Ever had one of those days?

[Epi-do]

So, I get into the firehouse today to start my 24, and the first thing out of the outgoing medic's mouth is "The truck needs fuel." I couldn't help it, the first thing out of my mouth was, "Again, really?" You see, this was the fourth shift out of the last 6 that the truck was left needing fueled. I listened to the rest of his report and then went about checking the rest of the truck. After stewing over it for a few minutes, I went up to him and asked what the deal was. After he gave me some lame excuse about how sometimes they just aren't able to get fuel, I told him that it was becoming a habit, it was getting really old, and it needed to stop so he had better figure out what needed to be done to change things. The only time we truly can't get fuel is between 2359-0400 on Sunday nights/Monday mornings. So, that accounts for today's incident, but doesn't explain the other 3 out of 5 shifts.

Then we started running. In the first 7 hours of our shift, we had 5 runs. The first couple were run-of-the-mill, no big deal, types of runs. On the third run, we had a very grumpy old man that had flu-like symptoms, refused to put a mask on, and was insistent on going to one of our heart hospitals rather than the "regular" ER.

Run 4 was an unresponsive person at this huge retirement compound and all the nurse could tell dispatch was we needed to go to "door 10." Each wing/building has a name and we know the facility by building names, not door numbers. It took us a few extra minutes to finally figure out where we needed to be, and that was after asking a few different employees who called/where door 10 was and no one could tell us. We finally get to the patient and she takes one last aginal breath and then stops breathing. She is also pulseless. She has a valid DNR, so I hook the monitor up to get my strip of asystole to include with the report & DNR, and she is in PEA. Yes, she is pulseless, but technically, her heart hasn't stopped beating yet, so now what the heck do I do? Since she has the DNR do I just stand there and do nothing until she is finally in asystole? Well, since I wasn't sure, and there wasn't another medic on scene with me, I opted to get the patient moved and to transport. Just as we were getting ready to move her, she converted to asystole. We double checked all of the leads to make sure none of them were pulled off (they weren't). I printed my strip, took the paperwork that I needed from the ECF, and we went on our way.

Run 5 was an unresponsive person at the Jr. high school. While we are enroute to the school, dispatch advises us that our patient is a 13yo special needs child who has stopped breathing, and CPR is now in progress. The engine arrives first, and takes over CPR until the pt has ROSC. When we get there, he is not letting them bag him any longer, and while he is pale, he is no longer cyanotic, like he was when the engine first got there. He is fighting having a NRB on his face, but needs the oxygen, so we use kerlex to restrain his hands at the side of the cot. He is breathing well on his own and is interacting with us at this point. We head downtown to the children's hospital, about 15 minutes away. About half-way there, he begins breathing inadequately again and we begin to bag him again. He eventually stops breathing again, and goes from sinus brady to PEA. I only had one other person in the back with me, so we start CPR and take him in with only an OP, BVM & chest compressions. He was ventilating well with the OP, so I didn't attempt to intubate. I also was unable to get a line or push drugs since CPR was taking precidence. The ER was able to get him back, but I am not sure what sort of quality of life he will have if he even survives.

So, that was the first 7 hours of my 24 hour shift. We haven't done anything else (yet), but we still have until 0800. (I swear if I get a third arrest this shift I am going home and will be done for the shift.)

 

[Shishkabob]

Wow that blows, I'm sorry.


Wanna trade? I need a Code... You can have my L&D shifts.

 

[Pudge40]

I have never had a code in the year and a half that I was running in fire/ems. And I have only been to two fatal accidents. Neither of which was with ems.

 

[Onceamedic]

Ahh Epi.. sounds like we have similar shifts. This is my shift a couple of weeks ago. I posted it on another forum but I thought I'd share. PS - the one I just finished was worse. We had 6 deaths.



I finished a 24 hour shift a couple of days ago. This is an easy day in the life of an AMR medic because it was not a 48. As you will read, sometimes it’s not about the length of the shift.

The shift began badly. I confronted an acting supervisor about an incident on the previous shift. I tore him a new one. The good thing is 20 minutes later, he followed me out to where I was doing my rig check to explain himself. I took it as a win for two reasons. First, he cared enough about my opinion of him to actually try to make it right, and secondly, I had made my point.

The first call of the day was a minor MVA. My patient was the restrained passenger of a car that had been rear-ended. He was complaining of neck pain – C1-C2. Routine. Stable patient, full immobilization and to the hospital.

Second was a “non-emergent” transfer from regional hospital to big city hospital. The transfer was ICU to ICU. I get to bedside and my patient has no eye-opening, responds to voice with moans, is on a 20 mcg/min NTG drip, contracture of the left upper extremity, spasms of left upper and lower extremities. BP is 146/90, HR of 101, respirations of 27 per minute. History of multiple sclerosis and hip fracture. Patient has three peripheral IVs including an EJ. This is a “stable” patient going by ground?

The nurse explains that the diagnosis is baclofen withdrawal secondary to possible pump malfunction and the patient is going to neurological ICU. She had started the patient on 40 mcg/min NTG to control BP and HR. Patient had gone down too much, rate had been adjusted to 20 mcg/min and symptoms were being controlled with Ativan.

The last time I had questioned the stability of a patient for non-emergent transfer, I had been told by the Dr. that if he didn’t think the patient was stable enough, he would have called for air. My supervisor had told me to shut up, document my concerns, and transport the patient.

I told the RN that I did not carry Ativan, and the only benzo options I have are Valium and Versed. She said that would work. I don’t have an infusion pump and told her I would have to take hers. She was upset about that. I told her that I would not take the patient without the pump (thank you St. V’s clinicals for making sure I am comfortable with the operation of the Alaris). She goes to confer with the higher ups and comes back with some ad-hoc paperwork pulled out of someone’s butt and it’s all good. I still have a hinky feeling about the whole thing, but it isn’t till well after the transport when I do some research that I find that if the Dx was on the money, the patient would be HYPO- not HYPER- tensive. Be that as it may, I load the patient and we head 100 miles across the desert.

To make a long story short, the details of which include delays across the dam, bleeding air out of the pump lines several times (it’s bumpy and at one point, the NTG bottle flew off the stand), emptying my drug box of benzos, considering upping the nitro, being misdirected by staff at the destination hospital not once but 3 times, assisting the RN at the destination hospital switch out incompatible tubing and no food for 6 hours, we finally arrive back at the station (after returning the pump to 2nd floor ICU and replenishing my drug box) at 8:00pm to find the crews had had their butts kicked, running about 20 calls in the time we were away and that we were up for the call. This is two crews mind you, with a couple of the calls being handled by a move-up crew from the sub-station.

Usually, when a transfer crew comes back, they drop to the bottom of the rotation. My EMT partner objects to us being up, but I silence her, telling her that rough as our transfer was, we had still had an easier time of it then the crews in the city.

I get to sleep about 10:30pm to get toned out at midnight for a difficulty breathing out of town, part of our coverage area, about 20 minutes out running code. Female patient, 73 years, history of CHF, COPD, oxygen dependent. Patient has cellulites bilateral lower extremities extending to the knees. I feel the heat radiate off her legs, treated 2 ½ weeks ago for an unspecified infection.
Pneumonia or pulmonary edema? Quiet in both lowers, sounds like snot in the right upper. I’m thinking diminished because of the COPD and snot because of pneumonia?

Fire first responders had started A & A via SVN – I hate that. It’s routine around here – they think any difficulty breathing needs A and A. Until we get her in the ambulance, it’s their patient. We load up the patient and as we are lifting her (she’s a hefty one – blue bloater) and there is a gurney “incident”.

My partner is about 5 feet tall, weights 100 lbs soaking wet and she was the leading contender in the station “who goes out with a career ending injury” pool. She had been back at work for about 4 months after 6 months light duty from her last back injury.

All I know at the time is that we are lifting and suddenly the gurney drops. I am at the dumb end (cause I’m a moose) and she is operating the legs. I control the descent of the gurney; patient barely realizes there was a problem. The patient was sitting straight up and blocking my view of my partner. I don’t know what happened. I peer around the patient, make eye contact with my partner, she nods and we lift again. This time she goes up without incident. Gurney is not as high as I like it but my partner does not want to try again. I lift the dumb end into the rig, go around to lift the other end (cause I’m a moose) and the fire medic is already lifting. Totally against company policy, but I raise the legs and off we go.

We are busy in the rig. I am treating pneumonia, the fire medic is treating CHF. She got about 250 mL, I checked lung sounds, shut off the fluids and we continued the CHF route. Fire medic was right, I was wrong. (This is only my 4th or 5th CHF patient in a year. It’s not the problem here in AZ like it is in WI. I guess that’s why we don’t have CPAP on the rigs.) PS.. sure makes that A & A treatment look good huh?

We get to the hospital and my supervisor opens the ambulance doors. WTF? Fire medic has disappeared. Supervisor and I transfer care, I take care of the paperwork and return to the rig. It’s at this point that I become aware that my partner was taken to ED room 7 in a wheelchair. She had called the supervisor while driving and told him she was hurt.

I am trying to make this really long story short. Bottom line – she is in CT scan, pumped full of dilaudid and muscle relaxers and telling the supervisor I dropped the gurney. I wind up waiting at the hospital until 3:30 in the morning while he does paperwork because we can’t get an EMT to man the rig and he is now my partner. When he is ready, we return to the station. I write out incident reports and try and figure out what happened. Opinion at the station is about 80% that the girl is looking for the injury and throwing me under a bus. I’m not so sure. I am filling out the paperwork to request evaluation and remediation if required of my lifting technique. I am more upset about this incident than anything
else that has happened – or will happen – this shift. (yes there is more – I am so grateful to those of you still with me on this.)

I don’t make it to sleep when we get toned out to a MVA on the highway. It is about 5:00 am. No idea what type of MVA or injuries if any. I ask my supervisor, who’s driving and is the senior medic if he wants patient care. He says no. I do the standard calculations of enroute times vs. launch times on a rotor and decide against a rotor. (20 minutes there – 20 minutes back vs. 35 minute ETA plus 15 to ED for rotor unless they are lying, which has happened.)

On scene, I see the rear axle of a vehicle in the northbound lane. The rest of the SUV in on its roof about 100 yards south in the ditch. First responders are log rolling a patient. The fire medic is palpating the back. The fire medic is relatively new, excellent with medical, tends to freeze up on trauma. He’s the guy that was puking his guts out on the scene a few months back when we ran on the guy tortured with the box cutter.

No O2 on the patient. EMTs directed to put a hi-flow NRB on the teenage female. She is messed up. In and out of consciousness, 4% partial thickness burn on right thigh, major lacs, abrasions, etc. etc. Scene time 9 minutes then running code to the hospital. Initial BP 128/70, HR 80. 8 minutes later BP is 103/58 and HR is 113. I got a BP cuff compressing the bag running NS into the I/O and a second line in the right AC.

Bottom line – 2 16 year old members of the swim team going to practice. Both moms in the car following. SUV hits left guard rail, over-corrects and rolls. Both occupants ejected. Driver lying partially under the SUV, dead on the scene. My patient has basilar skull fracture and other injuries, flown out to trauma. I get back to the station at 7:30am. (no sleep except for 2 ½ hours and up since midnight.)

Last but not least – I was supposed to be off at 8:00 am. One of my co-workers is doing FTO testing this am and was informed it would be from 8:00 am till 10:00 am and had asked me to hold over for him. He is a great guy and I am a big fan of improved education in the field. If you remember how I was thrown to the wolves when I started this job you will understand why.

I surrender my rig to the on-coming medic and take over the rig my friend was in. In the minds of some of the pea brains that work here, this puts me up for the next call. I refused. It didn’t do me any good tho… the FTO testing started at 9:00 am and my friend was not done until 1:00pm. I ran calls.


Call me crazy, but I still love my job.

 

[Thindian]

Kaisu, that's one hell of a shift. Hope your 100lb partner doesn't try and pin her lift problems on you man, you don't seem like you need that right now.

 

[emt1994]

my husband is a medic and he has some of those nights its non stop codes he said him and his partner feel like they need to put black wings on there uniforms as the death squad but a few weeks ago he delivered his first baby in 23 years of being on the road he said that made up for all the crummy calls . yes it was messy but the baby was ahealthy 8 pound 5oz boy

 

[Epi-do]

So, what is it with crappy peds runs? We ended up having about 4 more runs for the shift, and of course all of them were overnight. One of them came out as a seizure. We get there, and there is an 18 month old laying on the kitchen counter and dad is giving him rescue breaths. All I could think was, "You are :censored::censored::censored::censored:in' kidding me!" Turns out the kid was breathing (although not very well), and he was still seizing. Got hiim on O2 and gave him 2.5 mg of Versed and the seizure stopped.

Then I got to deal with the respiratory issue. He had a rate of around 30, with retractions and that awful looking see-saw motion between his belly and chest. He had tons of congestion in his chest, and wheezes. I started 2.5 mg of albuterol, and as all of the crap in his chest started to loosen up, I began to suction him. So much stuff came out of that little nose and mouth, it was amazing. We got him to the ER and along with continuing to suction him, and getting a line on him, they also tested him for the flu, meningitis, and did a blood gas on the poor little guy. However, he was breathing tons better when I left.

I can't tell you how glad I was to get off shift this morning. I really hope I don't have a repeat shift like that any time soon.

Kaisu, at least it isn't just me that is having the crappy shifts. I had another one just a couple weeks ago that involve a shooting, 2 different (and unrelated to the shooting) cardiac arrests, a CHF that was drowning in fluid, and a couple frequent fliers. I have had 5 cardiac arrest calls in the last 2 1/2 weeks.

 

[johnrsemt]

Epi you need the black wings. glad we don't work together anymore ha ha: course I got to that point towards the end at the Private service we worked at. everyone was dying on me.

needed a break; came west and it is s l o w . wish for shifts like yours (and mine) again. be careful what you ask for