When Snoring Really Isn't Good

0200. The lights clicked on and the speakers came to life. "Engine 51, medical aid...." I slipped out of bed and made my way toward the apparatus bay. I donned my bunker pants and slid into my seat, still trying to shake the cobwebs from my mind.

Arriving on scene we found our patient laying in bed. His wife told us that she called when she couldn't wake him up. The first thing to pop into my mind was that his blood sugar was low. It's always the sugar. My patient was breathing but his tongue was partially occluding his airway causing him to snore. I think that's what woke his wife up in the first place.

While I dealt with his partial airway obstruction my engineer grabbed the glucometer. The guys blood sugar was 35. Told you it's always the sugar.

I reached into the drug box and grabbed an IV start kit. My engineer spiked my IV bag and had it waiting for me when I needed it. While I was taping down my IV AMR showed up so I told them we had a hypoglycemic patient. The medic, trying to be helpful I'm sure, stepped up to the bedside. In doing so he managed to come between me and my drug box.

I asked the medic if he would grab the dextrose for me since he was in the way. After cleaning up the trash from my IV start (I had time since I assumed the AMR medic was taking care of the low blood sugar) I Reassessed my patient to see if he was coming around. He wasn't. It was about this point that I noticed the box for the pediatric dosage of dextrose on the bed.

I asked the medic if that's what he administered. He said yes. I then asked again if he gave D25 to the elderly gentleman. Again, an affirmative response. Since he wasn't getting my point I simply asked my engineer for the other dose of D25. Then the AMR medic realized what he had done and apologized. I can only assume that he was tired too. It was after 0200.

With the second dose of sugar on board the patient started to come around. He was still confused but he was improving. We helped AMR get him to the rig and cleaned up the rest of our mess. Time to head back to the barn.

Back Stabber

The gate to the back yard was open and we were being waved down. The woman ushered us into her backyard where we found her elderly father laying on the ground. It was apparent that he had been gardening but had DFO'd for some reason.

My patient was laying face up, half on the walkway and half in the bushes. I stepped into the bushes and grabbed his head, protecting him from moving it and possibly aggravating a spinal injury. I asked the daughter about her fathers medical history.

He was a diabetic, had hypertension and a fairly recent onset of seizures. She said that they had been gardening together that morning. She went to answer the phone and came back after a short conversation. That's when she found her dad laying where we found him.

While I continued to question the daughter my engineer started a head to toe assessment. Other than a couple of cuts and bruises there was nothing obviously wrong. He checked a blood sugar which came back WNL and placed the guy on some oxygen.

As a precaution we placed the old man on a backboard. That's when things got interesting. The patient started coming around, appearing to be postictal. Then he started to get combative. Understandably so. Can you imagine waking up confused to find several men strapping you to a board all while trying to tell you that they were there to help you? I'd be confrontational too. We enlisted the daughter to help calm him down and between us and the AMR crew we were able to get him strapped down.

By the time he reached the back of the ambulance he was lucid and answering questions. He did have head and neck pain and didn't remember what happened. At least the backboard and C-collar were justified.

After the call was over I had my captain pull a couple of thorns out of my back. The bushes that I had to crawl into to take care of my patient had been rose bushes. I was fine and careful until I had to struggle with the patient. Then the bushes stabbed be in the back. Ouch.

Embarrassing Beat Down

The tones jolted me awake again. It was just after 4 in the morning, about 2 hours after our last call. Whenever I get these calls I always hope it's at least for something legit. I hate getting up for BS (so does everyone in this profession).

Dispatch informed us that we were responding for an assault victim and that PD was already on scene. Coming around the corner in the quiet residential neighborhood we spotted several police cruisers. We were in the right spot.

My engineer pulled past the house, parked the rig and shut off the engine. There's no need to wake up everyone with our big diesel motor. We could hear yelling from inside the house. The officer at the door told us that the step-father and step-son had been drinking (shocker) and there had been an altercation. One look at the 19 year old kid and it was easy to see who had won that fight. He already had a big black eye, swollen face, bloody nose and cut lip. He may have been missing a tooth as well but I couldn't be sure.

My patient quickly refused to service. He told me rather indignantly that he was an EMT and he knew I couldn't touch him. He then tried to give me the silent treatment. That was until I quietly told him that if he refused to answer my questions I would have to assume that he was mentally impaired. And if I assumed that he would end up naked on a backboard with a C collar on and some IV's in his arms.

The kid became almost nice to me after that but he kept yelling at and antagonizing the cops. After refusing to be treated again he started arguing with one of the officers. Just then the on duty sergeant came in. After surveying the situation for a second he ask the other officers to place the young man under arrest. That didn't sit too well with the teen and he decided to fight. Alcohol made him think he could beat down his mom's new husband and then it made him think he could defeat several officers. He was sadly (for him) mistaken.

It must be a little embarrassing to wake up in jail having lost not one, but two fights in the previous night.

What A Month (part 4)

Day 7, Friday

I'd never had Lasix before. It worked really well. Within a couple of hours I was able to breath easier. The fluid build up around my gut had started to abate. This was a good thing. But then my labs came back.

My nurse came in and said that because I had been retaining fluid I my body had diluted its potassium. I'm not sure I believe that explanation. If that were true wouldn't all my electrolytes be diluted? Not that it mattered. They wanted to get my numbers up so I was given IV potassium. Another problem was that the Lasix was causing me to pee off the potassium in my body.

Because I was going to need labs drawn quite a bit my RN suggested a PICC line. This is basically an IV started in the upper arm (under the bicep) but the catheter is inserted to just before the right atrium. There are 3 different lumens allowing multiple fluids or medications to be administered and one line allows for blood draws. This kept me from having to be stuck every time labs were needed.

A specially trained RN came in for the procedure. She explained what she was going to do and then started preparing. Because of where the catheter is placed it is a sterile procedure. She draped me with a sterile sheet and prepped the area. During the insertion I wasn't allowed to look at the area. When I asked why I wasn't she informed me it was because I might breath germs onto the wound. So I asked if I could watch as long as I held my breath. She let me. Within a few minutes I had the PICC line in place. An x-ray tech came buy and confirmed that the placement was good. Every day after that the PICC RN would visit me and check on her line.

The rest of the day was kind of a blur, mostly because there wasn't much to distinguish it from other days. They just kind of meld together. I still wasn't sleeping well. Every night I was getting a fever and then breaking it causing me to sweat everywhere. Mostly I hurt and was miserable. I couldn't get comfortable.

The biggest thing was the ability to breath easier.

That night my wife left my side and went up to labor and delivery. The baby had been having moments where his heart rate would drop so they wanted her to stay the night. I told her that if she had the kid I'd hobble my way up there.

Day 8, Saturday

I was still being treated with the Lasix and the Potassium. My nurse, frustrated with my continuing low lab levels, asked if I'd be willing take some Potassium by mouth. It comes in about an ounce of fluid. It's super salty and nasty. At first they were going to dilute it in orange juice but I decided that was a bad idea. That would make it so I had to drink several ounces of bad tasting medicine. Instead I slammed the medication and then used the orange juice as a chaser.

All day we alternated between checking my blood for potassium and me drinking it. Talk about a bad day.

That evening, just after shift change, my RN looked in before making a lot of noise and noticed I was asleep. She let me sleep and came back 2 hours later. Such a great nurse! That night I was feeling better than I had for a week but that's not saying much. I decided to take myself off of the oxygen to see if I would de-sat. I didn't. I also stopped taking my pain medication. Not because I wasn't in pain but because I don't like the way it makes me feel. At that point I'd rather deal with the pain than the side effects.

Day 9, Sunday

By this point I was tired of being in the hospital. Sunday was much like Saturday with the RN constantly checking my potassium levels and giving more of the stuff. I was also to the point where I would try to stay off of the telemetry as much as possible. It's a real pain to have all those cables, cannula, and IV tubing connected to you all the time.

That afternoon the doc came by. He asked me how I was doing so I told him I wanted to go home. I listed the ways in which I had improved. He agreed that me wanting to go home was a good sign but he still had some concerns. We talked about the fact that I had a kid on the way....soon. Finally he agreed. He told me that since I knew what complications to keep an eye out for that he was willing to send me home but that I had to come back immediately if something was amiss. I reassured him with a joke that I was just going to be upstairs in L&D.

By 1930 I was home. It had taken them more than an hour to finish all of the paperwork and get everything else ready to send me home. Once at home I realized that my bed was not comfortable at all in my current condition. Still, it was good to be home.

Day 10, Monday

Monday morning my wife and I went back to the hospital. This time for her. She had a non stress test done to check on the baby. All was relatively well so they sent us home. The rest of the day was spent napping, at least by me.

Day 11, Tuesday

Again we packed up and headed to the hospital. Instead of a test they were going to induce labor. You can read more about the entire experience and see some cute pictures of the baby on my wife's blog.

Needles to say we were thrilled that that month is over.

Rock Star Status

Ok, not quite rock stars. But there are few professions where people everywhere wave at you. Kids are super excited to see you and will stop their parents if they think they can get a closer look and random people on the street will offer to buy you dinner. All this and they don't even know your name.

The tones sounded around 7 in the evening, just as dinner was being served. We responded for a smell of natural gas outside a local pizza shop. The pizza place was one of several restaurants on the far end of the parking lot for a grocery store.

Once on scene we were able to locate the source of the smell. One of the gas meters, was leaking. We determined that none of the restaurants needed to close. We blocked off the area so that no one would be able to get close to the hazard and waited for the gas company guy to show up.

So there we were in our turnouts, in a parking lot standing guard at dinner time. At first the people eating in the restaurants would see us and wave. They could see the lights on the engine flashing so they knew something was up. They were trying to rubber neck only there was nothing to see. Next a family walked up close to rig. The two kids, around 5 and 6, were wide eyed with excitement.

My engineer and I headed toward them, after all, guard duty was boring and we had a chance to brighten some kids day. I passed out junior firefighter badge stickers while my engineer grabbed some plastic helmets and divided them up. We also gave them a closer peek at the engine. We repeated that process a couple of times more before the gas guy showed. One of the parents even tried to buy us dinner. The generosity of the public toward us sometimes amazes me.

A little after 8 the tech from the gas company arrived. He confirmed what we had reported (that the gas meter was leaking) and ordered up another truck to repair it. Thankfully he was now in charge of the leak and we were released.

As we pulled out the kids in the restaurant that were wearing our helmets and badges waved. We smiled and waved back.

Rock star status.