We take a break from our regularly schedule discussion of professionalism to bring you some action!
The local ambulance service brings in an unrestrained driver from a rollover. He’s intubated, has a crazy, bounding pulse and there’s panic in the eyes of the Red Crescent ‘medics. We move him into the trauma room and it’s party time. BP is 186/106. The guy looks about 25 years old. He’s got a blown pupil, a pulse that won’t go below 130bpm and as we bag him with 100% O2, he starts to wake up and bite down on the ET tube.
I give the Red Crescent guys a lot of credit for effort but they don’t carry RSI drugs and they didn’t even put in a bite-block to protect the endotracheal tube from getting bitten closed. No matter now. The ER doc is from NZ and is calm, capable and concise. Vecuronium, succinylcholine and morphine makes our spastic boy calm down and his blood pressure starts to drop. Everyone does their thing with admirable cohesion. The only hangup is the excessive number of doctors giving orders. I run out of things to do and back out of the trauma room. He’s whisked up to CT and then Neurosurgery where they evacuate about 300 ml of blood from on top of his brain. All that pressure shoved much of his brainstem down his spinal canal and it would be a miracle if he ever wakes up.
The one pertinent negative was a complete lack of what I call "Seatbelt Rash." Yep. You guessed it. Another young Arab driving too fast with a complete disdain for restraint.
Later I float around the ED helping the nursing staff with difficult IV sticks and calming difficult patients. I guess there’s something worthwhile about having a 6’4" 240 lb bald white guy who wears a quasi-paramilitary uniform and a ready smile. Angry patients just chill out.
Then we’re sent to the residential area on a call to the dispatch that just had a hang-up. If I was still in the USA, I’d have staged out of firing range and waited for the police to clear the scene. Not here. It’s almost creepy how idyllic things can be. It’s an unconscious worker and I can tell walking up that it’s not gonna be diabetes, even as the nurse with me is whipping out the glucometer. I get that there’s no trauma from the bystander report and we fling him on the stretcher and into the ambulance. I make the driver wait 5 minutes while I go for a 12-lead. Sweaty, responsive to pain and a bounding radial pulse. I get a BP of 252/158 (seriously!) with a pulse of 80 and a 12-lead showing a left bundle branch block and possible inferior infarct. His sugar is 134 and he’s breathing on his own but only saturating at 88% through a clenched jaw.
12 liters per minute of oxygen via a mask brings his sats back up to 100% and we get down the road. I drop in a 16g IV in the crook of his elbow and hang a bag of fluid, leaving it closed off. Heads up to the ED and they meet us at the door. The team slides in and takes over and I run out of things to do. One of the nurses, observing my IV says, "We’ve got a beautiful 16 ovah heah." in her Aussie drawl, "I love working with paramedics!"
…and I love being one.
–maddog
