Funny how the nights are cold and wet in winter.

'Cause that's all I have to blame the work shortage on.

64M - Felt hot so he took his BP (I hate those home random number generators), the longer we stayed and talked the lower his BP got, anxiety.

65M - Chest pain, Hx of 3 AMI's, 2 stents, CVA/TIA events, pale (don't think he usually looks tanned), SOB, nausea with a big vomit and sinus rythym. Oxygen, aspirin and transport.

20M - Arm injury - UTL.

17M - Significant lac to hand with motor/sensory deficit to thumb. This was the above job but he left scene to walk home.

30F - IP and kicked out of the club.

86F - Constipated.



See you at the big One.

Taz

Oh quality stuff this shift.

Come on, you must have heard the sarcasm?

52F - Back pain.
32F - Altered LOC possibly drugs.
43M - Extreme decrease in mobility from peripheral neuropathy.
40F - IP.

Better be bigger tonight!

See you at the big One.

Taz

When did Heather Ledger die?

That was when I last worked with the offficer who came in today on overtime, or that's what he told me. I've looked it up and that's pre blog even!

My partner appears to be sick so I am getting over timers in, when you do overtime you normally treat as your on double time but to be consistent for the ride-a-long I am trying to treat-drive-treat-drive as I will in a normal block but it depends of their knowledge of the city also, so far I've been lucky.

78F - #NOF
18M - Tachycardia (120bpm), in the city to celebrate his 18th birthday. Tells us that it happen when he drinks Redbulls or the like, claims that he hasn't,,,, he thinks,,,,, well not a full one,,,, he thinks. We discuss his options with him and try to point out reality and he decides to go back home and chill with his family.
92F - Prolapse bowel.
77F - SOB, decreased mobility, nothing acute.
83F - Abnormal Behaviour, Alzheimer's not recognised by the family or accepted is my diagnosis.
82M - Back pain, SOB, COPD Hx, a chest infection again is my guess.

See you at the big One.

Taz

Uni Student Ride-a-Long!

Nice girl, she was at our station last year for her three week practical placement and had requested it again this year but lucked out and got me.
Not much of note today,

46F - Discharge to home post op knee reconstruction.

51F - Liver CA, increased pain and vomiting.

44F - Manic, off her meds.

87F - Hyperglycaemia.

18M - Obvious dislocation while playing tennis. Tricky part is the tennis court was three stories up the back of the house with a pathway and corners and handrails that would only allow single file. We ended up calling the Fireies for a stokes litter and more hands. Two fire crews, three paramedics, one student and 10mgs of Morphine we got him out and to the ambulance for the trip to hospital.

See you at the big One.

Taz

What might be the future in medicine.

I don't know if you have ever heard of TED.com.
It's short video's on advancements in Technology, Entertainment and Design presented by some very interesting people.
I watched this one because of a post Tom on EMS 12-lead.
Damn interesting stuff

Daniel Kraft: Medicine's future? There's an app for that Video on TED.com

See you at the big One.Taz

A quiet night and I put my head down.

68M - Phlegm plug in throat.
77M - SOB, chronic CCF.
37M - Forehead lac from a knee.
57M - Confused and lost.
90F - Head lac post a bathroom floor.

I normally don't sleep at all on night shift. I have my reasons I think I'm better able to respond instantly to a job, response driving and my mood is better. As one of our inspectors said to me once, be really honest with yourself and tell me you don't give a silent curse about disturbed sleep when the phone rings or the pager goes off? I'm paid to respond to the public need, not sleep.

I had a busy Monday so I put my head down on a slow night, I think I even got an hours shut eye but that was it. It just didn't feel right.

Why was I busy?

I am attending the Australian Youth and Road Trauma Forum at the Sydney Olympic site for the three days as one of the Paramedic crews in the scenario and Monday was our rehearsal with the actors who are the victims and the Police Highway Officers, Rescue and Fire Officers.

Later that night we presented one of the Traffic Offender Intervention Program presentations in an inner west suburb for adults who have already run a foul of the law.

So my days off aren't dull.

See you at the big One.

Taz

I hate drunk females.

20M - Drunk on a train, assaulted rail cops, assaulted normal cops, had some tried blood in his ear, we get called to look at it. It's nothing he's a tosser and I leave him there.

66M - Syncope with LOC, a 20 point postural drop but otherwise asymptomatic.

21F - Don't take a piss weak amount of sleeping pills if you've had a fight with the boyfriend because I have to take you in (under mental health if you don't comply) just to cover everyone's arse.

20F - IP++++++, crying, vomiting, screaming for her mummy and telling me how she's dying.
18F - IP+++ much better behaved which is lucky because the other moppet took all my time to manage.

30M - # R ankle.

26M - IP and knew that he was. Recognised the fact that he is unsafe on the streets in this condition and has been unsuccessful in hailing a taxi.

31M - Punched in the face, nil obvious injury, left to his own devices.

See you at the big One.

Taz

Day two of the current block.

96M - Just diagnosed with gall stones, huge gall stone and now severe abdo pain. Maybe they're perforated the gall bladder?

40F - Had a mental meltdown at work and did something out of character even for a high strung person and we came and cleaned it up and took her away to talk to someone.

80M - Possible GI bleed but being from an NESB the story wasn't quite right.

86M - From Big hospital to a Rehab facility. Turns out he was and old ambo back in his twenties. He said that they did have automobiles not horse and carts but the gear they used really nothing more than a bag of bandages, some splints and a canvas stretcher without wheels that they just carried you on. A fair dink'um gent.

22M - Lesson 1, don't piss off and become aggressive with Police carrying Capsicum spray.
Lesson 2, Don't continue you aggression towards the paramedics with the baby shampoo to wash your eyes.

??F - Unknown problem, UTL.

79F - SOB, Pale like a bed sheet with recurrent nose bleeds. Hb came back at 73!

40M - ? Cardiac arrest at an hour past knock off (them's the breaks and I was signing in drugs and my junior partner came and got me to accept the job even though it was the night she was going out with friends to have birthday drinks as we would be working on the day, great work ethic) 30 seconds out we got called off Code 4 Dead.

On the way back we were the only resource available so we took another just to help out,

26F - 13 weeks of 40 gestation, abdo pain and a very little bleeding.

15 and 1/2 hours after the shift started we got knocked off.

See you at the big One.

Taz

26M - Had a loss of consciousness while driving, I found him GCS = 15 and all obs good apart from being tachycardic, 150 - 180+ bpm in either a SVT or a very rapid AF. The ED Drs were still discussing that.

48M - Swollen knee, looks like gout to me.

66M - Who should have called three days ago when the severe pain in his eye became an issue and it was savable but the wide angle glaucoma has it dead from the three days of continuous pressure, it was dilated, unresponsive and had that death glaze look to it.

55F - Operated her mouth without engaging her brain and uttered something stupid in anger in front of Police. I came along had a sit down talk got to the bottom of her issue and made her realise you do have to watch what comes out of your mouth.

66F - Extensive Hx of lumbar issues, was due to have some imaging done today but couldn't get out of the house so the LMO decided that she needed them done at hospital.

43F - Stomach cramps from codeine. Left at home to self manage.

34F - Arm lac and no respect for Ambo's, Cop's, or everyone else.


See you at the big One.

Taz

A funny thing happed to me the other day.

While out of area doing some big jobs, we enjoyed some shortbread biscuits dropped in to a hospital ED by a local. This card was attached,

I've seen something similar but it still gave me a chuckle.
My much younger partner just looked at me strange!

Attended a training session today for the next logical development with grass roots driver education. The traffic offenders program I already participate in is for drivers who have already run foul of the law, there has been a high school program underway for some time but it has been enlarged and I along with quite a few of the other program presenters have signed up in an attempt to stop the new driver from making the mistakes that see them attending the Traffic Offenders Program as part of a pre-sentencing deal before they front the judge and lose their licence.

The more of a message we get out them more it must sink in,,,, somewhere.

See you at the big One.

Taz

Full Hospital ED's.

A question from Lauren on the post for our first night and being stuck on stretcher.

In the Sydney Australia metropolitan situation this is what happens.

There are two ways you arrive at hospital with us either walking in or on the stretcher.
If you aren't dying, don't need a bed, are not a danger to yourself or others and will be safe to sit in the waiting room then that's where you'll go to wait for the Dr.

We have rules on Nurse to pt ratios, there is a finite number of beds and if it's full at the Inn then we start lining up in the hallway.

Yes if we are able we will decide to transport to another hospital, we're very lucky to have 4 Trauma 1 hospitals, 7-8 other hospitals within a 25km radius of the city center (my work center) for this option but as a rule if one's busy so are the others.

From 10am to midnight we have off-duty officers on o/t who will arrive with a vehicle that has just empty stretchers and will take over your pt as long as they are not being cardiac monitored because remember they only have 3 stretchers and two officers. These are called ART (Ambulance Relief Team) or the baby sitters.

A current plan in development is that after ART knock off a duty crew will go and pick up the vehicle and return to take over other pts to allow those crews to get back to station and that this crew will be rotated during the shift to allow them some rest.

It's our system, if you need to be monitored/observed and your care has not been transferred to a hospital nursing staff member then it is my job to continue care for you. That can include, IV access, drug & fluid administration, phlebotomy, toileting, take around to x-ray and back, 'There, there' protocol (reassurance) everything a nurse may do and I always can call on a staff member to guide, assist or to escalate care (pt crashes).

Yes as an officer it's a pain in the arse but for the pt it must be reassuring, you don't get just chucked onto a random hallway bed and possibly lost in the crowd.

Hope that clarifies 'stuck on stretcher'

See you at the big One.

Taz

To finish what's beeen an interesting week.

22F - R1 backup for a level 2 crew with a suspected opiate overdose. They aren't authorised to administer IMI's or Naloxone. All good but, I let them do it all while I kinda supervised.

49M - Transfer by air from a country hospital for some treatment.

70M - Transfer to a hospice.

15M - IP, transport for family to collect.

21M - IP, transport for his own safety.

32M - IP, got smacked in the face at a McDonald's and needs some stitches.

28M - IP, got smacked in the head at a Hungry Jack's with a stiletto by a Tongan TV, needs stitches.

25M - Not IP, post ictal, no previous Hx and he was working so doubtful on drugs or alcohol.

38M - States had bumped ( really I mean bumped) his head twice during the night and thought it would be safer to be observed by someone? He was manic, he denied it but I sure he was on something. He was the last person we transported, thankfully.


See you at the big One.

Taz

And the good work keeps coming until!

78M - Near syncope, a Hx of irregular HR but has lived a full and active life un-medicated for it. I'm seeing AF with some very long intervals and VEB's (ventricular ectopic beats).

28M - Had some hand surgery today under general anaesthesia and after discharge had to walk a long way to the car with the wife or rather told the wife he could walk and to not go and get the car, sounds more likely. Got the expected near syncope stuff, all obs good so we discussed options and we escorted them to their motel room (to make sure he could make it and because we're now in the foyer of the motel) and they were going to self manage.

The big job for the night,




The pt is in the house we carried him to the road in the dark down fifty odd steps on a spine board.

83M - Called in a simple fall in kitchen. Pt is prone on the floor, conscious but suffers dementia and is not appearing to comply with primary survey questions. Spider sense is tingling, log roll with family assistance onto back. All this time their asking why we don't just pick him up of the floor.
HR - 40 - 46bpm
BP - 56/30 both arms three times
Nil arm or leg movement, no Babinski's reflex at all and no Intensive Care Paramedic backup in one of the few times I really want them for their Atropine.
R1 assist load for the absolute prick of an extrication where too many extra hands would have only got in the way.
In 30 min he's out in the back of the truck, bilateral 14G cannulars, 500mls of Hartmann's run which is similar to Ringer's Lactate, nil change in obs and some ICP have just come available and will meet us en route, family are still asking is this really necessary. Bat phone it in on the way.
In the Resus Bay,
GCS = 14
HR = 64 - 68
BP = 84/48
RR = 18
Some movement has occurred with the right arm only.
CT showed a smashed C5 and a spinal cord tumour. Stabilised, packaged off to the Spinal Care Unit at a nearby hospital by the time we're back two pt's later.

My first witnessed and treated Neurogenic Shock.

21M - IP.

30M - IP, fell over and now c/o central neck pain without motor/sensory deficits. All the hospitals are full, it's been a busy night of some trauma and good ol' sick people so even with a Cat 3 triage we're stuck there for 6 hours plus till day shift can come as take over.

So a bloody good night with a shit finish.


See you at the big One.

Taz

What a diverse day!

69M - Leukemia pt. Abdo pain, lethargy.

84M - Assist to feet, uninjured and safe to leave at home. Basic obs, some paperwork and off we went.

67F - At work something fell across her shins, Took a bit of skin off and some bruising. Work rang because in their words we thought it might have been broken (her leg if you didn't follow). She been and walking on them since the accident happened? We cleaned, advised and left.

49M - Low speed hit from behind in car, c/o lateral neck pain.
63F - Who hit him from behind, totally by accident. She was sitting that close to the wheel that the seat belt didn't stop her from nose butting the steering wheel.
We were six blocks from a hospital so we took both.

92F - Cardiac arrest, my partners first. We are the sole response on scene for 20 minutes due to the lack of available cars because of the workload in this area over the morning. I got my first of our trial iGEL LMA's in and it remained the airway adjunct through to the hospital and when they called it after running one more round of drugs. We got an output after the backup arrived, cannulated and dropped some adrenaline but the drugs were doing most of the work and output was lost and regained during transport.

29M -Man cold, what a let down from the intensity of our last job.

79M - Chest pain. The 12 lead I did looked like this.

Now I don't yet have the technology to transmit this to the hospital it might reach me in another year (When you part of one of the two largest ambulance services in the world, us and the London ambulance service change takes awhile) so I load an' go with a bat call to let them know what I have. They still did their own 12 lead and then took him straight to the Cath Lab.

An unknown problem call from the pay phone in the hospitals waiting room was next. UTL

88F - who's epistaxis would not stop. Waited an hour to call us!.


See you at the big One.

Taz

Didn't transport many.

But we saw a few!

85M - An old country GP, retired for 30yrs now and a lovely person with a bad chest infection he had tried to manage at home.

59M - CA pt of to respite care for a while.

30F - Assault your husband in front of the cops they will arrest you. Tell them that your pregnant and have had some spotting they'll call us, be dumb enough to tell us that your LMO has examined you and is not worried about it and you only asked for an ambulance because you didn't want to be in gaol (jail), TOUGH. Left in police care.

30F - No breakfast, swam on a very cold day outdoors, went into a sauna and collapsed??? wonder why. Simple lac under her chin that she will see her own LMO about.

90F - Sciatica like pain, transport for examination.

72F - Very hypotensive maybe an allergic reaction but not classic. Transport to do labs.

33M - Bipolar and PTSD rang because his counselor was not available and wanted to talk to someone. We talked, discussed things and he was happy to stay at home.

49M - Domestic assault, swollen nose.

81F - Transport to a ward with ascites.

See you at the big One.

Taz

Abbreviations

That I use anyway.

IP - Intoxicated Person
SNR - Services not required
UTL - Unable to Locate
Hx - History
Tx - Transport
Rx - Treatment
# - Fracture

In case anyone wanted to know and understand my dribble better.
Over at InsomniacMedic are examples of some interesting MDT - Mobile Data Terminal notes, check them out too.

See you at the big One.


Taz

5 jobs, 3 pts, 2 transports!

20F - Chest infection, not severe, has seen her Dr, told to stay at home, self manage and suck it up! In a nice way.

51M - Seizure, we witnessed four < 30 seconds.

53M - Possible closed head injury post trip and fall on a footpath or maybe he is not truthful about the amount he's had to drink. We'll take the head injury and not get caught out with the slowed speech, delayed reactions and drowsiness.

??M - Sending text messages from a park because some girl dumped him. IP and depressed. UTL.

??M - IP, vomiting and lost by his directions. UTL

See you at the big One.

Taz

From the public domain

A photo of yesterday's MVA from someone who was there, thank you


Like I said a very lucky girl.

Tonight,

32M - ? Sprained ankle playing indoor soccer. The pain increased on splinting and also moved further up the leg so when we checked back later the x-ray had confirmed a Fibula fracture instead.

01F - Basically checking out for a freaked out Mum post a very slow MVA. The pt was restrained in an approved child seat the damage was minimal but it was mum's first accident and when the pt saw mum upset it flowed onto her. Once everyone was calm there were no problems.

75M - From rehab to ED transfer and it's bed blocked.We waited five and half hours with him and babysitting various other crews pts (5 of them) and got relieved around 3am.

50M - Opiate OD, once we'd saved his life he declined transport for further observation.

So while we didn't do much straight out work it was a long night.


See you at the big One.

Taz