The Human Lightswitch

Okay, this is straight from the “wouldn’t believe it if I didn’t see it” file, and has been on my “Calls to blog” list for sometime.  (Yes, I have a list I keep…I’m such a nerd).  It was quite some time ago,  and I don’t have the usual level of detailed recall for it.  Never the less, I submit the Human Lightswitch.

Years ago I was an EMT-Basic, I’m not even sure if I was a lead yet or not, but had the fortune to run many nights in the back of an ALS unit.  MedicJon was the medic on that unit, and I learned a lot of things before my time then.  (at one point, I didn’t know how to properly use a KED, a device used to pull people from cars primarily and a bread-and-butter EMT tool, but I could set up a three lead ECG and tell if a rhythm was “Good” or “Bad” even if I could not name them yet).  Cat was still running Fire at the time, and may have been in EMT class, but I don’t think so.  It was the middle of the night, and we get called out for an older guy who fell and knocked his head.  (That is now known as FDGB – Fall Down Go Boom.)  The engine gets dispatched with us and off we go.  The guy is laying flat in bed when we get there, holding a knot on his head as I recall, and his wife is the one to let us in.  Now, we are fully in the ‘no big deal’ mode at this point, but head over to ask some questions.

The guy is plenty alert, answers everything appropriately, no delays.  He looks a bit pale, but nothing out of the ordinary for a relatively thin older dude at 2-3 am.  He’s got no chest pain, no trouble breathing etc.  He feels a bit light headed, and his head hurts where he knocked it.  Jon asks what happened and the guy says that he got up to use the bathroom, must have passed out and knocked his head on the toilet or the sink when he went out.  (For the record, that means it is not FDGB, it’s a DFO – Done Fell Out, there IS a difference).  FDGB is usually a traumatic deal, often related to failure to ambulate, or sudden increases in gravitation ie: they trip, slip or some other manner of “clumsy” themselves to the pavement.  DFO is usually medical, and can range from a good ole case of the southern ‘vapors’ or “Alleluia breakdown” all the way to no-kidding sudden cardiac death.  Most commonly, both are minor issues.  Since we moved from FDGB to DFO, Jon was explaining that we were going to get an ECG going to see what’s going on with his heart, and asks the fire guys to go get the stair chair so we can carry him out in a seated position.

I’d been around long enough to know about “Vagaling”, and I’m thinking that the poor old guy was having himself a old fashion intestinal grunting match on the thinking seat and the constant ‘pushing’ dropped his BP and pulse rate until he passed out.  It would not be the first, or last time I’d run THAT call.  I hear Jon say that he’s going to do the ECG, and I start pulling out the cables to get that set up.  As the leads go on, the guy is explaining that he was walking when it happened, but he does not remember hitting his head, so he must have passed out.  Okay, so he wasn’t on the pot.  That seemed a bit odd, but hey, I’m new-ish, Jon is the medic, and I’m setting up an ECG.  Everything looks like “Good” rhythm to me, and Jon isn’t puckered, so the dude must be ok.  (He, in fact, was in a regular sinus rhythm with no ectopy…see, you get to use big words in medic class).  His other vitals were normal, or I’d remember what they were.  The stair chair is coming, and Jon is starting the process of sitting the guy up to get him ready to do the stand-up and sit in our special carrying-chair maneuver.  The heart monitor is on, and I’m at the foot of the bed watching it, and generally packing to move.  Cat is in the room too, doing what firemen do on these things.  

Okay, so I said I know “good” and “Bad” on the monitor, so when the guy sat up, and the bumps and squigglies all went absolutely FLAT, I knew that was more towards the “Bad” side.  By flat, I mean, right of the TV, sound the steady tone, call for the doctor, FLAT.  (Yes, that is the sort of thing that went through my head in my early career.)  I know Jon can’t see the monitor, but clearly he needs to know.  “HOLY SHIT the Dude just DIED!” is what I was going to say, but fortunately I managed to censor that one.  As I start to talk, I remember that sometimes the leads would come loose, and you could get flat lines (okay, those are dashed, this was solid, but I didn’t know that then) or strange wiggles from movement.  So, before I yell that the guy with the bump to the head is dead, it occurs to me to check the leads to make sure one didn’t come off.  Oh yeah, and look at the guy to see if he’s moving, breathing or otherwise doing “not dead” things.  So, having started to talk, I look over the patient.  The leads are on just fine. But the patient is still seated, though has this STRANGE look on his face.  What came out was “Uh……..Jon?”  as I spin the monitor around.  The pause being my time checking the patient.  Jon looked over with a ‘bad’ look on his face to see the asystole on the monitor.  Right then, the guy falls flat back and is Not Moving.  Now that’s different.

More different, was the fact that in the little time it took to process the fact that our talking patient just stopped his heart and fell backwards, usually referred to as ‘died’, the patient regained a ‘good’ rhythm and started to move around, and wake up.  I think it is safe to say that all of us, including Jon, went from “yadda-yadda” to “holy shit!” to “woah.”  The guy was fully oriented in just a couple of seconds and Jon was asking how he felt.  He knew he must have passed out, since he was laying down again, and felt like he had been “dreaming”.  “No kidding” I thought to myself…”Was it a good dream, or a really bad one?”  That is a question I didn’t ask then, but really wish I had.  He was in no pain or distress, “just a little light headed”.  

Okay, so sitting up is bad.  Guess the stair chair is out, we’ll use the reeves.  The fire guys go back out to switch equipment and we say silly things like.  “It’s okay sir, just lay there, we’ll take care of everything”, and think things like, “Don’t get up…REALLY!”  The call goes smoothly from there, we carry him out in the reeves, and get him to the unit and the hospital.  I’m sure Jon got a line etc, but I don’t recall his pressure being so low as to get him a fluid challenge.  I know now that if your pressure is low and you go to sit or stand it can bottom out, and you pass out.  Now, that is not usually followed by abrupt asystole either, so there is that.  We take him to the ER, and they have one of the “big rooms” waiting for us.  The doc is waiting too, so the nurses have clearly relayed the story.  Jon and I are a bit puzzled as to what causes such behavior as we transfer care over to the ER.  The bed there is in the seated position and we lower it to move the patient over.  The Doc there is not known as the best on the staff and is insisting that the patient be sat up.  We advise against it, but back off after giving report.  As the nurse starts to move the back of the bed upward, she asks the doc “How far do you want me to sit him up?”   I lean over to Jon and say, “To the off position.”  As we are about to leave, we see the patient go unconscious, and asystolic.  “Lay him down! Lay him down!” the doc yells.  Jon and I share a “told ya so” and walk off to write a report, and get the unit ready for the next one.  Guess the doc believes us now.

DTXMatt12 comes out

Well it has happened again, someone else I have known for years, and have very high respect for, has started his own blog.  DTXMatt12 has posted his own humorous comments, and even an article here, and now has decided to go out on his own as well.  His first postings hint of life at our beloved firehouse, and the fraternal nature of those of us who live and run there.  You cannot understand a firehouse without understanding the heritage and traditions of the building and people there with you, and before you.  It is an aspect of life there that I have not yet addressed here due to the popularity of run stories.  I recommend his site, he is an endless source of great tales still told to our new members as a right of passage into our tight little family.  He is at http://www.dtxmatt12.blogspot.com/ and I will add him along with S. and MedicJon on the instigated blog lists tonight.  I am looking forward to reading him, and I hope he continues to participate here as well.  

As for myself, I’m looking to curl up with the laptop and get a story up on here either tonight or tomorrow.  I’m working on a call from years ago on a guy who was suffering from “Human Lightswitch Syndrome”. See ya there.

That dead lady gave me the finger

Alright, you won’t often hear a Medic (capital M) admit it, but there are times you look back and maybe doubt your past decisions.  Call it reviewing, re-evaluating, whatever you want, but the bottom line is you are scratching the quiet itch of doubt.  Now, if you honest with yourself, you find things to do better next time, or learn something new.  And if you’ve been doing it a while, and learned from your past, more often than not you can reaffirm your actions and stick to your guns.  Almost nothing puts you through that mental review process more frequently than a call that ends in a code.  And sometimes, the Reaper is just yanking your chain.

The engine crew was already on a run when the call came in for a Stoppage of Breathing at the assisted living place across the street from the station.  As result, we got a BLS ambulance and engine from our second due sent with us for help.  The extra information says that it is a 93 year old female patient, call placed by the staff who found her.  We did not get the usual “CPR instructions are being given”, but there are nurses there, so that may not mean anything.  Oh, and the call is on the top floor, but you knew that already too.

Jen was with Cat, Kelly and I, and was, at the time, in the midst of an epic run of codes.  By epic run, I mean something like 7-9 of them in a three month period.  She had her own entry in the CDC’s Morbidity and Mortality report.  This is the same stretch that had the guy on the bike hit by the car. Anyway, getting a code with her at the time was anything but surprising.  

We do the usual “toss everything on the cot, and haul it up to the room” routine and get upstairs pretty quick.  As we head down the hall to the room, we see two of the staffers waiting for us.  Of note, they are in the hall, not in the room…guess there is no CPR going on here.  A bit of an exasperated sigh, and we are past them into the room.  On the bed is a 93 year old lady, looking for all the world like anyone’s grandmother, but dead.  She’s flat on her back, eyes open, mouth gaping, and clearly not breathing.  She’s been down a while and I can see that her pupils are glazing over as I do the mandatory pulse check.  “So, you just found her like this?” I ask the staff.  They tell me yes, it was on a check, but they just saw her, “not long ago.”  Of course.  It always seems that whenever we get a code at a nursing home, or assisted living place, the patient was always “Just seen”.  Sometimes it is clearly a lie, like the time we took a guy out in full rigor, this is not that obvious but more likely they just didn’t realize how much time had passed.  I have Cat setup the LifePak to document the findings, knowing she’ll be asystolic even before everything is on.  I’m looking to call this here and now, but not long prior to this, a medic in an area north of us called a DOA, only to have the overdose patient later wake up and make a full recovery.  Her butt was in a sling, and that case is still pending.  As a result, EVERYONE gets an ECG, and we document it all.  

I’m on my cell phone even as Cat grabs the LifePac and hitting my speed dial to the Doc at the hospital.  The doc answers quickly, and it is a doc I know, but is middle of the pack as in reputation amongst the Medics.  I explain what I have, an unknown, but reportedly “not more than 30 min” down-time, no CPR in progress on arrival, milky pupils etc.  Our protocols say I can only call it with lividity, rigor, or “injuries incompatible with life.”   She doesn’t have obvious lividity etc yet, so I have to call.  The lifepak is on as we are talking, and no surprise, she’s textbook asystolic.  “What interventions have you performed?” is the question I get over the phone.  I explained we have done nothing ALS, that the call is to not work the code.  He explains that he ‘can’t have you stop if you have not done it yet’.  “Okay doc, copy, work the code…” Cat gives me the you-must-be-shitting-me look “we’ve got a lot to do, will call when we are on the way.”  I think the doc heard the tone in my voice and he started to say, “You don’t have to work it all the way, just call when you’ve done things.”  Okay, now THAT is confusing.  

A brief interjection here.  I am NOT in the habit of not working codes.  I’m considered fairly aggressive on the street, and I’m not going to use age, status, or medical condition (outside of being dead) to determine working a code or not.  Hell, my only two walk-out-of-the-hospital saves that I know of are a drug dealer (see S.’s blog) and a terminal cancer patient.  I’ll run the code with about no chance at all, just in case the big man upstairs wants someone back.  But, this lady is D-E-D Dead, and there is nothing else to be done about it.  I know of only one medic that can get this lady back, and last I heard he gave the slip to a couple of Roman Centurions about 2000 years ago.  This was just one of those cases where I was not going to go around protocol and say I saw something I didn’t (rigor etc) just to avoid the call.

Okay, so, we are working it.  It’s a training run, but if we are going to do this, it will be done right and by the numbers.  The engine and the basic come in to see us pumping chest and getting the BVM to the O2.  I had gotten past the unique pleasure of cracking the lady’s ribs with the first few compressions and started to hand compressions off to Jen and Kelly.  The basic unit lead was in EMT-I class, so with her, Kelly out of I class, Cat and I, we had silly ALS help.  The staff of the place wasn’t much help and was struggling to get paperwork in order for us.  Typical too.  I make the call to run the code BLS to the unit, and we are moving that way fast.  There is good compliance with the BVM, and we had her on the cot before the other unit got there.  The patient and the folks doing CPR head to the elevators, and I follow on another one.  There is limited room, and we could not all get in at once.  The team is solid, and I’m not adding anything to that point.  

We transition smoothly to the unit and get setup fast.  Everyone is kinda got that amped-up code groove going and I take a moment to calm everyone.  “Okay, everyone understands how this one is going to end right?”  I get nods from Cat and Kelly, and a little confusion from the rest.  “She’s dead, and nothing we do here is going to change that.  Let’s do this right, get everything done, and don’t poke each other…okay?”  I can feel the back of the unit calm and everyone gets going.  I have the intubation kit out and work with the lead from the basic to get going there.  Kelly offers to get the IV, not a trivial deal on the arm of a person with no blood pressure, and I tell her to give it a shot.  It’s good experience, and she’s pretty good with a needle.  If she doesn’t get it in the time it takes me to get the tube, I’ll have Cat try or I’ll just go for the EJ (IV access in the neck veins) from up here at the head.  Cat gets Kelly going and after the basic ventilates, I take a quick look into the trach of the patient.  Yeah, she’s been down a bit.  I see right away that there is none of the usual ‘goop’ you find in there.  She hasn’t vomited, she isn’t full of mucus etc and all in all, a very clean airway.  (okay, if you aren’t a medic, you may no know that that is a compliment.)  I know I have an EMT-I student next to me, and this is a good a shot at experience as she’s going to get.  (I can’t let her get the tube by protocol, no students get field intubations until after certification etc…kinda stinks, but thems the rules.)  So, I lean back and motion with my head for her to take a look.  She leans over fast and sees her first human airway.  “Cool, not like the dummy” she says.  “okay, so this is not a total waste” I think to myself.  Jen is on my other side, and giving me the raised eyebrows, so she gets a quick peek too.  I have the tube all set to go and pass it quickly, seeing it going through the vocal cords and into place.  I’m well under my 30 seconds for the intubation, so I have the student look in to see what that looks like too.  “Tube placement visualized by two providers” I think to myself and grin.  My documentation will show that this part was nailed.  I hear that Kelly hit the line, and Cat is pushing the first round of meds.  Compressions are going smoothly, and I listen to confirm placement of the tube I already know to be in place.  The Capnography is flat, but then, she’s dead so I have great ventilations, and no respirations.  (Air in and out of the lungs fine, but she’s been down to long for her body to exchange the O2 and CO2 in her blood).  You get that same effect when you intubate a tree.  

Alright, wow, smooth code I’m thinking.  Everything went great, worked the first time, and everyone knew what to do. Nice, smooth.  As much as I abhor a Custer-Fluck, I do admire a group just doing what needs to be done.  The student goes up front to drive and the hospital is only about a mile and a half or so away.  (Which is why we weren’t already rolling).  Quick checklist in my head:  Airway check, compressions check, IV in, drugs in, oh yeah monitor….still asystolic and textbook flat.  Time to call the doc.  “Hey doc, Okay, CPR in progress, asystolic at the start, Tube in, IV in, one round Epi, one round atropine, still asystolic. Pt eyes continue foggy, request permission to call it.”  He asks me how long it has been.  I check my pager…holy cow, I was Dispatched 20 min ago.  “20 min” I tell the doc, and he says to call it.  I give the wave-off to the team in the back of the unit.  “okay, 2 min out” to the doc. Hang up and yell up to the driver so we can just drive, no need for the lights.  (We were still in the parking lot)  Now that means that 20 min ago I was watching TV.  We got the call, got across the street, up the elevator, to the room, talked to the doc, talked to the staff, ran the CPR, got down the stairs, to the unit, ET, IV, drugs and another call, in 20 min.  That’s silly quick and just another case of the mantra: Smooth is fast.  Doing something right the first time, under stress, even though you think you are going slower to be careful, is actually much faster than rushing and messing up.  I’ve noticed our EMTs picking that up, and it’s fun to watch.  Again, a good team is everything.  

We get to the hospital and wait in the bay for the doc to come out and declare the death.  It takes a while, something like 15 minutes, the ER was busy and it took him a while to come out.  Some time during this, the Rescue Chief comes by to see how things went.  He finally comes out, listens to her chest, sees our leads and declares death.  We go into the ER and I work with the Charge Nurse to get someone to the morgue so we can take the body around.  This takes about another 10 minutes to arrange, but finally we can drive around, “downstairs”.  The Chief gives the wave and starts to leave.  

The morgue entrance is in a parking garage type structure that is under construction, so it takes a bit to maneuver the medic unit to the door.  We get the lady transferred onto the pan, after moving another resident and get started to leave.  I’m helping back the unit up around some obstacles when one of the ER staffers comes running out, eyes WIDE open and gesturing madly.  “Your patient is MOVING” he all but yells.  Aw, hell.  Visions of the medic north of us in my head, and grateful for all of my ECG tracings, I stop Cat from backing the unit.  I grab the LifePak from the unit and call back the Chief on my Nextel.  He comes screaming back into the garage in his buggy in a flash.  Me, Cat, Jen and the Chief head for the door to the morgue.  Inside, there is a patient rep, a nurse is just running in, and the patient on a table.  I rush in to see what’s up.  The rep is pointing and agape, not a good sign.  “Don’t touch her” I get from the Chief “that is the Hospital’s patient, not ours”.  Good, clear headed thinking on his part, and he’s exactly right.  We’d handed off care, and the ER doc examined the patient and declared death…this is not my patient.  About that time the doc is walking in.  “She’s moving her finger” the rep says and we all stop and stare.  Sure enough, she’s moving.  Her index finger is moving off and on, kind of a “Come here” move.  “You HAVE to be kidding me” I think as she does it again.  The doc is in now, and listens to her chest.  We are all silent as he leans in, and the finger twitches once more.  “It’s okay, just a reflex from the drugs” he says.  Well, that makes sense, and I’ve heard of such things, but never seen it.  It seems that the Epinephrine, given to help stimulate the heart muscle was causing twitches in her finger.  Let me tell you, hearing it is one thing, but seeing a lady who has been dead for at least an hour or so give you the “come here” will cause you to suck the underwear right up your butt, and I’m not too big a man to admit it.  I’ll know it if I see it again, and I damn well better not see it again too. Grin.

We pack up and go to write the report, and I un-pucker my backside.  I document he heck out of this one though, and have plenty of tracings to show the call.  We clean up and chuckle, knowing that we took a plain old code, and a practice run at that, and turned it into ‘one of those calls’.  To this day, I wish I’d just let her stay in bed, and none of this would have happened.  

Maybe it was the one-armed man

I have a confession to make.  Sometimes I have been guilty of mocking a dispatch.  Now, I know they are often just passing on what the person on the line is saying, and that person is the member of the public.  And as the little old ladies here would say, “Bless their heart”, we all know we can’t trust the public’s description to in anyway match reality when it comes to our emergencies.  So, a couple weeks ago, when Cat, Wayne and I get dispatched early in the night for a “Possible injury from a fall”, I admit I asked allowed of Wayne, “Well, did he, or did he not fall down?”  As it turns out, the dispatcher was correct.

The call was for our second due, and the MDT (our onboard computer) passed an update that Police were on the scene, and that the patient is disoriented, and saying someone attacked him.  “What does this have to do with a fall?”  I’m thinking as Wayne accelerates north, negotiating the moderate traffic.  The address is an apartment building in a part of town that has seen better days.  The apartments are known for a fine history of fires, and having multiple families per unit more recently.  We often get sent there for assaults, and unconscious calls that end up being cases of lots of alcohol, very little sense.  The first due engine gets there just ahead of us, and as we pull up, I see that there are one or two police cars waiting and the Rescue Chief has come along as well.  Yeah, just another call on Bayside.  

We trot up the stairs (again, it’s always upstairs) to the apartment.  Again, easy to see which one we are headed for, the door is open, there is plenty of people in the first room, and a Police officer at the door.  We get to the door, and I ask, “Where are we headed?”  I should have known the answer before I got it, “In the back room”.  Of course.  As I make my way through the apartment, I can’t help but notice that there are about 15-20 people in the front room, kitchen, hallway and bathroom.  Now normally, this would be a mix of all ages, and represent a couple of families.  In this case, they are all between the ages of 18 and 30, mostly male, and all in pretty good physical shape.  There are about three Police on the scene, and the further I walk back to the room, the more of these guys that are between my crew and the door.  That is not necessarily bad, but it is never good.  The engine crew seemed to be noticing it too, and they kinda spread out in a line from the front door to the back room.  There, I find the patient, face down on the floor, handcuffed and being held down by a female officer, who is kneeling on his back.  He looks confused, and while dressed, is a bit wet.  I notice that while she is on his back, she’s scanning the room as we enter….SOMETHING went down here.  

Her words to me are something along the lines of:  “I’m not sure what is wrong with him.  He says someone attacked him in the shower, but he’s all confused and not answering questions.  They,” motion to the door and the people beyond, “were fighting with him when we got here.  They say he came out crazy and was fighting all of them.”  The patient has his head lifted up and is looking about, and muttering something, but it is unintelligible.  The room is dark, lit only by the light from the attached bathroom, but I don’t see any real obvious clues.  But, I have one guy in police restraint, no obvious trauma, conscious but confused, looking around slowly…kinda like, “Hey, look…people.” And he was taking on a group from the other room.  Now, I know with family etc, they were probably taking it easy, but that group looked like a sports team, and I didn’t give my crew, plus the cops, plus the engine guys much better than a 60/40 edge if things went bad in here.  So, this thin guy must have been pretty ramped up.  (Any of this sound familiar, because it LOOKED familiar).  

Well, I got a string of guys from me to the exit, and the Rescue Chief is in the doorway to the room.  I know he’s thinking what I am, and has placed himself in a security position.  I stifled the urge to say to him, “Holy Shit Custer, look at all them Indians.”  I’m sure he’d have slowed down a rush long enough for us to do something before he got run over, and I’m glad he did that.  So, while the group is kinda anxious and walking around nervously, we are as good as we are getting, and I can’t hold past experiences against them…even past experience in this neighborhood.  I ask the patent a few questions, and basically get no answers, but he seems to be intent on conveying that he was showering, and “some dude attacked me”.  Eventually, we get out that this ‘dude’ reached in while he was showering, grabbed his ankles or legs and pulled him down.  (A-ha! A fall, now I get it.)  His girlfriend, nearby, tells me that she was in the other room, there was nobody in the bedroom but the patient, and nobody went in until he came out of the shower, “all crazy”.  Maybe it was the one-armed man, I think to myself.  His vitals come back okay, nothing out of the ordinary.  Pulse was up a bit I believe, but that makes sense here.  He’s not diabetic, not on any medications.  I check his pupils and they DO seem a bit small, not really pinpoint, but too small.  I’m thinking drugs, and so is Cat.  “Any chance he took something?”  I ask his girlfriend.  Now we are in front of the cops and everyone, so the “no, no” answer is neither surprising, nor necessarily accurate.  But, one has to ask.

Okay, let’s roll.  I’m thinking we’ll be trying the Narcan, a narcotic antagonist, to see if that doesn’t bring this guy back, but it’s a bit of a stretch.  The idea of un-cuffing him is never even discussed, so he’s going out like he is.  I have the engine crew get our Reeves from the unit.  I don’t know if I’ve described that here or not, but basically, it is a series of small strips of wood, about six feet long that are have been laid out side by side and wrapped in a plastic wrapping with handles.  The result is a very portable litter that is rigid from head to toe, but can be rolled up, or wrapped around someone.  We use it all the time.  Now, I’m thinking he should go out on his back, face up, so I can keep his airway clear as we go down the stairs.  The Chief opines that we need to take him face down so he’s not on top of his cuffed wrists.  I’m not so sure I like that, and I express some concern about positional asphyxia etc.  He points out that his legs are not bound, and that is a big part of the positional asphyxia thing.  Okay, I’m more interested in moving than arguing, and if he has issues when we get going, I have plenty of people to deal with that too.  Face down it is.  I had already made the call on the possible backboard issue – He was unclear on his falling or not in the shower, there is no sign of trauma, no pain or tenderness when I press on his neck/back, AND he has been wrestling his entire family since then.  Boarding would mean uncuffing, and we are not doing that if we didn’t have to.

We roll him onto the Reeve’s and get ready to carry him out.  As we exit the room and start down the hallway, the Chief gets a better look at the patient and the situation.  “Hey Chris, I think you’re right, he should be on his back.”  Now, we’ve discussed this moment between ourselves since then, so, while he may well be a reader, I feel confident when I say the thought, “Gee, that’s great timing on that one Chief.  Thanks for the help.”  (During the later conversation, he clarified that his concern was over stressing the wrists of the patient, and putting his torso’s weight on them.  As it turns out, the patient was kinda loose in the cuffs and able to move his wrists to his side…as we’d see in the unit.)
Now, I’m moving, carrying the patient, and we are NOT stopping again until there is an issue or we are at the cot.

The engine company has the cot waiting outside the door of the building, and when we get there, we open the Reeve’s and flip the patient over, careful to bring his arms to one side to help his wrists.  We load to the unit, and have an officer come with us.  They are okay with that in light of the struggle they had before our arrival, but to be honest that was only a minor concern.  We still didn’t know for sure what the deal was, and while he seemed stable now, if something happened, we’d need the cuffs off fast, and that is not something we can do.  Also, considering everything, I’m okay with an officer there to observe the fact that we take care not to harm the guy.  We get vitals, and Cat does a nice job getting the IV going in spite of the odd positioning on his arms.  The patient is starting to talk more now, and is making more and more sense as he does.  He’s calming and generally becoming “OK”.  I decide against the Narcan at this point.  While this may be a narcotic deal, it doesn’t feel like it, his behavior doesn’t dictate it, and even his pupils are looking okay in the light of the unit.  While Narcan is often considered one of those drugs that, “It doesn’t hurt ‘em to try”, I also was taught to remember that all medicines are poisons, but that they have really beneficial effects, so we use them.  I’m still thinking drugs are a possibility, but his behavior is more PCP or hallucinogen than narcotic.

His ECG is good, no ectopy, not tachy or anything.  He’s oxygenating well, and starting to hold a conversation with the police officer.  I try not to interrupt too much, the cop is asking good questions, and I’m more watching his level of response than anything else.  He is concerned about the cuffs, and the cop tells him that they can come off at the hospital.  We basically monitor him on the way, and don’t do much else.

Arriving at the hospital, we get him transferred quickly, and the officer loosens the cuffs after a clear explanation of the consequences of acting out once they are off.  I give report to the nurse, and she gives me a quizzical look.  He may or may not have fallen in the shower, he says he was attacked, but everyone says that is not possible.  He was certainly not responding well on scene, but recovered quickly in the unit.  He was battling his whole family, but is now calm and cooperative.  His vitals are good, and everything is stable.  I’ve got a line, cause that is what we do, and here you go, best of luck, gotta go, see you with the next one.  

In the report room, we compare guesses and notes.  Drugs, always a popular choice, but wow, that wore off kinda fast with no intervention, and they say he didn’t have any there.  That could be a fabrication, or perhaps it was a flashback.  Seizure of some sort, postictal when we got there, awake now, but that does not quite fit either.  Low sugar, no diabetes, and the number was okay.  Actually fell in the shower?  Possible, but that does not explain the rest.  Actually attacked?  Possible, but again why the incoherence?  Psych issue, again, a popular choice always, but who knows.  Was it an act in the house, looking to get out for whatever reason, domestic issue etc, and then the ‘wake up’ was just dropping the act now that he was out?  Again, fits well, but we don’t know.

These calls are always interesting, and frustrating at the same time.  We never did get a diagnosis from the hospital, as usual, and will never know for sure.  No matter what the cause, it does make you appreciate the complexity of humans and the things, internal and external, that affect them.  That’s something they don’t cover in class though, the “Gee, I dunno, he’s sick and I brought him here” calls that make up a fair bit of our practice.  Or, maybe I missed that day.