Paramedic students

[Muddin]

I hadn't been paying attention to the EMS radio. While the doctor examined an early twenties male with a genital problem, I was somewhat reclined in a chair behind the doctor's desk, flipping through lab reports. Bed eight had low sodium, ten was perfectly healthy, and eleven was pregnant. I tossed the reports into their cubby holes and glared at the printer who wasn't giving up the cardiac enzymes we needed to admit the patient in two.

"Muddin!"

I sat up. It sounded like the doctor so I peaked around the shelf which separated the doctors from everyone else effectively hiding doctors from patients. Blinkie lights flashed in the ambulance entry and with my sharply honed detective skills, I figured they brought in something critical.

I pushed my way past a few big bruiser of fire fighters and found an isolated corner with a view. Drats, the patient looked young. I wasn't sure if he was old enough to drive yet. The paramedics had him on a NRB mask and dried blood covered his forearm to his hand.
I remembered seeing the red shirt when I entered the room. It must have been him. The red shirts are paramedic students. It's almost like wearing a sign, "Caution, dangerous student!" He stuck out like a sore thumb. I was lucky and had to wear a navy blue shirt when I was a student.
Gaining a general impression of the patient, he looked to be perfect for starting a first IV on. He was so gorked, he barely responded to pain so, with the excitement of lights and sirens, the student got to have at him. And it looked like it was multiple times.

The doc gave the patient a firm sternal rub, then pinched his abdomen and twisted. The patient sucked in some air, moved one arm slightly, but that was about it. "He needs a tube," the doc stated, his tone leaving no room for argument. He gave him a few more pinches. Nodding, he added, "He's getting a tube."
"What's his GCS," a charting nurse asked. GCS refers to Glasgow Coma Scale and is a way to objectively determine your conscious state, the best score being a 15.
The doctor cocked his head. "Well, he doesn't open his eyes, so that's a one. He's non verbal, so that's another one. He withdrawls from pain...so...is that six? Yeah, six. Yep, that's a tube." He waved a circle in the air as a sign to move'em out into a more critical room.
"So what's the story," I asked one of the responding paramedics as he peeled off his gloves.
"His parents are out of town. He called his dad and said he took 300 pills. His dad called 911," the paramedic said and shook his head. With a laugh, he added, "He took the time to count them."
"It was a forced entry," a serious police officer began, stepping towards me. "We knocked, but there was no response, so we barged in and found him unresponsive with this." The officer pointed to a large ziplock bag full of bottles ranging from Advil to some serious antidepressants. I glanced at them, memorized the more important medications like the tricyclics, and handed the bag to the nurse with an apologetic look. She'd have to write down each medication, count the pills, and calculate how many were missing. That can make you hate everyone out there who's ever tried to overdose and was serious about it.
The doctor had listened into the conversation while the patient was pushed into a more critical room. "Has anyone spoken to the parents?"
The paramedic shook his head. "They know we were bringing him here."
The officer placed a piece of paper in the docs hand. "Here's the number." The doc handed it to me, I handed it to the charge nurse.
Another paramedic approached us with the red shirt in tow. He pulled up on his belt loops and asked, "We got a student with us doc. Do you mind if he tries to tube him?"
The doc smiled. He enjoyed teaching students. "Sure. Just don't break his teeth or otherwise fuck up."
The student, wide eyed and looking slightly pale, nodded. The doc clapped his shoulder and led him behind the patient. The student filled his lungs with air for support and walked along side the doc while nervously pulling on gloves. The doc gave him a few last minute tips and told him, "Don't worry if you can't get it because I'm right there." The student located a face shield and had all of the proper protective equipment on, like a good student.

Nine pairs of eyes watched this first timer intubate this kid. His hands shook. The gloves were beginning to become transparent from sweat. He positioned the patient's head. "Wait until the medication kicks in," the doc told the student who was ready to intubate now, right now. The doc tested the patient's jaw and gave the nod.

It went smoothly, or as smoothly as it can for a first time. No teeth were broken. It took the student three tries with positioning the blade, and two for positioning the tube. I couldn't help but smile seeing his hands shake. I know the feeling all too well of having the patient's care in your hands. After a while, you get smooth and it begins to become closer to second nature. Before that, a text book runs through your head and your heart threatens to break your rib cage open as it bolts from your chest, screaming into the night.
The doc listened to the patient's chest for air moving into his lungs and not into his stomach. He gave the student a complimentary nod. One of the seasoned medics shook the student's hand and pat him on the back. "Nice job," he told him. The student proudly smiled. He was that much closer to being a real live paramedic.

I presented the list of some of the more critical meds to the doctor and learned a neat trick the ER docs use. "He may have taken some Tricyclics," I proudly presented.
The doctor read over my list and spoke to the team. "Lets get that EKG. Then give him two of bicarb and get a repeat EKG." He looked at me and grinned, "Now, why would I do that?"
I shrugged. EKGs are still a mystery to me. I know how to get the rate and I know how to identify "tombstones" or a-fib, usually, but other than that it's a piece of art doodle graph paper to me.
"I'll look at the QRS complex on the before and see if the bicarb shortens it. You see, tricyclics inhibit the sodium channels. He could start out with a width within normal limits, but if it drastically shortens after the bicarb, then the bicarb has overwhelmed the tricyclics."
"So you're ruling out Tricyclics by using an EKG and bicarb."
"Exactly. If he hasn't taken much," the doctor said while accepting an EKG, "it won't change much. And he could seize before the lab could get us a tox report." As I pondered that, the doctor said, "He'll be okay. He'll be fine," and gave the patient a reassuring pat on the leg that he wouldn't feel.
Hopefully by now, the kid is doing well. He probably is. By the end of the shift, he was starting to fight the tube and causing the ventilator produce funny sounds. He's no stranger to this game. This wasn't the first time for him.

[UZI 9mm]

Originally Posted by Muddin

I hadn't been paying attention to the EMS radio. While the doctor examined an early twenties male with a genital problem,

....

Originally Posted by Muddin

It went smoothly, or as smoothly as it can for a first time. No teeth were broken. It took the student three tries with positioning the blade, and two for positioning the tube. I couldn't help but smile seeing his hands shake.

I thought intubation was just putting a tube down the inside of throat, not through the front

Originally Posted by Muddin

I know the feeling all too well of having the patient's care in your hands. After a while, you get smooth and it begins to become closer to second nature.

Nurse Muddin has done the hacking, blood spewing type deeds?

[dougmangi]

Originally Posted by UZI 9mm

I thought intubation was just putting a tube down the inside of throat, not through the front

not that kind of blade... this blade is like a shoe horn, holds the tongue out of the way and opens the throat so you can slide the tube in... not a cutting blade

[UZI 9mm]

Originally Posted by dougmangi

not that kind of blade... this blade is like a shoe horn, holds the tongue out of the way and opens the throat so you can slide the tube in... not a cutting blade

Ahh! I see

Hence the broken toofs thing. Gotcha.

[Muddin]

Originally Posted by UZI 9mm

....


I thought intubation was just putting a tube down the inside of throat, not through the front

Nurse Muddin has done the hacking, blood spewing type deeds?

You can tube people via different routes, but through the mouth is preferred over through the neck, if it's possible.
No, I haven't hacked on anyone yet

[Boheefus]

methinks being intubated sucks...period

[SirPoopsALot]

makes my throat sore, and talk funny afterwards.

[fj40guy]

Nothing worse than getting the tube shoved down you, unless by a red shirted student.

Sigh, every parents nightmare btw is getting one of those calls.

Tom

[Bondage]

Muddin, you might very well be in the wrong line of work.

[wireman]

You could make more money writing, but thanks for what you do.

[4thJeep]

Originally Posted by wireman

You could make more money writing, but thanks for what you do.

She wouldn't have anything to write about, that's why she needs the job.

[CaryW]

Do the docs refer to you as Muddin or were the names changed to protect the innocent?