WARNING: This post may make you queasy if you have a weak stomach. Some may find this post on the gross side. Told ya!
I have been in EMS since 2007, but yesterday and this morning I experienced a couple things I have only done on manikins or with training devices. Nothing uncommon, just the circumstances of the hundreds of calls I have been on never called for them. Kind of like what I have been told about serving in the military and actually seeing combat; it's the luck of the draw. Many thousands serve in more of a support role, like in the 123rd Messkit Maintenance Depot (or a rear echelon medical HQ unit like yours truly). But as I was once "schooled" by a combat wounded Viet Nam Vet, we all signed the blank check to Uncle Sam payable up to our lives. No service member is unimportant or shielded from making the ultimate sacrifice, so never think your service wasn't important.
New Thing #1
So yesterday, we had a call that turned out to be a catastrophic stroke in an elderly patient. The patient was unresponsive and having snoring respirations (which are not good quality) and needed respiratory support. I attempted to insert an oropharyngeal airway (OPA) but the patient still had a gag reflex, so it was removed. Below is a couple of photos of the airways and their use.
|Berman Style OPA Kit we carry. IMHO, these are better than the tubular style|
|This is how they work once inserted. They prevent the tongue from blocking the airway.|
I have used an OPA countless times, mostly on CPR calls where the patient is completely unconscious without a gag reflex. You measure the patient from the corner of the mouth to the ear opening with an airway estimated size, and go larger or smaller as needed. It is inserted curved end up to the roof of the mouth, pushed in and rotated 180 degrees. As long as the patient doesn't have a head injury but has a gag reflex, you can use a nasopharyngeal airway (NPA). This is a surgical rubber tube inserted in the nose to provide a clear path to the upper airway. Below is a couple of photos of the airways and their use.
|Standard NPA Kit|
|Insertion and use of an NPA|
The airway is measured from the nose to the ear, the tube is lubricated with surgical lube, usually inserted into the right nostril (tends to be larger) with the beveled edge towards the nasal septum, and rotated as it is inserted fully to the flare. We also provided bag-valve-mask (BVM) and supplemental high flow oxygen to assist the patient's breathing. Unfortunately, even with our efforts the outcome will be the same, most likely organ donation.
New Thing #2
This morning we got a call for a person having an allergic reaction at the local convenience store. We were short handed and did not have personnel to staff our ambulance, so I went alone with the Rescue Truck. I called for a mutual aid ambulance as well as the non-transport intercept paramedic that was initially dispatched. When I got to the patient, they were well on their way to full-blown anaphylaxis. A healthcare worker that was on scene had her pulse oximeter on the patient, whose pulse was through the roof and oxygen saturation was low. Just to be sure, I took hers off and put mine on, and got the same readings. The patients eyes were swollen shut and looked like the size of tennis balls, and he said he felt like his throat was closing and scratchy feeling. Per our standing medical control orders he gets a 0.3mg dose of epinephrine by auto injector, known by most folks as an EPI-Pen. I have trained on these forever, yet today was the first time using a real one on a person.
|EPI-Pen and EPI-Pen Jr. Adult dose is 0.3mg, and pediatric is 0.15mg. Our ambulance and rescue truck both carry one of each.|
Since we carry both adult and pedi, you have to make double sure of the dosage so you don't O.D. a kid or under dose an adult. We are allowed to give the first one ourselves, but if there is no improvement, we can call our medical control for authorization to give a second one. The leg is bared at the muscular part of the thigh (my patient was wearing shorts this morning so easy-peasy) and prepped with an alcohol wipe. The blue "safety" cap is removed and the orange tip is pressed against the prepped site. The large gauge needle pops out and the epinephrine automatically pumps into the muscle. We are required to hold the needle in place for 10 seconds to ensure all the medication is delivered and then extracted straight out. As the needle is withdrawn, the orange part comes out to fully encapsulate the needle for safety. My patient has had one before so knew the drill and didn't even flinch. The patient bled a little from the injection site and held a piece of gauze over the site. This is what it looks like after use.
The only other thing I have never done that I can immediately think of is a child birth. If I ever do one, I hope it is not the woman's first kid and there are no complications. All I'd have to do is catch, swaddle, suction baby's nose and mouth, deal with the cord and placenta, and of course the mess. I don't shy away from maternity calls like some people do. Deliver a kid and you get to wear a stork pin on your dress uniform, as well as be in the family's life forever!