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Firefighter Intern: Day 63 and 64
Feb. 23rd, 2019 07:40 am“Complete One’s Duties Within The Day: One Second Ahead Is Uncertain.” – Daidoji Yuzan
This week we sat around for our morning meeting, planning for weather conditions and also for some service needed on our Hurst (vehicle extrication) tools. We are also starting some Spring Cleaning projects, and I was assigned to update, standardize, and label all of the Fire Station master keys in the new lockbox.
Shortly after I sat down to start on this project, we were toned out for a woman with severe abdominal pain, with end-stage renal disease. We transported her, loading her carefully, and put her in a position of comfort. I took several sets of vitals with the monitor, practiced setting the four-lead for her heart's electrical connectivity, and kept her warm and entertained while we were en route to the hospital, despite her inability to urinate. I've gotten better with vitals assessment, gurney management, and cleaning and restocking Medic 483.
Once back at the station, I got in a few house chores, walked a couple of miles for firefighter fitness, and knocked out my personal laundry as well as some of the key project. I was busy with sorting keys until about 4 pm, when we got another tone-out for another abdominal pain call, this one a bit more urgent. An older lady, who had stopped antibiotics five days ago, and who was finding lots of blood in her urine and we suspected she was going into hypovolemic shock. She was also a transport, and we ran an IV line to increase her fluid volume. I handed the paramedic what he needed from the jump kit, and also kept up a running vital assessment to monitor her vitals closely. We got her into her room at the hospital, transferred her well, and I cleaned the monitor, the leads, the BP cuff and all of the instruments we used on the way back to the station.
We had just gotten back and the plate of Rueben sandwiches had just come out of the kitchen - and we were toned out again, this time for a well-known regular patient with severe diabetic comas and some significant learning and cognitive disorders. Apparently, he forgot his 4 pm meal and was found down, soaked in perspiration, and unresponsive by a neighbor who checks on him. In his kitchen, We quickly assessed his blood sugar, put in an IV line and administered high-volume glucose with a saline bag pushing fluids while he was in his wheelchair. I took vitals (that were a bit elevated with the administration of the glucose) and helped as best as I could with being somewhat unfamiliar with the procedure and with the IV sets. I did prepare the blood glucose tests, but I'm not allowed as an EMT student to engage in invasive procedures like IVs or even poking someone's finger with a lancet for a spot of blood for the glucose level. I did learn how to be more helpful for the paramedics for next time. After the glucose, he rapidly improved to the point he was smiling and joking with us, and refused transport. He told me that he had been diagnosed with juvenile diabetes as a child, and he regularly "had some problems, but he always was okay" after we treated him. Once we got back and I'd restocked the jump kit on Medic 483, then I got my cold Rueben sandwich.
We all watched Bohemian Rhapsody after dinner, while I took my ninth quiz (on Pediatric and Geriatric Emergencies) for my EMT class, and got a 90%. Oddly, I missed the one question on stress and burnout on the quiz! I slept well with no calls all night, and I was up at 7 am making coffee. We got all of the apparatus serviced, I got three loads of towels washed and folded and put away, two more miles walked for firefighter fitness, and all of the keys sorted. We went out for lunch with the Assistant Chief at a local pizza place.
We were toned out for another fairly regular patient with difficulty breathing, with COPD and Congestive Heart Failure, with radiating shoulder pain and low blood sugar. We suspected a possible cardiac issue with the shoulder pain, and I put the larger adult BP cuff on her and we found out from the vitals that she was within normal limits, but her blood sugar was low, and she wanted transport, so we transported her. We put her in a position of comfort and the paramedic administered a DuoNeb, so she maintained good oxygen saturation and stable vitals all the way to the hospital. I cleaned, reloaded, and restocked Medic 483 by myself once we were back.
After dinner, we were toned out for a 16-month-old child who caught his leg under the couch while his mother was moving it. We assessed him carefully and found some redness and swelling on his leg - but he was walking and crying and behaving normally, and the mother was appropriately concerned. Children are pretty pliable and resilient, and both of the paramedics with similarly-aged children were not concerned. We did not transport, and the mother agreed to monitor him and self-transport if necessary.
At 10:45 pm, we were toned out yet again for a lung cancer patient, 10 days after her last chemotherapy treatment, who needed a stair chair to get her down some pretty steep chairs and into the back of Medic 483. She had been vomiting all day and was dehydrated and running a fever. I took good vitals, learned a hack on the BP cuff, screwed up and then fixed the 4-lead I placed on her, and got more practice with gurney management.
At 4:39 am we were toned out again for an elderly woman with dementia who had just gotten a cast removed from her left arm, and it was swollen and very painful. I took a set of vitals in the field, and help load her onto the gurney. I took more vitals with the monitor, held her hand and kept her occupied while the paramedic administered some pain medicine. I led the gurney this time into the hospital room and learned some hospital bed management to be able to position the bed next to the gurney and led the patient transfer to the hospital bed. I cleaned, restocked, and reloaded the gurney back into Medic 483, although it came loose of its attachment when we hit a bump, so I resecured it enroute (with some mild concern- just me and a 400-pound metal object rolling around!)
We got back to the station just in time for me to get a quick shower before I got to go home.
Hypovolemic shock is a life-threatening condition that results when you lose more than 20 percent (one-fifth) of your body's blood or fluid supply. This severe fluid loss makes it impossible for the heart to pump a sufficient amount of blood to your body. Hypovolemic shock can lead to organ failure.
Chronic obstructive pulmonary disease (COPD) and heart failure are different conditions. But both can make you short of breath when you do something physical, like exercise, climbing stairs, or walking for a long distance. With COPD, it’s hard to exhale all of the air in your lungs because of lung damage, often from years of smoking. If you have COPD, you most likely breathe comfortably when you’re at rest. But when you’re active, your breath starts coming in before air from your last exhale goes out. That causes shortness of breath. If you have heart failure, your heart doesn’t pump blood efficiently. As with COPD, if you have heart failure, you can probably breathe easily when at rest. With activity, blood flow must increase, and your heart must pump harder and faster. If your heart can’t keep up, blood “backs up” into your lungs. This fluid congestion causes shortness of breath.
This week we sat around for our morning meeting, planning for weather conditions and also for some service needed on our Hurst (vehicle extrication) tools. We are also starting some Spring Cleaning projects, and I was assigned to update, standardize, and label all of the Fire Station master keys in the new lockbox.
Shortly after I sat down to start on this project, we were toned out for a woman with severe abdominal pain, with end-stage renal disease. We transported her, loading her carefully, and put her in a position of comfort. I took several sets of vitals with the monitor, practiced setting the four-lead for her heart's electrical connectivity, and kept her warm and entertained while we were en route to the hospital, despite her inability to urinate. I've gotten better with vitals assessment, gurney management, and cleaning and restocking Medic 483.
Once back at the station, I got in a few house chores, walked a couple of miles for firefighter fitness, and knocked out my personal laundry as well as some of the key project. I was busy with sorting keys until about 4 pm, when we got another tone-out for another abdominal pain call, this one a bit more urgent. An older lady, who had stopped antibiotics five days ago, and who was finding lots of blood in her urine and we suspected she was going into hypovolemic shock. She was also a transport, and we ran an IV line to increase her fluid volume. I handed the paramedic what he needed from the jump kit, and also kept up a running vital assessment to monitor her vitals closely. We got her into her room at the hospital, transferred her well, and I cleaned the monitor, the leads, the BP cuff and all of the instruments we used on the way back to the station.
We had just gotten back and the plate of Rueben sandwiches had just come out of the kitchen - and we were toned out again, this time for a well-known regular patient with severe diabetic comas and some significant learning and cognitive disorders. Apparently, he forgot his 4 pm meal and was found down, soaked in perspiration, and unresponsive by a neighbor who checks on him. In his kitchen, We quickly assessed his blood sugar, put in an IV line and administered high-volume glucose with a saline bag pushing fluids while he was in his wheelchair. I took vitals (that were a bit elevated with the administration of the glucose) and helped as best as I could with being somewhat unfamiliar with the procedure and with the IV sets. I did prepare the blood glucose tests, but I'm not allowed as an EMT student to engage in invasive procedures like IVs or even poking someone's finger with a lancet for a spot of blood for the glucose level. I did learn how to be more helpful for the paramedics for next time. After the glucose, he rapidly improved to the point he was smiling and joking with us, and refused transport. He told me that he had been diagnosed with juvenile diabetes as a child, and he regularly "had some problems, but he always was okay" after we treated him. Once we got back and I'd restocked the jump kit on Medic 483, then I got my cold Rueben sandwich.
We all watched Bohemian Rhapsody after dinner, while I took my ninth quiz (on Pediatric and Geriatric Emergencies) for my EMT class, and got a 90%. Oddly, I missed the one question on stress and burnout on the quiz! I slept well with no calls all night, and I was up at 7 am making coffee. We got all of the apparatus serviced, I got three loads of towels washed and folded and put away, two more miles walked for firefighter fitness, and all of the keys sorted. We went out for lunch with the Assistant Chief at a local pizza place.
We were toned out for another fairly regular patient with difficulty breathing, with COPD and Congestive Heart Failure, with radiating shoulder pain and low blood sugar. We suspected a possible cardiac issue with the shoulder pain, and I put the larger adult BP cuff on her and we found out from the vitals that she was within normal limits, but her blood sugar was low, and she wanted transport, so we transported her. We put her in a position of comfort and the paramedic administered a DuoNeb, so she maintained good oxygen saturation and stable vitals all the way to the hospital. I cleaned, reloaded, and restocked Medic 483 by myself once we were back.
After dinner, we were toned out for a 16-month-old child who caught his leg under the couch while his mother was moving it. We assessed him carefully and found some redness and swelling on his leg - but he was walking and crying and behaving normally, and the mother was appropriately concerned. Children are pretty pliable and resilient, and both of the paramedics with similarly-aged children were not concerned. We did not transport, and the mother agreed to monitor him and self-transport if necessary.
At 10:45 pm, we were toned out yet again for a lung cancer patient, 10 days after her last chemotherapy treatment, who needed a stair chair to get her down some pretty steep chairs and into the back of Medic 483. She had been vomiting all day and was dehydrated and running a fever. I took good vitals, learned a hack on the BP cuff, screwed up and then fixed the 4-lead I placed on her, and got more practice with gurney management.
At 4:39 am we were toned out again for an elderly woman with dementia who had just gotten a cast removed from her left arm, and it was swollen and very painful. I took a set of vitals in the field, and help load her onto the gurney. I took more vitals with the monitor, held her hand and kept her occupied while the paramedic administered some pain medicine. I led the gurney this time into the hospital room and learned some hospital bed management to be able to position the bed next to the gurney and led the patient transfer to the hospital bed. I cleaned, restocked, and reloaded the gurney back into Medic 483, although it came loose of its attachment when we hit a bump, so I resecured it enroute (with some mild concern- just me and a 400-pound metal object rolling around!)
We got back to the station just in time for me to get a quick shower before I got to go home.
Hypovolemic shock is a life-threatening condition that results when you lose more than 20 percent (one-fifth) of your body's blood or fluid supply. This severe fluid loss makes it impossible for the heart to pump a sufficient amount of blood to your body. Hypovolemic shock can lead to organ failure.
Chronic obstructive pulmonary disease (COPD) and heart failure are different conditions. But both can make you short of breath when you do something physical, like exercise, climbing stairs, or walking for a long distance. With COPD, it’s hard to exhale all of the air in your lungs because of lung damage, often from years of smoking. If you have COPD, you most likely breathe comfortably when you’re at rest. But when you’re active, your breath starts coming in before air from your last exhale goes out. That causes shortness of breath. If you have heart failure, your heart doesn’t pump blood efficiently. As with COPD, if you have heart failure, you can probably breathe easily when at rest. With activity, blood flow must increase, and your heart must pump harder and faster. If your heart can’t keep up, blood “backs up” into your lungs. This fluid congestion causes shortness of breath.
