Hello. This is what medic school feels like.
Hello. This is what medic school feels like.
As a medic student, just learning the basics of pharmacology, it was cool to see this in action the other day:
Fifty-something year old woman. “Cardiac emergency”.
To be specific, the patient says she’s having an SVT. She knows “it’s SVT”, because it’s happened before. Twice.
Turns out she’s She’s right:
The red lines in the EKG above are time. Five of those bigger boxes is a second. We have her at about 215 bpm:
The medic establishes an IV in the patient’s arm while I hang a bag. The medic pushes Adenosine into the line—with a fluid chaser, because it needs to get to the heart now. (Adenosine only stays potent for five seconds!).
But gets there it does. And what does it do when it’s there? Oh, it only stops the heart and restarts it. That’s all.
Above, you see the Adenosine work real time. First, the wave looks like a normal rhythm—only twice as fast. When the drug hits, the line gets all wacky. (Thats V-Tach: the lower bit of the heart going nuts).
Then the heart stops! For almost two seconds; the heart is not working.
The patient clutches her chest and says, “I don’t feel so good”. For almost two seconds.
Then she’s okay.
And that’s pharmacology.
So we get called to a toddler choking on a hotdog. By the time we arrive the kid’s airway is clear again, and his color is good.
At the house we quickly check the kid over and get some signatures before calling it quits for the day. As we’re standing there I notice two creepy coincidences:
Number One: The walls are decorated with framed, cheesy aphorisms. The most prominent piece, in the living room, reads: “Life Is Not Measured By the Number of Breaths We Take, But By the Moments That Take Our Breath Away”.
Number Two: The patient’s sister is sitting there the whole time playing with a Corpse Bride doll.
The doll has text book cyanosis.
Why do I feel I’m the only one who notices these things? Well, anyway good thing the kid didn’t die. That would have been weird for everyone.
It’s been a long time since I’ve posted.
I’d like to say that medic school has just been too time consuming, and I haven’t had the energy to post. And although that is true—books, and classes, and clinicals, and ride-time, not to mention working—the whole story is that I got a new computer and lost some passwords in the process.
But now I’m back (here anyway).
So, where was I? Oh, yeah… dead babies. Above is the wrong way to establish IV access in a peds. Or as we say in medic-school: “teratogenesis”.
The firehouse alarm sounds. Then another and another. Cop cars and fire trucks go screaming past my house. Tons of them. I check the 911 app on my phone and see that there’s an MVA down the road.
I can’t go—I’m about to start class for the new semester of the paramedic program at the community college—first day of patho is in 45 minutes on the other side of the river.
Then I hear the helicopter.
Okay… this is a bad one.
I throw on my jacket (haven’t worn the local volly gear in a while), and head to the scene. Past a million cops, and beyond the yellow tape, a pick up truck is mashed nose first into a tree. A medic was instructing firemen who were about to start CPR. I helped him fetch a few things while he was on his phone with medical control—already looking to “call it”.
You do this long enough and you know when they’re gone just by the look on their face. The driver had that look. His twin brother, the passenger, died in the hospital later that night.
The medic asked me to put a sheet over the driver, so I did. Then I went to school like nothing happened.
My patient—a sweet little old lady— looks out the window, at a magnificent rolling vista, and says, “Wow, that’s really beautiful … you wouldn’t know people are getting murdered out there. Murdered and killed.”
“Um… and falling in love,” I say.
• • •
Pt is a seven year old at a motocross. Kid fell off his bike and was fine, but when moving his bike off the track, got hit by a kid on another bike.
In the back of the ambulance kid his screaming in “pain”. Finally he says to dad (who is riding along in the captain’s chair), “I don’t want to ride motocross anymore.”
“Okay,” says dad. “You don’t have to. We’ll sell your bike tomorrow.”
Then, through sobs, kid says, “but… can’t we just keep it… for the memories?”
The first thing he asked was how are we going to get him out of there? A reasonable question.
Well, the fire-guys are here, setting up their equipment; they’re gonna’ cut the roof off, I told him.
Little did we know how hard it would be after that. It was a perfect storm of an entrapment: Bottom of car was wedged against a tree; side of car was dug into the hillside; and the pt weighed over 400 lbs.
We each took turns thinking, fuck how the hell are we going to get this guy out of here?
But eventually—after about an hour and fifty minutes—we had him out and en route to the hospital.
Many hands make light work.