Week 4

Sunday, Bloody, Sunday....

Well, this past week was quite an experience. I had a different preceptor each day because my usual preceptor was out of town for the weekend. It was especially an adjustment because the average age of the Paramedics covering for my preceptor was probable 50 years old, which is twice the age of my normal preceptor, Brittany.

Anyhow, I should just get to the nitty gritty of the calls. Sunday morning began with us getting a call as soon as we left the base station. We arrived on scene at 4:45 a.m. to find the police next to an apartment building with their flash lights pointed toward a woman sobbing and uttering incomprehensible speech, wearing only a shirt, which apparently came from a tenant who had found her and called the police. The woman was in her 20’s and was hunched over in a flowerbed holding her abdomen like the contents within would fall out if she were to let go. The police stated that no one knew who she was or where she had come from. The only item she had in her possession was a cell phone.

Did I mention that it was raining? This woman was lucky if she were to register 100 lbs. on a scale. You would’ve of thought she would be hypothermic wearing no clothes and being soaked to the bone. My first impression was that she was jacked up on Meth, but as we got our first set of vitals she was not tachycardic and her blood pressure was on the low side of normal. The medic, Preston said he thought it was a psychotic break and we immediately started to prepare for IV access and a regimen of sedatives.

The woman started using recognizable words, but still didn’t make much sense and seemed to be in a panic that “they” would hear her and come back to do her harm. Our attempt at peripheral IV’s failed so Preston decided to do an EJ (external jugular, IV). He had given versed IM (Intramuscular injection) a few minutes before so the woman was slowly becoming more and more flaccid and relaxed. Once the EJ was in he administered Haldol and the woman was out! We transported her to the ER and headed to our next post.

We barely made our next post and received a call for a stabbing. Dispatch confirmed that the assailant had fled from the scene and that police had secured the area. As we approach the address I notice that we were entering a nice apartment complex (much like the one that we live in currently). I began recalling the past calls I have been on, and not in a million years would I have guessed that my first actual serious assault would occur in a nice, well-kept community. We arrived on scene the same time as the Fire Dept. At this point, I am a little leery of just jumping out of the ambulance, so I take it slow and I am in total condition red, waiting for some lunatic to come running at me with a knife. As I step out of the back of the ambulance Preston comes to the back of the ambulance just as a black SUV quickly pulls in about 15 ft. away from us. A man jumps out and approaches us asking where his brother is. In a split second, Preston goes into defensive mode telling the man to stop right where he is at. The man continues to approach him saying, “the Dude is his brother!” With the use of some colorful language, Preston tells the man to stop where he is and to get back in his vehicle.

At this point I am trying to decide if I should continue to stay with Preston as both men are now seriously agitated with each other (I can see another assault about to take place). Just then another police officer pulls up and Preston points to the man and asks the officer to deal with him. I grab the trauma bag and follow Preston to the scene. As I approach the victim I see firefighters kneeling down beside the young man, they are holding pressure to the victim’s chest with a shirt that is soaked in blood. A girl is sobbing and walking away from the victim with blood on her shirt. The Firefighters say they need a HALO (Occlusive bandage) and ask me for a stethoscope to listen to lungs sounds.

Preston is not interested in staying on scene for long, so he directs the firemen to put the victim on a backboard and get him to the ambulance. The victim (a 21 year old male) is crying and screaming he can’t breathe, while the veteran EMS personnel assure him that he can because he is able to scream and tell them how much pain he is in (Not much for consoling the victim). The young man becomes more agitated and starts swearing at us. As I kneel beside him and help move him to the backboard I find another stab wound to his lower abdomen with minimal bleeding.

We get him in the back of the ambulance and the young man continues to yell in agony that he hurts and can’t breathe. I step up into the ambulance and Preston tells me to get an IV started. I apply a constricting band to the guy’s arm and Preston hands me a 16 gauge needle. (Now I was a little disappointed that he didn’t hand me a 14 gauge, but I haven’t stuck a patient with a 16 yet, so I guess I am working towards a 14). I get the IV and start a bag of fluids. Next I move to trying to calm the guy down and grab a NRB (non-rebreather mask) and tell the guy that he his breathing OK and that his vitals are looking good. We drive code to Oklahoma’s Level I Trauma Center (OU Presby). I continue my assessment and look for other stab wounds that we might have missed. The young man begins to tell us about the assault and that “The Dude” who stabbed him was a guy he worked with. (Talk about working with bad people!) All in all the young man had a 3 inch laceration to his left lateral chest (which I am sure it may have been from multiple stabbings to his chest) and one stab wound to his left lower abdomen, his lung sounds were diminished mainly because he wouldn't take a deep breathe due to the pain it caused. 
We got him to the ER and it was pretty amazing to see the trauma team go to work, I am estimating that they had him into surgery within 20 minutes of our arrival. Upon there assessment and x-ray they confirmed that his left lung had collapsed. I spent the next 5 minutes or so trying to wash the guy’s blood out of my pants. Later, I asked Preston what you do if a patient won't take a deep enough breath for you to hear lung sounds and he said that he just pressed his thumb in the guys wound to make him gasp and take a breath. "Do no harm", except when necessary.  We left the hospital with 8 hours left in our shift; it had been an exciting morning.