Big Yellow Taxi

[DN]

This is a fascinating journal. Always an interesting read.

[15 Storeys High]

Well....last night was one of the quietest nights I've had in a long time. Only 3 jobs. The first was a gentleman having a heart attack. We gave him oxygen, aspirin, gtn, cyclizine, clopidegrol and morphine and took him straight up to the cath lab for a clot busting procedure. The other two were pregnancy related issues. No deliveries though! Have had enough of them for a while. Two days off now, then a day of training, one more day off and then back for another run of shifts.

[sidehop]

What are some scenarios and situations that makes the job hard sometimes? I for one would probably lose it with smells...and anything dealing with children.

[15 Storeys High]

I don't like going to incidents where there's a high risk/concern of abuse or neglect, either towards children or vulnerable adults.

 

I remember one where there was an 18 month of boy who had had a seizure. The flat was a disgrace, the child was in a dirty nappy and nothing else, unkept, dirty.....the mother didn't want to carry him to the ambulance and didn't seem concerned about him at all. When I picked him up to carry him he flung his arms around my neck and cuddled into me and didn't want me to put him down. Usually, children shy away from us and only want their parents, which is understandable as we are strangers. When a child would rather be with you than their parent you start to wonder why.

 

Another job.....2 year old girl had swallowed an entire bottle of calpol (liquid paracetamol), the flat was not in a good state, there were lighters on the floor, the kids were dirty and unkept. The mother asked me to hold her crying baby while she got ready. The baby promptly fell asleep in my arms and I ended up having to hold him the entire way in as well as deal with the 2 year old. The interaction between the mother and the kids was almost non existant.

 

Those are two jobs where I didn't want to leave.

 

Smells you kind of get used to, although occasionally vomit and faeces smells make me retch. Congealed blood has a not so nice smell too. And the smell of decomposing flesh is pretty grim too.

 

Care homes sometimes get to me too. I've lost count of the amount of reports of concern I've put in about homes.

 

Stillbirths/miscarriages where the foetus is delivered aren't very nice either although thankfully we don't get many pre-hospital. And of course any child death.

 

Everybody has certain triggers that affect them more than others and until you experience it you don't know how you'll feel. I cried like a baby after going to a women 34 weeks pregnant having an asthma attack. She died and so did her baby. Her husband was sat in the hospital corridor when we came out and it just hit me.

[sidehop]

See I don't know if I could handle a situation where there are signs of neglect and the children are hurt. That would upset me to no end. So sad to hear about the mother and the baby. I'm sure you see the world a lot differently than most people when it comes to life.

 

The EMT friend I told you about had some gruesome stories which I'm sure you've experienced something similar. Do you work straight 24-hr shifts?

[15 Storeys High]

I do a rolling rota, 5 on, 4 off.....all 10 hours long. If I'm on the car rota I do 12 hours and it's block shifts...It would be impossible to do 24 hour shifts as we're so busy all the time. We'd be on the go for 24 hours straight.

 

My idea of gruesome and other peoples idea of gruesome is probably vastly different now. I've been to a huge amount of jobs that people not in the job might describe as gruesome but only a handful that I would describe as gruesome.

[DN]

One thing to consider when helping in situations involving neglect and abuse is this: people like me are so glad that people like you are there for that victim. If you were not - who would be?

[Mavh25]

Storeys, lovely to see you. This thread is so interesting, we could learn alot from it. Including how to fake unconciousness now lolol

[15 Storeys High]

One thing to consider when helping in situations involving neglect and abuse is this: people like me are so glad that people like you are there for that victim. If you were not - who would be?

 

Yeah.....that's how you have to think of it really.....and really, we are the people that will find victims because we get to go inside peoples houses and see their environment, how they live, how they interact with others.....we get to observe without giving prior warning.....we are the ones that really get to see things as they are....

 

Storeys, lovely to see you. This thread is so interesting, we could learn alot from it. Including how to fake unconciousness now lolol

 

Good to hear from you! How's tricks? I will still know if you're faking!

 

Today, I had my first taster of my HART training.....a bit of CBRN training....learning how to get in and out of a gas tight suit and how to put up and take down the decon tents. All very interesting and served as a taster for my 6 weeks training that starts in a week or so. We also saw the plans for our new base.....which looks very nice.

[DN]

One thing I learned in my course that shocked me was the relapse rate for residents in a residential rehab centre is 90%.

 

Easily to be disheartened with stats like that until you realise that 10% have better, drug-free and more fulfilling lives because of it.

 

Samr with what you do - it is the individual cases where you make a difference that make up for those where you don't. You can't win 'em all.

[15 Storeys High]

^ Exactly. Same with patient deaths......you can't save everyone...it's just not possible....the percentage of people that survive an out of hospital cardiac arrest is tiny....You just have to accept that's the way it is and you can only do what you can do. Lots of people mistakenly believe that you can just shock the heart and everything is rosy. Unfortunately, it's not how it on the television. On television they shock unshockable rythyms and bring them back to life.....it's not possible. Also......if you're a bit of a geek like me.....on tv shows when they show you the dramatic straight line on the heart monitor.....if there's a line with a little gap in.....like this

 

-------------- ------------------------------------------------------------

 

The monitor is actually turned off. It's not asystole. Just a little something to ruin your enjoyment of hospital dramas. Hahaha.

 

There are only two rythyms you can shock. One is VF (ventricular fibrillation) and the other is pulseless VT (ventricular tachycardia)......both basically mean the heart is shaking like a jelly on a plate and not pumping blood around effectively.....the purpose of shocking the heart is actually to stop it.....and then hope it restarts/resets itself to a normal sinus rythym. Most people that go into cardiac arrest begin in VF but quickly go into asystole or PEA (pulseless electrical activity) - neither can be shocked. This is why it's so important to get a defib there quickly.

 

I could bang on all day about this stuff.....I'm a bit of a job geek.

[DN]

I love reading this stuff and TV/fim drama is not a good way to get accurate info. I was in the Army and my father and I used to annoy my mother and sister by saying "that's nonsense" or other politer ways of say "b.s."

 

Then my sister joined the police and it started all over again.

[15 Storeys High]

^ hahaha.....that's exactly what I do, only with medical shows. I do it with medical dramas/fiction but I also do it on the "real life" stuff they show too. I'm not allowed to be in the room when others are watching stuff like Greys Anatomy or Casualty anymore.

[DN]

I have heard a lot of criticism about the CSI shows as being wildly inaccurate. CSI's are not police officers who interrogate witnesses, few cities have the money to pay for the labs they show and it can take weeks to get test results back from labs.

 

And some the 'science' doesn't even exist.

[annie24]

i love how they have the sexy music playing while they are in lab. we don't have that, lol.

 

and their labs are always so dark! like, how the heck can you see what you're doing? you can't. it's laughable. i can't even watch CSI.

[metrogirl]

I have often wondered what the real medical professionals say if they are watching a show like House? I find myself rolling my own eyes because every patient that comes to Dr House is thought to have Lupus and then some other malady and before you know it, the person has been tested and treated for 15 different illnesses when in reality all they had was an ingrown toenail. LOL

 

Sorry....I kinda went off on a tangent there.

[Mavh25]

Fine n dandooley thanks, things going good for you? Sounds like it!

Question, do you ever get called out for animals?

[15 Storeys High]

No, we don't get called to animals....that's the fire brigades thing....they rescue animals trapped/caught in stuff.

 

So, I'm trained to be able to give 30 different drugs should I be required to. They are....

 

Adrenaline (Epinephrine) 1:10,000 - For cardiac arrests

Adrenaline 1:1,000 - For anaphylaxis or life threatening asthma

Amiodarone - For cardiac arrests

Aspirin - For chest pain/cardiac conditions

Atropine - For cardiac arrests or symptomatic bradycardia (i.e. slow heart rate)

Benzylpenicillin - For suspected meningitis

Clorphenamine - For allergic reactions/anaphylaxis

Codeine - For pain relief

Dextrose 40% Gel - For oral treatment of low blood sugar

Diazepam PR - For seizures in children and those you can't cannulate

Diazepam (diazemuls) - For seizures in people cannulated (it's an intravenous drug)

Enotnox (nitrous oxide + oxygen) - For pain relief

Furosemide - For acute LVF (left ventricular failure)

Glucagon - I.M. treatment low blood sugar/hypoglycaemia in patients unable to maintain own airway.

Glucose 10% - I.V. treatment for hypoglycaemia in patients unable to maintain own airway.

Glyceryl Trinitrate (GTN) - For chest pain/cardiac conditions

Hydrocortisone - For allergic reactions/anaphylaxis

Ibuprofen - For pain relief and swelling

Ipratropium Bromide (atrovent) - For acute shortness of breath in asthma/COPD

Metoclopramide - For nausea (antiemetic)

Morphine - For severe pain

Naloxone (narcan) - To reverse opiate related respiratory depression (i.e. heroin OD's)

Oxygen - For hypoxia (lack of oxygen)

Paracetamol Oral Solution - For children with pain and/or fever

Paracetamol - For pain relief and fever

Penicillin - For mild to moderate infections

Salbutamol - For acute shortness of breath in asthma/COPD/LVF and anaphylaxis

Sodium Chloride - For fluid replacement

Thrombolytics - Clot busting for heart attack patients (rarely used now)

Trimethoprim - For infections, mainly urinary ones.

 

I've given all of them at some stage in my career. The most used drugs are GTN, Aspirin, Salbutamol, Paracetamol and Ibuprofen. Most rarely used are the thrombolytics because we're now able to admit straight to the cardiac catheter labs for PPCI (primary percutaneous coronary intervention) in most hospitals, which is a far better treatment with much less risk.

[15 Storeys High]

2nd job in today and I've managed to screw up my back and been sent home. This is just what I need a week before my training courses begin. Looks like a few trips to the chiropractor/physio are in order to sort it out.

[avman]

This subject was always the most interesting part for the students when I teach CPR class. They have a great video illustrating the different rhythms and showing how a defib actually works. Without fail most students believe that straight line asystole is exactly what defibrillators are supposed to fix.