November, 2015, and EMT stuff

*****STARTED IN EARLY NOVEMBER****
--I'm prepping for my EMT practical exercises, all next week. I'm not ready.


--Without getting specific, I had to officially apply my authority as a supervisor at work for the first time. I didn't much care for it.


--The weather in North Texas has been spectacular. Temps down in the mid-to-high 50s at night, up to almost 80 during the day. My wife put a drip irrigation system in for her garden in early September, and in early October, I gave her a high-end hose splitter and two-channel electric water timer. Our garden looks amazing.

--We noticed that the area around our water meter was getting swampy. I called the Public Works guys, who dug down and found a leak... on the city side! Huzzah! The very nice Public Works guy suggested that I put in a personally-owned water cut-off valve, so I bought one and a hand-hole box. He just installed that where the meter was, and moved the meter over a foot, and installed it a little higher upstream. To do this, he had to dig up the valve at the main, which was just direct-buried and not accessible by manhole or hand-hole. He took the old manhole cover and bit of steel culvert, and put it over the valve at the main, and put a new box over the meter, and put my purchased box over the valve that he had put in. He and his partner then put in sand around it, and carted away the mud, because, they said, it was dry into impermeable cement. (We have a high clay content in our soil.) 

***************LATER. MUCH LATER. WRITTEN IN DECEMBER, ACTUALLY******


--I did my skills week for my EMT studies. It was a 70+ mile drive, through downtown Fort Worth each way. Going there, I just started at about 5:45am, and made it right through the city. Coming back, I had to sit in traffic. I'm a wimp about traffic, having to only rarely deal with it. My normal daily commute is just from my front door to my car, and then on in to the office less than half a mile away.

--I took the final on a Friday. I got a 90. I'm not proud of that 90, because it means that 10% of the cases that I come across may well fall in a gap of my knowledge. I have a long way to go.


--I did my rotational internships at a regional hospital pursuing Level II Trauma Center status, and at a couple of mid-city firehouses. The fire guys were great, and were easy to chat with and get along with. They were people of the sort that I knew; they laughed and cut up, but turned on the professionalism as soon as a call for service came up.

At the ER (ED, actually), it was different. The staff was quite stiff. Tensions were up a little bit. I found myself in the way, apologizing a lot. Nurses would be professional, but often put the "curt" in "courteous." I understood. I was just an intern, and was furniture. In three days, I was gone, and there was no reason to really develop a relationship with me. Thus, I was at best a liability who could maybe be of some help in moving a patient, or cleaning up an exam room. I cleaned a LOT of exam rooms. I was surprised. My first ER preceptor, a "Tech," was a paramedic with street experience, but he was also treated a lot like an errand boy who also took vitals. And I was his assistant and intern. My preceptor was very nice, actually, and quite encouraging. He told me that he thought that I was going to be great as an EMT. I got handed off to another Tech/Paramedic, and then a nurse that I chose for her friendliness and willingness to answer questions. At the end of three days, the Charge Nurse gave me one compliment: He directed me to show the next EMT intern who was relieving me his way around the ED, and explain what was expected of him.

I did my final rotation as a 24 hour shift at the firehouse on Thanksgiving. I brought a couple of large pies with me.


--I got to see some stuff. One guy with normal vital signs had taken a trauma to the throat during sports, and during auscultation of his neck, I detected crackling sounds like rice crispies. Subcutaneous emphysema!  

An ambulance crew brought in an 84 year old man who was receiving CPR (begun within one minute of his collapse). I got put on compressions. He had been intubated. His sternum was completely broken free from his ribs. We shocked him three times. The doctors pushed a lot of drugs. As I was doing compressions, I felt something, and looked at the monitor, even as the ER doc was looking at it. He told me to stop compressions. At about this time, a paramedic and a nurse who were bagging him noticed eye movement. The patient had a viable rhythm! We backed away, and the RT put the patient onto a machine to help the patient breathe, and the doc started a central line.


We had a lot of rain on Thanksgiving night. I rolled with the fire guys to a swift water rescue that was so professionally performed that it looked actually kind of boring.  My ambulance preceptor was kind of a meat-and-potatoes guy.


An elderly woman with recent UTI and chest infection, with abnormally low BP, who had fainted in her bed and couldn't be awakened until shortly before we arrived? Well, that's just syncope (fainting). She refused to go to the hospital with us, but would with family. Walking out, I asked my preceptor about the possibility of it being septic shock. "Hey, it could well be," my preceptor said.


We had another older woman with a history of stroke, speaking in two-word sentences, with edema in her legs and respirations at about 28, who assented to go to the hospital.  While I was filling out my Patient Care Report (for my school-- this wasn't the official one), I got to the Assessment portion again. I asked my preceptor about the possibility of it being Right Ventricular Failure. He nodded and said that could be, and asked if I was sure that I wasn't going to go get my paramedic. I told him that I had too much respect for what those guys did, to assume that I could do it.

--I suppose that it's possible that someone will whine that I'm violating HIPAA by describing these cases. Of course, they'd be hard-put to figure out where the patient was, when they were seen, what the outcome was, etc, etc. I've learned a thing or two, observing my friend Kelly Grayson.

--I've sold a safe queen gun, to buy an amplified electronic stethoscope. I only asked enough to get the 3M™ Littmann® Electronic Stethoscope Model 3100, but I think that I want the 3200, with Bluetooth and recording capability. I will probably come up with the rest and buy it this weekend. I just don't feel that I can hear well enough with standard stethoscopes, over my tinnitus.


--I have to send in my EMT book to the school, and get their permission to take the National Registry test. (I'm not ready.)