Subaqua Sternal Rubs

Today on my way to work (actually early for once ), I turned on my radio to hear… absolutely nothing. Turns out my antennae, which used to go up halfway, now doesn't go up at all. Hence no reception, and no sound out of the speakers. Now I like to listen to my music loud, and I was unaccustomed to having to listen to the rattling of my engine.

Today's ED shift was relatively steady. I was assigned to one of large teams on the acute side of the ED, which was a nice break from the BS of "Fast-Track," however when it rains it pours. One of the other teams needed to close by 2300, due to a lack of staff, so my team ended up with 4-6 times the amount of patients that they had. We ended up with the sicker patients as well: a couple of AMI's that went to the Cardiac Catherization Lab, a couple of pneumonias, a couple of septic shocks, a couple of CHF'ers with potassiums of 2.0 and 9.0 (which causes some problems with the conduction of cardiac electical signals), a tachycardia, and a bradycardia in a junctional rhythm (at a rate of 30, pressure of 100 systolic) refusing a pacemaker, and a gentleman from home covered in feces and urine with unknown complaints.

Last night's EMS shift was also steady -and the calls were spaced so I only ended up with one hour of sleep. (Could have been I elected not to go to sleep early…) Among the calls:

• An elderly male with acute shortness of breath, and hypertensive crisis… Actually went out before shift change (and my arrival), but night crew took it, so don't know much more.
• A 2 year old who, according to parents, had a seizure. Upon our arrival, pt was CAOx3, not postictyl, in no acute distress. Just vomited once, otherwise transported without incident.
• A 60 year old male who spoke limited English who was complaining of chest pain. Medical history was unclear, except he did have a zipper (indicative of heart surgery - most likely a bypass), and a pacemaker. The pacemaker complicated things since the EKG is undiagnostic for seeing if the patient is currently suffering a myocardial infarction (heart attack.) Basically it will only show if the pacemaker is working or not. When we arrived on scene, a doctor called the house and said that she wanted the patient taken to [a local community hospital.] She said this was the only hospital where she had privileges, and could see the patient. Never mind that she wasn't the patient's attending physician, merely a family friend. So we began transport, and on the way, I hear the paramedic yell up to me that I shouldn't stop if I didn't have to. I've never really heard her say this… evidently the patient became very cool, and lost peripheral pulses. Sounds like a major cardiac event to me, and this moron MD requested us to transport the patient to a hospital that is not capable of caring for him. I wanted to call for a transport ambulance upon our arrival to the ED to bring him to a more capable facility, i.e. one with a cath lab and skip the possibly life-threatening middle-man delay.

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