Wednesday, April 18, 2012

Ride-Along Update

Time for a little more information from my ride along.
I can't publish information on who the patient was due to HIPAA (Health Insurance Portability and Accountability Act), but since I don't have much information on them anyway, I can pretty much tell you about the calls. 

          The first call was for an "unresponsive" male patient at an apartment complex.  The call  came in as a "Delta" priority from dispatch, so we responded what we call code 3 with lights and sirens.  That was my first ever time in an emergency vehicle like that, so I was extremely happy--just about giddy. 
Anyway, Kris looked at the residence area and said "I think we've transported this guy before.  Watch, we'll get there and he'll be responsive and want us to take him to the hospital."  Upon our arrival, Kris said "yup, this is the guy.  He has gotten combative before, so just make a note of that."  When we entered the room, sure enough, the man was responsive and complaining of nothing in particular, just that he hurt everywhere. 
He was able to get to the ambulance, so we began transport.  Once in the ambulance, the patient began complaining of chest pain, so according to protocol Kris hooked up the EKG or electrocardiogram to the patient to monitor his heart rythm and make sure he was stable and not having a heart attack or cardiac dysrythm.  Once we got to the hospital, the patient decided he felt OK and walked to the restroom while we turned in the patient report.

         Our second call was a shortness of breath call that we actually ended up letting the fire department take care of.  Residential neighborhood, husband called for wife.  During the time we were there, the fire medic asked the wife some questions, and when the husband answered for her, she screamed at him in full, coherent sentences, so we knew she was breathing quite well. 

          The third call was a little more interesting.  It came in as a "Charlie"-- respond code 3 for a possible MVC (motor vehicle collision) with pedestrian involvement.  it looked like a madhouse when we arrived  on-scene.  There were at leas two police squad cars, on fire engine and one fire ambulance inaddition to ours.  The fire EMTs already had the patient, a young woman appearing to be in here early twenties, backboarded and stabilized.  Kris asked the patient some of the standard orientation questions such as "what day is it?  Where are you right now?" and things of that nature.  This patient was unable to answer the questions given, so transport was indicated.  Once she was in the ambulance, Kris started an IV to keep her from going into shock.  He found that she was intoxicated at the time, and explained to me that that was the probable cause for here inability to answer the orientation questions.  Upon further examination, no evidence of physical trauma could be found upon the patient despite her complaint of pain in her legs.  Obtaining a history of the incident was pretty much impossible due to her uncooperative demeanor.  Once we got to the hospital, I actually got to lead the team in transferring her to a hospital bed from the long spine board.  After delivering the report, we reported ourselves back in service. 


          The fourth call was hands-down the best call, and quite a rare one at that.  We were dispatched at "Bravo" priority to the residence of victims of a previous MVC.  Upon arrival, we learned that the patient had walked from the scene of an accident to the residence.  Once we got the patient onto the gurney, Kris took his lung sounds because he was presenting with dyspnea and tachypnea, or difficulty breathing with fast respirations.  He could barely speak three words before having to take a few more breaths.  Kris looked surprised and said "You know you're missing a lung, right?"  The guy knew he was in pretty bad shape, but what he didn't know was that his exact condition was a tension pneumothorax, or air separating the lung from the chest wall, crushing it, and pushing it against the heart and other lung.  Due to the possibility of other unseen injuries, an IV was started, and rapid transport was initiated.  The interesting thing about this patient was that out of all of the patients so far, he was the most polite, the best historian, and the most normal seeming one so far that night.  We transported him to the trauma center at UNMH where he recieved a surgery on the spot.  With the pneumothorax condition being fairly rare, it is uncommon for a medic to just get to see a surgery normally, much less on a first ride-along.  It wasn't overly gory, but did remind me why I wanted to be the EMS medic patching someone up rather than cutting someone open for an emergency surgery.  They put a chest dart in the patient.  though not completely alike, it was similar to the posted link. 

WARNING: it is a graphic video, so don't watch unless you can handle blood and bodily fluids.

          All in all, a very good first ambulance ride. 

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