I crouch down next to the skinny white guy. He looks to be in his mid 60s and he’s not breathing. Little old guy in a tiny house. It’s a narrow, shotgun shack, redolent with the acrid stench of cat urine, crowded with piles of old newspapers and bags of empty bottles ready to go to the recycle bin. The guy shared the cluttered floor space with a Naugahyde Barcalounger and a massive 70’s vintage RCA console TV, which was blaring a green tinted rerun of The Rockford Files at an ear splitting volume.

Captain McGillis is tucked in tight behind the guy’s head, wedged up next to the wall, the BVM pressed tightly on the man’s face. He is rhythmically squeezing the bag every 5 seconds and watching me through his safety glasses.

Eric is on the right side, getting a blood sugar. The glucometer beeps. “Low”, he said, as he looks across the guy’s chest at me.

Doug, my preceptor, is standing back. Unable to fit in the room, he leans against the door jamb, also watching me.

There are IVs you want, and then there are IVs you need.

This one fell into the “need” category.

Now, in the interest of full disclosure, I have to admit that I usually blow IVs when my preceptor is standing there watching. I’m pretty damn close to 100% in the ER, but when it comes to getting the line on scene or in the back of the truck, it’s a 50/50 shot. Nerves? Maybe. Whatever it is, I’m working on getting over it.

I also know there’s a big difference between the line you want, and the line you need. This guy needed a line. He needed an amp of D50 and that meant he needed an 18 gauge or better. And it needs to be done right now.

There was no room to get the drug box, or anything else, for that matter, into the room with us, so I look over my shoulder at Doug and ask him to hand me the IV roll and an amp of D50. As he turns away, I smack my hand down on the TV’s power button, silencing James Garner in mid sentence.

“Hey! I was watching that!” Captian McGills says, from his spot at the head. We all chuckle as Eric manages to maneuver the lifepack around the small end table that is tight against the man’s leg to stick some patches on.

The IV gear appears in Doug’s hand over my shoulder as the ECG prints. Eric hands me the strip, because I can’t see the screen at the angle I’m at. Normal Sinus at 72.

I wrap the tourniquet around his skinny arm and silently pray that he’s got decent veins. BAM! Before I can even blink, his cephalic vein pops right up and I grab the chloral hexidine and scrub away. Quickly slipping in an 18, I attach an extension set, tape down the hub and push in the D50.

It’s ten minutes later and our guy is sitting up and looking a lot better. The Cap is puttering around in the tiny kitchen whipping up a peanut butter sandwich and our guy’s blood sugar is now 77. It turns out his name is Louis and he took his insulin this morning, but forgot to eat. No, he’s not married, but his daughter checks on him twice a day. And there was, “no F’in way that he was gonna go to no hospital!”

I get on the phone with Laurie, his daughter, who arrives less than 10 minutes later and talks her dad into taking the ride with us.

Back at the fire station, Doug sits down at the table with me to review the call. He tells me I did the right things. Made all the right moves and nailed the IV when everyone was watching. But the thing he is most proud of, he tells me, is the fact that I just grabbed the phone and called his daughter and got her there to help me talk Louis into going.

“That’s really being a solid patient advocate,” he says. “That’s what I want to see.”

He gets up from the table and pours two cups of coffee. He hands one to me and together we walk out to the bay to restock the medic.

I’m still a student, but this was my first ALS call where I acted as the “paramedic” start to finish.
Obviously, all the details have been changed to make sure I don’t get stepped on by a HIPAApotamous.

Medic 22 was dispatched priority to a private residence for a 56 year old male C/O low blood pressure and feeling dizzy with a slight SOB. PT states he had been feeling unwell, with some chest pain and fatigue since yesterday afternoon following power washing his deck. The pain yesterday was described as a sub-sternal burning pain rated as “13 out of 10”. Believing this pain to be heartburn, the PT took OTC antacid and received no relief. This evening he was still feeling dizzy with some CP, and took his BP with a home machine. His BP was 84/52, so he summoned 911. The PT has a history of hypertension and takes Metoprolol 50mg, Amlodipine 5mg, Clonidine 0.2mg and HCTZ. There have been no recent medication changes and he has been compliant with his meds and is positive he has not taken any more than usual. The patient is also a smoker and has recently reduced his consumption to a half pack a day. PT denies any diaphoresis or nausea or vomiting. PT has no other complaints aside from the chest tightness, dizzyness and slight SOB. PT’s last meal was a turkey sandwich about 90 minutes prior to our arrival. PT is allergic to codine.

Upon our arrival, PT was found sitting on the edge of his bed. He had just extinguished a cigarette as we arrived. He was CAOx3, GC15. His skin was cool and dry and pulse was slow and weak. BP: 90/62 HR: 52 RESPIR: 16 SpO2: 96% on RA. The monitor showed Sinus Brady with a rate of 54 with no ectopy. 12 lead was unremarkable with no noted ST elevation. HEENT: No trauma noted, Pupils PERRL. CHEST: Lung sounds were clear and equal bilaterally. PT says his chest “feels tight. About a 4/10.” No radiation. No palliation. He states he has felt this way all day. ABD: Soft and non-tender in 4 quadrants. PELVIS: Intact. EXTREMITIES: No edema noted. His extremities were cold to the touch, with slow capillary refill.

PT to be transported to XXXXX ER ALS to R/O MI.

BSI, PT contact followed by interview questions and exam. PT placed on 2 LPM of O2 via NC. SpO2 to 99% with Oxygen. Vitals obtained. PT placed on monitor and 12 lead obtained. The patient was able to stand and ambulate without difficulty. He was assisted in walking approximately 10 feet from his bedroom to the front door where he sat on the stretcher and was placed in a semi-fowler’s position, covered with blankets and moved to the ambulance. PT was assisted into a hospital gown. IV access was established in the Right AC with an 18ga angiocath and a 500ml fluid bolus of NS was started. PT was administered 324mg of ASA and 0.5mg of Atropine IVP. Following the fluid bolus and Atropine, vital signs were reassessed. BP: 106/88, HR: 72, RESPIR: 16 Lungs remained clear bilaterally. IV drip rate adjusted to TKO. PT was administered 0.4mg Nitro SL. PT states chest discomfort is gone.Telephone report to ED was made. A second 12 lead showed NSR at a rate of 72 with no ectopy or ST elevation noted. On arrival at ED, PT was transferred to bed 8 via 3-man draw sheet lift and report given to Jane Doe, RN. PT care and transport occurred without complication or incident. Signatures obtained and Medic 22 returned to service.

Not an earth shattering call, by any means… but the first one I ran soup to nuts. And what I did made a difference. 

It was pretty cool. I copied my SOAP here so I never forget how jazzed I was about this first call.

This cold will not go away. Is it becoming bronchitis? Why won’t it go away? Why can’t I stop coughing? Why do I feel better one day and the next feel like hammered dog shit? Why has this lasted a month?

I was at the point today where I almost, I said almost, went to the ER. As I was considering driving over to the local hospital, I was looking at myself in the rearview mirror. “What the HELL was wrong with me? Was I really going to show up in the ER to get checked out for a cold that I’ve had for a month?”

Consider it a momentary lapse of reason.

Needless to say, I didn’t go to the ER and embarrass myself in front of my EMS brothers and sisters. But I will be at the doc’s tomorrow. Antibiotics? Maybe. I need something. This is not getting any better, and I had to cancel tomorrow morning’s clinical because of it. That sucks.
In other news, I just got back from two weeks in the south with my wife at her new place. It’s pretty weird splitting up the household like this. She’s rented a little townhouse and she’s got some furniture from our Seattle house in there. The dogs are with her, too. It’s pretty weird. It’s like “Hey, here’s my stuff and my dogs, but this is not my house and I go home in a week…” Weird.

Well, it’s just until I finish school. Six months seems like forever, but it’ll go by quickly.

Another thing I’ve discovered about the south, I like all the food, except biscuits. Can’t stand biscuits. I like grits. I like BBQ. I like collard greens and black-eyed peas and sweet tea. However, I can’t stand biscuits. When I have breakfast, I want toast. How hard is that? It’s just bread, warmed up. Easy-peasy. Don’t look at me like I’m an idiot, I’m a Damn Yankee. I like toast. I know y’all got some bread back in that kitchen. Work with me.