A Reply for Coloneldom.

Last week in day two one of the pts was described as having an opiate overdose and coloneldom has asked whether I administered Naloxone (Narcan). Lets review firstly the job as I posted it.

'40F, OD on opiates, interesting because it's not her fault in my opinion. She has been prescribed by the one GP over ninety milligrams of a pain killer daily and therefore some days depending on her metabolism, other medication use and even stimulants like coffee she appears to OD.'

Naloxone Opioid Antagonist, reverses respiratory depression, sedation and hypotension caused by opioid analgesia.

Apart from the reversal of say Heroin ODs it can also be used to just back off on Opioid Pain relief with Pts.

My choice as a Qualified (the buck stops with you unless you call for Intensive Care Paramedics [Frogs - because everything they touch croaks]) Paramedic was not to give any Naloxone.

1. Pt was conscious.
2. Pt was fully ambulant.
3. Pt was not, while with us, in any life threatening danger.
4. Pt had refused transport and treatment initially which was her legal right as a pt who may have been under the influence of drugs but did display a competency and capacity to make decisions, even a bad one.
5. Pt only changed her mind after a short discussion with a staff member of the sanctuary she was was staying in. I did not hear any of the content but I believe it may have been coercion, but not by me.
6. I didn't wish to expose the Pt to possible infection from an IMI.
7. I didn't wish to expose myself to a possible needle-stick injury.
8. I wanted the Triage and ED Registrar to see with their own eyes the Pts true condition for assessment also of the GPs medication regimen.

Some of our allied Health Staff don't always believe what 'we saw' on the scene once a nicely package Pt is presented in the calm, controlled, well light, post any interventions by us, triage corridor.

So there you have it,

Simple short answer NO which doesn't explain the thought process to arrive at that answer.
It leaves me open to some prick thinking that I'm just a slack arsed ambo.
And doesn't provide direction to any Padawan reading the post.

I'm off back to bed for night shift tonight.

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

Taz

For Jinx.

Hello Jinx,

Welcome to the world of Aussie Ambo Blogging.

F.A.S. now this is not a cultural slurr but you will notice that with some of our patients from this ethnic background they just go floppy on you after their family member tells you about their current illness.

Now I've observed this to happen after vomiting and diarrhoea as well as non de script sore legs and sore finger and all kinds of other stupid conditions.

Beware they will also walk for about half the hallway and then collapse causing a sudden rush of family to pat, stroke and fan the patient.

I have also seen plenty of others deny the pain that is obvious to me and struggle to assist with their loading even though it pains me to see them do it..

With the transgender I communicate to them in the preferred style (feminine) but the paperwork I do ask the straight up, 'what sex are you legally?' and record that.

Hope this makes sense to you, we only did a normal twelve hour shift today that I will post about later but one of my dear friends and peers from station is moving to the quiet life up the cost and we had drinks after work and I'm a bit blurred!!!!!!

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

Taz

What did I do on the days off?

Not much,

We had visitors from Tassie for three days.

Ambowife's birthday is coming up and I have to get something (can't say too much because she reads this to check that I'm telling her all the things I have on my mind), So I went off on the bike on day four to do some shopping or browsing.

Day five was a beautiful day so we hopped on the bikes and went for a ride together, she even did some of the pace setting. Quicker than we have done this ride before, the final stats are;

Distance of 45km or 28m
Time moving of 2h, 44m.
Ave speed of 16kph or 10mph

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

Taz

Night Two.

Hospital to Hospital transfer of a young one in the child capsule with Grandma escort.

94F, Head Lac, those damn throw rugs on slippery tile floors.

Unable to locate.

Some Floppy Asian Syndrome (FAS) with abdo pain.

43M, Psych transfer, nice fella just lost all idea of who he was!

52M/F, Transgender, a legend around my patch whom I had never had the pleasure to attend. We, as I was to learn, were the third crew to have responded to the pt this evening. The pt had been escorted from A&E previously for verbal abuse to staff and other normal pts.
At two AM when we were responded to the same pt again, I must say I slipped the angry ambo suit on. A direct, blunt instruction and dressing down of the alleged pt occurred until the pt had indicated three times that they understood.
We then transported them to the next nearest hospital for their abdo pain.
Pts main fluid intake is Metho.


So 7.25 pts on average for the four shifts

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

Taz

Night One was one for the ladies!!!

Or rather they made up the majority of our pts.

Assault - Unable to locate.

34F, 3/24 of Diarrhoea.

16F, Intoxicated, Mum had been called so we waited, she was more than happy to take pt home.

44F, Intoxicated, friends called but pt wanted to go home, they were staying with her so they did.

64M, Has two inner ear conditions and had a syncope after leaving a club with live band, wonder why?????

18F, Decreased LOC, not intoxicated, history of similar idiopathic.

25M, Intoxicated found by police. They told me as we approached that they tried the sternal rub I showed them to nil effect, showed them a new one 'Chinese Ear Rub'. Lay flat of hand on the external ear and move back/forward real quick, older brothers have been doing this to little brothers for years. It worked and out of the kindness of their hearts they were going to drive him home until he pulled out the ol' fella and pissed over himself and the back of the cage truck he was in. New destination the charge room.

25F, # foot, dumb ox B/f stood on it. The swelling was that tight I couldn't even check for pulse.

35F, Osteogenisis Imperfecta underlying condition, suspected # post fall.

Finished up with a job that I still feel uneasy about, the transport of an alleged sexual assault victim. The victim can be male or female but the aggressor is nearly always a male.
I am very mindful of the respect and trust for my profession by the victim and ashamed to be a man.

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

Taz

Day Two

21F, MVA, no injuries.

40F, OD on opiates, interesting because it's not her fault in my opinion. She has been prescribed by the one GP over ninety milligrams of a pain killer daily and therefore some days depending on her metabolism, other medication use and even stimulants like coffee she appears to OD.

21M, First ever witnessed seizure, couldn't link a trigger either, none of the usual ones like illness, fatigue, drug use, etc.

Early elderly Pt who was visiting a Dr about a broken arm and tumbled and may have broken their hip, some days you just can't catch a trick.

96F, Bright as a box of sunshine too but with a nasty case of cellulitis in the legs.

73M, Dystonic gate, possible Parkinsonian Syndrome has had his meds increased but they seem to have left him even more immobile.


Interesting enough day except that 'Dorothy' (new affectionate nickname for Padawan) and I where definitely not in Kansas any more as we had slowly been dispatched further west with each case.

We also again had not received and lunch or crib break and without the aid of a twister we had to drive all the back to station making it a thirteen and a half hour shift.

Same last comment as previous post!!!!!!!!

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

Taz

Day One.

The system has been very busy when I talked to the staff finishing the nights so I looked set to continue the same for us.

Regular Pt doing to dialysis.
60F, misjudged the depth of the gutter and took a tumble, Left upper arm injury.
83F, Fell out of bed, Right wrist fracture very obvious and she kept trying to wave it around.
84M, Abdo Pain.
88F, Everything hurts, High maintenance Pt this one wasn't even hiding the pleasure of the attention.

84yo, Cerebral event. This one is worth a bit more of a story, called to a CVA but the history tells of symptoms as old as two weeks ago but not constant and then today some kind of a fall in the AM and six hours later dysphasia, semi obstruction of own airway by tongue, equal strength but no coordination.
On the way left deficit occurs, right upward gaze and decreased GCS.

As normal we didn't get to follow up that day but the next we got to see the scans. It appears to them that there was a slow bleed over the last two weeks and the fall opened the flood gates and the final presentation. Prognosis, not survivable.

Finished the day with a 30 something M with a hypo, GCS 15 with something like a 2.1BGL, sugared him up, he signed the PHCR and off back to the Ranch we went.

No lunch or crib break all day and it was a twelve and a half hour shift.

It buggers me as to how some old fart in the IRC or our own ivory towers can think that the extra two hours and still no breaks makes for an easier dayshift.

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

Taz