Priority 4

When the call comes in for a cardiac arrest, everyone gets a little fidgety. When the paramedics continue and say, "but we're requesting permission to make the victim a priority 4 due to asystole on arrival with an overwhelming lack of signs of life," the atmosphere changes from we-can-save-them to one of eh-just-a-fatality-too-bad. Usually the priority 4 patients are the little old nursing home patients who just need to be let go from this world. Those people we are relieved to see go, instead of prolonging their stay with brute force.

But when the request for a priority 4 is for a 20 year old pedestrian struck by an SUV, no one is relieved about anything.

Being the clinically curious people we are, everyone goes in to look at his awkwardly broken neck, the grossly deformed lower leg fractures, and the concave skull.

Being the emotional humans we are, everyone tears up when the parents come in to find their promising young son dead on the gurney.

We can be clinically dispassionate when looking at injuries, but to see the impact that one impulsive decision will have on this family for the rest of their life...that is something that no one can be dispassionate about.

EMS

EMS is a different world, as I found out yesterday during my ridealong.

The reason I enjoy the ER is because even when we've got a hot mess coming in, we have somewhat of an idea of what sort of hot mess this will be. I know that's not true all the time and sometimes we do get completely surprised by something, but usually we have the most basic of info about someone before they roll through the doors.

Not so with EMS. I went on 3 calls during my ridealong, and each one was vastly different than the others.

Call 1: Assist for older man falling in a parking lot.

I got to ride the ladder truck for this one. Not going to lie, I was so excited; I felt just like an 8 year old who tells everyone, "I'm going to be a fireman when I grow up!"

The ambulance was right in front of us, and we roll up at the same time. The fallen guy had a pillow under his head, little nasal cannula on, and his feet propped up against the door frame. He also weighed probably 500 pounds. And oh yeah, he was blue as a primary color. The nasal cannula might have helped if he was actually breathing. The paramedics snapped into ALS mode and we started CPR in the parking lot. He was intubated (barely; he was apparently the hardest one they've had in a long while) on the way, and I got to be on the giving end of a call to the hospital to warn of a coming priority 1.

Call 2: Headache

We get to the trailer park, and the young teenage girl on the couch tells us of how she vomits every time she stands and can't speak at all because of how short of breath she is. While she walks herself down the stairs to the stretcher. And oh yeah, her headache is so bad that she can't take her headache pain or nausea pills that she was prescribed during her hospital visit the night before. She even still had her wrist band on. Gah.

Call 3: Fast heart rate

The call from the local sleep center came at 1145 pm, for a guy who was experiencing some heart problems. When we get there, the nurse goes, "oh, his heart rate went from 80 to 140." And that was the extent of the report. Mkay. We go in and talk to the patient, who was confused after just being shaken awake for no apparent reason. He doesn't want to go to the hospital, but then gives us a little history of how he occasionally feels tired and SOB, and oh yeah, feels like his heart is racing. We ask to look at the EKG he was hooked to, and the paramedic and I both point to the A flutter at the same time. He went to the hospital after we explained to him the dangers of an unstable heart rhythm.

***
In short, it was a great experience. I have so much respect for those first responders. I can't imagine going to every call without knowing what it will be. They deserve some mad props for that.

It's also interesting to see these three scenarios in one shift. We went to the first call expecting to scoop a guy off the ground and set him back on his feet, but we found someone in cardiac arrest. The second one was from a system-abuser who is hurting because she won't help herself - and we still have to transport her on the big expensive ambulance. The third guy was something seemingly unnecessary on first glance, but whom we may actually have saved a life on - he could very well have thrown a clot 2 months from now and stroked out. Instead, he got to voluntarily walk to the stretcher and go to the hospital preemptively.

I jokingly mentioned to the EMTs last night that I was scared to come into their room in the ER, because it's a big scary boys club and I felt like I didn't know anything about their job. I'm glad that I now have an idea, a greater respect for them, and some dirt on which to poke fun at them with.

Jerk

I was warned about this guy. "He's a douche," they said. "He is the biggest jerkoff on the planet," they cried. "Oh, Mr. C? He's a dick. Don't go near him if at all possible." I should have listened. Woe upon me. I should have listened. Instead, I tried to give this guy the benefit of the doubt. Yes he is a frequent flier, but he does have some serious health issues. His reason for being here today is truly something he needs to have worked on. Without fail though, he was the most massive asstard that I have ever taken care of. Snarky comments, blatant rudeness, morbid slovenliness, and an all-around bow-to-me attitude. I can handle that, though. Some people in this world are incurable jerks and there is nothing to be done for them. I can handle his douchiness up to a point. But when I needed his room for the potential respiratory arrest coming in three minutes? He retaliated by taking a crap right on his own bed while being wheeled down the hallway. I decided right then and there that if I ever had him again as a patient, I would be the worst nurse possible for him while still keeping up to standards of care. In fact, if this guy codes and dies tomorrow, I might have a beer. He was that much of a complete failure at all things humane. Thoughts like these shouldn't occur until at least many years into nursing, when I'm close to burnout. It's just so effing frustrating to see the bottom feeders of society like this guy and have to not only wipe his ass but kiss it too. The worse part is that I went into nursing because I wanted to love and help people at their lowest points and do it by sharing Christ through words and actions...but people like this make me forget all that. They make me hateful, they make me bitter, and they make me cold. It breaks my own heart to see myself like that, because I feel like I'm failing at love. Sigh. It's a frustrating situation...

An atypical drug request

Scene: One soft-spoken doctor, one rookie nurse, and one patient sitter trying to pack a nosebleed.
***
Doctor: Hmm. I need cocaine...
Shrtstormtrooper: I beg your pardon?
Doctor: Yeah, cocaine. I need some.
Shrtstormtrooper: Ummmm....sure...

Apparently requesting cocaine is a perfectly sane scenario when packing a nosebleed. Interesting. I mean, we all know I have a little bit of experience with some lidocaine, but cocaine?

I went to the accudose and typed in "cocaine" and sure enough, 4% Cocaine 10 ml popped up on the screen. I had no idea that this was a completely normal request. On returning to the patients room, the doctor goes, "Yeah my bad, I probably should have been a little more tactful. I take it you've never packed a nosebleed like this before?"

Well, color me educated!

***
And while packing the nosebleed, the doc looks up and asks me if I knew what the most common cause of nosebleeds in males was. I had no idea so, to half take a guess and half be a smartass, I responded "nose-picking?"

Doc giggled and goes "yup, digital trauma!" Who knew?
***

Lastly, there are two types of people in this world: nose-pickers and liars.

Hitting the fan

I knew last night would be bad when the thunderstorm outside was so bad it blew open and broke the ambulance bay doors then caused a hospital-wide power outage for a good 30 seconds.

13 hours later, I am so glad to be home. Good Lord I'm glad to be home.

It was rough, folks. I had drunks, patients refuse to leave after discharge, crayzees, multiple peds patients at a time, state police blood draws - for which I will have to show up in court since there was a fatality in the vehicle, very sick people, very obnoxious people, and very drug seeking people.

Crayzee. Seriously.

I might have a beer before bed, is that bad?

Swine flu

Borrowed from someone wittier than I am...