Finally had my first shift.

May 19, 2014 23:27

Well, it took some waiting but I finally got my first shift.  On one hand, I was expecting a lot of what I saw, but on the other hand I had a few curve balls thrown at me.


My first patient came in as code 3, foot pain.  When we arrived we found an elderly patient stuck on his knees by his bed.  The pt had dementia and a very unsteady gait, he had fallen once a day for the past three days.  Pt had two big falls the last month and was prescribed a walker, but couldn't remember to use it so the pt kept falling.  There were bruises everywhere from all the falls the pt had, it was heartbreaking.  The pt probably retired in the last 10 years, and this is how the pt gets to spend their retirement.  We brought them into emerg,they were stable and low acuity so we unloaded them in the waiting room.

Our second patient had pulmonary emphysema that was being exacerbated by pneumonia, it was dispatched to us as a code 4 shortness of breath with an infectious advisory.   Fire was already on scene and did a preliminary assessment and put 02 on for us.  On our arrival we did our own assessment, and cardiac monitoring looking for a possible STMI.  Nothing remarkable was found except a possible bundle branch block.  On room air the patient was satting at 88-86%, on an NRB the pt got back up to the low 90's and finally up to 96% on CPAP at 5 cm/H2O.  The patient also fit protocols for PE symptom relief, and got two 0.8 mg doses of nitro.  Because the patient was on CPAP, they counted as being actively being assisted in ventilation, so they qualified as being CTAS 1.  The patient was immediately taken into recus and seen by an RT.  The pt seemed to have a good prognosis when we saw them before we left the hospital.

The third patient was a young adult patient that was called in as code 4 shortness of breath and possible chest pain.  The call was pretty uneventful, we responded to an apartment, and the patient made ambiguous claims of chest pain that didn't fit with any pathologies we knew.  Cardiac monitoring didn't reveal anything significant except normal sinus tach.  In the end it was determined that the patient was likely high and was having an anxiety attack.  Patient was stable and non acute, triage had us unload the patient into the waiting room.

The last patient of the shift was a trauma.  The patient was on a moving sidewalk type of escalator that allows shopping carts to go up and down levels.  The cart flipped over with a child in it and landed tripped our patient, who landed on top of the cart and damaged their flank.  The cart that was behind them kept going forward and ran over her foot.  When we arrived on scene an RRU was already assessing the patient and the child.  On assessment the older patient seemed to be suffering from musculoskeletal pain and a possible sprained or fractured ankel.  We splinted the ankle with a SAM splint and brought her to the emerg on a CTAS 3.

While waiting to leave the hospital I ran into one of my classmates who was bringing in a patient that needed ventilations.  The patient was a 91 year old nursing home patient with a DNR who had surgery some days ago and went septic, they had pretty bad localized edema in the arms and legs that was a swollen purple/red colour.  My preceptor let me go and assist my classmates crew, so I helped maintain the BVM seal while my classmate assisted with ventilations.  The rules behind DNR's mean no CPR, but ventilations that assist the patients ventilations are fine since they just help increase patient comfort.  The patient was in really bad shape, more or less in palliative care.

The bit I was expecting was the mixed bag of assorted stuff that ranged, I was partially expecting to feel lost a little bit, and I was expecting to have mixed emotions over different patients outcomes.  What I didn't expect was to have my calls end so soon, though apparently the lack of off load delay I experienced today was quite an anomaly.
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