Haloween 2009

Just a quick note,

Saturday night a bunch of buddies from work and I went to a costume party that was put on by a nurse that we work with. One thing I've learned since getting into EMS? Nurses and parmedics are some of the craziest party animals you will ever meet!

Here's a quick pick (poor quality) of my buddy and me. He's Axl Rose and I went as my hero Slash!

Another Tour in the Books

Well I just finished a quick mini tour consisting of a day shift on car and two nights in the ER.

My on car shift was unremarkable. The hours were 1100-2300 which isn't the greatest for several reasons. When the car starts in the AM, comm's will pile them with 3-4 transfers back to back because all the other cars have been on the street for 4 hours and are trying to get in their lunch break, then at shift change at 1730, we always find ourselves 'only unit avaible' downtown while comms attempts to get everyone home on time. The 11 o'clock car is constantly bombarded with BLS transfers (even when there is an ACP working in), never gets their complete lunch break, and rarely gets home on time at night. Regardless, hours are hours and I work this car quiet a bit and don't get too worked up about it anymore.

Thursday and friday night I was in Emerg and I know I'm repeating myself but once again it was an amazing learning experience and disturbingly busy. Highlights include:

- Six ortho patients that required conscious sedation and reductions. I think all six were shoulder dislocations, maybe there was a hip thrown in there but I cant really remember. I like helping with these sort of procedures, especially when pediatrics are involved as I get experience with meds that are usually foreign to me like Ketamine.

- A female patient who was rushed down to us from the active end with hypotension and no IV access. Pt was an IV drug user and we just could not get a line in her. Anasthesia even came down and used the ultra sound but had no luck. The ER doc was thinking about an IO but then placed a central line instead. Her blood work came back with a white count in the 40's and she was worked up as a septic patient. She went to PCU just as I left in the morning.

- A male patient brought in from Vegas by the Las Vegas Air Ambulance team who was post code 8 days ago. Apparently this gent was at the casino playing cards and felt some indigestion. Before he could even rub his chest he had coded and was being defibrillated by the casino AED. The paramedics got ROSC upon arrival at the hospital and the patient spent 6 days in CCU recovering from a acute inferior MI requiring cath lab and stenting. The patient was in a Atrial flutter rhythm upon returning home to Saskatchewan and was actually doing quiet well. The only thing cardiology here was upset about was that the patient had been in the flutter rhythm for several days now and seemingly had not been started on any warfarin therapy (which his INR would confirm). Pt went upstairs to a telemetry bed in the early AM

- A renal colic patient who was just gobbling up the narcotics. Poor guy took 300mcg of Fentanyl, 20mg of Morphine, 30mg of Toradol, and some Buscopan as well. Renal colic is one of those things that I see so much in the ER and I'm actually quiet paranoid about getting it, doesn't look like fun!

- A very old patient brought in by EMS in Cardiac Arrest. Rhythm was Asystole with EMS for 15 minutes and was the initial presentation in the ER as well. Ultra sound confirmed ventricular standstill. Code called.


I am on days off now for five. I don't really have much on the agenda so hopefully I can rest up because starting next pay period things get a little hectic. On the 24th of November I fly into Stoney Rapids up north for 2 weeks of work at the hospital in Stoney which is a extremely remote reservation at the northern most peak of Saskatchewan.


Should be fun.....

Typical ER shift (Typical as in crazy busy)

Here's a quick rundown of my most recent (Thursday) night shift in Emerg:

- arrived at shift change to a 78yr female patient in Trauma 1, pt was driving at 80km and SLAMMED into the back of a snow truck at a red light. Hypotensive, tachy, GCS of 10. Pt had a fractured pelvis, open humerus, closed femur, and severe bruising to upper abdomen. Sedated + Intubated, bilateral chest tubes placed (portable CXR showed bilateral pneumo/hemo's), and then rushed to the OR.

- 60yr male patient who must have weighed almost 350lbs brought in by EMS, query CVA/head injury. Combative enroute requiring sedation with IV Midazolam. Took five security guards to hold the big guy down as we applied restraints and gave numerous doses of Midazolam. Sedated and Intubated, taken to CT and then ICU (didnt get a follow up or Dx)

- Middle aged female patient from the active end of the ER, rushed down to trauma with SOB exacerbation. No previous history, sats falling, RR over 50, loud stridor, treated with IM Epi X 2, solumedrol and nebs with no relief. Pt ended up being consciously intubated and consulted by medicine and gen surg. Abdo CT showed necrotic bowel, OR booked for the next day. This was my first experience in dealing with a patient who has a ETT but is totally conscious, took a bit of getting used to (especially the suctioning!)

- Young teenage male had waaaaay to much to drink and fell off a balcony from about 15 feet up. GCS of 10 with EMS, combative upon arrival. Sedated and intubated to facilitate CT/X Ray. Toxicology came back negative, no C spine injury detected. Extubated and given a couple litres of fluids.

- Right before shift change in the AM, young female patient who had a DnC 1 week ago, complaining of excessive vaginal bleeding. BP 80 systolic on arrival to trauma 2, tachy in the 130's. Given 2 litres of saline before 2 units of blood. Continuous blood loss in excess of 700ml's an hour. 3rd unit of blood hung and rushed to the OR.

That's all that is really sticking out in my mind. Of course there were a fair share of intoxicated 16 year olds and the typical "talking when should've been listening" syndromes. All in all a good night.

Im on car today, the first half of my shift has flown by due to five calls in six hours. Definitely a change from last time! Oh well, Im not complaining. Time to go and catch up on paper work....

The slowest night of the year (or so it seems)

Its Wednesday night here in Saskatchewan and boy oh boy is it ever slow!

Ive been at work for almost nine hours and we've done one call, an elderly lady with anxiety.

How have I been passing the time? you may ask. Well there is only so much a guy can do. Ive rechecked the unit and the kits, done all the base duties, done all of tomorrows base duties, took apart the unit's peds kit and had a good curious look at everything, took a drive to subway for a 2AM snack, read 4 chapters "The Shining", read all of the blogs on my follow list, and watched two back to back episodes of Dog the Bounty Hunter!

I guess I shouldn't complain, its the slow nights like this that make up for the rest of my shifts, the majority of which are frantic blurs of ten or more calls in 12 hours. I sure couldnt handle this slow pace everyday, but it's really a welcome experience every month or two.

Something I forgot to mention from my most recent night in Emerg, we had three back to back allergic reactions come into the trauma area, all requiring IM Epi, IV Benadryll and numerous Combi Vent nebs. Nothing too serious requiring IV Epi or intubation, but still one heck of a coincidence getting three consecutively like that.

0230 and the entire city seems to be sleeping. Hard to believe knowing this town the way that I do. Just last week the city had its first homicide of the year (well the first I've heard of). A group of guys went into a seedy neighbourhood to confront a rival drug dealer. Instead of finding their intended target, they came across a drunken cousin sleeping one off on the couch. Before he could even wake up, one of the gang members thrust an axe into the mans chest, killing him instantly. To me this is the stuff violent movies are made of, not my humble town in the Prairies.


Anyways, back to the books/tv/computer/cleaning etc, 3 more hours to go.

Emerg on a Saturday night, what could possibly go wrong??

The first five or six hours of my most recent shift in Emerg went by uneventfully enough, a couple of renal colics (ouch), a few intoxicated young ladies (ah kids) and a fair share of young mothers in labour (right up to Antepardum ladies). In fact things were going so well that around midnight a collective feeling overcame most of the staff, the feeling that we have had it too easy thus far and will be put to work very soon.

Sure enough just as we discharged our last patient from the trauma hallway, we had a little bit of excitement waltz in through the front door.

In walks a 28 year old fella who had been enjoying some beverages at a new bar downtown. He looked obviously intoxicated as he leaned heavily on his buddy and he cracked jokes at the top of his voice.

"Hey sexy!" he says to triage when asked what his problem was.
Unable to get a straight answer from him (only complements likes hey sexy) triage sat him down at the desk and took some vitals.

Initial pressure- 78/30.
HHmmm, triage repeated the pressure manually - 68/0, hhhmmm.

While this was going on I was tucked away nearby in trauma 1, rearranging the tower and untangling ECG cables. My partner came through the door with a grin on his face, "better charge some lines" he chuckles.

The jokester was wheeled into the trauma room and the trauma doc was in for the assessment in a matter of minutes. Apparently, the young man had been at the bar, speaking loudly and laughing like a lunatic, which annoyed some other patrons. A fight ensued, which spilled out into the street. The young man's friend states that he broke up the fight and drove his buddy home. As he was putting him to bed, he noticed a small hole in his friends abdomen that was bleeding quiet a bit.

Sure enough there it was. Right in the upper right quadrant, a small 2 cm wide puncture wound that was bleeding profusely. Initial VS in trauma 1 were poor, BP in the 70's and a HR over 120. We obtained to large bored IV's and bolused 2 litres of Saline as quickly as possible. The ER doctor did a bedside ultra sound while we were getting the patient ready for CT, and he found no free fluid in the abdomen. We all breathed a little bit easier when our next pressure came up after 2 liters, 100/58. Phew!

The only other injury was a broken nose, which the patient seemed to be more concerned with than the anonymous stab wound to his belly. I don't know what this guy does for a living but he should consider a career in stand up comedy, he was hilarious all night. "There goes my modeling career!" he says, and "just put a bandaid on my gut so beer doesn't leak out of the hole!"

I went up stairs with him for a CT scan. We never actually did find out what kind of weapon was used, but the internal injuries were minimal. No pneumothorax, no liver injury, and no perforated organs. The comedian was stiched up down in ER and was sobering up down in the active end when I went home at shift change.


My night in Emerg was awesome as usual and I cant believe that I had a almost two month break between shifts. Im back in there on wednesday/friday/sunday of next week and cant wait to dive right back in.

Untill next time.

Not back in the Saddle, but back in a sense...

Almost two weeks ago I did a call that will probably change my life forever.
I wont say much about the call itself, due to both privacy issues and my own emotional compromise, but I will say that after going through CISD and speaking with the neonatologist involved, I feel much much better.

After the call happened, when all the details and outcomes were up in the air, I found myself sitting in the back of the unit out in the garage, convinced that my career in EMS was over. My confidence was shot, my level headedness kaput, and I couldn't help but be amazed at the impact a single call can have on a medic.

In the two weeks that have passed, I've been to countless meetings with supervisors, counsellors and physicians. The final verdict (and general consensus among coworkers) is that my partner and I made the right call. I don't yet feel 100%, but I feel recharged, relieved, and most importantly, ready to get back out there and do what I love doing.

I spent thanksgiving back home in British Columbia, sunny Kelowna more specifically, where my wife and I ran what will probably be our last road race of the season. We braved -9 temperatures and both finished our 10km races in respectable times to end the season on a high note. My family was also in Kelowna for the run, with my mother running another half marathon and my father, brother and sister along for the ride as enthusiastic spectators. I don't get to see my family as much as I would like, so its always nice to see how everyone goes out of their way to be together when I come to town on one of my running excursions.

I am off till Friday night, when I will make my triumphant return to the trauma center ER (I'm being sarcastic just to clarify). I really enjoy my time in Emerg but my last shift there was over a month ago and its almost impossible to retain ER specifics while you re out attending to bar fight victims. It should come back fast though, it always does, and if it doesn't, Im sure someone will give me a gentle push in the right direction.

In talking to my crew trainer at work, I've heard that our service will be getting Fentanyl in the very near future (finally!!). Hopefully this is a sign of things to come in terms of medications that we've needed for a long time, ie maxeran/mag sulphate/IV Glucagon/Toradol/RSI etc etc.

Anyways, this post was more or less a quick update to let everyone know that I'm doing fine, I'm back to work, and that the posts are going to be coming at you fast and furious over the next little while!

Until next time....

Good bye for now...

I regret to inform you all that my blog will be going on hiatus indefinitely.

Bad call at work today, going through CISD for the next couple days.

Thanks to everyone for their interest in my blog thus far,

Hope to be back soon,