Beginners’ Luck

[Captn' Tuddle]

This is for those stories where something interesting happened on your first ride-along, first shift ect..

I'll start:

On my ride-along we got called out to a 38y/o male who had fallen and hit his head on the stove. We run over there (lights and sirens yay!) to find that fire has beat us (the firehouse was two blocks away). Anyway, for the most part he was ok, no contusions, lacerations or obvious signs of trauma. He was a little confused but, according to his caretaker, that was normal. So we get him on the stretcher and half way to the ambulance he sticks three fingers down his throat and starts throwing up all over the place. The head paramedic even had me sit up front because there was only so much room back there to dodge the projectile vommit...

 

[mycrofft]

I had two ridealongs.

For my EMT class, it was actually a clinical day hanging with one of the two instructors at Creighton University's hospital (St Joseph's), took one ride across town in their mobile ICU to transfer linens from their new facility to the old on'e ER. Saw two outstanding pt's in the ER's (big J-shaped flap avulsion of the cheek, and an ANTERIOR dislocation of an ankle). Another person was along with us that day, who later turned out to be oe of my instructors at nuring college.
Seven years later I was riding along at a FD station for nursing school. I jumped right in helping with lifts etc (since I'd spent time as an EMT already) and we had a slow easy evening.

 

[MedicSparky]

My first clinical ride along had one interesting call, in fact the first call of this ride along.

Young girl in a school started having difficulty breathing in the middle of class. When we arrived the class was cleared out and the girl was laying supine on the floor in the front of the class, her head on a book, and her teacher was holding her head trying to calm her. The girl was hyperventilating with a GCS of 10 (E 3, V 1, M 6.)

We get there and are getting vitals, IV access is getting set up, and drugs are being drawn (first ride along for EMT-B class so I wasn't paying attention to drugs). She suddenly goes into a tonic-clonic seizure.

We get her through the event, loaded up in the truck (after having to carry her down a flight of steep stairs) and on the way. The trip to the hospital was uneventful with the pt being drugged and postictal. Just before arriving she awakens and seems to be without any of the previous signs/symptoms.

As the ER doc enters her room and we're walking out the door she goes into another grand-mal event.

Definitely an interesting call for my first. Unfortunately for my education (fortunately for the population) I was a white cloud for all of my clinicals.

 

[feldy]

My first two ride alongs were both quite eventful. first call of my first ride...young girl overdose on oxycontin chased with a bottle of alcohol, second ride ride first call, overdose on heroin (fire beat us to that one and we arrived at the same time as the medics). Also had a TIA, MVA...a few transfers and a one or two b.s. calls.

 

[Tincanfireman]

I think I've posted this before, but anyway...

My first day ever on the unit as a rider I was assigned to a notoriously slow station due to the number of riders vs. available units. I got the usual "we never do anything here" speech and both crewmembers told me I could familiarize myself with the unit while they checked out the recliners. We ran two calls that day, about 90 minutes apart. Both were cardiac arrests, CPR in progress. We did get ROSC on one of the patients, but the first one was a goat-roper's dream. I thought the crew was joking when they politely told me that I was no longer welcome at that station, but it was confirmed by my preceptor the following Tuesday night. While no one had any issues with my skills or patient care techniques, it seems I was the biggest black cloud they had ever had and told the downtown crews that they could have me...

 

[Anthony]

I was still in class doing our ER time when me and my partner were asked to go to the ICU to help with a patient. Earlier that day my partner gave me a piece of gum. We got up there and was helping change the pt and move him to a new bed. The man had dirtied himself, no big deal i have to boys so that really did not bother me. As we were rolling him the ICU nurse showed us bed sores that the man had on his bottom side. I never seen bed sores this bad. When i saw them i gasp and when i did the gum i had in my mouth hit the backside of my throat and i started to gag. The nurse looked at me and asked if i was alright. I told her i would be fine. After we had the man change the nurse asked what happened. I told her what happened and she laughed and laughed. I did not think it was so funny. After that i didnt chew anymore gum when i was in the ER.

 

[Whittier]

I was still in class doing our ER time when me and my partner were asked to go to the ICU to help with a patient. Earlier that day my partner gave me a piece of gum. We got up there and was helping change the pt and move him to a new bed. The man had dirtied himself, no big deal i have to boys so that really did not bother me. As we were rolling him the ICU nurse showed us bed sores that the man had on his bottom side. I never seen bed sores this bad. When i saw them i gasp and when i did the gum i had in my mouth hit the backside of my throat and i started to gag. The nurse looked at me and asked if i was alright. I told her i would be fine. After we had the man change the nurse asked what happened. I told her what happened and she laughed and laughed. I did not think it was so funny. After that i didnt chew anymore gum when i was in the ER.

Ha... and I *always* chew gum... I could see that happening to me though so I better lose it. I was chewing some during kickboxing a week ago and as I was exhaling during a quick jab it flew out of my mouth... :wacko:

 

[xgpt]

I was still in class doing our ER time when me and my partner were asked to go to the ICU to help with a patient. Earlier that day my partner gave me a piece of gum. We got up there and was helping change the pt and move him to a new bed. The man had dirtied himself, no big deal i have to boys so that really did not bother me. As we were rolling him the ICU nurse showed us bed sores that the man had on his bottom side. I never seen bed sores this bad. When i saw them i gasp and when i did the gum i had in my mouth hit the backside of my throat and i started to gag. The nurse looked at me and asked if i was alright. I told her i would be fine. After we had the man change the nurse asked what happened. I told her what happened and she laughed and laughed. I did not think it was so funny. After that i didnt chew anymore gum when i was in the ER.

Ha... and I *always* chew gum... I could see that happening to me though so I better lose it. I was chewing some during kickboxing a week ago and as I was exhaling during a quick jab it flew out of my mouth... :wacko:

Yeah...I'd be more concerned about it falling out of my mouth and onto the PT :blush:

 

[adamjh3]

My first ride along was just a couple days ago, and we did five CCT calls, very interesting, I learned a ton from both the CCT RN that was in the rig with us and the two EMTs I worked with. (both were in the latter stages of paramedic school, really had thier stuff together)

One of the transfers we did was an 81 yo lady who set off her life alert pendant when she fell. She was found supine, medics took her to UCSD. I'm not sure how exactly she deteriorated to the point she did, when we got the call she was on a BiPAP. She had Left side CHF, end stage renal failure, diabetes, asthma and COPD, and a DNR that specified she didn't want to be intubated. We had to transfer her to Kaiser. At UCSD they tried to take her off the ventilator and her SPO2 dropped to the low 70's within 5 minutes

So we take her over there, and transfer care to an MD (I was shocked at how unprepared the facility was, as my insurance is through Kaiser). MD saw she had a DNR, took her off the BiPAP and put her on an NRB. According to the nurse we were with, she went hypoxic by the time we were back to our rig, and died by the time we went back in service.

That was pretty sad for my first day.

 

[Tincanfireman]

MD saw she had a DNR, took her off the BiPAP and put her on an NRB. According to the nurse we were with, she went hypoxic by the time we were back to our rig, and died by the time we went back in service.

I know that this might well ignite a fecal hurricane, and yes, I understand that the above actions were performed/directed by an MD. That said, here's my question: In a pre-hospital setting, is CPAP/BiPAP truly considered outside the scope of a DNR? EMS providers routinely provide O2 via NRB and N/C to hypoxic patients who are in DNR status. As long as we don't utilize a BVM, we are not sustaining respiration via artificial means. Regarding CPAP, since it's only effective with spontaneous respirations, is it truly different? For the medics: can you administer Lasix to a person with a DNR with the end result of drying out their lungs, albeit over a long period of time than with CPAP? If that's OK, then why not use CPAP as well? I'm aware that protocols/standing orders vary greatly, but this scenario left me curious.

 

[EMSLaw]

My first ever call was to a big MVA a few miles away, a multiple-car pile-up that sent a few people to the trauma center, at least one by air.

Of course, I never saw that call, because we got 100 yards down the road and there was another MVA right in front of us at the intersection nearest the station.

Things have pretty much gone about the same since.

 

[adamjh3]

I know that this might well ignite a fecal hurricane, and yes, I understand that the above actions were performed/directed by an MD. That said, here's my question: In a pre-hospital setting, is CPAP/BiPAP truly considered outside the scope of a DNR? EMS providers routinely provide O2 via NRB and N/C to hypoxic patients who are in DNR status. As long as we don't utilize a BVM, we are not sustaining respiration via artificial means. Regarding CPAP, since it's only effective with spontaneous respirations, is it truly different? For the medics: can you administer Lasix to a person with a DNR with the end result of drying out their lungs, albeit over a long period of time than with CPAP? If that's OK, then why not use CPAP as well? I'm aware that protocols/standing orders vary greatly, but this scenario left me curious.

As far as I know (which isn't very far at all, I'm still just a student) CPAP nor BiPAP are outside the scope of a DNR, because, as you stated, the Pt is still respirating on their own, just with a little bit of help.

Again, that's as far as I know, take if for what it's worth.

 

[MTEMTB]

The most stuff I did was during my ER time during my training course.
Had 2 teens assaulted with a baseball bat, 6 heart attacks, 1 suicide DOA, 1 teen passed out after drinking alcohol, 1 young man with a seperated shoulder, and numerous others. Was suppose to spend 10 hours there and ended up doing over 13. I enjoyed it.
At one point there was a code called, but I missed it since I was with a pt.

The only pt that really got me was the one who had had a surgery in their nasal passage and just listening to the pt gurgle, snuff and gag got me gagging so bad I had to leave the room.

 

[snolvera]

My first clinical ride along had one interesting call, in fact the first call of this ride along.

Young girl in a school started having difficulty breathing in the middle of class. When we arrived the class was cleared out and the girl was laying supine on the floor in the front of the class, her head on a book, and her teacher was holding her head trying to calm her. The girl was hyperventilating with a GCS of 10 (E 3, V 1, M 6.)

We get there and are getting vitals, IV access is getting set up, and drugs are being drawn (first ride along for EMT-B class so I wasn't paying attention to drugs). She suddenly goes into a tonic-clonic seizure.

We get her through the event, loaded up in the truck (after having to carry her down a flight of steep stairs) and on the way. The trip to the hospital was uneventful with the pt being drugged and postictal. Just before arriving she awakens and seems to be without any of the previous signs/symptoms.

As the ER doc enters her room and we're walking out the door she goes into another grand-mal event.

Definitely an interesting call for my first. Unfortunately for my education (fortunately for the population) I was a white cloud for all of my clinicals.

I was a 'white cloud' too on ALL my clinicals. We napped at the station from 10pm-6am without ONE single call on a SATURDAY night. LOL and that's exactly what my paramedic called me: her white cloud.

 

[Motojunkie]

Another white cloud here. In seven clinicals, I saw one code in the hospital and that was pretty much the only interesting event. On four field clinicals, I had NO trauma calls and only about 12 calls total. 14 hours on a Saturday with one call is not fun.

 

[MedicSparky]

Another white cloud here. In seven clinicals, I saw one code in the hospital and that was pretty much the only interesting event. On four field clinicals, I had NO trauma calls and only about 12 calls total. 14 hours on a Saturday with one call is not fun.

Where were you in Orlando? I had Fl Hospital Kissimmee, O[sceola]RMC, and Orange County Fire stations 55, 58, 36 and 34.

 

[Motojunkie]

I did Florida East, Orlando and Celebration and stations 43, 63, 10 (city), and 71. Almost got to go to a drunk guy who fell out of a pickup bed at station 63, but we got another call first.

 

[reaper]

Welcome to the real world of EMS. Trauma is a Myth and one I am glad to avoid.

 

[EMSLaw]

Welcome to the real world of EMS. Trauma is a Myth and one I am glad to avoid.

Lots of things about Trauma are myths, but if you work in a big city like New York or parts of North Jersey, you can pretty much run all day long.

 

[triemal04]

I know that this might well ignite a fecal hurricane, and yes, I understand that the above actions were performed/directed by an MD. That said, here's my question: In a pre-hospital setting, is CPAP/BiPAP truly considered outside the scope of a DNR? EMS providers routinely provide O2 via NRB and N/C to hypoxic patients who are in DNR status. As long as we don't utilize a BVM, we are not sustaining respiration via artificial means. Regarding CPAP, since it's only effective with spontaneous respirations, is it truly different? For the medics: can you administer Lasix to a person with a DNR with the end result of drying out their lungs, albeit over a long period of time than with CPAP? If that's OK, then why not use CPAP as well? I'm aware that protocols/standing orders vary greatly, but this scenario left me curious.

This'll depend on your state's particular type of DNR. Many have gone to a form that has multiple "classes" of DNR orders; for instance the pt may not want to be resucitated but still have "comfort measures" taken; ie be kept comfortable. Or it may be "limited interventions;" this usually covers things like IV's, fluids, meds, possible antiobiotics and tube feeding and some other treatements. Then there's "full interventions" which is pretty self-explanatory. All of these things stop once the heart stops, but until then certain things might still be done. Check with your state to be sure what's offered though.

CPAP would usually fall under a type of mechanical ventilation, so if that isn't allowed then technically no, it can't be done. But...for instance, if the pt has pulmonary edema and has severe difficulty breathing, the arguement can be made (and has) that putting CPAP in place and nothing else is a "comfort measure."