And yet another busy night at Medic 82
Trip Start Sep 14, 2008
21Trip End Nov 01, 2008
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Had some good calls last night, though nothing spectacular. More and more I'm finding my preceptor has fewer problems with how I run calls - and even the things he does find he says is more style than anything. He does a 12-lead on everyone, almost regardless of age. Since this service charges for everything they do, I really don't see a need for it on a healthy 35 year old male with no cardiac history and no chest pain. I don't fault him for it, he's been doing this a lot longer than I and probably has a very good reason for it. I'm finding myself getting more and more confident in my abilities, and actually putting my knowledge to work on a variety of real patients is helping as well. While I realize my education is never going to be complete, I feel that this learning experience is definitely helping to make me ready for the streets.
Our first really good call of the day was a poor lady who was pulled over the handlebars of her bicycle by her dog. We found her laying on the street. She had some left sided rib pain, and a growing hematoma on her left thigh. The firefighters were really helpful and they got her completely c-spined while I took a history down and did a quick physical. Being hands-off is sometimes part of my job if I have extra hands, since it allows me to focus on history and physical exams. She took blood thinners, which made me worry a little about the hematoma on her left leg. It was hot to the touch and had increased in size from the time we backboarded her and got her into the ambulance. She was in quite a lot of pain, too. I started an IV and we headed out. Other than the couple of other scrapes, she was fine though.
We had a good respiratory - a 5 year old woke up with sudden barking cough and expiratory wheezing. After getting a set of vitals, I gave her a Xopanex treatment per protocol. Her lung sounds turned out to be upper airway, I was hearing them in the lower airway though, since she was so small. The Xopanex was still appropriate, however. We also ended up giving her 60mg of Solu-medrol. When we arrived, the doctor was very cranky. She didn't even wait for us to get the patient out... she said "I can't wait for you guys" and climbed in the ambulance and immediately started to bitch. Apparently we have microscopes and a lab in the our truck that we failed to utilize in order to check that the respiratory problem is a viral infection (croupe) and we should know better than to give Xopanex for croupe since it's not a lower airway problem. The only thing that will work for croupe is solu-medrol (which I gave) and raceimic epinephrine. I bit back my apology for not doing a full set of labs during the blood draw and for not giving her a medication that no EMS service I've ever heard of carries. Deep breath, think good thoughts. Ever the student and diplomat (snort) I cornered her in the hallway and asked a few routine questions about croupe - just enough to get her to calm down a little. She did once she explained it. I think she was probably just having a bad night, so I'll give her the benefit of the doubt.
We had a real CVA with difficulty speaking but no neurological deficits. Her BP would spike upwards and then her speach problems would get worse. Unfortunately her BP wasn't high enough to treat. Ah well, we got her to the hospital on time.
I've reached the 3/4 point in my internship. Next shift will see my 360 hour evaluation and less than two weeks until I go home! I miss everyone terribly - especially my class mates. There's so much I want to discuss with them now that I've done my internship. I miss my family and my friends as well. I'll see you all soon!