Rx: Divine Intervention

The discharge paperwork was still warm from the printer when I arrived at the patient’s bedside. Her work-up was simple; something that easily could have been treated at her PCP’s. But she couldn’t go to her PCP, because she was new to the area, or she didn’t like her doctor, or she was between doctors, or she called them up and they couldn’t fit her in until April 2032…I forget. Something like that. I digress…

I began reading over the doctor’s notes, created using that new “speech-to-text” dictation program. Simple patient, simple assessment, simple treatment, simple discharge. Right?

“…if the infection does not improve over the next few days, please return and we will…” I paused. I stifled a giggle, bit my lip, and excused myself from the room. I scurried back to the nurses’ station, taking a seat next to the doctor and passing him his discharge notes.

“Really, Doc? Seems a little desperate, don’t you think?” I asked. He shot me a confused look. “Discharge notes, at the bottom. Read.”

“‘If the infection does not improve over the next few days, please return and we will…ask the Catholics’?? What? No! I said ‘Prescribe Keflex.’ Damn software…”

“I was gonna say, I didn’t think her infection was quite that bad yet.”

Doctors Say The Darnedest Things

Patient: “Oh! Look what we have here! Are you the good doctor?”

Doctor: “Well, I’m not the bad one…”

Another Day In The Life

Nursing Assistant: Can you bring in the patient through the employee entrance? I’ll meet you on the other side. Just knock, and I’ll open the door.

P2P: No problem. We’ll scoot right over.

(20 seconds later…)*knockknockknock*

Nursing Assistant (surprised): Who is it?

P2P (also surprised): Uh…ambulance?

P2P’s Partner: Housekeeping! You want mint on your pillow?

The Other Night On The Ambulance…

The other night, during a “Q” shift, my partner and I were chatting to pass the time. Somehow we came onto the idea of writing a massive series of books/articles/whatever, describing everything you could possibly want to know about EMS. So far, our collection includes:

The Newbie’s Guide To Surviving Long Shifts: You’re A Machine…A Slowly Rusting Machine

The Magic of Reverse 24’s: Sleep Is What?

Wait, What Day Is Today?

” ‘EMT-B’ Stands For ‘Empty My Trash, B****’ “, And Other Things Paramedics Regret Saying To Their Basics

“I Can See The Head!”, And Other Things You Don’t Want To Hear From The Front Seat

“Patching In” In 30 Seconds Or Less: Nobody Cares About The Patient’s Favorite Color

Body Mechanics For Dummies: I Pick People Up And Put Them Down

Coffee, Pens, and Time: Things You’ll Never Have Enough Of

Words And Phrases You Must Never, Ever Say

 

Any others?

 

Kids Say The Darnedest Things

Observations and opinions of one of my pedi patients…

Junior: Do you have any kids?

P2P: Nope.

Junior: Oh. That’s too bad. You’re nice, like my mom. I think you’d be a good mom.

P2P: (totally taken aback and blushing): Oh…Thank you, that’s very kind of you.

Junior: Are you married?

P2P: Nope.

Junior: Do you want to get married?

P2P: Someday, I think I would like to.

Junior: Why don’t you want to get married now?

P2P: Just haven’t found the right person yet.

Junior: How old are you?

P2P: Twenty.

Junior: Jeez…you’re running out of time.

 

Thanks, kid.

I gave him a sticker anyway. He still won the “Coolest Patient of the Day” award.

Only One Pair of Gloves Per Call

“You must only use one pair of gloves throughout the duration of a call.”

I’m looking around the inside of the ambulance for a little plaque or a sign that says this. I already checked the protocol book…it’s not there either. I’m willing to bet a week’s pay that such a rule does not exist. So then why do people act like it does?

Let’s get specific here. Someone calls 911. You show up in your shiny truck with your partner. Turns out, the guy’s not feeling super well. In fact, he looks almost as icky as he feels. Poor dude. Better get him to the hospital and see if we can make him feel a little better. So you do your on scene assessment (and, assuming you’re doing it right, you’re touching your patient), load him onto the stretcher, put him in the truck, and help your partner get some things accomplished in the back.

After a few minutes, you look at your partner and say, “Ready to go? Need me for anything else?”

And he’ll say, “No thanks, buddy, I got it now. We can get going.”

“Righty-oh,” I hope you don’t say, and then get in the front of the ambulance and drive.

With your freaking gloves on.

The very same gloves that were just all over Mr Sicky back there. You pretty much just rubbed your patient’s body all over that steering wheel. And if you did something more invasive? Like check his BGL? Or start an IV? Or intubate? Or suction? Then his blood/saliva/vomit is all over that steering wheel too.

I don’t know anyone who ordinarily drives (non-emergency, like between calls) with gloves on. So, if you are in that category of people who puts your gloves on when arriving on scene, then doesn’t take them off until you’ve transported the patient to the hospital…then you just inadvertently exposed yourself, your partner, and anybody who drives that truck, to the very things that you wore gloves to protect yourself from.

Maybe I’m crazy. That kind of thing just drives me nuts. Take the gloves off–And throw them away!–when you get up front to drive. If you can use some sort of hand-sanitizing product after taking off the gloves, even better.

In the meantime, I’ll keep looking for where that sign is…

Little Tape Chevrons

My IV skills are slowly but surely developing. Everyone who’s new at starting an IV gets so excited about getting flash, that there’s kind of that “Oh crap…well now what do I do?” moment after you withdraw the needle. I’m starting to nail more and more IV sticks, so the “OH MY GOD, I GOT IT!! YAY! Oh, wait, I’m not done?” feeling isn’t quite as strong. I’m actually thinking ahead a little bit more before just diving right in. That includes focusing on the less glamorous parts of starting the IV. Such as, oh, properly occluding the vein as you attach the extension set, so the patient doesn’t bleed out freaking everywhere.

"Uh...well, I think his blood pressure was high enough to handle this..."

“Uh…well, I think his blood pressure was high enough to handle this…”

(Image credit)*

 

I don’t really have that down 100% either, but I’m getting better at it.

The other big piece is securing the line in place. I tend to be pretty decent at that. One day, a paramedic showed me something I hadn’t been taught in class–the chevron. It looked pretty neat and handy. I liked that you could secure it more firmly in place if the loop of the chevron was pointed distally. And, if you pointed the loop proximally, you could pull the edge of the catheter off of the inside of the vein wall just enough so that it flows better. Pretty sweet, huh?

Oh, except that I saw it done in the nice, quiet, controlled environment of the hospital with a cooperative patient. And that the tape had already been ripped for me.

The next time I started an IV, I gleefully thought to myself, “I’m going to make my preceptor so proud! I’m going to surprise him with this cool little chevron trick! He’s going to just beam with pride!”

Oh, you ignorant, ignorant AEMT.

First off, I had an EMT-B tear my tape for me. I’ll be the first to admit that when I was a Basic, and a medic asked me to tear him tape, I never really knew exactly what he was looking for. How long? How wide? Well, turns out this Basic did exactly what I used to do…just take off huge hunks of the 1″ tape, stick it against the cabinet, and assume I’d figure it out. The paramedic preceptor I was with was busy sticking on EKG leads, so I went ahead and tried to quickly whip together my chevron. I was hoping he’d look back at me after he was done, and grin at my cleverness (even though he’s been in the business forever).

Have you ever tried to make a neat little chevron using 1″ tape while bouncing down the road? Because it comes highly NOT recommended.

This is what a tape chevron is *supposed* to look like. Just admire that textbook perfection.

This is what a tape chevron is *supposed* to look like. Just admire that textbook perfection.

(Image credit)

And this is what mine looks like.

And this is what mine looks like.

(Original image credit…I just added some Paintbrush magic.)

This is the newbie, frustrated, stubborn, bouncing-around-in-the-back-of-an-ambulance version.

When I finally smoothed down the last crinkled piece of tape, I looked up at my paramedic preceptor. He was watching me from the captain’s char, with that sad, “aw…that’s so cute,” patronizing, “good effort, kiddo” smile on his face, complete with the “your earnest innocence is so endearing” raised eyebrows. I returned the look, and sheepishly smiled.

After we transferred care of the ball-of-tape-with-the-patient-trapped-inside, the paramedic chuckled and patted my shoulder.

“So, next time?” He started, stifling a good-hearted, bemused giggle. “You tear the 1″ tape in half. And uh…chevrons are…well…”

“A textbook thing?” I offered.

“Kind of. Yeah. Not so easy or practical in real life, huh?”

I shook my head, smiling just a little.

“It’s okay…at least that line isn’t going anywhere. For, like, the rest of that patient’s life.”

*By the way, it’s not real blood in that picture. Promise.

Just Be Quiet

This particular male subject was impressively intoxicated. If he wasn’t such a jerk, and if we weren’t so busy dodging (mostly unintentional) swings and (mostly intentional) loogies when he broke the police officers’ grip, we might have all looked at each other with the “Wow. Strong work. Good job.” expression.

At one point, he looked at me and charmingly slurred (minus the expletives), “You look good, so iss alright. Lemme tell you, you’d never leave the kitchen or my room if you wuz my girlfriend. (hiccup)”

As I opened my mouth to reply, my big brother partner snapped back, “Hey, enough! You do not speak to my partner that way. Ever. She’s here to help you. You’re going to sit there and respect that, and we’re not going to have any more problems. Are we clear?”

The patient looks at me and says earnestly, “Sweetheart, I’m sorry.” Then he rolls his head back to my partner and lets out a long-winded, ever-loudening, slurred apology.

“Man, I’m sorry. I’m not meaning to cause no dizzrepeck. Not to you. Not to your lady fran’. Not to the ambalamps. Not to God. Not to the cops…well, maybe to the cops. But not to you. Or her. I’m sorry. I wuz jus’ compamentin’. Because she’s pretty. And you’re pretty. You’re BOTH pretty. I’m sorry. And I’m drunk. So iss h’okay. Maybe iss not okay. No. Iss no’ okay. I’m sorry. And–”

“Sir, don’t be sorry. Just be quiet.”

“H’okay.”

Quote of the Day

My professor during my maternity lecture:

“Let me just tell you now that I really don’t recommend Googling ‘nipple pinch test.’ I had a very specific result in mind…and it certainly wasn’t what came up.”

“I’m on the phone!”

We roll up on scene to find our patient standing outside on her cell phone. Figuring she’s still on the line with 911, we get out of the truck and approach her to see what the issue is. Something scared her enough, hurt her enough, or made her sick enough to want immediate evaluation. As my partner and I approach, we see she’s talking to her boyfriend, using the same attitude that would make your mother snap back, “Don’t you use that tone with me!”

“Ma’am? I’m P2P and this is Partner. Did you call for an ambulance?”

We receive a glance, before she goes back to arguing with the boyfriend. I give it about 30 more seconds.

“Ma’am?”

Then comes the eye roll. “Yes, hold on, I’m on the phone.”

After another 30 seconds of uncomfortably shifting around, I ask, “Ma’am, could you please put your phone away?”

Up comes a raised index finger, the unofficial sign for “Wait a minute, I’m too busy to be bothered with you right now.” Then a pair of incredulously raised eyebrows. And the hissed statement, “Would you shut up?! I’m on the phone!”

“Oh, my bad, ma’am. I’m sorry. See, when you called 911, we thought you had an emergency, so we came over to see if we could help. Because, well, that’s kind of our thing. Sorry to interrupt you. Is there a better time for us to come back? Like maybe, oh, never?” I replied, right before climbing back in the ambulance, leaving the supposed patient to finish her argument uninterrupted, and riding off into the sunset, never to deal with her again.

That’s not true, actually. That’s just what my brain fantasized about.

What actually happened? After asking if we would shut up, she saw the expressions on our faces, and the glance I exchanged with Partner. Then she huffed and mumbled into the phone, “I’ve got to go….” before hanging up. And then we went on doing our evaluating our patient, and doing the ambulance thing.

God. I hate patients on cell phones.