Just Say No! from Le
by

I was in paramedic school...finished with the didactic and clinical part, and into my internship. This took part in "the big city" (I live and work in a rural/wilderness area). I'd already been in this business a lot of years....enough to have the basics, as well as IV starts down pat. Well, I came to learn pretty fast that most every call in the big city turned rapidly into a fuster cluck, as, between the fire department and ambulance, there were never less than 5 paramedics on any given scene. Too many chiefs....not enough Indians! Luckily, they were all "used to" students, and, most of the time, were more than willing to let us "take charge" of the patient care.

We arrived at a very nice (read "Expensive" and "posh" here) retirement complex for a "difficulty breathing" call. Upon entering a lavish apartment, we found a 75 year old gentleman sitting in a tripod position in a chair. The fire department medics on scene had him on a nasal cannula at 3 liters of O2 per minute, and were standing around chatting with him and his wife (this patient's SpO2 was 54%). This gentleman looked BAD! I mean: cyanotic, diaphoretic, wide-eyed...the whole ball of wax!


My paramedic preceptor and I looked at each other. I introduced myself to the patient, and told him that I was going to start an IV. While applying the tourniquet, I asked the nearest fire medic "Would you please change that nasal cannula to a non rebreather mask, and administer 15 liters of O2 per minute?". He immediately complied, and the patient and I were grateful. I was getting patient history from another medic as I looked for a good vein (MI 1 year prior, diabetes).


I asked another medic "May I please have an alcohol swab, and 18g angiocath, and a bag of NS set up?". My preceptor took a BP....220/126. Hmmm.. Time passed. "May I please have an alcohol swab, an 18g angiocath, and a bag of NS set up?". Hmmm...more time passed.


My paramedic preceptor listened to lung sounds, and handed me the stethescope for a listen. This guy's lungs were so full that there WERE no lung sounds!!!!! (Directed to the SAME medic that I had asked before) "May I please have an alcohol swab, an 18g angiocath, and a bag of NS set up...PLEASE????". Time passed. This poor patient's arm was now as blue as his lips.


Ok....I KNOW that as a student, I was supposed to remain polite AT ALL TIMES, as this was a PRIVLEDGE, and these folks were dealing with students on a daily basis. And, my patient was in trouble!!! I'd had enough, and, I figured, had been polite enough for long enough!


"What the h- e- double hockey sticks is this? A prozac moment? I need that IV set up! This man needs some lasix, nitro, and morphine NOW, and I can't administer ANY of it without an IV!!!".
Boy...THAT GOT FOLKS MOVING!!!! Well, the job was accomplished, we got the patient to the big city hospital.

The patient lived. When I walked outside the hospital to start putting the ambulance back togeher, my paramedic preceptor and our EMT were laughing so hard, there were tears rolling down their faces. The particular paramedic that I had asked REPEATEDLY to get me what I needed was, indeed, on prozac!!!!!!! Me and my BIG mouth!

Regards, Le