07 March 2006

Hot or Cold?

D and I actually got to go on an almost real call yesterday (on top of the other 5 transfers we ran). Someone needed to go to the ED, but the nursing home didn't want the whole world to show up lights and sirens, so they called us. Possible dehydration leading to altered mental status (i.e. he hadn't eaten/drank anything for nearly 24h and was only responsive to pain). When we arrived, it was my tech and D's turn to drive, but it had been so long since I'd been on a real call that it was hard to get back into the swing of things.

The nurse met us at the desk and offered her "current" set of vitals and her opinion that the patient's vitals were stable. Nurses are so weird - I don't know how anyone considers vital signs current when they were taken at 10:30 that morning and it is now 3:30 in the afternoon, nor how they can assume stability when they only took them once...but that is a story for another day. As you can tell, if the patient had been in this condition for more than 5 hours, it wasn't a real emergency and we didn't get to use the fancy lights and siren to go over to the nursing home. When we got the patient in the truck, D actually asked me if I wanted to go hot (lights/siren) or cold (usual driving mode). Since I'm responsible for the patient, it is my decision, but it is a question I've never been asked. The answer here was obvious, but it definitely points out that there are more issues I need to make myself aware of so I can make a good decision on future patients.

To top the whole thing off, this patient is a full code - if he crashes, I have to do CPR and the AED and the whole deal, which I've never done and which is reasonably rare in long-term nursing home patients - and we're 20 minutes from the hospital. The point when he appeared to go from rapid regular breathing to shallow and/or non-existent breathing was enough for a moment of panic - so he got some painful stimuli and some encouragement to keep working on some nice, deep breaths. Once he settled in again, I started talking to him again and suddenly he starts responding. He wasn't all the way there, but he was responding with short appropriate phrases so maybe today wasn't his day to die, nor my day to learn what breaking someone's ribs with the first compressions of CPR feels like.

I had another moment of major panic when D tells me I have to patch in to the ED - another thing I've never done. I punted. D knew everything that was going on and has plenty of experience doing this, so he patched for us. For those who don't know, patching is when you alert the ED that you are coming with a patient and give them information on the patient's current condition. I've listened to way too many conversations about how everyone thinks people who give bad patches are complete idiots, so now I'm paranoid about sounding like an idiot when I do it. Of course, I'm not going to get any better by not doing it, but I was freaked enough yesterday without that too.

Patient was still alive when we left the ED and I expect that some IV fluids probably got him a lot closer to the mental status he usually has so that he could help the doctors figure out what the rest of the situation is.

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