Keeping Promises

I’m big on keeping any promises I make. In my eyes, if I tell you I’m going to do something, I wouldn’t consider myself much of a person if I didn’t do it. And to that extent, one of my promises to someone is getting closer to fruition.

I took my classroom Paramedic Final Exam… 196 questions, all multiple choice, with parts from every section of that giantass purple book. I finished it in just under an hour… I’ve spent the last two weeks going over every page of notes, every review and exam online. I’ve looked at books that aren’t required reading, some that I’ve been told are way above what I need to know (which of course makes me even happier to read them). All to be ready for this exam. When I finished, I was tempted to go over all the questions, just to double check. Then I remembered that I am much better at trusting my gut instinct than to question what I do.

To that end, when I finished, I made sure the Scantron was ready to go, and then damn near flung it at my instructor and walked out. I was so freaking nervous when I walked out. I spend time pacing outside and I think my first twitter was… wait, let me pull it up.

“Oh dear god oh dear god… 196 questions in just under an hour… Either I suck or I kicked ass… One of the two. Freaking out now!”

I was so freakign worried about it… I just don’t like tests, I get almost physically sick… and I almost puked afterwards. Oh? What’s that? What did I get on it? Well… my intructor that was testing us came outside to get me, and told me he needed to talk to me. He told me I didn’t do nearly as well as he’d hoped I would, and then showed me a score of 47. I swear my heart sunk in my chest and I felt like looking for the nearest cliff to jump off of. Then I noticed it said ‘Section Grade’. And I thought “Wait… there were 4, 50 question sections to that test” and I think he saw my face so he just started laughing at me.

Turns out…. 87% on the written final! I was so freaking happy I couldn’t get words out. Turns out I was also the highest written grade on the test :) Now I start the long process of clinical and internship shifts. Which my first 14 hour shift is in TX Saturday starting at 0800 or so. I plan on being done, tested, and raped by the state of NM and NREMT and be a TX, NM, and NR certified paramedic by the middle of Feb. Let’s do this shit :) Now it’s the fun part.

But first, tonight I get to have fun. I get to go to this beautiful girls graduation party tonight. She is graduating with her BS from a local university, and I figure I wanna spend time with her, plus it’s a chance to relax. I’m just glad I passed the final or this party would be a little less fun :p

Oh, and in other news…. Ya’ll know this yea has not been the best for me. And this holiday season feels rather empty for me as well. I was asked by a friend of mine, a medical professional that used to be quite active on Twitter under an older name, to help her and do a guest post on suicide prevention and recognition. I was flattered that Dani would ask me, and I said yes. It was a hard post to write, but it’s one that needed to be written. And in writing it, I think it helped me a little bit too. Ya’ll can go take a look here (click the image):

My guest post

For Some, Its NOT the Most Wonderful Time of the Year – Part One

 

Alright, well I’m out for now. I need a nap before tonight :p That drive to and from TX sucks lately :p Ya’ll stay safe

Why am I doing this?

“3027, we’ve got a code 3 two blocks from you,” a radio crackles from the cab.

I look up from my paperwork and sit bolt straight. Time to stop being the box troll and actually get to do something.

“27, responding to address,” my preceptor calls in as the MDT shows the location. “Any info on type of call?”

With this I perk up, picking up the handset in the back to listen better to what is going on.

“Working code. PD states scene is secure, officer performing CPR. Fire is five out, Engine and Rescue 12 responding with you,” the usually demonic box blurts out.

Hearing this I start piling the gurney with our bags and monitor. I look up and see us pulling up to the address stated on the monitor. Jumping out of the module, I notice a chaotic scene already. Multiple police units on scene blocking off traffic. We get to the wreck of a vehicle, or what had once been a vehicle and take in the area.

A blue Land Rover, brand new from the paper plates on the back end, somehow wrapped itself around a light pole in a residential community. Usually a quiet section of town, everyone seems to be out rubbernecking. The front end of this SUV seems to be pushed all the way into the passenger compartment, with the engine no where in sight. No glass anywhere in the vehicle, the rear end shatter with wheels pointing in opposite directions.

We rush over to where the cops are all gathered in a huddle and ask what is going on.

“Kid was racing some friends down this road, lost control and then over-corrected, looks like he rolled it once or twice and then smacked right hard into that pole. We found the kid laying right here,” the shift Sgt tells us as I look at the distance between the wreck and the body on the road. A good 20 yards or so.

I look at the mangled form lying before us. He doesn’t look a day older than 16, wearing the colors of a local high school. Blood coming from his nose and one ear, a leg that is bending in a way it shouldn’t, bone coming out of his left wrist… This kid is not doing good. The cops have him hooked to their AED and are doing CPR, for once good quality, and bagging the kid. I quickly remember that being the box troll means I’m in charge of the scene.

“Get our monitor on him, grab the airway kit and O2 tank. Lets get him exposed,” I start barking out orders as I get set into motion. “We need someone to hold him C-Spine and then get IV access. Two large bores if we can get them.”

As I’m saying this the engine and the rescue pull up onto scene. I yell at the oncoming crews to being a board, block, and straps. Quickly looking at the monitor I see a flat line where we should be seeing beats. It turns into a mess of jumbles when the cops finish their bagged breaths into the kids and start compressions again. I look at the fire medic and tell him to get me some lines.

With that I grab the intubation gear and move to the head. 7.0 tube, stylet, 10cc syringe, laryngoscope, and tube tamer all in my hands as I get set up. I look up as I get ready and see two lines in place from the fire crews.

“Push a mg of Epi now!” I shout out towards the other medic. Then I turn my attention back towards the head. They have just finished bagging him again. I lay on my stomach with the scope and tube in my hands. Feeling the gravel cut into my chest, I go in and take a look. I ask for suction and start to clear away some of the bloody secretions I’m seeing. I think I’m seeing the white lined hole of the vocal cords. I push the tube through and pull the scope out. Pulling the stylet out and inflating the syringe I hold the tube steady. I quickly attach the inline capno and the bag to it and tell the firefighter to give it a few good squeezes.

Grabbing the stethoscope from it’s place in my right left pocket, I take a listen. It’s hard to make out, but I hear air movement in the left and very little in the right. A quick glance at the capnography shows that we’re in. Thinking quickly I reach over to the airway kit and bring out some iodine and a very large fourteen gauge catheter. Swab the betadine and stab the cath into the right side of the chest. We get a large rush of air and the firefighter tells me that the bag is easier to squeeze now.

“Squeeze that bag about 15 times a minute and tell me if it gets harder to squeeze again. Don’t stop while he’s doing compressions!”

I go to the med box and start handing my fire medic drugs as I want him to push them. A mg of Atropine, then another mg of Epi. We alternate until we have all three of Atropine on board. Then it’s just straight Epi. Amp after amp of the drug is pushed into this kids body. We don’t seem to be making a difference. I decide on a Hail-Mary and toss the other medic an amp of bicarb. We push it in along with another 500cc’s of fluid. Still nothing. I tell everyone to stop what they’re doing. Looking at the monitor reveals no change. They resume.

I ask for the hand-held from my preceptor, about to call the hospital for orders to terminate efforts when we stop and I see a lot of random squiggles on the monitor. V-Fib!

I reach over and crank the monitor to 200J, and yell out to everyone to clear.

“Everyone clear! Shocking!” The monitor hums as it builds energy. When it stops and the button flashes I hit the button, kindly marked with a lightning bolt for those firefighters who can’t read (I kid I kid, but we do call it firefighter proof). And then the sound. The sound that only a defibrillator can make. The patient gets a good jolt as 200 Joules of electricity get pumped into his body. The person doing compressions, now my units driver who happens to be an EMT-Intermediate, starts up as soon as the shock is delivered. I take the bag and start squeezing, trying not to go so fast, and knowing I’m failing at it.

When we end our set of compression I look again. This time it’s a more regular set of squiggly up and down waves. Ventricular Tachycardia. I reach towards the neck and am rewarded with a weak and thready pulse. But it’s a pulse!

I give the bag to another firefighter and reach back to the med box. I draw up 1.5mg/kg of Lidocaine to try and get his heart under control. No more compressions and he seems to pink up a little. The Lido is in. We quickly get him boarded and in my truck. The rhythm is still V-Tach, still has a weak pulse. I flip the monitor to sync cardiovert as I feel us get moving.

“Code return!” I shout up to the front. Grabbing the radio I give a quick report, “Male, late teens, was pulseless and apneic on scene. Tubed on scene. Worked him for twenty. 3 of Atro, 3 of Epi on board. 1 of bicarb. Went into V-fib, shocked once at 200 then into V-Tach with a pulse. 1.5 of Lido on board as well. Running hot to ya’ll, be there in five, see ya in the trauma room. BP is 70 palp. Getting ready to sync him.” I try my best to keep it short and give them all the info they need.

I charge the monitor to 150 and ensure it’s still on sync. It is, marking the peak of each QRS. “Everyone clear!” I yell out.

I let it charge and listen to the whining sound it makes. Then I press the shock button. The patient jolts again. I quickly look at the monitor and feel for a pulse. Monitor is showing a sinus rhythm with multiple PVCs. Pulse is now
stronger.

We get to the hospital and have a team of techs and nurses waiting for us in the bay. We get the gurney out and rush him into the trauma room. “Late teens male, was pulseless and apneic on scene. 7.0 22 at the teeth, good waveforms on the monitor. Apparently ejected from vehicle. 3 Atro, 3 Epi, 1 of bicarb, and 1.5 Lido on board. Converted to VF, one shock at 200, converted to VT with a pulse. Low BP. Sync’d at 150 converted to Sinus with multiple PVCs. A liter and a half in so far.” I watch with fascination as the trauma team takes over from here. An art line, blood hung on one of our lines, ABG drawn, fractures assessed.

We get the kids wallet out of his tattered pants and give the unit coordinator the info. I look at the date of birth… The kid is seventeen a couple of days ago. Seeing that I walk out to the bus, and look inside. It’s a mess. Almost like a tornado hit it. I suddenly feel dizzy and sit heavily on the back bumper. I feel my breakfast coming up and the next thing I know I’m staring at it in a puddle on the sidewalk.

I feel arms help me up and someone putting a mask to my face. I see my preceptor smiling and telling me that I did great for my first code. I’m not really hearing it. I just keep seeing that kids birthdate floating in my head.

—————————————————————

I have been asked, since this is my extension, why I want to do this. Why I want to be a paramedic. To run the streets and help people. I’ve never been able to come up with a good reason. It really boils down to the fact that nursing school was full and had a long wait list. Now it’s become something else.

I can’t imagine doing anything else. The street has an allure that is not easily turned down. And when you have that good call it energizes you. Calls like the one above. My first code this internship. My first field tube. My first shock. My first save. I can’t get the memories of that call out of my head even now, a week later.

I’ve been told that I have all the knowledge I need, but now I just need to show I can use it in the field. Calls like this help with that. It shows I can think on my feet. I know what needs to be done so I do it.

And for anyone wondering what happened to us after this call… We were out of service for almost an hour, and I was sucking down O2 for a good half hour trying to calm down. It feels good to get it on paper though.