driving.  Drive to post... drive to patient.... drive to hospital... drive back to post to only get called in 10 minutes to pt.... drive to patient.... drive to hospital... and the cycle continues.  Since we only spend about 10 minutes on scene I do feel like I sit almost 12 hours of the day.  I try to get out at post sometimes, or we'll walk around a grocery store, it's till not much.  Driving in traffic is the worst.  Matt isn't the best driver, he drives the ambulance as a car and doesn't think about those in the back so much.  By the end of the day I feel kind of sick, since the last few hours are usually full of traffic.  Alas, it is still fun.  My first 2 days were slow.  They said an average day is 12 calls.  Day one was only 6.  Still kept us pretty busy for most of the day, still more calls than I ever got in Rexburg/Idaho Falls! 

Day one was an observing day for me, to get use to how they do things and their protocols.  Some patients worth noting:
  • Some women who was having difficulty breathing, about 8 pillows were stacked behind her to hold her up.  She weighed about 300 lb. and I was looking at her one leg hanging off the bed and her other leg to see how we'd lift her.  Turns out she only had one leg... Her left leg had been amputated and was a fat nub just sitting up there.  I was caught a little off gaurd. :/
  • The only emergency of the day was to a 66 y/o M having an asthma attack we did every step on their protocols.  For me it was good to see the process that they went through and how fast they caught on to how severe this was for the guy.  We'd only asked him if he had asthma and if he tried his albuterol, before we had our own oxygen on him and was nebulizing our albuterol with his atrovent.  Crazy!
  • The rest of the day was to sick people not feeling well, or minor injuries.
Something I love about being here in the south, no matter if the patient is extremely sick or just called us becuase they couldn't get up, they are so thankful that we were able to come and help them.  It's so nice of them!  So far at least, I'm sure I'll have other patients that aren't so thankful, but everyone has been nice, funny, and easy to talk to. 

I've found many new places I want to explore downtown too watching out the back of the ambulance window.  I try to see street names and write them down so I can remember them for later!  Can't wait to go back and explore! 

A little about Grady

My scedule is to ride Monday and Tuesday with Ronnie Puckett, and Thursdays and Fridays with Todd Clark.  Starting at 0630-1830.  To get the truck ready and everything I arrive at 6, and we don't usually get back to the station till 7.  If we get back sooner than 7, we still have to wash the truck.  So I usually leave between 1900-1930.  I love my schedule though, I couldn't have asked for better days!  I can basically pick any other days I want to add ride alongs either with my preceptors or different ones based on when I want to go.  Love having the options. :) 

Most medics here do a 3 schedule where they only work 3 days a week of 12 hours.  Everything about their medicine is pretty straight forward.  I felt like Rexburg had TONS of options of drugs they could use compared to Grady.  Pain Med= Fentanyl, Benzo.= Versed, then they have all the typical drugs atropine, epi, mag sulfate, nitro, aspirin, amiodarone, toradol, albuterol, decadron... that's all I can think of, like I said straight forward. 

The treatment here is different than what I was thinking, just because of what I was used to.  Most of the time it's just a simple pick up for somebody who isn't in critical need.  We'll even bring patients to the hospital just to sit in the waiting room.  Sometimes because there aren't any beds, other times becuase they don't need to be seen right away so they go to the waiting room.  Most patients don't get a full assessment becuase it is unnecessary to them.  They just know what will happen and I haven't caught on to that yet. 

There are also time restraints on everything.  So based on the call we'll have 7, 10, 15, or 20 minutes to get to the scene.  Once on scene we have 10 minutes, unless they tell dispatch what they are doing and how long they will be.  At the hospital we ahve 15 minutes to drop off the patient and get our cot ready and be back in service.

Grady hospital is such a unique hospital, I love it!  When we bring a patient to grady we always lock the doors of the ambulance becuase of  the area we're in.  We bring the patient through the first sliding doors where a cop asks "Do you have any weapons?" Then proceeds to scan them with a metal detector and puts a sticker on them with their number in line.  So crazy! 

I'm excited to have more experiences and see what else this city has to show me!! :)