First string of night shifts down.
Had quite a bit going on the last two shifts. Some of it good, some of it not so good.
Today was a shit show ... on my end anyways. There was nothing too special about it, we did 4 calls, which is pretty normal and the calls were the kind of massively dramatic acute calls people would automatically think happen all the time.
First call was a bit of a joke, we were called for a person who was stumbling and disoriented near a bank ... which I guess is code for "drunk guy we don't want around here". As soon as we rolled up to the plaza with an officer right behind us the patient mysteriously vanished. We left and the officer decided to play hide-and-seek with out no show patient.
The next call disappointed me with myself. We were called for shortness of breath, when we arrived the patient was reclined in a chair in the lobby of the apartment building they lived in with fire there doing their thing, which for this particular call it was attach an spO2 sensor and wait for us to show up since we were so close behind. On seeing the patient it was kind of obvious that they were sick, but I had no idea how sick and totally low balled it. They had thick mucousey secretions encrusting their eyes, they had a pretty intense fever going on, despite a tympanic temp of only 36.1°, the patient was going to chemo therapy for stomach cancer, they were tachycardic and tachypneic. Three out of the four SIRS criteria right there ... well sort of. After the call my preceptor asked me my opinion of whether I thought the pt was sick or not sick. I thought about it, I realized he was sick, but at first didn't think he was too bad and figured an ambulance ride wasn't 100% necessary. This is when my preceptor directed me to the SIRS criteria and told me to check it out and come back to him with that sick/not sick verdict. After reading this I realized the patient was in compensatory septic shock and probably needed IV fluids and broad spectrum antibiotics yesterday. Ok, the temp was 36.1°, but that's only .2° away from meeting the less than 36° criteria. The patient was still sitting with a HR around 110-120 the while time we were with them, and they were at rest the whole time. Also, at no point was the blood pressure sitting anywhere near what a heart rate like that would have me expect, the pt was essentially normotensive. The tachypnea was sort of borderline, but it was still there. If I were this patients primary care giver then I'd have utterly failed them, and I didn't take that realization very well.
After some hours we got a call for chest pain, the patient was at a gas station and was in the process of trying to drive themselves to a hospital when their pain got too bad and they decided to call 911. We got on scene and did the usual for a patient with chest pain, asked them about the nature and severity of their pain. Our patient had a previous MI, so they were able to relate it to that fairly well. They had a history of ASA and nitro, so it was essentially a formality to go through the protocols. We attached a 12-lead but didn't see any ST elevation, but it was still very possible that the patient was having a nonSTEMI. We gave nitro, I was asked to go through the protocol on nitro and fumbled around with it. I can see why they didn't bother asking me about ASA, since that's the actual drug that would save his life. Nitro is just a nice to have drug that helps reduce pain ... sometimes. Strike 2 for my confidence.
A bunch more time went by and we got a call for a young patient with suicidal intentions. This call came in some time around 0500, so I had some time to sleep, but when I got woken up, i was just a fucking zombie, the lights were on, but nobody was home. I hardly remember anything from the call other than taking a back seat to the call and essentially just lugging around bags because I didn't end up being good for much else. Strike 3 for confidence ... you're out. The patient was fine, a high school student with depression going through shitty life problems and trying to fight off suicidal thoughts. Luckily the patient decided to call 911 and ask for help ... as for me. Well by the time I was driving home I had pretty much just undermined any sense of confidence I had been trying to build up and set up all kinds of self-sabotaging thoughts that made me feel absolutely worthless and like a piece of shit.
So I went for a run after that shift and went to bed. It sort of helped ... but I'm really tired right now and need to sleep. Maybe I'll write about this shift in a comment to this post after I get some sleep.
Today was a shit show ... on my end anyways. There was nothing too special about it, we did 4 calls, which is pretty normal and the calls were the kind of massively dramatic acute calls people would automatically think happen all the time.
First call was a bit of a joke, we were called for a person who was stumbling and disoriented near a bank ... which I guess is code for "drunk guy we don't want around here". As soon as we rolled up to the plaza with an officer right behind us the patient mysteriously vanished. We left and the officer decided to play hide-and-seek with out no show patient.
The next call disappointed me with myself. We were called for shortness of breath, when we arrived the patient was reclined in a chair in the lobby of the apartment building they lived in with fire there doing their thing, which for this particular call it was attach an spO2 sensor and wait for us to show up since we were so close behind. On seeing the patient it was kind of obvious that they were sick, but I had no idea how sick and totally low balled it. They had thick mucousey secretions encrusting their eyes, they had a pretty intense fever going on, despite a tympanic temp of only 36.1°, the patient was going to chemo therapy for stomach cancer, they were tachycardic and tachypneic. Three out of the four SIRS criteria right there ... well sort of. After the call my preceptor asked me my opinion of whether I thought the pt was sick or not sick. I thought about it, I realized he was sick, but at first didn't think he was too bad and figured an ambulance ride wasn't 100% necessary. This is when my preceptor directed me to the SIRS criteria and told me to check it out and come back to him with that sick/not sick verdict. After reading this I realized the patient was in compensatory septic shock and probably needed IV fluids and broad spectrum antibiotics yesterday. Ok, the temp was 36.1°, but that's only .2° away from meeting the less than 36° criteria. The patient was still sitting with a HR around 110-120 the while time we were with them, and they were at rest the whole time. Also, at no point was the blood pressure sitting anywhere near what a heart rate like that would have me expect, the pt was essentially normotensive. The tachypnea was sort of borderline, but it was still there. If I were this patients primary care giver then I'd have utterly failed them, and I didn't take that realization very well.
After some hours we got a call for chest pain, the patient was at a gas station and was in the process of trying to drive themselves to a hospital when their pain got too bad and they decided to call 911. We got on scene and did the usual for a patient with chest pain, asked them about the nature and severity of their pain. Our patient had a previous MI, so they were able to relate it to that fairly well. They had a history of ASA and nitro, so it was essentially a formality to go through the protocols. We attached a 12-lead but didn't see any ST elevation, but it was still very possible that the patient was having a nonSTEMI. We gave nitro, I was asked to go through the protocol on nitro and fumbled around with it. I can see why they didn't bother asking me about ASA, since that's the actual drug that would save his life. Nitro is just a nice to have drug that helps reduce pain ... sometimes. Strike 2 for my confidence.
A bunch more time went by and we got a call for a young patient with suicidal intentions. This call came in some time around 0500, so I had some time to sleep, but when I got woken up, i was just a fucking zombie, the lights were on, but nobody was home. I hardly remember anything from the call other than taking a back seat to the call and essentially just lugging around bags because I didn't end up being good for much else. Strike 3 for confidence ... you're out. The patient was fine, a high school student with depression going through shitty life problems and trying to fight off suicidal thoughts. Luckily the patient decided to call 911 and ask for help ... as for me. Well by the time I was driving home I had pretty much just undermined any sense of confidence I had been trying to build up and set up all kinds of self-sabotaging thoughts that made me feel absolutely worthless and like a piece of shit.
So I went for a run after that shift and went to bed. It sort of helped ... but I'm really tired right now and need to sleep. Maybe I'll write about this shift in a comment to this post after I get some sleep.