Week 3

So, things are going well! I am enjoying the new experiences of each day! This last week has been the most eye opening of experiences. To start, Sunday morning first call of the day, which came at 5 a.m in the morning was for a man with breathing problems. As I walk into the home, a lady greets me and points to her husband who is sitting across the room in an office chair hooked up to oxygen via nasal canulla. The man is about 450 lbs. (imagine the man in picture and add about 30-40 years) and has a scraggily white beard, and looking very, very sick! The man was not the model of health. I start my assessment and history of the man's present illness. As I am asking questions, I learn that the man had just been released from the hospital the day before and was diagnosed with pneumonia, in addition existing severe case of COPD. As I am questioning the man and continuing my assessment, I see drool/snot coming from his oxygen tubing attached to his face. As my preceptor and driver enter the room followed by 5 firefighters, she comes up to me and asked me if I had listened to his lungs yet (as she takes her stethoscope and listens). She looks up at me and says "He isn't moving any air!" At this point, I am not only kicking myself for not jumping right to it and listening to his lung sounds, but I am also freaking out! THE MAN IS NOT MOVING ANY AIR IN OR OUT OF HIS LUNGS! I yell to my driver to grab me a BVM, so I can start bagging the man and start breathing for him as he has lost the ability to do it himself. My preceptor then asks, "Didn't you notice the cyanosis in his lips?!" I am thinking to myself how in the world did I not take that into account as I totally see that they are blue-ish in color. And here I am, asking the man questions about his present illness, when I should've been performing interventions to save the man's life!
     Well, not 15 seconds pass, and the man stops breathing all together and collapses. I finally get the BVM in my hand and start bagging him. The firefighters are scrabbling around trying to prepare a route to move this man out to the ambulance. My preceptor and driver are preparing the cot, and I begin cutting the man's shirt off to throw the fast patches(defibrillation pads) on the man's chest. The firefighters finally get a back board and we are all trying to maneuver to move this guy to the cot. One firefighter is trying to get around the head of the guy and me and he begins to kick stuff out of the way, which is classic scenario of trying to move a patient from whatever "hole" your trying to get them out of. I mean there was stuff everywhere in this house. This man weighs 450+ lbs. and there I tiny paths to maneuver through the house. I highly doubt he ever went to some parts of his house! Now, I am trying to emphasize and paint a picture of the difficulty of moving any and all patients from their living quarters and the challenges of maneuvering a cot in such tight spaces, not focus or make fun of this man's weight. We finally get him loaded on to the cot (which doesn't seem like its ever made for any of the rounder patients we frequently pick up) and get him into the ambulance. The man is now pulseless and I continue bagging him, while our crew and two firefighters begin chest compressions. My preceptor is preparing advanced airway equipment and as well as attempting to get IV access. There are so many things going on at once in a cardiac arrest call, that it is like a whirlwind of events, so many things needing to be done and prepared and all at once. Meanwhile, the man is building up a lot of thick mucous secretions. My preceptor tells me I need to attempt to intubate the man. I have the laryngoscope  right there in front of me and she has prepared the tube for me. I am now taking into account the man's size and that he literally has no neck(pretty much the most difficult of patients to intubate). I make my first attempt and as I open his mouth and stick the laryngoscope into his mouth and view his throat, I see nothing but heavy secretions and that is it! I pull the blade out and call for suction and begin suctioning, and then begin bagging him again. I make my second attempt and cannot see any cords, I lift, bend and push his head back to get a better view, but my attempts to get a better view are unsuccessful. I pull the blade out and begin bagging and prepare to move for my preceptor to make her attempt. Luckily, she gets the tube and we are now getting a huge improvement on ventilating this man. We confirm with lung sounds present and ETCO2 and I continue bagging. We are driving lights and sirens to the ER and a minute before we arrive we get ROSC (Return of Spontaneous Circulation or simply put, the man pulse returns) and we get him into the ER. This call was a huge eye opener for me and I am still kicking myself for not noticing the signs of his severe respiratory distress upon entering the room. Not a mistake I will make twice! My preceptor and I had a long talk about it and she assures me that it is really the experience that makes the training and knowledge all come together and stick for  that next moment or call when you face the same circumstance again.
The following Monday, we get a call for a man with a diabetic emergency. As we arrive on scene, I step out of the Ambulance and see this man in the driver seat of a red pickup. He appears to be completely naked, excluding that he still had his socks on. A Police officer and Firefighters are on scene. I walk up to the truck and the Fireman tells me that the man's sugar is 441 and that he shouldn't be driving. I step closer to the truck and ask the man what is going on today? He looks at me with the most disgusted facial expressions and says "You skinny white boy, ya'll just tryin to mess wit me today!" I ask him where his clothes are at, and he just shakes his head with the same disgusted look. My preceptor steps up beside me and ask the man where his clothes are and the man begins to laugh. Ha! Ha! "I know you! I recognize you!" She is as surprised as I am. She has never met this man in her life. The man asks us, what we want from him. I say we are just here to help you out. He laughs and says, "You don't give a *@$! about me!" By the way, the man can only answer one question correctly. He knew who the president of the U.S. was. We finally convince him to come with us as his only other choice was to go with police officer. As we get him into the ambulance he is furious that we are just trying to get him locked up in the hospital. We take another blood sugar and it comes up 475! This man's sugar was sky high! No wonder he was so out of his mind. After arguing with him for about 20 minutes, I finally convince him that it wasn't normal for him to be completely naked and that he wasn't supposed to be driving. Funny thing is, that once I convinced him that he wasn't behaving normal, he was convinced that his daughter who he lives with set him up. He said, "That Jemima! I am gonna whoop her _ _ _!" After it was all said and done, the man gave the ER staff the same pleasant greeting he gave us! He was not happy to be in the hospital, but politely thanked me and told me it was great to see me, when I said goodbye to him as we left.