The gut was right.

The US TV drama NCIS, the 'Gibbs Gut' is always trusted.
The same goes for our job, if it doesn't feel right it isn't.
This instinct or intuition generally comes with experience and an open mind.

17M - Horsing around with his twin and stuck his arm through a glass door panel. one large lac with muscle exposed but it appears no tendon or nerve damage. It's going to need a surgical washout.
25M - Horsing around with other backpackers and dislocated his shoulder, 20mg of Morphine got him up off the floor and walking down the twisting convoluted stairwells of this backpackers and on his way to hospital.
52M - Who was out celebrating the Bucks Night of one of his sons and when trying to stop a fight between strangers got pushed backwards and suffered a minor scalp injury.
28M - GHB OD
86M Angina resolved declined Tx.

27F - Fainted, a very common job. We arrive and while she's LL on the floor she's talking so I sit her up then to her feet and as she appears steady we walk outside the restaurant for a sit down examination.
Physically she is a fine healthy young lady but there is a scared/fear in her eyes and she says that she doesn't feel right. At first there seems to be confusion to questions but it didn't seem right so investigated further it's more an aphasia but even then it depends on the way your phrase the question;
Whats you DOB? no answer just a struggling look.
When's your birthday? the something of the something 19something, straight off no problem.

Strange!

No drugs, trauma, over exertion, fatigue, illness, recent overseas travel, medical Hx and appeared clean, sensible, well presented, high functioning and not seeking attention.

There had been a previous syncope today that they put done to heat in the middle of the day, but I would like her to see a Dr tonight because I can't convince myself of any obvious cause for this.

While at first Triage was doubtful of my concerns after talking to the pt and witnessing another syncope and adding incontinence to the presentations some sort of seizure is looming.
A tumour larger than a golf ball in her frontal lobe region was found on CT.
It appears very aggressive as symptoms continued.

I hope they can do something, she's a very lovely girl.    

Be Excellent to Each Other and See You at the Big One!

Taz

A bit of that!

62F - I've been here before and she does have really bad anxiety and if her own control methods don't work she calls us.
51F - Fell or pushed over last night and she walked home, today her hip hurts (has taken no analgesia) and rang us, I feel it's muscular really.
16F - Wanted Methadone.
31M - Effected by Xanax and walked off the curb into the side of a truck that was hardly moving, an abrasion to his forehead, unsure when the truck last had a tetanus shot but it was uninjured.
50F - Restrained driver in a two car head on. Didn't need to cut the car but there was a possible SC injury.
49M - Who tested mine, my partner and everyone he came in contact with's patience, and that is being really, really nice about how much this guy pissed me off.
72M - Looked like he was pre-arrest brachial pulse weak, very diaphoretic, 70sys the best I got but the ECG came back with NSR and after a bolus 500mls of Hartmann's or Ringers Lactate it was up to 91/54.
As a retired Dr he thinks it's a reaction to seafood but I'm not sure.

Be Excellent to Each Other and See You at the Big One!

Taz

A bit of this!

89M - Fell from bed and his legs are weak, Geriatric Assessment needed.
90M - Fell transferring to a chair but only wants a hand up.
39F - Thought her heart was racing but all we had to do was take her pulse and tell her it wasn't and she was off?
57F - Delusions, Paranoid and all very genuine.
71M - Collapse, may be septic, need bloods.
28M - Cyclist, was wearing a helmet I'll give him points for that but seriously Dude trust me I have had way bigger stacks than that and got back on and rode off, he wanted a hospital.
??M - Road rage incident, never could figure out if our pt was the victim or not.
MVC - SNR
49F - Hyperventilating after a hard walk on what was a hot day.


Be Excellent to Each Other and See You at the Big One!

Taz

Non Australian Patients

To be clear,
I don't care where you come from on this planet,
I don't care what you believe in unless it involves your treatment like Jehovah's not taking blood products
I don't care who you pray to
I don't care that you think your Ok
I don't like you spitting at me
I don't like you urinating or defecating in my work place
I don't like you taking a swing at me or my partner

I will treat you to the best of my ability
I will treat you with more respect than you show me

I know that my fellow Paramedic, EMT, EMS from around the world look after as many Australian citizens with the same care as I have, Thank you

Happy Birthday to Lauren for the 12th, I don't seem to be able to leave comment on any of your posts

Be Excellent to Each Other and See You at the Big One!

Taz

Record Temperature Day.

And therefore a stupidly busy night, but no there was a general calm.
This may have been from the heatwave just being too much and the punters just staying indoors.

47F - Working on a river cruise boat who suffered a small trauma and re-injured a neck issue
30M - Witnesses state a seizure and he said a faint because he's had similar before to the point where they have installed a on demand pacemaker for bradicardic events they thought he was having. I saw a proper post ictal stage not recovering from a faint. To be investigated.
24M - Blind sided by some thug, top lip split to the gum line. Very nice young dude I very much doubt that he provoked this random attack.
?26F - Slapped in the face by her BFF, who cares really!
?36M - IP passed out in a hotel foyer, woken by the cops and after they explained it 20 times you leave in a Taxi right now or go with us (Ambos) to hospital to sober up he took the taxi option
Assist another crew with extrication of a pt.
32M - claimed a Redback Spider bite ?????
66M - Acute cardiac failure causeing a fall in the nursing home and pre-arrest developing en route. Luckily we were 3-4km from hospital so just ran there but the outcome was unsuccessful.
79M - Dialysis

Be Excellent to Each Other and See You at the Big One!

Taz

It's getting hard for me to find a patient worth transporting.

Three in an entire shift,

20M - SCI Quad also with a life threatening respiratory disease with increased SOB
31M - City Ranger who got sprayed in the face by a hooligan when caught being a public nuisance, black paint.
32F - Suicidal thoughts and plans.

Then there was,
Public transport officer who was slapped in the face, he didn't want us and had told the bosses just that.
20M - Heavy drinking last night and at the beach today and now feels weak, shivering and hot and nauseous, do you think you might have just over done it?
21M - Citizen of the US who was celebrating his 21st by getting pissed in Australia (where he could have drunk for the last three yrs) and falling asleep in a park garden.
21M - In Police custody, was too happy even though he was in very serious trouble, so he must be on drugs please check him out. No this little crime wave was just trying to play with their brains as well as playing the No speak English card which may (I doubt it) have been true but he sure as shit could understand English.

Oh I guess the two Dialysis pts did need to go.

Be Excellent to Each Other and See You at the Big One!

Taz

Busy Day

Lots of jobs but the quality could have been better.

62M - Epistaxis, well a flood sometimes and others a dribble going on for nearly 24hrs.
89F - Public assistance to lift of the floor and back to bed
83F - Fit, healthy, swims in the sea 3X's a week as well as goes to the gym but today suffered a skin tear to her calf area that split her left gastrocnemius (calf) muscles from an accident with someone else's dog lead wrapping around her leg. While this looked a nasty wound, with her good health recover should be excellent.
32M - Don't know how but he split the skin on the underside of his middle toe on one foot. He was wearing footwear, so go figure?
27F - Abdo pain, sounds like an inflamed appendix.
26F - Abdo pain, period pain, you can go home and before I get howled down my wife agrees with me.
32M - With behavioural issues not Psychiatric ones, so ED don't want him.
58M - Transport to a detox clinic for his first attempt.
75F - A theme here, stumbled and went down on one knee causing a huge skin tear from medial to lateral right over the patella, add being on anticoagulants and a diabetic and this has to be seen at hospital.
82M - who rang the Fire Brigade and us because he smelt something funny! Nothing found.


Be Excellent to Each Other and See You at the Big One!


Taz

Just another Day.

77M - With a week long history of a pain around his pacemaker
44M - Ate something spoilt and is paying for it today
?70M - Found Deceased in a park
82F - Very obvious chest infection
43F - Fell and suffered a large lac to her forehead
87F - Chest pain with a wide complex QRS
83F - Hospital transfer

Be Excellent to Each Other and See You at the Big One!

Taz

Not as hot tonight.

Attended an obvious death first case, only young so we spent some time with the father who found him.
31M - asleep on the street, OD on Xanax. Decreased GCS so transported for his safety.
27F - 7/40 pregnant and nauseous,,,, must have seen the stories about Princess Kate and how she needed a hospital with morning sickness. And before I get hung drawn and quartered we did transport.
??M - IP sleeping at the train station, concerned passerby couldn't wake him but the Cops who beat us there could. SNR
18F - Learning the hard way about Tequila, need I say more?
61F - Praying on the good nature of other people, nothing wrong with this moocher.

Be Excellent to Each Other and See You at the Big One!

Taz

A very hot night.

Australia is in the grip of a heat wave this week and many States are fighting bush fires. in fact because of the combustible nature of eucalyptus forests, Australia is considered to be one of the most explosive and fire-prone countries on earth.
Here in the city it's heat related cases, heat stroke, exhaustion, dehydration and syncope that crews have been dealing with as well as an increase in the elderly cardiac arrests of patients with chronic illness.
I've not got much of that tonight but I am stuck at hospital with my own patient as well as babysitting others crews patients until there are beds.
68F - Sudden onset of nausea and pre-syncope symptoms without exposure to the heat and there is no BP drop. Normally healthy deserves immediate investigation at a hospital tonight.
64F - Felt hot and weak, also cannot find her fan. So while my partner finds that I do a baseline set of obs (all fine there) and with the fan found and operating the problem is solved. 'I'll stay at home thank you'.
28M - Uni students celebrating finishing exams, fine, it's even ok that you have over indulged and now need the services of the Ambulance Service but don't go around the scene and later the ED introducing yourself as a Medical Student and everything is 'OK' with your drunk friend (whom I have transported in restraints because he's an Aggressive drunk and doesn't need an assault charge against him) to the Qualified and knowledgeable staff. All that book learning and not smart enough to shut up when I told him to before we arrived at the ED.
41F - Migraine that has not responded to her own medications.
51M - Partner says he had 2 seizures overnight, but it was still 38 degrees at 3AM and he was exhausted from not being able to sleep in the heat but the change has come in now and it's 10 degrees cooler and he is competent and shows capacity to refuse transport that I offer. I'm happy with that too.

  

Be Excellent to Each Other and See You at the Big One!

Taz

A coffee with two other crews.
7 Police crews drop by the scenic spot we're in also.
The radio crackles can you call the Nth channel for a job
24F - Fainted, but wait there's more now it's saying possible agonal breathing and then in arrest. Asystole on arrival with the oddest agonal huge breaths I've ever seen. CPR, 2 x Adrenaline and some Narcan because we believe it may be an intended opiate OD, 8 min in we have ROSC or her heart starts to beat and perfuse her body and while we were first to arrive the others transport and we follow to Hospital
While printing of the eMR another crew back up into the bay and shout jump in he's arresting and there we have a ?60M in VF, one 200j pops him back along with a little CPR.
The sweat is dripping from me.
56F - Who wants to go to hospital because she can't breath. Problem I have is that it took her several minutes of loud, full and complete sentences to inform me of this breathing difficulty she has?? I took her.
50F - Known epileptic had a moment, left in care of others.
45M - IP.
6M - with a suspected # humerus.

Very slow start and on nights next and the temp is due to climb over 40C in the day, UCK.

Be Excellent to Each Other and See You at the Big One!

 Taz

So what does the 1st real shift of the New Year offer?

35F - Denies alcohol, drugs or a need for us (3rd party caller) she's a bit of a space cadet/hippie but I can't fault that so off she goes. Another car picks her up 5hrs later with a Xanax OD.
26M - Got drunk on a plane flight, played up and was arrested on touchdown and they wanted a quick psych evaluation. Now 7hrs post landing he is sober and shitting himself because the fact of him being put on a return flight later today is looming large!
79F - Bless her, she waited 4/7 before calling about this fever she had. Pneumonia.
36M - 4/7 Hx of illness overseas and a syncope at the airport on return.
23M - Depressed after getting drunk.
46M - Hypoglycaemia, excellent this we can treat and reverse.
37M - Witnessed syncope and profound confusion, must remember to follow him up because it looks like the aftermath of a bender.
40M - Opiate use, drowsy at a bus stop but you mention Narcan,,,,
 

Be Excellent to Each Other and See You at the Big One!

 Taz

Happy New Year Everybody

I had requested to be on rostered shift this year rather than Special Events Coverage at one of the celebration sites, you spend the night putting bandaids on cut feet or reassuring someone that their friend is just really drunk.
Working on the streets isn't that much better but at least you can move and drive around.
12 Completed cases
20+ on the computer but either cancelled or called off
Physical restraints used as early as the second job for a drunk 25M hallucinating and getting violent and there really were no extra cops around to come with us so they helped us while we applied ours and secured him to the stretcher for everyone's safety.
Got a New Year snog from some nurses at the ED!

And that was 2012
  

Be Excellent to Each Other and See You at the Big One!

 Taz

Twas the night before NYE

15mth M - The family are on holiday away from their normal support structures and had been doing everything I would expect to get the little chaps temp down but it wasn't playing along.
57M - Who's family (not living with him) called us to go and take him to hospital. He didn't want to go and frankly there was nothing that a hospital had to offer him he wasn't acutely sick and didn't want detox, so I left him at home.
44F - Anxiety and many different and moving pains in many different spots and not constant nor describable.
70M - Verrucas vein haemorrhage. It had resolved with direct pressure and again this is not an acute problem and he was not on anti coagulants so a clean dressing, some instructions and go see you own Dr tomorrow.
49M - A third party called us to see to this homeless or between residence person with some pain around his liver region that when asked he could even tell you what it was. He didn't want to go to hospital either.
23M - Obvious ankle injury from jumping over a fence.
23M - Lac to the eye lid.

Be Excellent to Each Other and See You at the Big One! Taz