Flu, Parkinsons and stones.
The second day of my preceptorship was today, and it went pretty well despite having my first patient die ... or perhaps because I was able to deal with a VSA patient.
Our first call was for renal colic, or kidney stones. We met the patient in their driveway and in a great amount of pain. One of the problems with renal colic is that there is no position of comfort, just absurd amounts pain. An advanced care crew would have been able to give morphine or fentanyl for pain (which may not even work on the pain), but primary care medics don't have any pain management measures. So we spent all sort of time with a patient that I felt completely powerless to help, which is an absolutely terrible feeling.
The second call came in as a middle aged patient with shortness of breath and FRI positive. After gathering some history we determined that she had influenza and was suffering from it for the past 4 day. We then found out that the patients spouse had left two weeks ago on top of the flu that she was experiencing. The patient was given dimenhydraminate to help with their nausea. The hospital staff were on shift change at the time we brought our patient in so it took a bit of time to get the patient admitted. I spent a lot of time trying to reassure the patient and tell them they had no reason to feel ashamed or embarrassed for what she was going through.
The next patient we dealt with was an elderly person with Parkinsons, the call came in as code 3, difficulty swallowing. When we arrived on scene we were lead into the bedroom by a caretaker and shown the patient. The patient was very small and thin, I could have put my thumb and index finger around the pt's wrist and touched my second knuckle, the patient may have been 40 kg in total. The patient had diminishing ability to respond to begin with, today the patient was even further declined and wasn't able to swallow. Not being able to swallow meant that the patient wasn't able to take their daily medication and they haven't been able to eat since noon yesterday. There wasn't much we could do for the patient other than transport and monitor the patient until the patient was admitted. This was my first time having to deal with offload delay, which was only around 3 hours.
During my off load delay with the Parkinsons patient there was a VSA call at a medical professional building just down the street from the hospital. My preceptor decided it would be good for me to attend this call and we left our patient with my preceptors partner while we went across the street and assisted the ALS crew that was attending the call. When I arrived there were a truck of firefighters on scene assisting CPR and the ALS crew was already running their arrest, so I simply asked where they needed me. First they put me on ventilations with the ALS medics partner holding the mask seal. After several CPR cycles they had me giving compressions and rotating with the firefighters while the attending ALS medic pushed epi. We moved the patient and brought them to the hospital where another classmate of mine picked up compressions as we headed to recus. After two more cycles of CPR a doctor pronounced the patient.
Saying that this was an amazing day may seem tasteless or odd to some people, but this is a pretty vital step in my education. I've gone from having practically no patient exposure to having worked a patient that was pronounced. Having done that and being told that I performed well meant a lot to me and I'm hoping to be able to improve my ability to assess patients to the point that I'm able to run calls before the end of my spring ride outs.
Our first call was for renal colic, or kidney stones. We met the patient in their driveway and in a great amount of pain. One of the problems with renal colic is that there is no position of comfort, just absurd amounts pain. An advanced care crew would have been able to give morphine or fentanyl for pain (which may not even work on the pain), but primary care medics don't have any pain management measures. So we spent all sort of time with a patient that I felt completely powerless to help, which is an absolutely terrible feeling.
The second call came in as a middle aged patient with shortness of breath and FRI positive. After gathering some history we determined that she had influenza and was suffering from it for the past 4 day. We then found out that the patients spouse had left two weeks ago on top of the flu that she was experiencing. The patient was given dimenhydraminate to help with their nausea. The hospital staff were on shift change at the time we brought our patient in so it took a bit of time to get the patient admitted. I spent a lot of time trying to reassure the patient and tell them they had no reason to feel ashamed or embarrassed for what she was going through.
The next patient we dealt with was an elderly person with Parkinsons, the call came in as code 3, difficulty swallowing. When we arrived on scene we were lead into the bedroom by a caretaker and shown the patient. The patient was very small and thin, I could have put my thumb and index finger around the pt's wrist and touched my second knuckle, the patient may have been 40 kg in total. The patient had diminishing ability to respond to begin with, today the patient was even further declined and wasn't able to swallow. Not being able to swallow meant that the patient wasn't able to take their daily medication and they haven't been able to eat since noon yesterday. There wasn't much we could do for the patient other than transport and monitor the patient until the patient was admitted. This was my first time having to deal with offload delay, which was only around 3 hours.
During my off load delay with the Parkinsons patient there was a VSA call at a medical professional building just down the street from the hospital. My preceptor decided it would be good for me to attend this call and we left our patient with my preceptors partner while we went across the street and assisted the ALS crew that was attending the call. When I arrived there were a truck of firefighters on scene assisting CPR and the ALS crew was already running their arrest, so I simply asked where they needed me. First they put me on ventilations with the ALS medics partner holding the mask seal. After several CPR cycles they had me giving compressions and rotating with the firefighters while the attending ALS medic pushed epi. We moved the patient and brought them to the hospital where another classmate of mine picked up compressions as we headed to recus. After two more cycles of CPR a doctor pronounced the patient.
Saying that this was an amazing day may seem tasteless or odd to some people, but this is a pretty vital step in my education. I've gone from having practically no patient exposure to having worked a patient that was pronounced. Having done that and being told that I performed well meant a lot to me and I'm hoping to be able to improve my ability to assess patients to the point that I'm able to run calls before the end of my spring ride outs.