Solo Again

Yesterday my preceptee didn’t come to work. He told me he might not come in. That was okay because he is pretty much done. We’re just waiting for the hospital coordinator (who officially cuts him loose) to come back from vacation and sign the paperwork.

The truth is it was great being the medic again. While I love precepting, I also love being a solo medic. You get tired of standing back watching someone else handle the call. I like talking directly to the patient, putting my hand on their forehead, feeling their skin temperature, then holding my finger tips at their wrist, feeling the pulse waves from their beating hearts. I like having them look to me to help them.

It was a busy day, back to back to back to back calls. Nothing out of the ordinary, but all with their own unique challenges. A possible broken arm, a case of vertigo, an elderly fall with change in mental status and a rapid afib causing weakness and lightheadness.

I carefully splinted the woman’s arm, which wasn’t deformed, but had point tenderness near the elbow and was causing her to wince when she moved it. I used a cardboard splint, some towells as padding and an ice pack. Her pain wasn’t great when she was still — only a 2 on the 0-10 scale so I held off on morphine.

The woman with vertigo and nausea I gave Zofran, making certain to push it nice and slow. Her nausea cleared up and she only felt a little dizzy.

The elderly man who fell had severe kifosis so we had to really pad him to get him comfortable on the board. He ended up in the trauma room. It was an unremarkable fall, but he wasn’t the same person afterwards as he was before so he really did need the special attention that comes with being an alert. I am curious what his CAT scan showed.

The man with rapid afib was on a beta blocker so I got to use Metoprolol for the first time. Our new protocol calls for Metoprolol for rapid afib before Cardizem if the patient is already on a beta blocker. I felt the excitement I always do at pushing a new drug or using a new devise for the first time. I pushed it slow — over five minutes, but it didn’t seem to have any effect. He was still cranking along in the 160’s-170’s. We were at the hospital in a short time so I was still waiting to see if the Metoprolol would kick in by the time we rolled through the doors. They ended up giving him Cardizem and that did the trick.

He and his family thanked me afterwards. When I was walking out the woman who’d had the vertigo was in the hallway with her husband who was getting ready to take her home. She thanked me also, and introduced me to her husband, who shook my hand, placing his other hand on top of mine as we shook.

Back at the station, I restocked the truck, and then punched out. Driving home, I thought I would surely miss this work if I couldn’t be a paramedic anymore.


  • Sarah says:

    Very jealous you can push so many more drugs than us. Love reading your blog, especially with the precepting stuff.

  • manchmedic says:

    Up here (in NH) for the longest time we had Cardizem – one of my favorite drugs for dealing with rapid a-fib. It became unavailable in Lyoject form, so our resource hospital dropped it and Metoprolol was put in Cardizem’s place. The few times I’ve used it I’ve seen exactly what you describe, and the ED doc has ordered up Cardizem, which has worked as it is supposed to.Frustrating, isn’t it?Great blog, and I love your books.

  • DavisEmt says:

    So are any of your first responding units ALS?The fire dept. here is. There isn’t always drama, but everyone wants to be the caretaker, push the fun drugs. I can share, but it really lets the air out of the otherwise exciting calls.

  • Rogue Medic says:

    Precepting is different and afterward it is like you have taken a bit of a vacation, at least as far as taking care of patients.

  • Witness says:

    I find it interesting that so many medics don’t have access to diltiazem. It’s a staple of medicine around here, and we use it pretty often.

  • PC says:

    Thanks for the comments.With the exception of some towns I rarely am called to, none of our first responders are medics.I need to learn more about how long it takes metoprolol to typically break a rapid afib. I fear now, as your experience points out that it might take longer or more doses than reasonable for us to give to see a change prehospitally like we see with Cardizem. We still carry Cardizem — in vials that need to be changed out every month — for patients in rapid afib not on Beta Blockers and for those who beta blockers don’t work in.

  • Sewmouse says:

    Due to a irregular heart beat (there’s a clinical term, but I’m an accountant, Jim, Not a Doctor, so I don’t remember it), I take both Cardizem and Metoprolol in tablet form daily.If I miss a dose on the metoprolol, I can’t tell at all. If I miss a dose on the cardizem, it is immediately apparent to me.

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