Multiple GSW's

Last night we were called out to a GSW victim. We found the patient sitting in the backseat of a patrol car (not in custody, just sitting there waiting on us). The senior medic (a Captain) wanted the guy moved to the stretcher before starting an assessment, being on the transporting unit, I turned into the stretcher-fetcher.

Keep in mind our patient is approx. 6' and 300lbs. In the rig, we find 2 entrance wounds on his upper right thigh, 1 inside, 1 outside. Also 1 entrance wound on the outside of his left upper thigh. He's a big guy and we can't really get to the backs of his legs to do a better assessment (thanks Cap.)

Vitals 160/80, pusle 88, sats 99% room air, respirations 20.....We called in a report to our trauma center at this point.

I started an 18ga IV in his left AC, and attempted to give a bolus of Lactated Ringers. **I think the IV was positional and the patient kept calling everyone on his phone. **

I kicked everyone out of the truck so I could have room to move and also so we could get on the road. I finished cutting off the guy's pants and found a 2nd entrance wound near the first on the left thigh. He was also complaining of pain when he moved his right leg, and his "nuts are numb".

I called in an update, 4 entrance wounds, vitals 152/80, pulse 86, sats 99% on room air, respirations 20 nonlabored, IV established giving bolus, ETA 10

The patient's blood pressure continued to fall enroute and he became diaphoretic (sweaty).

Blood pressure was 114/52 on arrival to the ER, pulse 92, resp. rate and sats unchanged. Once the patient was moved to the ER's stretcher, we discovered a single exit wound on the back of his right thigh.

I left to type up my report and when I went back inside to drop off the copy, they were taking him to CT to rule out a pelvic fracture. You could clearly see 1 intact and fragments of a 2nd bullet in his left leg, they thought the round that didn't exit his right leg may have bounced upward and hit his hip.

I'm going to try to get an update on him next shift.

Nothing too interesting to report from work lately. We've had a few calls that I guess I could write about, but they're not too interesting(at least I don't think so). The only call I want to write about I'm going to hold off writing about until I can load a picture of the EKG strip. I'll give a little info as a teaser, severe hypothermia.

You win some, you lose some

While some calls are inherently worse than others, there's always those calls that we get more involved with emotionally. For some, it's traumas that get the blood flowing, for others the critical elderly patient does the trick. No matter how new or experienced, parent or not, everyone goes on high alert when the call is about a small child, especially cardiac arrests.

Fortunately, most calls that are dispatched as pedi arrests, really aren't arrests. Unfortunately, most that actually are arrests, are extremely hard on all involved. I've been fairly lucky in my career and haven't been on very many of these calls.

I remember my first one very well. We were dispatched for a 3 month old in respiratory distress. On the way, we were updated with CPR in progress. My partner told me to stand by the truck and if the child actually was in arrest, he'd bring her to the truck and we'd work on her there.

Onscene, it seemed like the moment he walked through the door, he was on the way back out with the baby in his arms. She was blue from the nipple-line up.

In the rig, we started CPR while my partner prepared and tried to intubate. As soon as the the tube was in place, a nice little geyser of milk came up through the tube. It was obvious at that point that when the home care nurse was feeding the child, she aspirated the milk.

I still don't know how he did it, but my partner also managed to find a vein and start an IV. I was ready to use the IO needle if needed.

A few months later, I attended a regional Star of Life awards ceremony where I was presented a Star of Life award. These awards are only given if a patient, confirmed to be in cardiac arrest, is able to leave the hospital expected to make a full recovery.
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More recently, we were sent to a 1 month old in arrest. There was already 2 units onscene when we arrived. I jumped into the ambulance along with my partner to see what I could do to help. When my partner unlocked the drug box to grab the Epi, I pulled the IO needle out of the bottom of the box and asked if he wanted me to go on and get access. He gave me the green light so I wiped the area of the leg with alcohol and mentally prepared myself for what I was about to do. I also tried to think back to the academy, which was the last time I used an IO needle, and that was on a mannequin. I double-checked my placement and went for it, digging the large needle through skin, tissue, and bone. It went in with a creepy "pop" I could feel. The line was hooked up and flowing extremely slow, which is the best you could ever hope for from an IO.

We worked our hardest all the way to the hospital, and the hospital staff did their best as well, but it just wasn't enough.

In the last couple weeks there have been a large number of SIDS cases. My guess is that this may have been one of them and the parents just happened to be awake and found it early.

If you have kids, give them a hug and tell them you love them.

Bad weather, and worse drivers

Hope everyone had a wonderful Christmas, and if you were working like I was, an uneventful shift.

What is it about bad weather that suddenly causes people to forget how to do the simplest of tasks, like driving? Whether it be ice, sleet, snow, or rain, some people tend to throw caution to the wind and do some pretty stupid things while behind the wheel. Then there's the smaller crowd of people who are doing the right thing and simply get caught in the wrong place at the wrong time.

While I'm on my mini-rant, I also want to mention the stupid drivers that feel the need to do stupid things during beautiful weather. Driving a car is NOT the time or the place to do things like put on makeup, talk on the phone, eat, nap, or read. At some time or another, I've seen all the above and I still wonder how some have survived this long. Then again, go ahead and do all those things, it's job security.

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First thing in the morning on a cold, rainy morning, I'm toned out to respond to a vehicle accident with injuries and entrapment. Onscene, we find 2 cars involved, an SUV and a sedan. The occupants of the SUV were walking around and appeared ok. The occupant of the sedan was pinned. As soon as the units with extrication gear arrived, we set to work cutting the car away to free the driver.

There was already an EMT in the back seat holding C-spine, but since she isn't fire trained and didn't have any protective gear on, I kicked her out of the car and took her place. I took the time to tell the patient my name and get hers. She said the EMT hadn't told her what would happen. I explained that we were going to cut the car away so we could easily get her out. The roof would be the first to go, then we would roll the dash away from her legs and get her out of there. She would be put on a hard backboard and moved to the truck where we would cut her clothes out of the way, start IV's, and get more of her medical history.

Once the roof was cut away and removed, the next focus was rolling the dash. All the appropriate cuts were made and the ram was placed. It took a little experimenting to figure out which length ram was needed. Once the dash was rolled, we realized that in order to shift the patient to the backboard, her spine was going to be twisted at a weird angle. We did one of the few things I haven't done since the academy (I believe), and broke out a KED.
This is the best picture I could find of someone in a KED. I have no idea who these people are, but if you find your way here and want the pic removed, just let me know.


We got the KED on as best we could, the ram (what was holding up the dash) was in the way of the left leg strap. Since it (the ram) wasn't very secure, we just went without the strap and moved the patient. I already knew from talking to her that she had some left-side injuries, but was finally able to truely assess her and see what we had to deal with. In the car, her left leg had been crossed under her right and the emergency brake was under her left knee. Her right foot was tangled in the pedals. Nothing appeared to be broken, but she had 2 lacerations that were to the bone; one near her elbow, the other at her knee. Of course, she was also complaining of knee pain and pain in her hip. The main impact was to the driver's door and there was 6"-10" of intrusion.

In the truck, we started IV's, checked vitals, cut clothing, and bandaged wounds. As soon as they were ready, the ambulance went enroute to Big City Trauma. We called BCT for the crew and gave them a heads-up of what was coming.

Time from initial dispatch until victim freed: 40 minutes.

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Before I can barely sit down back in quarters, we get toned out for another entrapment. Single vehicle loses control in the rain, spins out into a tree. Nothing too special there, until we hear the car is now on it's side and the driver is trapped.

The driver wasn't really trapped, she was just in a really weird position and we couldn't easily get her backboarded. We stabilized the car and cut part of the roof away (the sunroof was already missing). One of our guys crawled into the car and helped lift the patient while we shoved a backboard under her. From there, all the care is the same as above.

Not sure of the total time from this one, if I manage to find out, I'll edit it in.

New, Old, and the Indifferent

Well, things aren't totally different from before, but a little has changed. Still no decision has been made regarding the complaint, I've only heard rumors.

I finally finished testing for the engine license and hope to pick my new one up from HQ tomorrow. Hopefully, I'll be driving full time within a few weeks.

I've had a busy couple of days this week. Of course, there's all the Christmas shopping issues to deal with, traffic, stupid people, etc. I worked a training drill yesterday and had to go through a full decon, it was in the 30's and raining a little. I can't go into details too much, but I can say that the shower was so warm, I didn't want to get out. I also went to visit a good friend of mine that will be retiring soon. He doesn't have any family in the fire department, so he passed his hook down to me. He also took the time to show me how to drive a tiller, front and rear. I had an absolute blast!

Back to the regular old grind tomorrow.

More drama than a sitcom

Work has been both chaotic and boring lately. Nothing too worthy of mention that I feel like talking about right now. I'm dealing with a lot of unnecessary drama at work and will try to get back into a normal posting routine once this is resolved. I may or may not post details about this case once it's been resolved.

For now, pray for my sanity.

Vacation

I was bad, I'm sorry. I forgot to post that I would be out of town for a week.

I really enjoyed my time with family and friends. Don't you hate the feeling near the end of a vacation, you're ready to be home, but you don't want to leave.

As for work, nothing interesting to report. All the calls I've been on were just boring, mostly very basic things.