Sunday, May 11, 2008

Crunch

Sometimes, in EMS, particularly in the jaded urban world, we get a tendency to discount the opinions of bystanders -- or anyone except us and our partner (nursing home staff, fire dept, etc). How many times, either through intent or stupidity, have they told us something completely wrong?

"She's having a seizure!" the man shouts, as his wife screams and beats her fists on the floor. No, she's throwing a tantrum -- at fifty years old.

"He's having difficulty breathing," the CNA tells me, holding out a packet of paperwork. On the bed behind her, the man is pale and still. His chest does not move at all, I feel nothing on either side of his throat when I dig for a pulse. "Medic 38," I snarl into the radio, as I help my partner yard him onto the floor, "with patient, working code."

"She's having an asthma attack, it's her asthma, you've got to give her the medicine!" But sixty seconds of assessment show me clear lung sounds, perfect saturations -- and a CO2 of 15 with a respiratory rate of fifty. "No, ma'am, ma'am -- ma'am, listen to me -- ma'am, look at me, right here -- you are breathing just fine. You are hyperventilating. Listen to me, we're going to slow your breathing down, okay?"

So with all these -- with all these tales, and a million more that could keep me and my coworkers telling stories for an entire night, laughing over beers at the poor diagnostic skills of laypeople with no medical training, clearing the inevitable ring of tables around us -- with all these, can you accept our inclination to be disbelieving? Or, if not accept, can you at least understand?


* * * *


Last week we were first onscene of a motorcycle vs. car wreck. The motorcycle rider crouches, holding the shoulders of a child sitting on the ground next to the bike. The rider -- the father -- looks up at me. "His femur is broken."

I couldn't help thinking, Yeah, okay, sure thing, buddy. I think I simply told him "Okay, let us check him out," and moved in on the kid. We cut his pants leg open and see a nasty open tib-fib fracture. I do a half-assed palp of his upper leg and glance at it, keeping half an eye on the firemedic doing bleeding control and stabilization on the lower leg, and half a mind on managing the rest of the scene. Ask the kid where it hurts, and he says his ankle.

Two minutes later, we're getting a vacuum splint in place around the kid's leg, and we cut his pants leg a bit more. The lieutenant from the engine abruptly says, "Whoa, what about that femur?"

And indeed, the deformity that wasn't obvious from my viewpoint with the pants half-cut is now very obvious. Totally fractured. Balls. We can't do a traction split because of the ankle fracture, our treatment won't change, but balls on missing that first go around. And a big pat on the back to the knuckle-dragging clipboard-holding EMT-Basic lieutenant. They say basics save medics, and I'm here to tell you it's the truth, more times than I can recall even in my short career.

As we're loading the kid up, I talk to the dad briefly, tell him what's up, what we're doing, where we're going. "And," I finish, "good call on that femur; you were spot on."

"Hey, man," he shrugs, "I was a field medic," and by this and his age and bearing I can only guess military.

"Besides," he says, "I felt that shit move."

7 comments:

Medic61 said...

My favorite is a patient's husband saying she had a seizure when she jerked before falling asleep.

I have yet to have a bystander be right, though, so I'll have to keep a lookout!

Birdy said...

I've been reading for a long time--Just saying hi.

Ellie said...

Indeed it is good to reach the point of not being swayed by other peoples' opinions.
Thanks for the co2 tip, will try it out soon!

Anonymous said...

"He's having an allergic reaction! Look! There's a blister on his lip! Should I give him his epi-pen?!"

::2 y/o kid giggling, acting normal and bouncing around on a park bench::

"Ma'am it looks like your son's lips are just very chapped. Does he lick them a lot?"

"Oh yeah all the time."

- DR

NJ EMS said...

"He's having difficulty breathing"...love that one.

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Rogue Medic said...

When you have a femur and ankle fracture, you cannot use the scientifically baseless traction splint, but you can use a lot of pain medicine.

I do mean a lot. I had one who received 30 mg morphine, then 7.5 mg midazolam (because there wasn't any more morphine, but there was a good medical command doctor on duty).