Hospital Rotation

Ok, so part of our EMT training is a required minimum of 5 hours of time spent in the ER. We do our rotations at the hospital closest to the Fire Academy a much slower ED than the trauma center close to my house.

Usual SOP for an EMT-B rotation in the hospital is 5 hours spent in triage taking blood pressures, pulse ox %, and random assundry other vitals. Throw in your odd rectal temperature on a croupy baby and your night is complete. As expected i get put into triage and see my share of barking coughs, dehydrated elederly patients, and the odd chest pain patient. There was only one mildly interesting case that came through triage in my time there. One lady came in complaining of numbness on one side of her body, difficulty speaking and general confusion and a pounding headache. I take her vitals and listen to the SAMPLE history and all that other stuff. They take her next door to get a 12-lead on her to rule out cardiac issues and schedule time in the CT suite and get a full set of bloodwork ordered. She was just so scared, she just kept crying and repeating how she couldnt say goodnight to her kids, it was a bit emotional but you have to maintain a certain distance and keep your emotions in control so your patient's know that there is someone in control, someone they can rely on in their time of need.

We send her from triage back to get admitted, still numb down her right side and all trussed up ready for CT scan. It was a bit sad, I talked to one of the nurses and the two real obvious possibilities that she thought were either a tumor isolated to one hemisphere of the brain which decided to assert itself in to the motor control areas of her brain, or some sort of stroke, CVA or TIA that was causing the unilateral numbness etc. Sad to consider either in the case of a woman so young.

After seeing her me and my "mentor" were asked to come back into the "pit" or the receiving section of the ER to assist on a trauma coming in with the local medic unit. No clue what it was other than a young man who was found unconscious and unresponsive at a party. The police called EMS and tried to get some information from the bystanders at the party, no such luck. No one would give any information to the police because they might get arrested.

The long and short of this patient is that I got more experience with trauma cases in that 2 hours thani think i will in MONTHS of riding the ambulance. He was RSI'ed, had an OG tube and a foley in place. I got to help move the patient, took vitals when the nurses needed, suctioned the patient's airway, helped clean the patient who was incontinent to bowel and bladder (fun stuff let me tell you, but all part of the game). This poor guy came in as a John Doe, no ID until they searched his belongings again and found out he had been into the hospital before for followup on a previous surgery the aftercare of which would have precluded this gentleman from drinking, oddly enough he came to us with a BAC of .40 (just to give you an idea the local legal limit is .08 which is about 2 drinks in a 185# man in an hour). You gotta drink a LOT to get to a .40.

They finally found our human distillery's parents, they were en route from home and would be there in about 45 minutes. Finally dad shows up and supplies our much needed information and deals with the County Police that are waiting to inform dad what the son is in for when he is capable of responding.

Dad thanks us, the cops and the ER staff over and over and over and basically keeps insisting that his son doesnt drink and that his friends must have done something to him. I really hope that case came out ok, the kid has enough going on in his life that he doesnt need to spend any more time on an autovent than absolutely neccessary. Kinda fealt bad for him in the end. By the time i moved to the next patient the docs and nurses were pretty happy with the stability of the patient and had good hopes for being able to take him off the vent and off the "milk of amnesia" (propofol) by morning. He was carted off to teh ICU for a couple more hours of monitoring.



Next patient! I told you things got good. Had a gentleman come in on the medic unit with severe respiratory distress. Thats what they told us, what we found when they showed up was so much more interesting. He was inflated like a beachball, abdomen so distended and retaining so much fluid that there's no wonder he was having trouble breathing. He was tight as a drum with fluid. And jaundiced, jaundiced like none other, so badly so that his skin matched the neon yellow sclera. Liver failure, makes sense in a heavy EtOH abuser, the doctor said most likely he has complete liver failure.

To give you an idea of what this guy looked like there is a good picture included in this post. I mean i kinda fealt bad for this guy and was almost nervous to touch him, thought he might pop. Unfortunately at this point i was called back up to triage to help the only nurse up there at this point who was slammed with pediatric cases. Odd for 3am.

I ended my night portering patients into rooms in the ER and hooking them up to monitors and giving the croupy kids cool humified oxygen tubes to help ease their coughs.

All in all a banner night for me, i was quick, i was on point, i did quite well in my own mind. I got a glowing review from the nurse i was working with and an invitation to come back and help whenever i want.

I don't know how these people do this night after night, its a lot of work. I think i might come back and do a couple more rotations just to get some more experience.