New Week and new work.

It's the last week of the roster and G and I work all four of the last shifts.
It's been an enjoyable roster and we've had fun but the work has been short until today.
With a ride-a-long from our education centre the quality was so so but the quantity was there.

44M - Motor bike V Car, minor abrasion on the lower leg elected to self manage.
53M - Painful cellulitis.
53F - Pre Syncope episode on a crowded train and so she called us. Left to self manage after a calming chat.
91F - Fell two days ago and Hubby hadn't called us yet attempting to manage at home. Mobility was now a real issue and we Tx for an X-ray and there was a #.
87M - Multiple problems but mostly extreme lethargy, renal failure leading to beta blocker toxicity and severe bradycardia.
37F - Abdo pain. 28/40 gestation, a bit of a panic and call us Tx to Mums an' Bubs for a check up.
Sailor on a base gave himself a minor lac on the forehead and called us and the base medics. We got there first and cleaned it up and handed him over to them.
62F - ? Anaemia.
25F - Police were concerned after they saw all these little cuts on her arms and leg, new and old. Called us thinking it was a possible suicide attempt. I had a talk to her and she was pleased that I knew what they were, her control valve for her temper and moods with un-medicated bi polar disorder and addiction to heroin and cannabis that she's trying to kick, it was how she controls the rage. All understood now I left her be.
88M - Left groin pain not like a stone, idiopathic.

 
See you at the big One.

Taz

Two extra jobs this shift but really!

32M - IP who stated that he was looking for the local cliff to jump off. Had asked directions???? Mr Police and me get called. Yes he has some issues and they only seem to surface while drunk or so the wife says. We transported a very nice, troubled guy to some help.
38F - IP who had an anxiety episode on the train. Fully resolved well before we arrived but her brother wanted her checked out?
16M - Lovely chap this one, full of piss an' wind and all the hallmarks of being a fruitful and successful member of society. Left in the care of the poor constabulary as we had nothing to offer him.
38M - Don't get in-between girls when they're fighting on the street drunk! Copped a stiletto in the ear for his troubles.
19F - IP, threatening self harm, had a 12cm (6") knife in her handbag. Transported.

See you at the big One.

Taz

Still not much work!

What do you do if you've washed it, restocked it?

61M - IP, know to the staff of the hospital and myself, abusive usually but too far in the drink to string and coherent abuse yet.
55F - Minor scalp wound. Happy for her to continue home and self manage.
48M - Seizure or was it. A known sufferer of seizures but on first examination while I got the Midazolam drawn up I put it off to one side. It wasn't quite right for a purely epileptic seizure. Long story short he got some Midaz because there was something that looked like a seizure later and while I had a feeling, if it had been wrong and I hadn't given my drug where would have my duty of care been. I don't have the knowledge of a Dr or the imaging or other diagnostic aids available in a hospital with me seven flights up in the patients bedroom. Treat what I can, do no harm and ABC.
37M - Got a bystander to call and claim suicidal intent. Didn't like it much when we took him to the nearest hospital because he'd already been there and escorted of the site for abusing the staff after they didn't respond immediately to his demands for food and a bed. It was too late to call up the shelters and hostels and he didn't like that.

See you at the big One.

Taz

Way too slow for my liking!

There doesn't have to be trauma galore but at least a quantity of work for starters please.

Four jobs all day and while I acknowledge that my attendance and the pts condition was very important to them I wanted more!
41M - Back pain.
97F - From Nursing home to a Rehab hospital.
81M - Back pain.
42F - Had some premature contractions that were settled at the nearest hospital to her and we transferred her to her own maternity hospital for further treatment.

I would start to think about food if I was really bored before but what with no smokes that was it I bought food, health food but not normal for me and I even fell asleep on the couch at station because we had done all the car and our station duties.

This is embarrassing  for me.

I NEED MORE WORK!

See you at the big One.

Taz

Managed to get to work in one piece.

The hand is still swollen and sore but usable.

25days M - Gave his parent a shock and they called us. All good and we transported for their peace of mind.
35F - Big night on the town with her G/f's and not much sleep and when they did wake up lets go and sit around a pools and soak up sun and have a fatigue/alcohol syncope looks like a seizure episode. Left in the care of the G/f"s and some more sleep and hydration.
89F - Expressive Dysphasia and aura, maybe a TIA resolving in front of me but needs to be followed up on.
53F - Minor head injury from a fall. Left in own care.
22M - IP, backpacker.
??F - passed out on a bus. Cops got there first and woke her up and will take her home.
75M - Fall resulting in a not major head lac.
21M - IP, woken by Police and still not retaining info at triage.
83M - Deceased.

See you at the big One.

Taz

I went to the waiting room!

So I went for a ride today to enjoy the day and to stretch these recovering lungs and other body systems so I had a 30k or 20m ride yesterday and the plan was to increase that today.
At the 15k mark I had a stack, while going around a pedestrian walking as he should on the footpath I went on the grass and the difference between the grass and concrete as I tried to rejoin the pavement was missed judged and I fell to my left and the outstretched hand.
He helped me up and asked if I was alright, I said that I was and off he walked.
I tried to use my hand and couldn't and in fact felt some internal displacement and pain. I've never broken a bone and have only felt others on the job.
I walked for 10 minutes before thinking I really need to get home so I jumped on the bike and slowly and often painfully rode home. I knew I needed an x-ray by the time I had got there and the wife wasn't home so I grabbed some things after failing to contact her on her mobile and was about to drive myself (in my manual/stick shift) car when she called and said she would be here soon.

We went to our local A&E and used the public entrance and thank you to all my allied health professionals was seen very quickly. Diagnosis before was possible fracture of the 4th and 5th Metacarpals from swelling and pain, not something I wanted even if it is my non dominant hand.
X-ray was clear, thank the cycling gods, and I just have to get this swelling down in the next few days so I can return to work, don't want to miss something good!

The bike seems unscathed, I believe the wobble in the front wheel was more from one hand operation and the pain. I think that I had dislocated those bones and what I felt was me realigning them, also something I've never experienced before.

The wife gave me a silent blast for being a dumb arse in riding home but is also relieved that again this shows how careful and safe I ride when on the roads because all my accidents have been on footpaths or the like and around pedestrians.

As a present or reward to myself for giving up the fags I was going to be getting a new bike anyway!


See you at the big One.

Taz

I am amused!

By several thing actually.
I know that this is a simplified version of the troubles I had with management or rather the watchdog of management, I can't identify myself. Which state do I live in or city because that may alert you to which ambulance service I work for. If you already know me that doesn't worry them because it's logical that you would because you probably work with me. Doesn't matter how proud I am of my job and the people I work with it's managements policy.
But several days off ago I get a phone call, off the official record asking if I was going to a media event in the future? Would I reconsider? There was a possible photo opportunity with the family member of a patient so it's OK to be identified in full uniform posed with a member of the public full name listed when it suits.

It has now been eleven days since the wife and I stopped smoking.
We are not wearing nicotine patches.
We are not putting on weight.
We are not suffering any obvious psychological or behavioural problems.
We have been exposed to a night of alcohol and didn't want to smoke.
We have been exposed to working days and days off during this time, boredom and activity.
We have not noticed any changes so far in either of our bodies.

Does hypnosis work if you fall asleep during the session?
She spent $10 and got a Stop Smoking by Hypnosis DVD. I hadn't seen it but she has. It was a wet ol' afternoon so I got it and put it on. Apparently I was snoring during it. I woke up at the end and don't feel any different so I don't know but it was boring so I'm not going to replay it.

See you at the big One.

Taz

To finish off this block.

51M - Post ictal, transported.
16F - Dizzy and slightly drunk with friends who were going to look after her till she sobered.
34M - Shot up some Heroin, fell over banged his bald head and cut it. Big enough to need stitches.
26F - Chest pain that was more likely pericarditis or the such.
26M - Sleeping on the floor at a MacDonalds. They called us, we woke him up, he went to purchase another burger and they served him.
51F - Off her meds, very disjointed abnormal behaviour and needs assessment.

See you at the big One.

Taz

Missed a shift.

Had a family wedding to attend and did a swap with someone and came back the next shift to,

37F - Depressed, just knew she needed to talk to someone.
Assist another crew.
??M - With a head injury, maybe, bystanders called and even told us the pt had left the scene. They followed him home and then waited for us. I am fully aware of the possible complications of a head injury. I am fully aware of concussion altered mental ability etc. I also respect independent free will and the sanctity of one's home and the right of an individual to decide if they need medical attention.
20M - Anxiety attack the co-workers thought was an asthma attack. I't wasn't and I cleared him to stay.
42M - Localised left shoulder pain that didn't appear to be atypical cardiac related and didn't want the go to hospital but will follow up with LMO and did have the two types of simple analgesia on hand that I recommend to take to get to sleep.
18M - Hearing voices, the booze, non compliance with medications and his confrontational aggressive behaviour towards the Police, Us, Hospital Staff and the general public meant this was only going to end up bad for him and lots of us were put in danger to protect the greater good of humanity. This is a story replayed over and over again on the News and current affair programs. None of us truly wish to deprive someone of their liberty by physical and chemical restraint but it has to happen sometimes.
41M - Well known frequent personality to us who work on the streets. Stranded in the city without money to catch a bus home. We take him to a waiting room for his safety and so his ?carer's? can collect him when it's light.
27M - Paranoid post taking LSD! Internal voice shouts 'SHIT DUDE THAT MEANS THE DRUGS ARE WORKING'  External voice reassures him that I am a Paramedic, I get my partner to put the beacons on to help prove it. A very sheepish young fella opens the door and agrees that if he feels like this maybe I should take him somewhere safe to be observed.
Young F - Fell backwards onto two thickly carpeted steps inside the house. As complete an examination as we are able to perform in the house finds no serious reason for the prolonged SOB she experienced that has now fully resolved and I believe that I am confidently able to diagnose she winded herself. Stayed at home.

See you at the big One.

Taz

That was a good shift.

A little bit of Mental Health.
A little bit of Tonsils.
A whole lot of drugs and a whole shift to play in.

21F - Drug induced psychosis in a unsafe environment, transported against her drug addled will for her safety and treatment. Saw her hours later after the drugs had worn off and she thanked me and apologised for being difficult, which I didn't think she was.
31F - Swollen angry throat, tonsillitis maybe? Transport so assessment.
49M - Drug induced dystonic movement concerning the Police in the charge room. Time will allow it to wear off so they kept him there under their observation.
82M - Very localised specific right sided chest pain, I think it is m,ore the chest wall or pleura.
35M - Sore chest after a coughing fit. I can say no more. I didn't transport.
91F - Sleepy. Discussion with not so concerned daughter as Mum had woken up and was normal when we arrived. It's nicer for Mum to stay at home.
37M - Got sprayed by the Police with Pepper Spray and we had to decontaminate. Surprisingly he openly admitted that he was misbehaving and had deserved to get sprayed.
54F - Mechanical face plant on the footpath. Two minor lacs and a few abrasions.
45M - Seizure. Midazolam and transport.
28F - More tonsils playing up. LMO already treating with ABs but they're not winning the battle. The surgeon might be needed.
83M - Hospital to Hospital transfer for treatment on a failing heart.

See you at the big One.

Taz

This is a 4 shift block.

With pressure of the blog meeting, the dental work, mother-in-law coming and a wedding to attend I didn't even post in draft any of the work from the last block.
I don't think there was anything really spectacular in it just run of the mill bread and butter stuff that is a normal shifts work for any Paramedic.


76F - Ataxia with increasing falls.
93F - SOB/Chest pain on walking on the flat.
43M - Hospital to Hospital transfer.
69M - Who's BP is normal now after he's taken his BP meds.
61F - Hx of atrial tachycardia and a 2/24 long episode today.
48F - SVT or ATach (there were some P waves) no Hx of either.
41M - Drug effected.
85F - Decreased mobility.
50M - Near syncope X 3.
72M - Gout and very painful crystal growths on finger knuckles.
81M - Urinary retention, known Hx of same.
Multiple Pts, 6 non transports and 1 for observation.
44M - Abdo pain.
53M - IP and depressed.
63M - IP unable to walk.
 35M - Vomiting.
19M - IP, wouldn't believe me that his current condition was alcohol based. When I was able to later tell him that he was 4 times over the legal limit to drive I think it was starting to sink in.
24F - Simple syncope at an event on a very warm evening. Declined transport.
??F - Unable to locate the pt.
19F - Abdo pain and diarrhoea for over 1/52.
19F - IP, parents coming to collect friends to look after her till they arrive.
64F - Can't get to sleep, could we check her BP, it was fine. Left at home.
23M - Minor abrasions from low speed motorbike V car. Left at scene.
60M - IP almost home. Was in his neighbours front yard. When this was figured out we knocked on his door and left him there.
86M - Hypo. Fixed and left with family at home.
26F - Abdo pain.
20F - IP Backpacker who also wouldn't believe me that alcohol was to blame for her condition (4x over). 
97M - #NOF.

And that was 48 hours worth of work for me and my partner.


See you at the big One.

Taz

For the Australian Readers.

Australian National Paramedic Support Foundation

I received this yesterday and became a foundation member almost straight away.

I was happy to join, it seemed the right thing but you have to make your own decision.



See you at the big One.

Taz

How am I going without smokes?

Pretty well actually.
I had my last one the night before the post was put in my jaw for the crown and that was three days ago now.
The dental surgeon has little idea about pain and analgesia and I have been using a combination of simple over the counter medications that work better in combination. So the pain, swelling, stitches have been assisting me to not really think about smoking.
Neither of us have as yet found it necessary to put a nicotine patch on although there are numerous packets of  gum or mints around the house. Time will tell, for me it will be on my return to work and as a couple we have a wedding to attend so there will be the demon drink and it always wants a smoke.

I will be honest and admit to any slip ups but at this stage we're going good. 

See you at the big One.

Taz

The Wife said 'You always get good work on an extra shift!"

And there was, an interesting medical case, an OD/Cardiac Arrest that was philosophically discussed later, and the very first long term deceased my partner has ever seen and this was discussed by us afterwards also.

50M - Decreased movement. I know this person on a casual basis and I could see the unsteady gait. In the last 10/24s increased numbness/altered sensation in peripheries, vertigo and ataxia. No trauma current or past, no drugs or abnormal occurrences, no current or recent illness! Even more interesting was 12/24s later the symptoms were progressing!!!!
87M - Angina pain. Feels just like his last episode (10yrs ago) when they gave him 5 grafts. Started about 4hrs ago but has nearly gone now. The wife made him ring, God Love Her. I think he was due for a check-up and this was a warning sign plus they never gave him any nitrates for emergencies.
2F - 2/52 Hx of respiratory illness not responding to pharmacology's and still quite unwell.
78F - Know trauma under treatment but pain management has gone out the window today.
29M - Opiate overdose suspected leading to cardiac arrest. No shock just O2, CPR and Narc with Adrenaline resuscitated the body but here's where the philosophy comes into it.

A young fit ready to live body was probably always going to respond very favourably to our treatment. But what of the brain. Our clinical pathways have been developed further to provide times researched from evidence based best practise to signpost when we may consider not starting (example;15/60 asystole with no CPR prior to our arrival). We arrived well inside this but how long had he been down before discovery?
Everything we did was correct and textbook and generally what is believed to be in the pts best interests and nothing in it would I change but it makes you think?

90F - A beautiful person with a loving family who needed all the TLC I could muster and it was my pleasure.
73M - Found outside on a footpath unable to stand or walk but appearing to make sense in conversation (there was a language barrier) no wallet or other ID and then I find the chocolates in one jacket pocket and the sugar cubes in the other?! A Hypo, easy to fix, contacted the wife (they did live at this address {every noticed that, how many hypos almost get home}) and release him to her care after we get the BGL up.
??M - Deceased. There was no need of us to enter the room. It was obvious from the hallway downstairs but my partner had never encountered this type of incident and there were resources rushing to help us if I didn't call them off. I'm sorry that a person that I didn't know has past away but is a common part of our job and one that must be dealt with professionally. Disturb the scene as little as possible and tell the Police what you did touch. When you can handover to the Police get away from there and discuss it with your partner. None of us are invincible to the constant exposure to what we see and this one may be what breaks the camels back if not managed properly. Most services have either Peer Support or Counselling services, use them because we need you out here with us.
83M - DVT, after getting unloaded well all day this the last one of the shift cocked us up, 2 1/2 hours overtime on the last job.

See you at the big One.

Taz

No, that's not what I wanted!

More jobs came down but there was no quality!

66F - Hosp to Hosp transfer.
82M - Had a fall, got a black eye but refuse rational transport offer. This patient was able to display competency and capacity in deciding that he didn't want to go to hospital, he was able to believe and understand that 20% of his face was so badly swollen with the contusion that he couldn't open his eye. That the very slow drip from his nose was probably haemorrhage from the eye draining via the tear duct. He understood mine and the family's concerns for possible loss of vision, stroke or even death from inter cranial injuries but still refused. We were all involved in the discussion, pt, wife, adult children and us. The pt has the right to a bad choice.
43M - Hearing voices.
19M - Epistaxis from a friend.
26M - Drug effected.
25M - Drug effected.
19F - Alcohol effected.
89M - Assist to feet, no injury.

Got a shift swap during the days off to allow Ambowife and I to attend a wedding next month, these usually bring good work.


See you at the big One.

Taz

Work's slowing again.

 63M - IP, that's not the problem it's his argumentative friends who keep ringing us to take him away to stop his drinking all the while they are there drinking with him. Pot calling kettle black?
87F - Abdo pain.
86M - Assist to feet, no injury.
23M - With one of the best #noses I've seen. It wasn't splattered but the way it moved when I touched it!!!!!
62M - Drinking Diesel!!!!!! but wants to go to hospital for a shave and a feed.
30F - Self harm thoughts.

See you at the big One.

Taz

Started as a day of Abnormal Behaviour!

37M - Two bottles of dexamphetamine's. Totally compliant but if he hadn't started to randomly shout gibberish at passers-by and totally pinging off the walls the Police wouldn't have noticed him or called me. He got a little fiesty in the ED and was given something strong to help him sleep. For his protection and that of staff and the public.
37F - Threatening everyone harm. None of the threats were believable but just wouldn't stop making them. It appeared to be an attention seeking action and it got attention.
45M - Huge anxiety attack, poor fellow very debilitating, a massive PTSD history that made this very nice quiet dude an emotional wreak. Physical violence is not the only way to harm others.
94M - To a Hospice.
53M - Acute back pain non traumatic.
59F - Chest pain. Not cardiac.
Baby fallen from knee height. No injuries apart from Mum's confidence. Apart from the actual birth experience this was possibly the most traumatic thing to have happened to this pt and it scared the shit out of them. I have found that the baby is usually very quiet and withdrawn post incident and before we arrive but if they're starting to return to some of their normal interaction (crying at the sight of me, all babies do?) movement and normal eye movement that the old idiom has some merit 'Babies do bounce'. Transport for observation was accepted and is always offered.

See you at the big One.

Taz

14 Jobs on the Data Terminal screen!

But only ten case sheets written, called off the others for either a closer crew or the caller cancelled

27F - In a motherly way and had to endure a 30 min bus ride standing all the way (where has chivalry gone) and had a faint. Declined transport.
59M - Just an odd dude that the Police wanted us to discover if he had any mental health issues. No just someone who is different.
?50M - Unconscious, maybe drugs pharmacology treatment not successful. Follow up was poly-pharmacy OD, amphetamines, opiates and alcohol. He was still in a higher care ward when I finished this block of shifts.
81M - Left chest pain from his Drs. Not cardiac related.
22F - ?Syncope, maybe pregnant. Took to hospital for a check up.
64M - Tachy at 180 in AF.
27M - Dislocated left shoulder and watched an ER Dr massage it back in, awesome.
32F - Heat stress/exhaustion. At home and understands self management so we left her.
55M - Has a broken arm that hasn't been put in a cast while waiting for the swelling to reduce. Couldn't remember how to put the sling on that had been provided. Called for an ambulance, neither of us have ever seen this sling set up but we figured it out and put it on the pt and wrote him some instructions for next time.
83M - Haematuria and urinary retention.

This was a draft post from the day I was told about the complaint about the blog. In hindsight I don't think that I'll review and repost the older posts 'cause that will just be a real pain in the arse for you readers, in particular those who follow and get updates on new posts.
They won't be new and I don't think there is any literary brilliance in these pages unlike some of the prose in Insomniac Medic's blog

See you at the big One.

Taz

So what's happening with the blog?

Lots actually.
A lot of the content has disappeared, well everything has apart from the last two posts. They're not deleted but reverted to drafts so I can review each and every one and alter to meet the agreed upon format from my meeting with management.

Firstly I'm very pleased to say while not supported or endorsed by my employer in anyway they are happy with most of the content of the blog, it is obvious that I am very proud of what I do and I write in a positive and complimentary manner.

I must mystify myself more so that I may not be recognised by new readers or followers and to that end my profile has been altered I work in Australia and I'm a Paramedic. I can not have photo's of myself in uniform that may identify for whom I work and/or where I work. I am not to post any photo's that may identify what I look like out of uniform to again protect my confidentiality and safety and there by my patients.
I'm a little unclear on this one when I have been filmed several times in a reality TV series that identifies me but that was in a public place and I was not making comment but only doing my job and was approved by the powers at the time.

My comments are largely OK but I must be mindful of being misquoted, taken out of context or misinterpreted by the uninitiated to the word and phrase that most of us understand universally.

There will always be those that sit in the shadows and complain, hell I even have a gripe every now and then, it does good to get it off your chest but I happy that this matter is done an' dusted and this should be an end to it.

See you at the big One.

Taz

Lookout World, I'm giving up the Smoke's!!!!

Yep after 33yrs of cigars, tailor-made (normal) or roll your own cigarettes, pipes of various shapes and the few odd 'herbal' cigarettes I'm officially off them from the 7th November. 


I was going to do this next year when I do officially turn 50 but I am having some dental work done with a whole crown done on the above date and was told the best chance of success was to also stop smoking.


With several thousand of my own dollars paying for this I decided to bring it forward.


Combining that with giving up sugar in my many cups of coffee, Dr said my triglyceride was elevated at my last blood test so I had to stop eating lollies, cakes and drinking all the soft drink that I must! Problem was that I don't, I know I have a sweet tooth and avoid that stuff because I was fat twenty years ago.

I don't mind the unsweetened coffee but I have been noticing a small lack of late shift energy.
The smokes well there are some people out there I work with who have never seen me smoke, I seem more physically addicted than mental I'll still carry the Zippo for awhile as well as a lot of gum. 


So maybe BEWARE TAZ the AMBO he may be a little jumpy and hair triggered for a while.

See you at the big One.

Taz