Smokers...u gotta love'em!

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divinewind_007

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So a little story of a code i had yesterday....first a litle background info. on patient from previous run.

Pt:
43 year old male
Right lung removed due to MVA x1 year
Emphysema
CHF
Narcotics abuse
Heavy Smoker

Last time i picked him up he was laying on couch with a O2 sat of 50%.
He was breathing about 46 times a minute, couldn't talk, but was still smoking his cigratte. Other crews that have also hauled him said thats how he was everytime they got him too. Always a smoking a cigratte.

Now for our run...critique if you want...always open to suggestion.

Call comes in, dispatcher states bystander CPR in progress.

We jump in the truck...Even got our director to hop in with us. Pt's house on county line 15 minutes out. Director in back went ahead and laid out our stuff. Arrival on scene found pt. lying on couch with sister doing CPR. She stated he had just had a breathing treatment and then just stopped breathing. She had also puked all over him. He apparently managed to at least lite up his cigratte before he crashed because it had burnt his chest a little. I think her puke put it out.

So we load him up and work him. On Scene Time 7 minutes.

Asstoyle on monitor
Contiuned CPR
Intubated 7.5 tube
Bi-lateral IV's 20 gauge and 18 gauge
3 Epi's on way in
Maxed out on Atropine
1 Narcan
1 Bi-Carb
Finger Stick 132
No change in route to hospital.
Transport time 15 minutes to nearest hospital.

Doctor gave him another round of EPI and he went into Coarse V-Fib.
Shocked once and he came back to normal sinus. Doc. started Dopine drip...3 minutes later he crashed. Doc. worked him about 10 more minutes and then called it. At least he got one last puff on his cigratte.
 
Typical COPD and wheezer... good to the last puff!

R/r 911
 
Ridryder911 said:
Typical COPD and wheezer... good to the last puff!

R/r 911
Click to expand...

Hubby breaks down the COPDers into the Pink Puffers (the skinny ones) and the Blue Bloaters (heavy)
 
Actually "pink puffers" are such as emphysema. with barrel chest and thin extremities and those with chronic bronchitis having hypoxemia, and increased CO2 retention, these patients have signs of right heart failure and are known as "blue bloaters."
 
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Anomalous said:
Wow!! I haven't heard those terms since Moses was a Medic. :)
Click to expand...

His # was 5. Moses was a madman. He would split the sea to get to a call.
 
My husband is a COPDr

His lungs were recked by agent orange in Vietnam.... I hope noone ever calls him a bloater or a whatever the other one was...
 
Kaisu said:
His lungs were recked by agent orange in Vietnam.... I hope noone ever calls him a bloater or a whatever the other one was...
Click to expand...

What ? How did you come up with that one? I am older than 43 and was too young to go to Vietnam, so unless he volunteered when he was 10 years old something is wrong!....

As well, nothing was discussed from Agent Orange, even then most of the Agent Orange cases produced cancerous toxins, not COPD. My brother is a victim of Agent Orange.
The killer was his lack of ability and persistence not to smoke and obvious lifestyle by choice.

Blue bloater is an acceptable medical term as describing a patient and has been for at least the past fifty years. One might want to research the terminology before criticizing, such as "barrel chested" and "Thorazine Shuffle" are typical justified descriptions, based upon the presentation of symptoms and appearance of the patient.

R/r 911
 
Smokers are wonderful. My grandfather a few decades ago almost died quite smoking was doing good. Then out of the blue started again and then died a slow demeaning death all the while smoking his pipe. Sometimes you just want to smack em but whats the point.
 
Ridryder911 said:
What ? How did you come up with that one? I am older than 43 and was too young to go to Vietnam, so unless he volunteered when he was 10 years old something is wrong!....
R/r 911
Click to expand...


He's 63 with over 125 air assaults to his credit....never smoked... and the VA has recognized his condition as directly related to his exposure....
 
divinewind_007 said:
So a little story of a code i had yesterday....first a litle background info. on patient from previous run.

Pt:
43 year old male
Right lung removed due to MVA x1 year
Emphysema
CHF
Narcotics abuse
Heavy Smoker

Last time i picked him up he was laying on couch with a O2 sat of 50%.
He was breathing about 46 times a minute, couldn't talk, but was still smoking his cigratte. Other crews that have also hauled him said thats how he was everytime they got him too. Always a smoking a cigratte.
Click to expand...

I don't know what scenario your working on? But, the original post was in regards to a 43 year old male with COPD, and contributing factors. Agent Orange was never discussed in the scenario or history.

Now, if you are regarding another scenario or situation, please discuss it with more information or another scenario.

R/r 911
 
wasnt working on any specific scenario.. didnt realize comments on the thread were restricted to the specific scenario... didnt like the judgementalism.... responded to that....
 
Kaisu said:
wasnt working on any specific scenario.. didnt realize comments on the thread were restricted to the specific scenario... didnt like the judgementalism.... responded to that....
Click to expand...


Have you been in EMS long? If you have you would realize there are many terms that are used for patients that the uneducated may not understand. No judging going on, just poster stated what people are refered to because of condition. Do not take things on this or any site as an attack.
 
As an EMT you should had been taught the terms "pink puffer" and "Blue Bloater" during your respiratory systems module. As I described they are reference to assist to remember what type of disease they represent. These are not "degrading comments" rather again just description of what the patient may represent.

As (or if) you decide to go into the medical field, you will see more and more references to symbolic of descriptive terms. This is part of medicine and even disease stages are even defined as similarities..i.e. elephantittis, nurse maid dislocation.

Medicine does not attempt to be politically correct nor should it be. The point is to be matter of fact, and feelings are subsided for the disease process, while having empathy for the patient.

For reference in regards to your Agent Orange, you may want to start another post with more information, to assure clarity.

R/r 911
 
nope.. never heard them before... and I did real well in school... ;)

going to begin paramedic school on August 20.... bet I wont be taught them in medic classes either....
 
Kaisu said:
His lungs were recked by agent orange in Vietnam.... I hope noone ever calls him a bloater or a whatever the other one was...
Click to expand...

Just to clarify, I think the title of this was "My husband is a COPD'r"
Took me a while to figure that one out....
 
Kaisu said:
nope.. never heard them before... and I did real well in school... ;)

going to begin paramedic school on August 20.... bet I wont be taught them in medic classes either....
Click to expand...

Your instructor did not teach you very well then. I learned those terms as well as others as a first responder, again as a basic, again etc. As an instructor I use these terms and so do the better text books. Another one that upsets many is abortion. Many only use this for the deliberate ending of unborn life, but this term is also used instead of miscarriage in the medical field.

Again don't be offended. Open your mind to more and you'll do fine in EMS.
 
Kaisu said:
nope.. never heard them before... and I did real well in school... ;)

going to begin paramedic school on August 20.... bet I wont be taught them in medic classes either....
Click to expand...

You may have done well in EMT class, but remember that EMT is just above advanced first aid and not everything is taught in that one class or possibly your instructor or program lacked teaching something. Remember, the Basic EMT is only written at junior high level as well as even the medic book is only at a high school level, so in comparison in medical academics EMS texts are not regarded very highly.

As well, I hope you don't assume you know what you will be taught or not be taught in medic class since you have yet attended, and then a lot of the true learning will be outside the classroom as in clinical experience.

If the medical terms blue bloater and pink puffer offend you, then other medical terms as was noted might just as offensive. These terms are not even meant to be offensive, but remember as well EMS is street medicine and the environment is not always the best place for those of the politically correctness.

I have heard patients referred to as scum, maggots, beached whale, etc. Yes, albeit unprofessional and I do not condone such behavior, these was stated by all level of physicians znd providers. Not excusing such behavior but it can be hard at times to maintain such objective and professional attitude after examining the drug seeker twice in one day, or seeing parents describing they can not afford antibiotics for their child although they have a pack of cigarettes, and then picking up that 600 pound patient the third time this week for "back pain"...

EMS is definitely not like what is portrayed as on television. It is a job, and that job is to provide quality medical care to those requiring emergency care, and just like any other job it has its down side.

I really suggest maybe spending some time and getting exposure to the real environment of EMS and emergency care and making sure this is the environment you want to be exposed to, before expanding your career.
 
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