I'm always left shaking my head at the amount of oxygen tubing that some of our COPD patients have throughout their house. The most recent one had a total of 56ft of oxygen tubing with a concentrator set at 2LPM. Complaint? Can't breathe after putting away laundry.
O2 sats were in the low 80's.
Pt is normally sedentary and hasn't attempted doing housework for over 2 months (it was obvious).
Pt was adament that she must have gotten pneumonia walking around her house within the past 15 minutes.
While taking her hx and writing down meds, we attached her 6ft cannula to our portable bottle at 2LPM. After about 3 minutes, she stated that she feels "a lot better." Imagine that!
When my partner and I tried to explain WHY she feels better, the patient pretty much told us that we were stupid. She informed us that her home health service oxygen "delivery man"(the ones that brought out the initial 25ft tubing and 6ft cannula) had told her that it would be fine to attach another 25ft section of tubing so that she could walk around the house, when she asked him earlier today. Quote: "they actually KNOW what they're talkin' about 'cause they do this all the time!" Yes, somebody who brought you an oxygen concentrator and delivers oxygen bottles to your house, with absolutely no medical knowledge, knows more about oxygen concentration percentages than the two of us, who have actually had some schooling and knowledge in this area. When I asked if the "delivery man" actually takes her vitals and checks her oxygen level, the pt got pissed off and stated that she didn't "want no man touchin' me that I don't know!"
In the end, we ended up explaining oxygen delivery like a water hose outside. Apparently she used to like to garden, so this made sense to her (we ended up talking about her now-dead vegetable garden).
Of course, she refused to go to the hospital. We shortened her hose back down to just the 25ft tubing with her cannula since "without that tubing, I just strangle cause I go to walk and get pulled right back with this thing around my neck."
Sigh. Really? Oh yeah, she's been on home oxygen for over a year now.
Friday, April 2, 2010
Friday, February 26, 2010
Waffles mmmmm
So, we of course, have quite a few frequent fliers. You know the address by heart while you curse in the back of your mind (or on your way to the truck). Some of them have true medical problems and aren't very well medicated, so they call pretty often but are happy to have you there to help them. Others just flat out abuse the system. Oh, they have medical problems alright, but would rather spend their welfare and social security checks on drugs than on their actual prescribed medications.
We have one patient, she is in her early 60's that call AT LEAST 3 times a week. Of course, with the way our schedule is, more often than not, one of us ends up running her at least twice in a week (more if you work overtime). The issue? COPD and CHF. Nothing like trying to figure out which one it is when you have some nice COPD and CHF symptoms occuring simultaneously. She will now be know as SALL (Smokes A Lot Lady) due to her 2 pack/day habit. The bigger problem of course, is the fact that she will smoke some pot or crack (depends on the time of day), will flip out because she is now having trouble breathing. DUH!
Now, often times, she will go ahead a start a neb while calling us. Many times we get there and she says she is fine now, she was "freakin' though cause dis thang won't work" indicating her nebulizer (that is clearly working correctly). Pretty much, she will turn it on after filling the chamber correctly and will pull and pull on it trying to get the medication to aerosolize faster (which of course, isn't how it works). This is normally what happens.
SALL: I's jus' sittin' here and couldn't breathe so I put this thing in here but it wasn't workin' good and fast so I's call you.
DP: How are you feeling now SALL?
SALL: Fine. You's can go now.
DP: You realize you just called us out at 3am right? You called and so they sent an ambulance AND a firetruck out here because you said you couldn't breathe and your medicine wasn't helping.
SALL: Um yeah.
DP: It's not as simple as us just leaving now. You can't just do that and act like we were just hanging out in the neighborhood and decided to drop by. Were you smokin' crack tonight? (smell was in the air)
SALL: Um no. I was um cookin'. Waffles. Yeah. I was cookin' waffles.
DP: Really? You were cooking waffles, huh?
SALL: Yeah... nawwwww. *deep smoker laugh* I was smokin' some crack. How'd ya know?
DP: The smell. You need to sign a refusal saying you don't want to go to the hospital if you're not going with us now.
SALL: What? Last time I did that I got a thing from you's billin' people sayin' I owe 'em money and my insurance won't pay fer y'all.
DP: What insurance? You're on medicaid and medicare.
SALL: Yeah, that's what I'm sayin... my insurance.
DP: *facepalm* That's not actually insurance and it is billed differently. Since you chose to not go to the hospital before, then it was you saying that you decided to call 911 and then changed your mind and so therefore it was not an emergency when you called. Medicaid and Medicare will only pay for it if you actually go to the hospital.
SALL: Oh. You's gonna bill me this time since I'm not goin'?
DP: I don't know. I'm not in charge of billing.
SALL: Oh. Can I make you some waffles so I don't get a bill?
DP: NO. (never mind the fact that I definitely do not want anything from your kitchen! UGH!)
SALL: Okay, gimme that thing and let me sign it so I can get back to my waffles *winks at me*
DP: Alright, here. Just give your neb some time to work after you "cook waffles" next time (actually did quotes in the air).
Sadly enough, my partner and I ended up going to Denny's since we were now hungry for breakfast food. I just do NOT understand some people and how it doesn't seem to matter to them to just blatantly abuse the system.
We have one patient, she is in her early 60's that call AT LEAST 3 times a week. Of course, with the way our schedule is, more often than not, one of us ends up running her at least twice in a week (more if you work overtime). The issue? COPD and CHF. Nothing like trying to figure out which one it is when you have some nice COPD and CHF symptoms occuring simultaneously. She will now be know as SALL (Smokes A Lot Lady) due to her 2 pack/day habit. The bigger problem of course, is the fact that she will smoke some pot or crack (depends on the time of day), will flip out because she is now having trouble breathing. DUH!
Now, often times, she will go ahead a start a neb while calling us. Many times we get there and she says she is fine now, she was "freakin' though cause dis thang won't work" indicating her nebulizer (that is clearly working correctly). Pretty much, she will turn it on after filling the chamber correctly and will pull and pull on it trying to get the medication to aerosolize faster (which of course, isn't how it works). This is normally what happens.
SALL: I's jus' sittin' here and couldn't breathe so I put this thing in here but it wasn't workin' good and fast so I's call you.
DP: How are you feeling now SALL?
SALL: Fine. You's can go now.
DP: You realize you just called us out at 3am right? You called and so they sent an ambulance AND a firetruck out here because you said you couldn't breathe and your medicine wasn't helping.
SALL: Um yeah.
DP: It's not as simple as us just leaving now. You can't just do that and act like we were just hanging out in the neighborhood and decided to drop by. Were you smokin' crack tonight? (smell was in the air)
SALL: Um no. I was um cookin'. Waffles. Yeah. I was cookin' waffles.
DP: Really? You were cooking waffles, huh?
SALL: Yeah... nawwwww. *deep smoker laugh* I was smokin' some crack. How'd ya know?
DP: The smell. You need to sign a refusal saying you don't want to go to the hospital if you're not going with us now.
SALL: What? Last time I did that I got a thing from you's billin' people sayin' I owe 'em money and my insurance won't pay fer y'all.
DP: What insurance? You're on medicaid and medicare.
SALL: Yeah, that's what I'm sayin... my insurance.
DP: *facepalm* That's not actually insurance and it is billed differently. Since you chose to not go to the hospital before, then it was you saying that you decided to call 911 and then changed your mind and so therefore it was not an emergency when you called. Medicaid and Medicare will only pay for it if you actually go to the hospital.
SALL: Oh. You's gonna bill me this time since I'm not goin'?
DP: I don't know. I'm not in charge of billing.
SALL: Oh. Can I make you some waffles so I don't get a bill?
DP: NO. (never mind the fact that I definitely do not want anything from your kitchen! UGH!)
SALL: Okay, gimme that thing and let me sign it so I can get back to my waffles *winks at me*
DP: Alright, here. Just give your neb some time to work after you "cook waffles" next time (actually did quotes in the air).
Sadly enough, my partner and I ended up going to Denny's since we were now hungry for breakfast food. I just do NOT understand some people and how it doesn't seem to matter to them to just blatantly abuse the system.
Monday, February 8, 2010
Ugh
Tonight, while reading the news, I realized that just a few months ago, I'd transported a little boy that died from being beaten to death two days ago. I didn't run the call for the code, another paramedic that I've been friends with for years ran it. I didn't realize it until I saw the toddler's name in the paper (unusual name) and had that "wait, didn't I run him before?" Previously, it was because the mom was uneducated about basic stuff (in this case, having to use a bulb syringe to clear little noses rather than thinking a 1yr old will blow his own nose). Transported little guy and tried to educate mom on basics of taking care of a baby with a cold. No signs of abuse at the time (well-fed, up-to-date immu, and we undressed him down to the diaper because he had a fever). Kiddo was cute as could be and interacted a lot with my partner and I (even for his age and the fact that he probably felt like crap). Hell, I was the one that carried him to the truck.
It saddens me that the mom has been charged with child abuse and neglect, while the mom's boyfriend (not baby's daddy) is charged with the child's death due to reported ongoing abuse throughout the day while the mom was reportedly at work. Of course, not all of the bruises and cuts were new, so claiming that she had "no idea" isn't going to fly. I think they should both be charged with the death.
I need a drink. I just don't understand how somebody could ever hurt a child, much less KNOW that their child is being abused and not do anything to prevent it or remove themselves and their child(ren) out of that position. We have plenty of women and children's shelters down here with resources to help. All of our officers down here will take any woman and children(and arrange for car seats to be brought to the scene for children that need them) that want/need to go to the shelter.
It saddens me that the mom has been charged with child abuse and neglect, while the mom's boyfriend (not baby's daddy) is charged with the child's death due to reported ongoing abuse throughout the day while the mom was reportedly at work. Of course, not all of the bruises and cuts were new, so claiming that she had "no idea" isn't going to fly. I think they should both be charged with the death.
I need a drink. I just don't understand how somebody could ever hurt a child, much less KNOW that their child is being abused and not do anything to prevent it or remove themselves and their child(ren) out of that position. We have plenty of women and children's shelters down here with resources to help. All of our officers down here will take any woman and children(and arrange for car seats to be brought to the scene for children that need them) that want/need to go to the shelter.
Tuesday, January 26, 2010
Ignorance
Especially when it is related to kids, annoys the crap out of me. I don't understand how parents can be so wrapped up in themselves that they just forget to pay attention to those other little humans that they created.
Tonight we went to a "sick call" for a toddler. On scene, family and neighbors were outside literally screaming and yelling while mom was just screaming and pushing a little girl into my partner's arms. The little one was very hot to the touch, pale, mottled, and cyanotic around her lips.
Does anybody know what happened? No.
Has anybody been drinking? Yup, all of the adults (and it seemed like some of the teenagers).
How long has she been this color? About 5 minutes. They actually waited over 5 minutes before calling 911... Long enough for the kid to stop having a grand mal seizure and just start staring upwards (per the kid's grandmother who was the only semi-calm one on scene).
Okay... so a febrile seizure. No biggie, kiddos have them all the time.
Get her in the truck, little oxygen, quite a bit of stimulation since she wasn't breathing as fast as she should have been, and get her undressed. I would just like to say this: if you have cats or dogs in your house, clean up their shit! Don't let your kids play in it or walk in it. That's just disgusting and shows me that you are a lousy parent who doesn't take the time to wipe your child's feet off before you put their shoes on them. (The shoes would have had to be put on by an adult, the kiddo couldn't have tied them or slid them on with how tight they were.)
Dirty clothes I can understand. Wet/dirty diapers I understand. Dried and crusty animal shit on your kid's feet? No I don't understand.
We got a line in her and took her to the nearby pedi facility. She did do better enroute but still wasn't really acting appropriate for age.
Turns out that she was unsteady and "shaky" all day earlier and hadn't been as active as normal. This apparently didn't seem like a big deal until I started asking the grandmother about her activities during the day, after we'd gotten to the hospital. Apparently no adults had "really messed with her" since lunch. It's now 10pm. How can you just "not mess with" a 2 year old for probably 10 hours? That would explain why her diaper was completely soaked with urine to the point where it was only being held up by the pants that she'd been wearing.
I don't understand how some people can just procreate like it is nobody's business but yet there are so many couples that are trying so hard for a baby and can't conceive.
Oh, after we cleared from the hospital. RAD (from quite a few posts back) tells me "they're putting money on that she has croup."
DP: On what basis?
RAD: Well the sudden spike in fever and she was coughing in there.
DP: Yeah, she started coughing when she was crying (this was in the ER) and was sniffling. Her lungs were completely clear and she didn't have any stridor. (One of the first things I checked when I saw how cyanotic she was initially.) She has a really strong cry and doesn't even have the typical barking cough.
RAD: Well the nurses are putting money on it. So's the doc even! I'd put my money on croup.
Note: The doc doesn't impress me. It's the same doc from the status seizure pt I took there a while back.
DP: The nurses didn't say anything about that. All three of them were in the room the whole time with me, the patient, and the grandmother. (Those were the only nurses around that had even seen the patient.) If I had to put money on something, I'd say it was an ear infection.
RAD: Well, she has a high fever though! (It was 104.1F at the ER after we'd already been cooling her and she'd been given APAP enroute.)
DP: Yes, but that isn't really indicative of croup. Croup is normally lower grade fevers and doesn't normally hit suddenly or present with no respiratory symptoms.
RAD rattled on some other ignorant bullshit and I just tuned him out. It was a long ride back to the station.
Tonight we went to a "sick call" for a toddler. On scene, family and neighbors were outside literally screaming and yelling while mom was just screaming and pushing a little girl into my partner's arms. The little one was very hot to the touch, pale, mottled, and cyanotic around her lips.
Does anybody know what happened? No.
Has anybody been drinking? Yup, all of the adults (and it seemed like some of the teenagers).
How long has she been this color? About 5 minutes. They actually waited over 5 minutes before calling 911... Long enough for the kid to stop having a grand mal seizure and just start staring upwards (per the kid's grandmother who was the only semi-calm one on scene).
Okay... so a febrile seizure. No biggie, kiddos have them all the time.
Get her in the truck, little oxygen, quite a bit of stimulation since she wasn't breathing as fast as she should have been, and get her undressed. I would just like to say this: if you have cats or dogs in your house, clean up their shit! Don't let your kids play in it or walk in it. That's just disgusting and shows me that you are a lousy parent who doesn't take the time to wipe your child's feet off before you put their shoes on them. (The shoes would have had to be put on by an adult, the kiddo couldn't have tied them or slid them on with how tight they were.)
Dirty clothes I can understand. Wet/dirty diapers I understand. Dried and crusty animal shit on your kid's feet? No I don't understand.
We got a line in her and took her to the nearby pedi facility. She did do better enroute but still wasn't really acting appropriate for age.
Turns out that she was unsteady and "shaky" all day earlier and hadn't been as active as normal. This apparently didn't seem like a big deal until I started asking the grandmother about her activities during the day, after we'd gotten to the hospital. Apparently no adults had "really messed with her" since lunch. It's now 10pm. How can you just "not mess with" a 2 year old for probably 10 hours? That would explain why her diaper was completely soaked with urine to the point where it was only being held up by the pants that she'd been wearing.
I don't understand how some people can just procreate like it is nobody's business but yet there are so many couples that are trying so hard for a baby and can't conceive.
Oh, after we cleared from the hospital. RAD (from quite a few posts back) tells me "they're putting money on that she has croup."
DP: On what basis?
RAD: Well the sudden spike in fever and she was coughing in there.
DP: Yeah, she started coughing when she was crying (this was in the ER) and was sniffling. Her lungs were completely clear and she didn't have any stridor. (One of the first things I checked when I saw how cyanotic she was initially.) She has a really strong cry and doesn't even have the typical barking cough.
RAD: Well the nurses are putting money on it. So's the doc even! I'd put my money on croup.
Note: The doc doesn't impress me. It's the same doc from the status seizure pt I took there a while back.
DP: The nurses didn't say anything about that. All three of them were in the room the whole time with me, the patient, and the grandmother. (Those were the only nurses around that had even seen the patient.) If I had to put money on something, I'd say it was an ear infection.
RAD: Well, she has a high fever though! (It was 104.1F at the ER after we'd already been cooling her and she'd been given APAP enroute.)
DP: Yes, but that isn't really indicative of croup. Croup is normally lower grade fevers and doesn't normally hit suddenly or present with no respiratory symptoms.
RAD rattled on some other ignorant bullshit and I just tuned him out. It was a long ride back to the station.
Sunday, January 3, 2010
Buzzzzzzzzz
You know those times when you can't help but laugh? When you're standing there, trying SO very hard to hold it in that you start snorting? This is one of those times.....
We got called out to an elderly female having chest pain. Okay, no big deal.... the firefighters on scene tell us that the pt has a history of anxiety and has been treated for it earlier today at her doctor's office.
When we get on scene (picture a very well-to-do neighborhood), this nice little old lady (LOL) is sitting in her living room, very calm and complaining of generalized chest pain, arm pain, neck pain, leg pain, and head pain x3 months. Okey dokey.
After we've loaded her up in the box and are transporting her to the hospital (it's about a 25-30 minute trip from there depending on the traffic), I start asking her some more questions about her pain.
DP: Have any medications helped your pain?
LOL: No
DP: Has anything else relieved your pain?
LOL: Well, yes. Actually my vibrator helps it feel a lot better.
DP: o-O ummmm really?
LOL: Oh yes, it's just wonderful and it vibrates so good! It helps work out a lot of my tension.
*thinking to myself* Surely she must have mispoken. I'm all for being in touch with your sexuality but this was just plain awkward now.
Of course... since it's awkward, I start to get the giggles.
DP: So could you describe it to me?
LOL: Describe what?
DP: The thing that you said helps you. (I was trying to not embaress her at this point.)
LOL: Oh my vibrator! Well it's about this long (holds hands up about 10" apart) and about this big around (about the size of a 1L bottle of soda). It vibrates really good and you can adjust the speed. Oh! There's heat from it too. That works the best.
DP: Heat? You have a heated vibrator? (at this point, I'm sure she's pulling my leg)
LOL: Oh yes, it's wonderful. My daughter gave it to me for Christmas.
I finally got an idea of what she was trying to say.
DP: Is it also called a back massager?
LOL: Oh yes! That's it... a vibrator or massager thing.
I was trying so hard to not laugh, I started snorting and just couldn't help myself. I swear I would have pissed my pants if I hadn't started laughing. I felt so bad for this poor lady. Here I am, laughing my ass off and she has no clue why. Her transport was uneventful and she did just fine.
Of course, the best part..... telling the receiving RN at the facility what makes her pain better.
We got called out to an elderly female having chest pain. Okay, no big deal.... the firefighters on scene tell us that the pt has a history of anxiety and has been treated for it earlier today at her doctor's office.
When we get on scene (picture a very well-to-do neighborhood), this nice little old lady (LOL) is sitting in her living room, very calm and complaining of generalized chest pain, arm pain, neck pain, leg pain, and head pain x3 months. Okey dokey.
After we've loaded her up in the box and are transporting her to the hospital (it's about a 25-30 minute trip from there depending on the traffic), I start asking her some more questions about her pain.
DP: Have any medications helped your pain?
LOL: No
DP: Has anything else relieved your pain?
LOL: Well, yes. Actually my vibrator helps it feel a lot better.
DP: o-O ummmm really?
LOL: Oh yes, it's just wonderful and it vibrates so good! It helps work out a lot of my tension.
*thinking to myself* Surely she must have mispoken. I'm all for being in touch with your sexuality but this was just plain awkward now.
Of course... since it's awkward, I start to get the giggles.
DP: So could you describe it to me?
LOL: Describe what?
DP: The thing that you said helps you. (I was trying to not embaress her at this point.)
LOL: Oh my vibrator! Well it's about this long (holds hands up about 10" apart) and about this big around (about the size of a 1L bottle of soda). It vibrates really good and you can adjust the speed. Oh! There's heat from it too. That works the best.
DP: Heat? You have a heated vibrator? (at this point, I'm sure she's pulling my leg)
LOL: Oh yes, it's wonderful. My daughter gave it to me for Christmas.
I finally got an idea of what she was trying to say.
DP: Is it also called a back massager?
LOL: Oh yes! That's it... a vibrator or massager thing.
I was trying so hard to not laugh, I started snorting and just couldn't help myself. I swear I would have pissed my pants if I hadn't started laughing. I felt so bad for this poor lady. Here I am, laughing my ass off and she has no clue why. Her transport was uneventful and she did just fine.
Of course, the best part..... telling the receiving RN at the facility what makes her pain better.
Monday, December 21, 2009
Merry Christmas
Merry Christmas to everybody.... Yes, I said it... MERRY CHRISTMAS!!! It irks the hell out of me when people say shit like "happy holidays" or "season's greetings." This did actually cause me to yell "Merry Christmas" at a crazy lady in a store today.
End of the year updates: I'm still working in this hellhole. The powers-that-be have decided since a change of hands that occured this fall that they are going to majorly limit overtime. So, I'm going to focus on getting my RN since I'm pretty much being forced to have time off from work. I'm also in an absolutely wonderful relationship with a great guy.
End of the year updates: I'm still working in this hellhole. The powers-that-be have decided since a change of hands that occured this fall that they are going to majorly limit overtime. So, I'm going to focus on getting my RN since I'm pretty much being forced to have time off from work. I'm also in an absolutely wonderful relationship with a great guy.
Saturday, July 18, 2009
Brief overview
I realize it's been a long time since I actually posted anything on here. Life happens. I don't think anybody reads this either, so it is more just something for me to do in my spare time (which I don't have much of lately).
Let's see, this will be a brief synopsis of all my jacked up calls since last time I posted.
Really nasty fatality wreck that will definitely be going to court. Yeah, that's not fun. No, I'm not posting more on it.
Then a really bad wreck thanks to a drunk driver. The driver and the passenger (both adults) were both drunk as shit and went the wrong way on a one-way street, smashing into another car. Once we really got to look at the vehicles (after all the patients had been transported) it was amazing that we had anybody survive at all. Apparently the driver that caused the wreck is still alive (this was about a month ago), even though he's paralyzed from the chest down, had massive internal injuries, had both legs amputated, and is essentially a vegetable now because of his multiple head injuries.
Then I had a patient that apparently walked out of the bathroom, told her family she had a horrible headache and went unconscious. When we got there, she was having a stroke. We treated her and flew her out to a stroke center. On follow up, they said that she had a such a massive bleed that there really isn't anything they can do about it at this point accept make her comfortable.
Well, that's about all I want to post for now.
Let's see, this will be a brief synopsis of all my jacked up calls since last time I posted.
Really nasty fatality wreck that will definitely be going to court. Yeah, that's not fun. No, I'm not posting more on it.
Then a really bad wreck thanks to a drunk driver. The driver and the passenger (both adults) were both drunk as shit and went the wrong way on a one-way street, smashing into another car. Once we really got to look at the vehicles (after all the patients had been transported) it was amazing that we had anybody survive at all. Apparently the driver that caused the wreck is still alive (this was about a month ago), even though he's paralyzed from the chest down, had massive internal injuries, had both legs amputated, and is essentially a vegetable now because of his multiple head injuries.
Then I had a patient that apparently walked out of the bathroom, told her family she had a horrible headache and went unconscious. When we got there, she was having a stroke. We treated her and flew her out to a stroke center. On follow up, they said that she had a such a massive bleed that there really isn't anything they can do about it at this point accept make her comfortable.
Well, that's about all I want to post for now.
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