Experience is one of the main components of a paramedic’s smarts. Others include, but are not limited to, book learning, common sense, and mental acuity.
To put experience mathematically, a paramedic is only as smart as all the calls he has ever done minus those he has forgotten about. Thus a paramedic who is working consistently should continue to get smarter provided he continues to do new calls faster than he forgets old calls.
I am smarter this week than I was last week. Here is what I learned:
A young person who presents like a text book case of kidney stones, cool, diaphoretic, with cramping flank pain is likely having kidney stones even if their 12-lead shows mild elevation in Leads V2 and V3 with depression in III and AVF. A 12-lead, while useful, is not a perfect test.
A call that comes in as an MVA, is updated as “a person thrown from the back of a pickup truck and is now unconscious,” that the dispatcher repeatedly asks for your ETA and whether or not you are a paramedic unit, and when you get there you find the patient sprawled on the sidewalk and only agonally breathing, may not necessarily be a trauma. Be thankful after you scooped and ran that you and your partner, after finding no bruising, indentations or abrasions, checked their pupils, saw they were pinpoint and gave narcan waking him up before you made it the four minutes to the hospital. Hope that next time you check the patient’s pupils before you call in a trauma alert. (The patient you later learn was pulled from the back of a pickup truck by bystanders who found him unresponsive).
Do not, particularly in the midst of a bad call, let a anyone who is unfamiliar with how your stretcher works, try to unload your patient, no matter how well intentioned they may be. Be thankful that the worse did not happen, and the patient stayed on the stretcher and the stretcher did not completely tip over.
When someone tells you the woman you are treating is a “Madea”*, do not be surprised in cutting their clothes off to discover the woman has a penis. (*Madea is large grandmother character played by Tyler Perry).
While your protocol calls for you to consider termination of a cardiac arrest after twenty minutes with no success, if the patient still has a decent end tidal, it is not a bad idea to continue the resuscitation as they may come back after 30 minutes (and stay back at least until hospital admission to the ICU).
When carrying a patient on a scoop stretcher down incredibly narrow stairs with tight turning stairwells, a good approach is to stand them straight up at the bottom of each landing, pivot the scoop, and then continue carrying. This will save smashed hands, ruptured backs and much sweating and grunting.
While as a rule, confrontations should be avoided, when questioned about pain management, it never feels bad to politely point out that your dosing is correct and that the patient remains hemodynamically stable and is still in pain, and could benefit from redosing. Additionally, if the health care provider has fewer years of experience than you, it is acceptable to tell them that instead of assuming everyone is a drug seeker, the health care provider should inspect the patient for themselves before making judgments.
If you are posted at Blue Hills and Tower in the morning, don’t forget the Mount Sinai cafeteria is open in the hospital basement and the oatmeal is only 60 cents for a small.
Also, the ackee and saltfish at Sisters Restaurant north on Main Street is excellent, although you cannot get it in a small portion.
Vaginas have glands that can become swollen. They are evidently capable of being quite painful as a young person with swollen vaginal glands found them too painful to walk the two blocks to the hospital and called for us instead.
When a doctor tells you a boil on a patient’s bottom is draining and malodorous, malodorous is an apt word.
There is a new splash pad in the Sigourney Street Park that makes an excellent midday destination stop on hot humid, sweating through your clothes, ambulance AC is not getting the job done kind of days. Don’t forget to bring a towel to dry your head.
Things I forgot this week:
I don’t know, but the good thing about forgetting things is that they are not always lost forever. Some of the things I learned this week I had learned and forgotten before. Old lessons are around you all the time just waiting to be refound.