Power tool safety

An unfortunate mishap that a coworker had reminded me of a call I did about 2 or 3 years ago.

It was a bright summer day when we were dispatched to a amputation. Arriving on scene, we were met in the patient's driveway by the patient and the fire department. There was blood dripping down the man's hand and his right hand was wrapped in a bloody towel.

He has been using a table saw and the piece of wood he was using got stuck and he tried to get it unstuck without turning it off. The wood kicked back and he ended up amputating his thumb at the first knuckle and split his forefinger length-wise up to his hand.

The poor guy was so pale. The firefighters had searched through all the saw dust and found the tip of his thumb, so we were able to preserve it in hopes of a successful reattachment. We loaded him up and I called medical control for guidance. Shee, I know that he needed to go to the trauma center when they had micro surgery available to try to reattach his thumb but he was severely hypotensive--from shock, I think more than blood loss. He was also in an extreme amount of pain, but our protocols prohibited giving him anything because his BP was too low.

So I consulted with our local ED doc and he said to take him to the trauma center and to bolus him with fluids and titrate Morphine administration to his BP and pain control. We started 2 large bore IVs and gave him 2 mgs of morphine at a time. I so wish we could have given him more, but I didn't want to keep his pressure bottomed out.

It took 2 liters of fluid to get his pressure to 90 systolic. I think we ended up giving him 6 or 8 mgs of Morphine total. He was a lot more comfortable when we dropped him off at the trauma center.

I don't know if they were ever able to reattach his thumb or not but I know that we go him to the best place to take care of him, regardless.

Please remember---TURN OFF the power equipment BEFORE grabbing things when they are stuck. All your parts are precious and deserve to stay where they are--you will miss them when they are gone, I promise!!!

Because everything that you see on TV is NOT real!

I was watching Law and Order the other night. I love this show although it does get old sometimes. Well the other night, Detective Benson was driving Detective Stabler's wife to the doctor's offcie when they were hit by another vehicle, striking the passenger's front door and rendering Kathy (the wife) unconscious and pinned. Well once EMS arrived and they realized that she couldn't be removed immediately, Olivia begged until they let her re enter the vehicle without it being stabilized and without any personal protection gear. Furthermore, the medic on scene allowed Olivia to start an IV on her.

Number one, I am assuming that she doesn't have a license to do any medical procedures, nor does she have any training. Now many of our procedures are not that difficult, they just take a little practice. So I was totally blown away when the medic handed Olivia an IV catheter and told her he would walk her through it--AND then proceeds to tell her how to start an IV upside down.

Ok--this is where my problem is....I like to think that I am fairly skilled at IVs. Yes, I have my share that I miss as all providers do. But it took a number of year before I could successfully stick a line upside down. And I'll only do it if the patient's condition warrants it because the miss rate is higher. No WAY would I have done it on my first attempt AND have success.
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Now onto ER---

They are frequently doing things that would never happen in the real world.

WE DO NOT SHOCK ASYSTOLE.....Period!!! Asystole (flat line) is a non shockable rhythm according to the AHA. And you don't just give drugs until the patient is successfully resuscitated. Codes follow a prescribed set of algorithms until there is nothing else that you can do or the patient is resuscitated.

We don't have time to just "hang out" with the nurses and doctors chatting and cutting up--and most of them don't want to even bother with us anyways.

Patients do not always have a blood pressure of 120/80 and a heart rate of 80. Yes, I know that is "normal" but very rarely in my career have I had a patient that has "perfect" vital signs.

I just get so sick of people thinking that these medical and legal drama shows are how things work in the real world....It make our job much much harder than it has to be.

Are those really cockroaches?

Thanks to Jen for inspiring today's blog...

I head heard about them...The family that was so nasty the firefighters didn't even want to go inside. The house that you could smell from around the corner. The people that no one wanted to even touch.

I gave into the false sense of security..."They don't live in my zone, so I won't ever have to pick them up,"

Until I had to travel to another station to cover someone out sick....

I got the quick run down from the firefighters and my partner.

*Hold your breath
*Don't touch anything
*Scoop the patient and run
*Don't take anything in with you
*Don't let them touch you


So by the time they were done reading me the litany of dont's, I was thoroughly grossed out and VERY glad that I had brought an extra change of clothes with me.

If you don't know much about EMS people, it's that we are a superstitious group. We don't polish our boots much because as soon as you do, you go on a nasty call in the mud or get a really bloody trauma call. We don't wash the truck until the END of our shift because as soon as you do, you'll be off roading in it to reach a patient.

So, if there is a patient or a household that we do NOT want to go to, we talk around it...We never mention the address or the people by name because somehow, they know that you are talking about them and they call...

And of course, that is exactly what happened. The tones dropped for 1234 ABC avenue. If looks could have killed, I would be 6 feet under by now.

I let my student ride up front and as we went around the corner, I could smell the odor coming out of the house before we even pulled up in front of it. The fire captain handed me a little bottle of peppermint oil and told me to dab it on the end of my nose. Then they pulled out the boot covers and the trauma sleeves--and I'm thinking "Oh hell, what have I gotten myself into?"

As soon as we hit the front door, I was overcome with the nastiness of the house. The smell was overpowering. I felt like I was standing in the middle of a landfill. The carpet squished when you walked on it, there was so much crap piled up in the house that we couldn't even fit the cot in the doorway. The walls were supposed to be white, I think, but there were smeared handprints and dirt on them. You could see the lines in the walls where the drywall had obviously gotten wet. There were baby cockroaches crawling up the wall.....

So I finally pick my way through the house to the room where the patient is. I poke my head in the door and everything looked under control, so I made a beeline outside to the fresh air. On my way out, I made the mistake of peeking into the bathroom. No wonder the floor was squishy...the shower had boxes piled in it, I never did see the toilet, and there was no way to wash your hands. There were literally paths through the house but it wasn't just "stuff" hoarding. It was literally piles of human waste and other things I shall not mention here.

In the unit, I prepped for the patient. Vent fan on, windows open, fan on. Change gloves and then double glove. Towels on the floor to stand on.

The patient was clearly not well taken care of. She had dried food on her face and clothes and obviously hadn't been bathed because her belly button was crusted shut. The foulest odor came off of her as we tried to unwrap the sheets to perform at least a cursory assessment. Before re-wraping her, we noticed something moving under her gown. I didn't want to look, truly I didn't...

It was a cockroach. A teeny tiny cockroach. I think I screamed.

I used an entire bottle of disinfectant to clean the back of the truck, spray the passenger seat, and wet my uniforms so that I could not gross myself out on the way back to the station where I promptly chucked my uniform in a biohazard bag and showered for nearly 20 minutes.

Gross. I have never been so horrified in my life.

I've been on vacation...

For those who actually care---I've been on vacation since last week and have not posted anything. I am on my way home today, traveling most of the day. I did get some great ideas for new blogs (thanks to Jen!!), so look for a few new ones in the days to come.

Hope all my readers are being safe out there!!!!

Strange searches...

I am curious about how people find my blog and am almost anal about checking few places to find out where my readers have come from.

Here's one google search that pointed a recent reader to my blog:

poem my husband is a coke addict


Hmmmm....Is that coke addict (as in the beverage)? Or is that coke addict (as in illegal drugs)?

Either way....You made it to my blog so welcome!!!!