Yeah baby! I am rackin’ up those frequent flier miles! When I fly somewhere, I make sure it counts!

This weekend, I’m off to the great state of Connecticut (via Providence Rhode Island) to see my folks and on Saturday night I’ll be zipping up to Portsmouth New Hampshire to see some old friends from my radio days.

Lucky for me it’s a LONG flight so I’ll have plenty of time to study my notes for the Paramedic midterm coming up on Thursday.  So far my quiz average is a 93 and I’m feeling pretty good about all of the material. Of course, I occasionally confuse easy stuff like the roles of potassium and sodium. I think I know it inside out, then when the quiz come, I totally blank. That’ll be fixed with this round of studying. Promise.

School is really clicking. Every Wednesday morning, our lab group, “PM lab,” meets for a couple of hours prior to the actual lab session. We dig out the gear and practice lines, rhythm recognition and all of the other skills that will help us work together as a team. ACLS mega codes are a few weeks away and we want to be a machine by that time. It was a great idea. We also meet as a whole class every Thursday for a couple of beers following the last lecture to defuse and unwind.  It’s a good group of people. There’s some very smart folks in that room. It’s a real treat to be in the same group with these guys and gals.

Okay. I’m off to finish packing my stuff for the next few days. See you after the weekend. And to all my friends in Fire and EMS, be safe.

This weekend my wife and I flew to the “secret location” to check out a potential job for her. It looks pretty good. They want her and offered her a stupid amount of money. Now we just have to decide if we can live apart for the next 8 months while I finish medic school in the PNW. We’ve lived in a split household before, when I moved to Seattle, she stayed behind to sell the house. It was 6 months of racking up frequent flier miles. Not fun, but certainly not something that was a marriage ender. We both know it’s the means to an end.

While she was interviewing, I grabbed the keys to the rental car and cruised around. I was checking out potential places to live, looking at the city… all that fun stuff. While I was sitting at a red light, waiting to jump back on the freeway, I looked to my left and saw a Paramedic rig posted in a parking lot.

“Aha,” I said to myself, “I’ll go pick the brains of those guys in the truck.”

So I pulled in, introduced myself and spent the next 45 minutes discussing the pros and cons of their system, their protocols, pay, morale and everything else. Score!

First, it was a dual medic truck. That’s very nice. It was also a decent truck. It was clean and neat, Phillips monitor, standard load out for a medic truck. The medics were in crisp, neat uniforms. The condition of the rig and the guys in it says something about the company, don’t you think?

An additional plus, the medics were both really nice. Very forthcoming about the pros and shortcomings of working for *****. (Yeah, I’m not saying the name. Sorry.)The pay? Not too bad. The protocols? Not bad. They’re doing hypothermia for cardiac arrest but no RSI. “We’re mostly dropping King tubes,” the medic told me.

So, I asked about turnover. The senior guy on the truck had been there for 13 years and there wasn’t a lot of turnover. Sweet. How about quarters? They do System Status Management. Ohhh no. That sucks. I asked if he tought it would be difficult for me to get a job there. He looked me over and said, “If you know your shit, we always hire good medics. We like to hire older guys, too. There’s less cowboy in ‘em.” Then he grinned at me.  I shook his hand and said thanks and got on my way.

Hmm. Sounds promising.

It seems like an okay job. Morale is pretty good, there’s decent pay and the trucks are mostly dual medics. The downside, SSM and 12 hour shifts, no 24s. I guess you gotta take the good with the bad.

We’re flying home tomorrow and we’ll decide if we’re going to make the move or not within in the next day or two…

I wish I could say that I spotted it right off the bat. That I stood up and said to the firefighters crowded into the small room, “Hey guys, somethin’ ain’t right. Let’s get a medic here now!”

We marked on scene. I knew we were in the area. The fire apparatus parked on the street corner was a dead giveaway, but I couldn’t find the house. I double checked the address on the MDT. It should be right here.

“Where is this damn place,”‘ I muttered to my partner as I checked house numbers with my flashlight, walking from mailbox to mailbox.

A little kid with no shoes ran out to the street to wave us in. The small house was tucked behind a chain link fence and a stand of trees at the end of the dead end street.

When Mark and I walked in, we found the tiny house was packed with furniture and relatives and a steaming rice cooker. It smelled like a luau and  felt like a sauna. A crowded sauna. Tropical music was blaring from a radio as I walked toward the pile of BLS gear in the hallway.

The guy was 350 pounds if he was an ounce. The guy was sprawled on the queen sized bed, looking like he had the flu. The guy had said he’d been ill for the past week and now he felt weak and crummy and wanted to get checked out. The guy wanted to know if he could just skip this “ambulance stuff” and get a ride to the hospital from his wife.

“I started feeling really lousy about 5 hours ago,” he said. “My wife made me call.”

“Any pain in your chest?”

“Nope.”

We went down the list, asking the questions. Abdomen? Nope. Short of breath? Nope. We were looking for anything that might suggest this was more than a guy who simply didn’t feel well.

Yeah, his BP was high, but it was always high. He wasn’t compliant with his meds, he said. He couldn’t remember the last time he took his Lisinopril or HCTZ.

“Yes,” he said when we asked him about other medical issues. “I have diabetes. I take Glipizide and I just had some juice. I thought that my sugar was low and that’s why I felt crappy.” His BGL was 110.

His O2 sat was about 92% on room air. We got him on the cot, and I put him on 3lpm on a nasal and his sat went up to 96.  It was a big effort getting the guy into the truck. It took 4 firefighters to help load him. They handed me a SOAP, and off we went.

As we were en route, I was doing another exam in the truck. I noticed his pulse was kind of thready, but rapid. His BP was 200 palp and he was diaphoretic and cool to the touch. In clinical terms, he was looking like crap.

“Shit.”

I told my partner to put his foot down and get us to the ER. I swapped the guy over to a NRB at 15.

We rolled in to the ER and the RN said, “Is this the ‘been ill for a week’ guy?” I nodded and said, “Yeah, but I think it’s an MI.”

Zip! Off to a Cardiac Room, quick 12 lead and yep, it was an MI. “Wow,” the doc said. “Look at that ST elevation in V2 and V3.”

I had guessed right, but felt like shit.

We were so focused on the fact that he was denying chest pain and any of the other typical MI symptoms that we didn’t even consider that it might be cardiac.

Now I agree with the guys that say every patient deserves an ALS evaluation. Some Nitro for vasodilation was defiantly in order. Aspirin? Yeah, that would have been nice too.

Am I going to look at every “sick/unwell” patient a little closer? You’re damn right.

I’m not a medic yet. I have a lot to learn. And I don’t know about you guys, but I use almost every call as a learning experience.

During a break in the pathophysiology lecture in school this morning, I spotted a TXT on my phone from my old partner…

So this is how EVERY call went last shift, “My elbow hurts, it’s been hurting since 1967 and I just can’t take it anymore, and I want to go to St. Faraway Hospital.” I’m not kidding. FML.

Oh damn… that’s nothing but a bad shift, considering we did about 12 to 14 calls per shift on that truck.

I’ll take a pathophysiology lecture any day!

Before I say anything else about medic school, let me say this … if you don’t like to read a lot, or have difficulty in comprehending dense textbooks, medic school is NOT for you.

The reading assignments have been substantial. And very dense.

Luckily for me, I’ve never had much difficulty in working over the text to get the important stuff out. I’m good with that. It’s not so easy for some of my classmates. One of the guys I worked with is also in my class and he’s admitted that he’s having a tough time with the reading already.

And it’s just going to get worse.

We’re into airway management and our first quiz on that is tomorrow. I’ve built a set of flashcards that address the DOT objectives and should get me thorough it no problem. However, I’m a little concerned about how in depth we need to be on all of this stuff. I mean, do I need to know all of the details on HOW a depolarizing muscular blocking agent works, or do I just need to know that the correct dosage of Succinycholine is 1.5-2.0 mg/kg? The instructors haven’t been really clear on that, so I’m just  cramming every bit of it into my head. Too much information is better than not enough, right?

Now, aside from the fact that I have been whipping out flashcards like a fool and reading and studying almost every waking minute, I have to be honest and admit that I love this stuff. This class is amazing and it’s where I was meant to be. I’m going to mine those instructors and docs and respiratory therapists and guest speakers to get as much info as I can from each of them. This class is the foundation of my education as a medic and I want to make the very most of it.

I worked a fill in 24 shift over the weekend in the eastern portion of district where I was recently working full time, so I knew the area pretty well, and was able to get to all the calls sans mapbook or GPS. That was sweet. It was also a VERY slow shift, with six calls total, so I had plenty of study time. As a matter of fact, we were able to sleep straight through from about 1 AM until 6, then up for a quick call, which we were canceled on, and then back to sleep for a couple of hours. It was most excellent.

As I alluded to below, I will be moving the blog to a new spot. I was invited to join a group of other EMS and fire bloggers at a new “blog portal” and I will be changing the URL to reach the blog and slightly redesigning the site. I’ll have more about that soon. It’s been tough to fit blog work in among the flashcards.