The second day.

About nine jobs for the shift, only two of note.

Pedestrian V Car, a motorcycle responding from Kings Cross as well, just beat us. Nice run with the other drivers doing the right thing all the way there.

Low speed<15km, but with a significant joint injury, very obvious Dislocation/Fracture of the ankle. The foot was fully rotated laterally and I could feel the crepitus when we splinted it.

Good pedal pulse, analgesia, splinted, loaded and lets move around the corner to run a complete secondary survey. Single injury but protocol is protocol and of course if you don't look, you won't find!

Near syncope at the Conservatorium of Music.

Elderly gent felt crook in the queue and was assisted to the ground.
Pale, sitting in a wheelchair when we arrived, BP 68/30 and I checked the sys with a palpated brachial, Pulse 54, afebrile and had his appendix out 75 years ago and that is it for medical history!!!!!!!

Our ECG looked ok, pinned and started on a cautious amount of IV fluids, GCS was always 15 and at hospital BP now 113/50, palour was better and pulse the same.



Be careful out there and I'll see you at the Big One.

Taz

All Hail the Nanna Bus.

That was us for the day so I'll say no more.

The only jobs we did go to under lights and sirens where both ones that elected to stay at home.

Aaargh.......

Be careful out there and I'll see you at the Big One.

Taz

So days off then.

Sleep and that stuff of course. Tracy and I also took the bikes for a run.

We chose the route out to the Olympic site at Homebush. We only travelled about 15klm or a bit over an hour. There was a lot of work being done on the track as well as quite a bit of flood damage as well.

I have also commenced the torture of writing a job application.

It's an internal position but still has to be written in the style of any other job application for a Government position, full of Horse Manure.

Maybe it's because I have really only written a handful of applications in my nearly thirty years in the work force?

I don't think so, I think their full of political correctness knob wanking.

Tracy has just run her eyes over it so it's nearly finished anyway.

Be careful out there and I'll see you at the Big One.

Taz

Continuing Education Program.

ACAP, (Australian College of Ambulance Professionals) monthly holds education evenings at the NSW Ambulance Education Centre, Rozelle, Sydney.

Apart from the drink and food these are great opportunities for officers to network, catchup and socialise with people they may have not seen for a while.

They also represent a terrific opportunity to enhance and develop the knowledge and understanding of officers.

The June topic was the assessment and treatment of burns.

With ASNSW changing it's protocol for Burns this was a well timed event.
The first half was a combined presentation by a Registrar from Westmead Hospital and a Nursing Specialist from the NSW Severe Burn Injury Service

The second half was an introduction to the new protocol by two senior educators as well as some Q & A by the attendees and an introduction to the latest material for burn management Hydrogel in the form of Burnaid from Rye Pharmaceuticals.

I think I can hear the cries from afar 'that's not new stuff', well it is for ASNSW.
It was great to have packets of the Burnaid to open and familiarise ourselves with before we are confronted with a burnt pt.



Be careful out there and I'll see you at the Big One.

Taz

Second Night.

23F SOB, renal pt who is due for dialysis tomorrow but is full of fluid now. Transport.

24F Due for an Obstetrics Op tomorrow, blocked tubes but has 10/10 pain now and vomiting. Transport.

24M Decontaminate, thought our No More Tears shampoo was better that the Police stuff. Left him there.

60M Serial caller, SOB, 60 cigs a day had to transport, he'd call again.

64F SOB, crackles, febrile, low oxygen sats. The x-ray confirmed my diagnosis of pnuemonia.

90M Dry throat cough, chronic >6/12, left at home to see his GP but a NEB of saline fixed the dry throat.

Regular Dialysis pt was our last.

Be careful out there and I'll see you at the Big One.

Taz

First Night.

It's been wet again and cold (so the locals tell me) so we didn't expect much work.

A lady who wanted to know if she should take her regular, prescribed medication tomorrow because it makes her feel nauseous about twelve hours later. Treatment - go and talk to a chemist or your doctor.

A man with a 'Red, Itchy Nose'. And it was! Something had cause irritation to the point of his nose and he had been scratching it for hours and subsequently ruptured some capillaries and producing a red nose!!!! Treatment - Leave it alone! and see your doctor in two days if it hasn't started to return to normal.

Older lady with a triple A, last leg in a multiple transport, handover from staff saying she was a grouch, but was lovely with me. I have special charm with the oldies.

Young fella in the city for only the third time in his life, wrong place wrong time. There are just places that are not safe and the locals can tell that your a victim waiting to happen. He was lucky, got away with only a few minor lacerations to the neck.

45M with what we came to suspect as his first ever seizure. Unwitnessed, no history, no trauma just presenting very post ictal.

24M Intoxicated.

19F Intoxicated, the girls are usually the hardest to manage but she was a treat.

26M Who thought he knew more than me about popping pills and told me to F*#k off so I did. Plenty of his EMO friends to hold his hand and give him some TLC.

Last job, a couple of cyclists who had been clipped by a car. He did stop asked if they were ok and the pissed off. CCTV should get him, they have no idea how well covered the City is with cameras. Anyway the girls really only had really bad road rash (which bloody well hurts) but all precautions were taken.

This Padawan and I only have one more block of shifts together and then I get a different one.

Be careful out there and I'll see you at the Big One.

Taz

Second Day.

30M, Sore face after being punched? You don't need to go to hospital.

36F, MVA, Central neck pain, sensory deficit hand/feet, nil LOC, GCS=15, played with the tools, Maxalon because of the C-collar in situ, touch of Morph for the pain and away we go.

37M, Drug Effected, told us it was ICE, poor quality if it was unless he had Benzos or Opiates on board as well? Transport for welfare because he was just all wrong.

38F, Intoxicated, Mental Health and Violence (she is) Issues. Transport.

54M, Opiate OD, Pisses me off when the gears just lying there in front of me and they deny taking it? Refused transport.

55M, per my current Padawan a confirmed case of 'Softcockalitis' I'd have called it a 'Man Cold'. He requested transport, he didn't need it but I am still bound to provide this waste emergency services.

62F, Chest pain, huge BBB, ST elevation, Type 2 DM with insulin currently hyper at 17.1mmol/litre, central heaviness radiating to left arm, we know what we're dealing with, it's Bread an' Butter time with a good job. Transported.

75F, Feels Dizzy, after getting up from bed to go to the toilet. Felt really great when we arrived and looked surprise when we asked 'do you want to go to hospital for further examination?'. This was not a frail person, this was a person who considers me as a government employee to be there for their use inappropriate or not.

78M from hospital back to his nursing home.

90F, UTI, probable increase in dementia like behaviour also.

Assist another crew to extricate an OBESE SOB pt.

The jobs didn't come in age order I just felt like listing them so.

Thirteen hours and ten minute shift with three min total break time.


Be careful out there and I'll see you at the Big One.

Taz

First Day.

Eight jobs done by our car which is a surprise for the wet, overcast day it was.

25F Dislocated Shoulder, told the trainer she couldn't do the last rep. Bit of any extreme way to prove it! 600 mcg Fentanyl IN worked well and relaxed pt enought to then cannulate.

34M Carbon Monoxide Inhalation, all good, was found in time and just required monitoring and help with the other stuff.

Gave Maxalon to a pt in the care of another crew who didn't have P1 qualification yet.

TeenageF with abdo pain, central and Supra Pubic, with out any of the other obvious symptoms, the pain response was real so I took care of that again with IN Fentanyl and transported.

Now lets start the age climb,

55M 1 day post fall to L Hip unable to weight bear, previous ortho surgery to that leg so it ain't straight or the same length anyway.

71F Near Syncope, lovely lady who is just starting to get a cold she thinks, but still took the dog for a walk and then walked to the shops and then stopped for a coffee all the while wearing a spencer vest, a long sleeved T-shirt, a flannelette shirt, a woolen jumper and a quilted jacket!!!
We gave her a lift home and some advise.

92F going in for a hip replacement. Won't catch her when it's done I reckon the nursing home will ask her to leave because she's a young person trapped in an old body.

94F Suspect a TIA.

Thirteen hours and twenty minutes shift length with two breaks, 23min and the whole 30min.

Be careful out there and I'll see you at the Big One.

Taz

About Tassie.

I had a talk with my Station Manager and Ambowife today and the basic message is if I don't give it a go I'll never know???? Strange that!

I was only newly qualified the last time and I have going on four years of experience now so there, the decision is made.

Be careful out there and I'll see you at the Big One.

Taz

I have been active.

So I gave up some of my plasma and platelets and received my lapel badge and Parker pen for twenty five donations.

I still had the raw product to manufacture some more of the Question Booklets so I have finished off another thirty five of those.

I need to get myself a new pair of ?leggings or whatever their called for riding. I had been using an old pair of bright red, tight track pants that were originally part of my uniform for the crew on my fathers yacht when we raced out of the Geilston Bay Boat Club on the Derwent River!

Now that was a long time ago, so like they were ??? twenty years old easy.

The continued cold and rain here in Sydney and the hour earlier start time means that I'm on the road in the dark to and from for day shift and it's not much better for the nights.

I do have to look after my comfort after all.

Some interesting news out of Tasmania this week. I have posted a farewell to the departing CEO of the service and I found out at the end of last week one of our senior managers would be taking up the reins down home (Ol' Tassie Boy he is too!).

Tasmania is also advertising for students and qualified officers wishing to make the move.
I'm not sure what I'll do.
I have got the CV out and updated stuff.
But the last time I kind of applied it was such a stuff up and I felt that the work I had done here didn't count so I'm alittle apprehensive.

Tracy says she doesn't care where we live but I know she would love to be back in Tassie and just being back there it wouldn't matter where it's always closer that NSW.

Anyway one more day off and then back to the rigors of not only being a Clinical Mentor and just about every Qualified P1 is in the city but I'm also having my turn as an Acting Team Leader (2IC) of the station and that holds a lot of extra paperwork and responsibility.

Be careful out there and I'll see you at the Big One.

Taz

This is a good US Cop

http://www.youtube.com/watch?v=fyHMbHHtArE

Be careful out there and I'll see you at the Big One.

Taz

Blood Donation!

I've had to pop up for some air and to go and donate some of my fluids (that doesn't sound right does it?)

You can save three lives with one donation.

So what are you waiting for?

http://www.donateblood.com.au/

Be careful out there and I'll see you at the Big One.

Taz

Things like this make you appreciate living in Australia?

http://carlosmiller.com/2009/05/28/oklahoma-cop-pulls-ambulance-over-puts-emt-in-chokehold-while-patient-lingers/

Now I thought, well the site looks a bit like a conspiracy theory place but I followed it to the actual dashcam tape.

I'm sorry to other people who live in America, I do realise that this is an isolated incident but that cop was out of order.

It makes me love my cops and the relationship I have with them even more.

Be careful out there and I'll see you at the Big One.

Taz

So what work have I been up to?

Well the reduced temperatures along the Eastern Sea board of Australia has impacted on the amount of work.

A dislocated shoulder that in itself was not that impressive but the cannula I got in the cube foss on the supporting arm for the IV analgesia all without him letting go of the dislocated one (because he wasn't going to anyway) did impress me.

A lovely lady who had undergone an IVF egg retrieval this same day but was now suffering abdo pain and quite hypotensive. I was very happy to talk details and with intimate knowledge from our own IVF treatments, she was even seeing the same clinic!

A couple of get up off the floors and put back to bed jobs.
Two more abdo pains.

And a Cardiac Arrest that turned out to be just pissed and no longer responding. The best GCS I could get was a seven 1,1,5. Blood Alcohol Concentration was 0.47 the maximum legal limit for driving in Australia is 0.05 you do the math!!

The next night started with two opiate ODs, run of the mill our bread and butter here in my patch.

Pulmonary Oedema but caught in the early phase so not needing bagging yet.

Metal Health pt who was ejected from the hospital because he started tossing chairs around in the waiting room so he went to the phone box on the corner and rang for an Ambulance!
We brought him back, he promised he would behave and then lite a smoke and started to burn the back of his hand. Security now put him in one of the secure rooms and I did the Mental Health Schedule paperwork.

Well done job for the shift was the Restaurant Syncope.
Clammy,
Pale,
Pt confirmed LOC with the statement 'and then I woke up on the floor',
Weak and thready pulse,
Several big vomits without relief,
Small frame and admits to 3-4 Champagnes,
Hypotensive,

And managed to capture the SVT in leads 1,2,3 before she self reverted to Normal Sinus Rhythm.

Always good to have the dots on early.

Well the return of Ambowife may mean that I will not post for a day or so,

But


Be careful out there and I'll see you at the Big One.

Taz

What do you think of the new artwork by Ambowife?

Be careful out there and I'll see you at the Big One.

Taz

Got the Morphine out of the way.

It's the newest of my pharmacologies but had not yet used it.

Oh I've given it under direction for years but now I can make the decision and found myself reluctant????

But that's done and dusted now.

On the dark side, the pt is now dead.
But the mere 7.5mg I gave over the forty odd minutes before we moved them to our stretcher without pain were not the cause.
Reason for being there was shoulder and back pain post a fall over night.
But while in hospital the body seems to have just given up the ghost.

They were very, very old so it could have been time??

Other jobs of note were;

Attending to some ladies early this morning who had been to the PINK concert and partied on with one member having a fall in their room. Nothing special about the injury just being the centre of attention in uniform in a room full of ladies!!! (SO! I know I look gorgeous).

Tib/Fib fracture, how it never compounded I'll never figure out.

And that's it.
It's been shit cold here and that has kept most people in doors.

Tracy arrives back on Friday afternoon and I'm working night shift!


Be careful out there and I'll see you at the Big One.

Taz

The night that was!

So it's a long weekend here.
That means Sunday night is still a party night. With the exception of a Big MVA at the end of the shift I don't think any crews were worked too hard.
Take our car for example;

Responded to thirteen jobs, only attended nine, diverted or called off the others.

60 yo F, simple mechanical fall forwards, ? fracture orbit.
25 yo M, absconded from Mental Health Facility and needs to be returned.
23 yo M, who doesn't understand don't fight the Police, their handcuffs always hurt, he was attempting to delay the inevitable charges.
30 yo M, Air Ambulance, going home post Cardiac Stents.
16 yo F, absconded from Youth Mental Health Facility, thoughts of self harm.
29 yo F, Drug effected, what and qty unknown, volatile environment, called in Police to assist.
14 yo F, Intoxicated, 1st time, and not enjoying it!!!! Very apologetic.
30 yo M, Punched to eye, possible ruptured pupil.
36 yo M, Drug taking pig, had 4ml of GHB by himself and collapsed. Nice guy but.

And that was our night.

Be careful out there and I'll see you at the Big One.

Taz

Pulled some O/t!

I didn't think I was getting anything and the to pull Sunday Night!

Shame really, I washed the bike this afternoon.

I'll let you know if I get anything good.

Be careful out there and I'll see you at the Big One.

Taz

Paediatric Trauma Seminar

Well that was time and money well spent.

Hosted by Sydney Children's Hospital.

With thirteen guest speakers on topics like;

Maintaining expertise in the face of low volume,
Paediatric trauma in the Pre-Hospital setting,
Paediatric trauma management in a mixed ED,
Trauma series X-rays,
CT reconstructions in trauma,

Morning tea.

Surgical dilemmas in Paediatric trauma,
Paediatric Head Trauma,
Children who fall from windows, an emerging trend,
Paediatric Burns,
Paediatric drowning,
Paediatric Orthopaedics,

Lunch.

A postcard from Afghanistan - Paediatric Trauma in a war zone,
The importance of hope in the recovery from injury, pt's family advocate group.

Then a number of skills sessions of which you could attend upto three;

Airway Management,
Vascular access/Intraosseous,
Spinal Management,
Cervical Collar,
Trauma Triage,
Needle Thoracocentesis and chest drain insertion,
Burn wound management,
Ultrasound workshop.

Per the organisers it was over booked and so there was a second lecture theatre with an audio/visual link set up.

And I even rode my bike to it for the exercise.

Be careful out there and I'll see you at the Big One.

Taz

Well I haven't had anything to post about really!

That's to say that there was no job that I felt I wanted to come straight home and tell you about.

The days held only one point of interest, the Padawan and I got to visit the assault victim I posted about two weeks ago who has had a truly remarkable recovery from the injuries she sustained and is now at home with her family.

That is to say although she still has a long recovery for the actual wounds there has been no brain injury and only a lingering psychological scar that as we know only time can heal.

Padawan was off on family and carer leave for the nights so I had a station peer come in on o/t the first night and while not busy three jobs were interesting to us..

1. Elderly male fell in bathroom against towel rail, moderate to severe back pain and now lying on the lounge floor. Our first analgesia didn't touch it and our assist load crew got called off and then we both thought about the Morphine we have now been authorised to use. It's still a new drug for us to carry and while we have administered lots in our careers it's always under ICP direction.
Anyway it worked a treat and he was even able to walk out.

2. Twenty something male still fitting on the street in the red light district near the Coke sign in Sydney. My partner had not yet given Midazolam so we walked through that and ticked it off their list of thing they hadn't yet given (more of a mental/confidence list really).

3. And a mild Pulmonary Oedema that we managed without assistance.

Last night I was forgotten about and therefore partner less for an hour or two before the powers decided that I could go third up on one of our cars. We swapped duties around had some laughs but it was a boring night.

I'm Batching again. Tracy has gone to Queensland to see her mother so the little dog and I are all alone (means I get all the bed to myself!).

I'm available for o/t on the weekend and am attending a Paediatric Trauma Seminar at Sydney Children's Hospital tomorrow, should be cool, we don't treat may kids so some extra knowledge is good.



Be careful out there and I'll see you at the Big One.

Taz