Monday, January 8, 2007

BLS Still

On an overnight shift at work with an EMT rocker on my arm, we head north for an overdose at a drug rehab center. My partner and I joke about the irony of the call as we cruise up the darkened streets, lights but no sirens.

Arriving on scene I hop out and grab our gear. The EMT bag is so small, light. Inside are the mere basics: some O2 supplies, a BVM, oral glucose, minor trauma stuff. I carry the bag around to the stretcher in back and wonder if I've forgotten something. The ALS gear is so much more difficult to carry: heavy with tools and potential. The bag I carry is sparse, and reflects my capability on this call. I remember to bring the handheld radio in case we need to call for a medic. Probably my most valuable tool, I think.

Upstairs we find our patient leaned back in a chair, alone in a lobby with dimmed lights and the feint sound of a TV from another room. His head is back and he snores with each respiration. A nurse comes out from a side room and hands us his paperwork, giving a look like she is annoyed this would happen tonight, at such a late hour and during her TV program. Her report to us informs us only that she knows nothing about the patient.

I put my hand on the shoulder of the man and call his name. "Anthony." I say it twice, louder the second time as I give his shoulder a little shake. His head moves forward as he sluggishly opens his eyes, dazed. He yawns and stands up, ready to get on the stretcher. I guess this guy knows the drill.

He is alert and oriented times four, a little lethargic but so am I this early in the morning. He is without complaint and the vital signs are stable. Pupils are equal round and reactive to light, perhaps a little dilated. Asked if he has been using any drugs tonight, he admits to 2 bags of heroin "a little while ago" and some vodka afterwards. He inquires as to why we dont just take him to the hospital and quit asking him questions.

Getting him down the elevator and into the ambulance, he is becoming increasingly lethargic. I ask him several times to open his eyes and to try and stay awake for us, that the hospital is only a few minutes away. I make a joke about how our driver will need to stay awake also, but the patient doesnt laugh. He's asleep again, awakened this time by a more forceful shake. In the back of the ambulance I take a look at his pupils again. Now they are pinpoint. Very pinpoint, almost as if they arent even there. He is sleeping again, even as I peel his eyelids back to shine my flashlight in.

I put the patient on oxygen and tell my partner that we need to get going. The patient is changing right in front of my eyes, from alert to lethargic, dilated to constricted. I wonder how quickly he will go from breathing to not breathing. I retake vital signs on the way, do a rapid trauma assessment and watch the breathing. His respirations are at a good rate and depth at about 14, but I'm worried. I get the BVM out of the BLS bag and set it on the bench.

Still 5 minutes left to get to the hospital, I sit back on the bench seat and wonder what else I can do for this guy. I found track marks on my trauma assessment and he admitted to recent heroin use, his pupils are constricted and his mental status is changing. I know what a medic would do here -- what I would do if I had a different rocker on my shoulder -- but right now all I can do is sit back and watch. He has great veins, too.

We make it to the hospital without incident. Our patient is increasingly lethargic but continues to breathe well. My report to the nurse is clean and to the point. I say "he needs narcan" without actually saying it, painting the picture as well as I know how. The nurse, looking tired, glances at the patient and sighs. "No IV?" Nope, I tell her, pointing to my shoulder. "I cant."

We are assigned a room and another nurse comes in carrying an IV kit and a frown on her face. I try and tell her the story but she's already heard it from the triage nurse. She knows what needs to be done as well as I do, she doesnt need me around to tell her all about it for a second time. I ask her if there is anything I can do to help but no, she's got it. I take a step backwards as the curtain is zipped from left to right in front of my face. I need to just get out of the way.

I go back and write my run form in the EMS room. The narrative is breif, detailed in assessment but short in treatment. I reluctantly check the "reassurance" box under treatments provided. Thats pretty much it. Returning to the patients room to drop off my paperwork, the patient is awake and asking for some food. He has an IV in his arm and there is no longer any trace of lethargy. He doesnt recognize me.

As long and frustrating as a lot of paramedic school has been, this has got to be one of the hardest times to endure. I work at least 40 hours a week now as an EMT, forced to keep my new knowledge inside, refraining from moving forward with what I know is best for the patient.

I'm not allowed. Yet.


I am scheduled to take the National Registry exams this week, on Wednesday (the written) and Thursday (the practical). I've got sheets and sheets of information spread out all over my desk at home, laminated skill stations and scribbled note cards. Only a few more hurdles left to go, and I'm determined to make it through on the first try. Wish me luck!


Brett said...

I know this story all too well... just pray you dont have 6 months of BLS hell that I had

firefighter girl said...

you are a gifted writer and, I can tell from your postings, a gifted medic as well. You don't need luck, my friend, but I'll wish it for you, anyway.

Anonymous said...

Yup, I know the feeling.

In my system BLS attendants take a 450-500 course, and are IV endorsed with a basic symptom Relief Package (nitro, asa, ventolin, epi, benadryl, narcan, dextrose, thiamine, glucagon, aed, and entonox).

I can remember before we had this BLS level of care, and it was as you described. The best you could do is bag them up if their resps became inadequate and drive to the hospital.

If you don't mind me asking, once you are licensed as a medic, will your company allow you to function at that level right away?

Great post. Good luck on your exams!!!

Anonymous said...

good luck with NR

Brendan said...

Typical nurse. She'd already talked to another nurse, and that's all she cared about. You could've told her that the patient had no pulse and she wouldn't have even given you a second look.

Jamie Davis, the Podmedic said...

Good luck on your exams. Take your time and trust your training and skills. Remember for the written, BLS before ALS. Remember for the skills, take a deep breath before you begin, look around at the equipment available and try to relax into the scenario.

brittany said...

Hey, love the blog. I'm a big fan. Good luck on exams, but it seems like you don't really need it. I think you'll do fine. I enjoy reading, so please keep writing!

PDXEMT said...

It is hard to not be able to do the ALS stuff. As a brand new medic, though, I am constantly reminding myself BLS before ALS. My best advice for the NR practicals is take it slow and do everything methodically. The time limit shouldn't be a concern; missing things should be.

But it sounds like you're smart, and conscientious, and on top of your game, so I don't think you'll need to worry much.

Good luck.