Flight 031

Now this is what scene calls were meant to be. Not too much blood, but just enough to be gory. Not too injured, but injured enough to require intubation. 🙂 This guy was in a motorcycle accident, he wasn’t wearing a helmet. he was drunk and acting goofy, didn’t want to lie flat and complaining of troubl ebreathing. When you’re making quick decisions with limited time, resources and personal thos symptoms addup to head & lung injury. The patient needs to have his airway definitively protected from vomting, blood, changes in mental status resulting in an inability to breath for themslves, and lung injury making the lungs difficlut for th epatient to fill with air.

Intubations are my favorate procedure, I think because it is so incredibly invasive and definitive of a treatment. First you sedate the patient, then you paralyze the patient, removing his or her ability ot breath for themselves. You have to assure that they are getting enough oxygen and ventilating enough carbon dioxide. After you have made the patient completely helpless, essentially giving the same medicines given during an execution, you use a metal blade with a light on the end to lift up the patient’s tongue and jaw, look down into their airway, find the vocal cords and insert a breathing tube of a prechosen size (bigger than a straw, smaller than a garden hose) into the lungs. If you put it accidentally down the esophagus (the openings are right next to one another), the patient will not get any oxygen, vomit all over you, and potentially may die if you don’t fix it in time.

Now imagine doing this procedure in the back of a bloody ambulance giving orders for medications and equipement, directing assistance for neck stabilization, cricoid pressure, external laryngeal manipulation, suction, ventilation…the works.

So ultimately, they get “tubed” (intubated), get more sedative medicines, and all the way bakc ot the hospital, somebody has to squeeze the bag to keep giving oxygen into the lungs.

You make them 100% helpless and dependant upon your actions, and if you make a mistake, they die. Sounds like fun, eh? That’s my kind of scene call! It makes me feel like a superstar.

BTW, we were right on the mark with our field diagnosis. Cerebral contusions and subarachnoid blood with right sided pulmonary contusion & aspiration.

Lost

I hit the trails again this evening for a dusk ride by myself. It took me 36 minutes to reach the very top of the ridgeline where the power cut divides teh trails in half. I went straight across like I did last week, but then quickly came to a tri-furcation in the trail. First I tried the left, but that soon led to a farmers field. I turned around and this time went straight. I’m not sure if I’ve been on that one before, but at some point, I think I got lost! I’m not really certain, though. The trails were a little irritating because they kept switching back going UP the hillside when I wanted to go DOWN! It was gettign dark and I was getting tired. When I was thrown off my bike for the third time, I took that as a sign and slowed down a bit, and just rode home. I’ll have to go back up and try the trail all the way on the right. I think that’s the super fun one I did last week, but last week the trails were marked for the race and since then all the signs have been removed.

Five

Now I can count them on one hand. 🙂

Last night was the busiest night I’ve ever worked, we had 11 people check in between midnight and 1 AM. What were they all thinking? After that we had about 3 an hour right up until 7 AM when it finally slowed down.

Lots of farmers with chest pain, one of them went straight to the cath lab for his acute ST elevations in his inferior leads. he had a massive right circumflex…it could have been “the big one”, but they were able to open up the artery and he is doing well.

Flight 030

This flight was nice because it was a long (ish) trip to the pickup site. The patient’s story was pretty ho-hum, though. I’m not sure why they asked for a helicopter. Basically she was drunk adn passed out next to her car and woke up with slurred speech. We picked her up in a hospital parking lot…why the didn’t just see her there, I’m not quite sure of.

But it’s always nice to fly.

Six

The first member of my class to move on had his final shift today. It was surreal watching him walk out the door, knowing that he wouldn’t be back. He put in a long shift, came back after an hour of charting to find his last patient crashing. He intubated him as his last official act as an emergency medicine resident. How cool is that?