Sunday, November 1, 2009

Ghetto Medical Terminology

Working in a "distressed urban area" like I did until recently has its unique challenges. People who ignore lights and sirens on the ambulance, people calling for foolish reasons (that's a whole other post), and language barriers. Usually when people say language barrier they mean that people are trying to communicate but they each speak different languages. But in the Great White North, I mean my patients use strange medical phrases and a lovely "language" known as Ebonics. Phrases that new EMTs have never heard of. Phrases that, frankly, boggle the mind.

So, here are the phrases you need to learn to work in EMS in an urban area.

Ammalance: Personally my favorite word. This is how your properly say "That giant box on wheels with the flashy lights that comes when we calls 911". You'll notice that the word Ammalance has no "b" in it. I have actually trained everyone I know to pronounce the word this way. Ammalance, that's what I work on.

Fell out: Ah, the most common. And one of my favorites. Fall out means passed out, lost consciousness or had a syncopal episode. It does not mean they fell out of a car, out of a tree or off a building. And this isn't a slang phrase as best I know. This is honestly the only term some of my patients know to express this idea. I've had people deny passing out but a little further questioning reveals that they definitely "fell out"

I got the sugar: Pretty common and pretty simple to understand. This means that they have diabetes. A little more probing with reveal how compliant they are with meds, how often the check there blood sugar, what type of diabetes, etc. If they say this, taking a blood sugar is never a bad idea.

Worser: I hate this 'word'. It’s like fingernails on a chalkboard, Paris Hilton on the radio or a cheese grater vigorously rubbed against your nipples. Just painful. Worser means the pain is increasing. Frequently it really means that the pain started 4 days ago, the concept of primary care doctor is completely unknown to the patient and right now there's nothing good on TV so they'll call 911 for a ride to the ER. 90% of the time "worser" means low levels of pain and a whinny person.

My ______ is painin' me: The National Grammer Chancellor started sobbing inconsolably when he heard this. This phrase means that a particular area or organ is causing pain/distress/discomfort/annoyance. However, very few people who say this are well versed in basic anatomy. So it's possible that your "heart" is painin' you/you're having a "heart attack" but that the pain is actually in your abdomen. Kidney pain may be felt in your epigastric area and a headache can occur in the groin. You should not just write down what they say on you run report. Ask them to point to the pain and go from there.

10/10 pain or Pains a TEN!!!: Some asshat decided we needed a way to measure pain, a self-reported number. So we have a 0-10 scale, 0 being no pain and 10 being "the worst pain you can possibly imagine".

Let me paint a picture of true 10/10're walking down the street, minding your own business, drinking a glass of wholesome milk, when Sumdude shoots you in the knee for no reason. You stagger a little on what remains of your knee and end up wandering into the street, where you are promptly hit by a bus going 40 miles per hour. So now you have 6 broken ribs, broken clavicle, dislocated shoulder, bruised kidney, lacerated liver and spleen, multiple random bruises and lacerations plus the gunshot to the knee. And miraculously your spine is totally intact and you are totally awake and alert and aware of your surroundings. You plead with god for unconsciousness or, failing that, death because the pain is so bad. Then when I roll up in the ammalance, my partner accidentally drops the backboard on your face breaking your nose. You got that mental picture??? Great, that is 10/10 pain. Pain as bad as you can imagine. Pain that makes death seem like a damn fine idea.

I had a 14 year old girl who "may" have mildly twisted her ankle try tell me she had 10/10 pain. After I watched her walk to the hallway and get her shoes for her trip to the ER. The most mild of limps was questionably present. I lost my cool a little bit. A 'discussion' ensued between me and the patient. We ended up calling it 8/10 pain. And when the first thing you say when I walk in the door, while smoking a cigarette, is "Pains a TEN!", that makes me 95% sure that your complaint is BS.

I take peanut butter balls: Um, okay we all like peanut butter balls but I don't know what would make you think they are a medication. Oh wait. You take them for your seizures? Ahhhh, is it possible the doctor meant Phenobarbital?? An old school medication for seizures?? Yes, I did hear this once. You kids will her it less and less since Phenobarbital is being slowly replaced by a variety of better medications with less side effects and less funny names. But yeah, that man with the "shakes" takes peanut butter balls

Part Duex will follow soon.


Monday, October 26, 2009

Tips on Overdosing - A Guide for the Do It Yourselfer

EMT's are not quite as dumb as you think we are, so here are some tips on doing and calling in your own OD. Following these tips will make the call more interesting for EMS and more fun for you, so please pay attention and follow along.

1. If you are going to make a heroic effort in your current condition to move your normally barely ambulatory body to your living room, unlock your door, and position yourself on the sofa, so we can see your barely alive self slumped on your couch, please remember to unlock both your main front door and your screen/glass door or we most definitely will break the door down to get to you. Also, please buy a door with a stronger handle. If I tug on the door because I think it's just stuck and the handle breaks and I cut my hand, I might lose focus on your plight for a moment.

2. If you forget to unlock the screen/glass door, please do not move your nearly lifeless body suddenly to the door to unlock it when you hear me asking for tools to break in. It kinda blows the illusion you're going for.

3. If you do choose to hop up and unlock the door you forgot to unlock because you do not want us to break it, please do not return to the sofa and resume the exact nearly lifeless position you were just in. Maybe fall on the floor or something. Just a suggestion.

4. If you plan to vomit for our benefit upon our arrival, at least swallow some empty capsules or sugar pills, so we see something in your vomitus. If you OD'd 15 minutes ago, trust me, particles would still be in your stomach.

5. Vomiting should not take the much effort if you just OD'd. If it doesn't come easy, don't force it. Again. You're really trying to make me believe.

6. If you want me to believe you really did OD on prescription meds, pick one that would match up with the effects you are play acting. If the pills and the symptoms don't match, I'm not gonna buy it. Again, you really have to work a little to keep the illusion going for me.

7. If you tell me you OD'd on one of your prescription meds, toss them in the toilet or something and present me with the empty bottle. If you tell me you took XXX drug, and I open your prescription bottle and count 28 pills, and the label says there were 30 in the bottle ... again with the illusion. It just faded a little.

8. Please specify WHICH top drawer you are talking about when I ask where you keep all your meds. I am planning to go get them and bring them with me to the hospital. I will be opening the drawer to do this. If I open the wrong top drawer and find your porn stash, I could be traumatized for minutes, hours or days. It's not nice to traumatize the person who is trying so very hard to save your life. You OD'd remember? I'm here to help.

9. Oxygen doesn't fix everything. Even though I will swear it does, it doesn't. So when you improve DRAMATICALLY in the ambulance on 2 liters of O2 and nothing else, you are once again messing with the illusion.

10. Precipitous drops in vigor and acute onset blindness are not symptoms of many drugs. Hardly any actually. So if you're pink and chatty and happy in the amalance, don't expect me, the nurses or the ED doc to believe you have suddenly become so lethargic that you literally cannot lift a finger, and that you have suddenly gone blind as we pass thru the ED doors. Not even the phlebotomy student is buying this.

11. I absolutely will tell the ED doc that your are full of shit if you push me far enough. And yes, in case you're wondering. You pushed me far enough.

Try again another day. With these tips in hand, you might be more successful.

12. One last tip. If you print these tips out, do not have them within sight when I show up. I actually enjoy well acted plays, and I'd like to play along as long as you can keep me interested.

Sunday, October 4, 2009

You are incorrect sir ...

I do NOT hate all Mexicans. I do not even hate you. I am however a little miffed that it is 4AM, you have admitted to the use of illicit substances, and you are being such a baby that I cannot touch your sprained ankle without eliciting a stream of profanity from you, and yet you are now sitting in the back of the very expensive ambulance, receiving care for which you will not pay, on your way to the hospital, to receive services for which you will not pay, and you choose to accuse me of being racist because the splint I put on your ankle is uncomfortable. Should I take a look at your gang tattoos and summon your homeboys to see what a tough guy you really are?


Saturday, September 26, 2009

Man, do we suck

The title kind of says it all doesn't it?

WSS and I have totally dropped the ball. We have both had hilarious patients, great posts, sad patients and entertaining stories to tell recently and neither of us has posted.

We suck. And not it the happy, fun way.

But all is not lost. I have 2 posts that are partly written that I will make sure to get up within the next week. And I'm sure WSS can crank something out too.

So, stay tuned, we're still here and we still have funny stories.


Of yeah, as a favor to Ambulance Driver we just wanted to pass this along.

Cycles and More still sucks.

Sunday, June 28, 2009

Let's call him SGT Smith

So I went to Great Big Hospital to pick up a patient who had recovered from an acute MI and was going home to the long term care facility where he had been living for the past several years . I stopped by the nurses station to begin the requisite paperwork while my intrepid partner went to the patient room to introduce himself, grab a set of vitals, see if the patient could get on the cot by himself, and check for things like a foley, IV, monitor, etc that might need to be discontinued before we left. He came back in a few with a set of vitals and didn't say much else. I finished the paperwork and went down to the room where a CNA was attempting to dress our patient in a hospital gown, since the patient apparently favored nudity. The patient was literally kicking and screaming at the nurse and telling her how expensive the clothes were and that they were the property of the USMC and that she shouldn't be so careless with them and that he was fine to stay just the way he was. He became more and more combative and abusive as time went on, but due to perserverance and some cool CNA ninja moves, our intrepid aide finally managed to get our patient somewhat dressed. He was still more than a little immodest, but at least she'd tried.

I asked her if our patient was normally this combative and she said he wasn't. I told her I was uncomfortable taking him in our ambulance unless everyone was clear that I might need to use restraints, and/or they gave him a sedative before we left. So I went to talk to the nurse and she seemed confused as the patient had never been that way with her. As soon as she and I walked back into the room, the patient saw the nurse, and turned into a very calm man, smiling and making borderline suggestive comments, and there was actually a spark and a gleam in his eye. 3 minutes ago, he was angry and combative and now he's on the prowl with the admittedly quite attractive nurse.

The patient's history suggested that his altered mental status worsened significantly after his MI, so now I knew that I had a normally calm, but confused patient and something about the CNA and the gown had set him off. My partner and I loaded him to our stretcher and cocooned him a bit in the sheets just in case and set off through the hallways of Great Big Hospital. As we walked, our patient was making random observations and comments which I initially ignored, but then began to listen to. A lot of what he was saying made no sense until it hit me. Our patient, Mr. Smith (not his real name of course) was actually a former Marine Corps infantryman and right this very minute in his mind, we were in a combat zone. His unit had just been hit hard by enemy fire and he and all of his buddies were wounded badly. The reason he was so upset was that someone (presumably a Medic) had snatched him away from his buddies to treat his wounds and he was concerned about the rest of his unit. As soon as I figured this out, and started to tailor my conversation to suit his reality, he started to calm down quite a bit.

By the time I had him in the back of our ambulance, I had the whole story, and I had assured SGT Smith, that me and my partner were indeed military medics and we were assigned to take him to a facility where he could be properly treated and more importantly the remainder of the medics in our group had been sent to take care of the rest of his sqad. He relaxed more and then asked me where I was taking him to get fixed up. He was concerned that the drive to Philadelphia might be a very long one and he wasn't sure he could make it. I asked him if he had ever been to Georgia (not really, but it's a southern state and it works for the story) and he lit up like a kid at christmas and said "Son, I was BORN in Georgia." I asked him where and he said "Eatonton , I was born in Eatonton Georgia." And I said, well SGT Smith, I'm taking you to a military hospital in Warner Robins. Then with a sly grin, SGT Smith said "are you SURE you can't take me to Eatonton?"

No sir, I said, I have my orders and you know how the Corps is about orders. We're going to Warner Robins and that's the end of it. He laughed and said, "Son, I knew you couldn't, but I had to try. You just carry out your orders and I'm sure I'll be fine". With that, my formerly confused, angry, combative patient closed his eyes and napped for the rest of our 20 minute ride to his nursing home.

When we got there and unloaded him, he recognized the nurses and aides on his ward, and seemed quite content to be there. Now whether he knew he was in the nursing home, or thought they all worked in a military hospital in Warner Robins, GA, I'll never know, but at least he was calm and peaceful and no one had to drug or restrain him.

Some days I love my job.


Saturday, June 20, 2009

Sometimes ...

Sometimes this job just sucks hot rocks. It's not actually the job that sucks, but who you are called on to help. We're supposed to be working on "them", not "us". If you pray, please pray. One of our own got hurt tonight.

Friday, May 22, 2009

Mothers Day

On Mother's Day, I was able to be a part of the unofficial Dive Rescue Team which was able to save 10 tiny ducklings from a sewer drain.

One of our other squads saw a mother duck acting very strangely near a sewer grate, and so they stopped to take a look. The found 10 of her little ones had fallen through a sewer grate.

We were called in as back up that's where Dispatch told us to go. We were bringing some backup supplies. One of the EMTs from the first squad on scene was nominated to get into the sewer to get the ducks. He said the smell didn't bother him because it reminded him of the air at Really Terrible Nursing Home.

So here are two pictures of the GWN Dive Rescue Team in action. I'm not in either of these pictures. And Mom was soon reunited with her ducklings.


Great White North