Friday, May 19, 2006

Paramedics Save Lives (Despite ER Staffs' Efforts)

People say we practice "cowboy EMS."
I say "Damn straight!"

So Frezel is bringing a guy who got all beat to hell to Elmwood. Halfway there he codes, and Elmwood diverts the unit to E.J. (By the way, does the trauma center accept any trauma patients? WTF?!) So Frezel arrives at E.J. with the guy in asystole. (Hey Dave, what's up with no IV's on the guy?) So we start coding him; I'm charting everything and calling out reminders like 'time for another Epi.' After 4 Epi's and 3 atropines the guy goes into V-tach w/ a pulse, then after shocking him into pulseless V-tach, then into V-fib. After Amiodarone and several more shocks, the guy is still in V-fib. Nothing's working. Dr. Creel is standing there wondering what else to do. So I hollered out, "let's give him some mag sulfate." The doc looked at me quizzically and said "Well I guess if you want to, but I don't think it'll do any good." So I told the nurse pushing the drugs to give a couple grams of magnesium sulfate.
Right after she did, and circulating it for a few seconds, the v-fib converted into a beautiful sinus rhythm with pulse and a decent blood pressure! The doc's jaw hit the floor. He said "I haven't used magnesium in years; what made you think of that?"
"Doc, I've used it a million times, and I know the shit works. Always," I replied.
"I'll remember that."

Same night: Susan brings a lady with a decreased LOC to Tulane. The patient wasn't really protecting her airway so they decide to RSI her. After pushing the succinylcholine, the ICU resident tried three times to intubate the woman, three times he only pulled back a bloody ET tube. Then Ehlenberger tried. Again, no dice (big surprise).
So Mike Condatore, one of the RN's there, said "Hey, why don't you let Greg [Gavel] try. He was a paramedic with the city for years."
The docs step aside and let Greg give it a shot. One quick attempt by Greg, and the woman was tubed!
"Uh, nice technique," said Dr E.
"How'd you learn to do that?" the ICU doc asked.
Greg answered, "Experience, Doc; lots of practice!"

2 lives snatched by paramedics from the jowls of a doctory death! Tell us more!

Tuesday, May 16, 2006

Times Picayune 5/16/06

Do you have to stick me? I don't likes no needles!

Darryl: What I think happened is the perp shot him from the back of a red car, using a 9mm, probably a Taurus. The bullet entered at the mastoid process, taking out his medulla oblongata, then did a little dance and traveled to his left hand along the cephalic vein, backed up and visited his duodenum and nicked the aorta on the way, then exited above his asscrack. Anyway, this muthafucka's dead.