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#61 A. Breslin

A. Breslin

    EMS Lieutenant

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  • Character Hometown:Scottsdale

Posted 19 July 2017 - 11:31 PM

*Sitting outside the ER I flick away my cigarette. A metrostar truck pulls into the Bay*

 

Arnold: 'Hey Alyssa'

 

*Looking over I see A goofy 6 foot tall ginger walking towards me*

 

'Hello Arnold.'

 

Arnold: 'How have you been? I haven't seen you in a while.'

 

'Ive been good. With the promotion Ive been doing more time here then Metro star. Doing a discharge?'

 

Arnold: 'Yeah out of the ICU for a vent transfer to Crescent Falls.'

 

'Fun.'

 

Arnold: 'So this heat is killing me.'

 

'I'm from Arizona. I'm used to it,'

 

Metrostar Dispatch "111 Can I get a status off you the floor is calling asking for your ETA"

 

Arnold: "Metrocomm we are at scene show us going up now."

 

Metrostar Dispatch"Arnold you dont have to be so serious. This is a a Nextel not a real radio"

 

'Is that Dan?'

 

Arnold: 'Yeah'

 

*I grab the nextel out of his hand*

 

"Dan do you remember this voice?"

 

Metrostar Dispatch "Alyssa is that you?"

 

"Yeah Dan, Whats up?"

 

*Phones are ringing in the background of dispatch*

 

Metrostar Dispatch: "I havent seen you in forever. Stop by the base and say hi sometime. But I have to answer this"

 

"10-4 Ill see you soon."

 

Arnold: 'So yeah I was going to ask you this when you worked at metrostar but do you want to grab dinner and a movie with me sometime.'

 

'Sure. I'll text you I have your number.'


edolt.png
Paramedic Lieutenant Alyssa Breslin
EMS Duty Officer (EDO-1)


#62 Dr. Grant

Dr. Grant

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Posted 21 August 2017 - 10:13 PM

*The strong smell of disinfectant with a mild hint of feces hit Dr. Grant's nostrils. The constant groaning from the patient ER room 9 filled the hallway. As he walked by the room, it was also undoubtedly the source of the smell. He continued walking down the hallway unfaultered, since he's used to much worse. He approached the nurse's station and  went up to a tall man in navy blue scrubs who's gaze was unbroken on the computer screen.*

 

Grant - "Hey there, are you the off-going attending?"

 

*The man's gaze broke from the computer screen and looked at Dr. Grant. He looked terrible. The fatigue in his face glowed brighter than the blond whiskers under his unshaven chin*

 

Doctor - "yea. Thank God."

 

*He extended his hand and Dr. Grant returned the gesture to form a solid handshake. As he was shaking his hand he looked around the visibly thrashed ER*

 

Grant - "Bad night?"

 

Doctor - "You have no idea. this place was packed all night. I've managed to get them all discharged or shipped upstairs. This is not what I expected when I decided to work a shift last night."

 

*The hand shake ceased*

 

Doctor - "Anyway, I'm Dr. Kathros, I moonlight here from time to time, mostly nights. I'm a third year resident over at University Med Center."

 

*Small yet unimportant chit chat insued between Dr. Grant and Dr. Kathos.

 

Kathros - "Anyway, we have two patients, both are pretty much all worked up. Room 6 is a 16 year old female who came in for nausea and dizziness. N oother complaints. ECG was unremarkable, and blood work was probably better than mine, except for one tiny little detail. Her hCG came back 31...so it was a little awkward telling her in front of mom that she's pregnant which explains her issues. The nurse is getting her discharged."

 

*Dr. Grant grinned*

 

Kathros - "And room 9....a 89 year old female who's normally altered...from the con home, came in for increased ALOC. The family states that she's acting normally, and all the blood work and workup is negative. From what it sounds like, she's was feisty all night and the night staff at the nursing home didnt want to deal with her anymore so they sent her here."

 

*Dr. Grant smirked*

 

Grant - "Wow....not surprising at all"

 

*Dr. Kathros smirked as well*

 

Kathros - "We're waiting on the ambulance to take her back. Other than that, the waiting room is surprisingly empty. Nursing is fully staffed and you have a near perfect shift set up for you."

 

*The change of shift report concluded...Dr. Kathros said his good byes and left, with a smile on his face. Dr. Grant took a deep breath and muttered under his breath*

 

"Ok....first shift....not bad.....12 hours...how bad could this be?"


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)

Attending Physician

Emergency Medicine
Shiloh County General Hospital


#63 Dr. Braun

Dr. Braun

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Posted 22 August 2017 - 01:30 AM

*I park my car in the ambulance bay and see a new Dr. I lean on the counter.*

 

'Hows it going?'


md1.png

Dr. William Braun

SCFD EMS Medical Director / SCERT Medical Officer

MD-1

 


#64 E.Raven

E.Raven

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Posted 22 August 2017 - 01:35 AM

I stroll through the ER restocking the rig. 

"Hey Braun, hey new guy, would you like to buy tickets to the department's pancake breakfast Saturday?" I ask. 


Our department takes 1,120 calls every day. Do you know how many of the calls the public expects perfection on? 1,120. Nobody calls the fire department and says, 'Send me two dumb-ass firemen in a pickup truck.' In three minutes they want five brain-surgeon decathlon champions to come and solve all their problems.






#GEGFDMAFIA


PLEASE SUPPORT THE FIRE DEPARTMENT


PLEASE BUY A PANCAKE BREAKFAST TICKET


#65 F.Garcia

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Posted 22 August 2017 - 01:36 AM

I walk into the ER just after Raven, miss the conversation and lean on "the counter".

 

"Hey guys. Would you be interested in buying tickets to our pancake breakfast or spaghetti dinner?"


#GEGFDMAFIA


#66 E.Raven

E.Raven

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Posted 22 August 2017 - 01:38 AM

"They're both on Saturday."


Our department takes 1,120 calls every day. Do you know how many of the calls the public expects perfection on? 1,120. Nobody calls the fire department and says, 'Send me two dumb-ass firemen in a pickup truck.' In three minutes they want five brain-surgeon decathlon champions to come and solve all their problems.






#GEGFDMAFIA


PLEASE SUPPORT THE FIRE DEPARTMENT


PLEASE BUY A PANCAKE BREAKFAST TICKET


#67 Dr. Grant

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Posted 22 August 2017 - 01:55 AM

*look up from my computer screen. Few hours in and only a couple new patients....today's going great!*

 

"Hey there!"

 

*I look down at Dr. Braun's name badge. I get excited*

 

"Oh, Dr. Braun! It's really nice to meet you. I'm Dr. Chris Grant...I'm glad to meet you finally. Too bad I wasn't able to meet you at the interview, but thanks for the opportunity and bringing me on as a fellow!"

 

*Realizing I'm getting like a little school girl with excitement after finally meeting the guy who's going to train me to be an EMS director, I calm down*

 

*At that moment two Firefighter catch my attention.*

 

"Hey!"

 

*I listen to their sales pitch regarding the pancake breakfast and their attempt to raise funds for new department T-Shirts*

 

"You know what, I'm free this Saturday. I'll take three for the Breakfast. I'm a sucker for good pancakes. I'll pass on the Spaghetti though, I have prior commitments."

 

*I pull out $30 (a twenty and two fives) from my wallet and hand them to Raven*

 

"There you go"

 

*I look back at Dr. Braun*

 

"Sorry about that"

 

*I extend my hand*


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)

Attending Physician

Emergency Medicine
Shiloh County General Hospital


#68 Dr. Braun

Dr. Braun

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Posted 23 August 2017 - 12:04 AM

*2 guys from FD EMS approach me and Grant. selling tickets to the pancake breakfast. Locking eyes with me and ravenously telling me that its on Saturday*

 

'You can put me down for 2'

 

*Pulling a 20 out of my wallet and giving it to them*

 

'Thank you for your service'

 

*I extend my hand to Grant.*

 

'I regret not being there for the interview. But I do want to take the opportunity to welcome you to Shiloh County EMS'


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Dr. William Braun

SCFD EMS Medical Director / SCERT Medical Officer

MD-1

 


#69 Dr. Grant

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Posted 23 August 2017 - 03:05 AM

*I shake Dr. Braun's hand*

 

'Well, I'm sure I'll get on your nerves soon enough' I said jokingly.

 

*After shaking Dr. Braun's hand, I reach for my half drunken, room temperature, bottle of Coke Zero and start to unscrew the cap*

 

'From what I hear you have good group of people out here. Really eager and community oriented...I can't wait to start.'

 

*I take a drink and spill a little drop on my navy blue scrub shirt. What a klutz. I instinctively extend my head forward trying to avoid another drop from spilling and quickly wipe my mouth*

 

'I swear I gotta get the hole in this lip fixed' I said to try and make light of the awkward situation.

 

*At that moment I hear someone calling my name*

 

"Dr. Grant!" the ER secretary shouted from behind the count.

 

*I turn around and look at her, half surprised*

 

"I just got off the phone with a private BLS ambulance. They're reporting that their patient's in severe respiratory distress and that they're pulling in right now."

 

"Now?" I asked.

 

"That's what he said" she replied.

 

*Way to give us some heads up. Whatever. Probably a brand new scared EMT who's had his first patient go south on him. I've been there. At least they called.*

 

"Ok."

 

"We'll set-up in Resus 1" the charge nurse, Kathy, who overheard the conversation stated confidently.

 

"Awesome." I said looking at her.

 

*I look back at Dr. Braun*

 

'Excuse me.' I tell him politely.

 

*I put my drink down on the counter next to the computer and begin walking towards Resus 1. After a second or two I turn around and look back at Dr. Braun*

 

"Unless you want to tag in. I might need a hand with this one."

 

*I turn around and continue walking. My long white coat swishing behind me. I reach the doors of Resus 1 and take the opportunity to quickly wash my hands in the sink. As I'm finishing up, I see a gurney and two EMTs approaching with their patient on the ambulance gurney sitting fully upright. I wait outside of the door as the charge nurse, Kathy, points the BLS crew into Resus 1. After they had entered the resuscitation room, I entered, pulled two large gloves out of one of the boxes on the wall, and began putting them on. I took a quick second to get a generalized impression of the situation.

 

Two EMTs, both probably fresh out of high school. Either I'm getting old, or EMTs are getting younger. One looks visibly shaken, and the other is a little annoyed. I notice that the shaken one is attempting to give respirations with a bag-valve mask to his patient...but the mask is upside down and each squeeze of the bag is mostly useless. I think to myself "Okay...we're off to a good start"

 

I look at the patient. Elderly male, probably 80+ very thin, emaciated, and with a visibly large chest. He's struggling to breath. Each inhalation is a strenuous effort with the sound of fluid and congestion coming from his lungs with every breath.*

 

"Okay, what do we got?" I asked the EMTs.


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)

Attending Physician

Emergency Medicine
Shiloh County General Hospital


#70 Dr. Grant

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Posted 25 August 2017 - 05:09 AM

I've seen this case countless times before. A victim of 40+ years of abuse to his own body, and now it's failing one system at a time. The respiratory distress is always expected when someone comes in for COPD exacerbation, but when I saw nothing but white in the lung region of the chest X-ray, I knew there was something more. His breathing was inadequate, and who knows how long he had had an SpO2 sub 80%. Intubation, while not exactly ideal in a case like this, was my only course of action, and at least guaranteed that he was getting the Oxygen he needed. IV Nitroglycerin did a decent job in clearing a little bit of the fluid out of his lungs initially, and the lasix pretty much did the rest, but what caused it? Well not much in the way of a detailed medical history was known, but the fact that he was severely altered and hot to the touch gave me some clues. Sepsis, a true killer, probably originating from a pneumonia in his lungs. After 40 years of habitual smoking, his lungs are scarred and no longer have their elastic quality, making him prone to such deadly infections. With the antibiotics started, he has a chance, but I can't say that it is a very good one. 

 

*After giving a lengthy telephone report to the pulmonologist receiving the patient in the ICU, I put the phone back on the hook*

 

"Okay, Resus 1 is good to go to ICU on my end." I said to the nurse next to me.

 

"Alright, I'll call my nursing report up to the ICU in a minute then I'll take him upstairs." She replied.

 

"Thanks" I told her.

 

*I look at the computer screen and check to see how many pending patients we have* 

 

'Every room is full and we have twelve waiting. Perfect' I said to myself.

 

*I looked at the screen again and at the next patient in the electronic queue*

 

I read to myself: 'James Moore, 13, dislocation of right shoulder...'

 

*Someone taps me on the shoulder, I turn around and see a middle aged woman in similar navy blue scrubs as mine*

 

'Hey, I'm your relief.' she said.

 

*I look at the clock, 19:17. Oh thank goodness, time to go home! I spend the next 35 minutes briefing the woman doctor on all of the patients in the ER and finishing my charts.*

 

*I sit in the back of the nurses station in relative seclusion at a computer and finish my charts*

 

*tap* *tap* *tap* *click* *click* '....and....I....am....outta here' I say happily as I sign my last electronic chart.

 

*I look at my wrist watch. 19:54...not bad. I go into the break room, grab my backpack out of the locker, head out the door and to my car.*


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)

Attending Physician

Emergency Medicine
Shiloh County General Hospital


#71 Dr. Grant

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Posted 30 August 2017 - 04:43 AM

*I walk into the ER. Fresh after a good night's sleep. The last two days were pretty easy. I attended an EVOC course with the Fire Department new hires so I could be cleared to drive the physician response vehicle for my future ride out days.  Man that brought back memories. Sure the class was just as boring as I remember from back in 2003, but the in-vehicle part was much more entertaining. It may have been close nine years since I last drove code, but all I can say is I still got it.*

 

*I put my stuff into a locker in the staff lounge, get report from the off going physician and prepare to start my next shift.*


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)

Attending Physician

Emergency Medicine
Shiloh County General Hospital


#72 E.Raven

E.Raven

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Posted 30 August 2017 - 08:53 PM

==============HEAR radio transmission==============
 

"County Hospital, County Hospital, this is RA-1 on the HEAR with a patient report when you're ready."
"RA-1 this is County, we copy go ahead"

"County we're on scene with a male approximate age is 35, found in a parking lot acting strangely. Chief complaint is altered mental status but he is also experiencing right sided weakness and unequal pupils. He is awake at this time but non verbal, with a GCS of 12.  Blood pressure was 230 over 118, SPO2 93 on 4 liters per minute, heart rate 137, respirations are 24. We are still onscene at the moment but will be transporting soon and will be at your doors in 12 minutes. We have established a 18g IV in the left AC.  Any questions or orders."

"RA-1 do you have a blood glucose?"

"10-4 blood glucose was 109."
"We copy RA-1, be advised your patient will be going to blue-1 on arrival. County clear."

"RA-1 clear."


Our department takes 1,120 calls every day. Do you know how many of the calls the public expects perfection on? 1,120. Nobody calls the fire department and says, 'Send me two dumb-ass firemen in a pickup truck.' In three minutes they want five brain-surgeon decathlon champions to come and solve all their problems.






#GEGFDMAFIA


PLEASE SUPPORT THE FIRE DEPARTMENT


PLEASE BUY A PANCAKE BREAKFAST TICKET


#73 Dr. Grant

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Posted 31 August 2017 - 06:02 AM

The ER is starting to get slammed. It's only morning and the waiting room is already starting to fill. Even with 4 ER doctors, and 2 PAs on duty today, the workload is crazy this morning and its only going to get worse. I guess it's going to be one of those days.

 

"Hey, Jan" I shout across the nurses station to the other side. A nurse looks up from her computer. "Exam 6 is good to go, I entered in a prescription for Keflex and Motrin and to follow up with their PCP" I tell her. She nods "Ok, I'll get her discharged after I draw labs on 5." she replied as she got up from her stool and proceeded to the phlebotomy cart to load up on vials.

 

To an outsider, a busy ER might look like chaos, but to the trained professional, it's an intricate ballet. So long as everyone is communicating and working effectively, the chaos isn't all that bad. 

 

*I look at the ER queue on the computer and start browsing through the triage information of everyone out in the waiting room.*

 

'15 year old male...sore throat for a week...no history.....' I mutter to my self. 'my PA can take that' I mutter as I click to assign that case to the PA in the rapid treatment area.

'91 year old female short of breath for 2 weeks....I'll take that.'  *click*

 

"Dr. Grant!" a shout came from the across the nursing station interrupting my train of thought. 

"We have EMS coming in with a 35 year old male ALOC with neuro deficits. ETA is 12 minutes." a nurse shouted from across the nursing station.

"Okay, what room are you thinking about?" I asked.

"Exam 2's opening up, we'll get it cleaned and it should be available by the time they get here." she responds.

"Sounds good" I reply.

 

*A 35 year old male ALOC with neuro-deficits? Wow...could it really be a stroke in someone so young? I've seen younger people have a stroke but its so uncommon that its not typically the number one differential. Is he drug user? I guess we'll have to wait to find out. I look back the the computer screen and begin looking at the ER queue again.*


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)

Attending Physician

Emergency Medicine
Shiloh County General Hospital


#74 E.Raven

E.Raven

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Posted 01 September 2017 - 01:37 AM

We roll into the ER with our possible CVA. I go to the room indicated by registration and I give turnover to the nurse and drop my PCR off. 

 

--------------------Call Info--------------------
Incident #: 2017005896
Department: SCFD
Address: Crown Plaza Oxnard
Dispatched As: Possible overdose
First: E.Raven
Second: F. Garcia
Third: N/A
Other Agencies At Scene: N/A
 
--------------------Patient Info--------------------
Patient Name: Unable to complete
Date of Birth: Unable to complete
Age: Unable to complete
Patient Address: Unable to complete
Conscious or Unconscious: Initially conscious then became unconscious
Trauma: Unknown
Chief complaint: Unresponsive
Signs & Symptoms: Altered mental status, abnormal gait, unresponsive
Past History: Unable to complete
Medications: Unable to complete
Interventions: Vital signs taken, patient assessment, 4 lead EKG, 12 lead EKG, venous access established, oxygen administered, fluid bolus, dopamine drip, airway adjunct, ventilation assistance, intubation with capnography, transport.
Transport or Refusal: Emergent transport to County 
 
--------------------Vital Signs (1/4)--------------------
P: 130 Sinus tach
RR: 24
BP: 218/120
Eyes: Right side fixed and dilated, left side normal
Skin: Pale, warm
Lungs: Clear bilaterally 
SPO2: 87
SPO2 Qualifier: On room air
BGL: 109
 
--------------------Vital Signs (2/4)--------------------
P: 137 Sinus tach
RR: 24
BP: 230/118
Eyes: Right side fixed and dilated, left side normal
Skin: Pale, warm
Lungs: Clear bilaterally 
SPO2: 93
SPO2 Qualifier: 4 LPM NC
BGL: Not Done
 
--------------------Vital Signs (3/4)--------------------
P: 148 Sinus tach
RR: 32
BP: 54/32
Eyes: Right side fixed and dilated, left side normal
Skin: Pale, warm
Lungs: Clear bilaterally 
SPO2: 90
SPO2 Qualifier: 4 LPM NC
BGL: Not Done
 
--------------------Vital Signs (4/4)--------------------
P: 143 Sinus tach
RR: 12 forced ventillation
BP: 62/40
Eyes: Right side fixed and dilated, left side normal
Skin: Pale, warm
Lungs: Clear bilaterally 
SPO2: 95
SPO2 Qualifier: Intubated
BGL: Not Done
 
--------------------Narrative--------------------
 
ON AUGUST 30TH 2017 RA-1 WAS DISPATCHED AND RESPONDED TO A REPORT OF A POSSIBLE OVERDOSE AT THE ABOVE ADDRESS.
 
CC: UNRESPONSIVE SECONDARY TO POSSIBLE CVA
 
HPI: EMS WAS ACTIVATED BY A BYSTANDARD AND INITIALLY REPORTED AS A POSSIBLE OVERDOSE. PATIENT WAS NON VERBAL AND LATER INTUBATED, EMS WAS UNABLE TO DETERMINE FURTHER INFORMATION.
 
PMH: EMS WAS UNABLE TO DETERMINE ANY PAST MEDICAL HISTORY, MEDICATIONS, OR ALLERGIES.
 
PE: UPON EMS ARRIVAL PATIENT WAS FOUND STANDING BESIDE A CAR ACTING STRANGELY. PATIENT WAS AWAKE, BUT WAS NOT TALKING WITH EMS. EMS WAS UNABLE TO DETERMINE LEVEL OF ALERTNESS. PATIENTS PUPILS WERE UNEQUAL, PATIENT'S LEFT SIDE WAS REACTIVE TO LIGHT, PATIENT'S RIGHT SIDE WAS FIXED AND DILATED. PATIENT'S BREATH SOUNDS WERE CLEAR BILATERALLY. PATIENT HAD WEAKNESS AND ARM DRIFT IN THE RIGHT SIDE, NO ABNORMALITIES NOTED IN THE LEFT SIDE. PATIENTS SKIN WAS WARM AND PALE, WITH CAPILARY REFILL TIMES GREATER THAN 2 SECONDS. EMS WAS UNABLE TO DETERMINE IF PATIENT WAS HAVING CHEST PAIN, DIFFICULTY BREATHING, OR HAD A TRAUMATIC FALL. 12 LEAD EKG READ AND INTERPRETED SINUS TACHYCARDIA WITH OCCASIONAL PVCS. NO DCAPBTLS WAS NOTED.
 
UPON REASSESSMENT PATEINT HAD BECOME UNRESPONSIVE, PATIENT'S PUPILS STATUS HAD NOT CHANGED. BREATH SOUNDS WERE CLEAR BILATERALLY WHILE PATIENT WAS INTUBATED. PATIENT'S SKIN WAS STILL WARM AND PALE, WITH CAPILARY REFIL TIMES GREATER THAN TWO SCONDS. 12 LEAD EKG READ AND INTERPRETED SINUS TACHYCARDIA. 
 
TX: UPON ARRIVAL A GENERAL IMPRESSION WAS FORMED. PATIENT WAS ASSISTED INTO THE AMBULANCE AND VITAL SIGNS TAKEN AS NOTED ABOVE. PATIENT WAS INITIALLY PLACED ON 4 LEAD EKG, WHICH READ AND INTERPRETED PVCS. PATIENT WAS THEN PLACED ON A 12 LEAD EKG WHICH READ AND INTERPRETED AS SINUS TACHYCARDIA. IV ACCESS WAS OBTAINED WITH A 18G NEEDLE IN THE LEFT AC. DURING TRANSPORT THE PATIENT'S BLOOD PRESSURE DROPPED AND THE PATIENT BECAME UNRESPONSIVE, INITIALLY A 28 FRENCH NASAL AIRWAY WAS INSERTED, THEN PATIENT WAS INTUBATED WITH A 7.5MM ET TUBE. PATIENT'S BREATH SOUNDS WERE CHECKED FOR ACCURATE TUBE PLACEMENT. A 1000 CC FLUID BOLUS WAS ADMINISTERED; PATIENT WAS ALSO PLACED ON A DOPAMINE DRIP AT THE APPROPRIATE RATE AS NOTED ABOVE. EMS ASSISTED PATIENT'S RESPIRATONS THROUGH END TIDAL CO2 READINGS AND APPLIED AED PADS TO THE PATIENT.
 
RTX: WORSE
 
OUTCOME: PATIENT WAS TRANSPORTED CODE 3 TO COUNTY HOSPITAL AND LEFT IN CARE OF STAFF IN BLUE 1. PATIENT'S BELONGINGS WERE LEFT IN CARE OF STAFF. 
 
E.RAVEN NREMTP       
 

Our department takes 1,120 calls every day. Do you know how many of the calls the public expects perfection on? 1,120. Nobody calls the fire department and says, 'Send me two dumb-ass firemen in a pickup truck.' In three minutes they want five brain-surgeon decathlon champions to come and solve all their problems.






#GEGFDMAFIA


PLEASE SUPPORT THE FIRE DEPARTMENT


PLEASE BUY A PANCAKE BREAKFAST TICKET


#75 L. Sparks

L. Sparks

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Posted 01 September 2017 - 02:08 AM

As we walk into the busy ER, a nurse asks:

 

"Are you guys the STEMI?"

 

'yea', I replied.

 

"Exam 2" she said pointing down the hall.

 

*As we approached the room we were greated by a small team. A small, 5 foot 3 inch, hundred and nothing pound woman with a black jacket and blue scrub bottoms came up and started walking with me *

 

'What do you guys got?' she asked.

 

'This is Mr. O'Rielly, a 69 year old male we found at Middleland Park. He complained of sudden onset substernal chest pain radiating to the neck rated as a 7/10.

 

*We enter the room, put the stretcher next to the ER bed and begin removing all of our equipment from the man.*

'12-lead revealed an inferior MI with ST elevation in leads II, III, and aVF. Initial BP was 102/54 and it dropped to the 80s systolic. With fluids and positioning its now back up to 96 systolic. He got 324 of aspirin and did not recieve nitro because of his later blood pressures. History of high cholesterol and high blood pressure for which he takes medication.' I say to conclude my report.

 

*We transfer him over to the ER bed using a sheet underneath him. The woman thanks me and begins talking to Mr. O'Rielly*

 

'Hi Mr. O'Rielly, I'm Dr. Harrison, one of the Emergency physicians on duty today...can you tell me how you're feeling right now'?' I hear her say to him as I leave the room with the Beslin and the stretcher. As I exit, other medical team members flood the room. I find the patient's nurse and give a seperate report to her. After I get her signature I hear a voice behind me. 

 

'Excuse me.' a woman's voice stated from behind me.

 

*I turn around and notice the woman doctor looking right at me*

 

'Yea?' I ask.

 

*She walks up to me with a large ECG print out in her hand*

 

'You didn't give him Nitro?' She asked.

 

*My heart sank. My first solo shift and I'm already screwing up!*

 

'Yea, I totally forgot about it until we were halfway here, but by that time his BP had dropped so I couldn't give it' I said in my defense.

 

She smiled a little bit. 'Well it's a good thing you didn't. His MI is right sided and inferior. If you'd have given him Nitro it would have killed him.' she said as she walked away.

 

*I stood there a bit shocked for a moment, then proceeded down the hall and out to the ambulance to complete my PCR*.


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Paramedic Logan Sparks

Medic - 1


#76 L. Sparks

L. Sparks

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Posted 01 September 2017 - 02:28 AM

--------------------Call Info--------------------

Incident #: 2017005903
Department: SCFD
Address: Middleland Park, WWI Memorial
Dispatched As: Chest Pain
First: Logan Sparks, Paramedic
Second: Alyssa Beslin, Paramedic
Third: None
Other Agencies At Scene: None
 

--------------------Patient Info--------------------

Patient Name: Paul O'Rielly
Date of Birth: 5/12/1948
Age: 69
Patient Address: 17 Standard Ave. Clinton
Conscious or Unconscious: Conscious
Trauma: No
Chief complaint: Chest Pain
Signs & Symptoms: Chest Pain, shortness of breath, dizzy.
Past History: High Blood Pressure, Hyperlipidemia
Medications: Lisinopril, Atorvastatin
Interventions: IV with NS in left AC (Condition Improved). 324mg Aspirin (No condition change). O2 via NRB @ 12lpm (No condition change)
Transport or Refusal: Transport - Shiloh County Hospital
 

--------------------Vital Signs--------------------

P: 44
RR: 24
BP: 96/54
Eyes: PEARL
Skin: Pale, cool, diaphoretic
Lungs: Clear Bilaterally

--------------------Narrative--------------------

 

Arrived on scene of Middleland park to find the patient seated on a bench at the WWI memorial. The patient was A/Ox4 GCS 15 and appeared to be in mild distress. The patient complained of sudden onset crushing chest pain which radiated to his neck. The pain was rated as a 7/10 with no alleviating or aggravating factors. The patient stated that his chest pain began suddenly while excising in the park.  (+) Shortness of Breath (+) Dizziness (+) Nausea (-) Vomiting (-) ALOC (-) Trauma. The patient's skin was pale, cool, diaphoretic, and his radial pulse was thready. Physical exam of the chest revealed no abnormalities. A 12-lead was obtained and revealed ST elevation in leads II, III, and aVF and computer interpretation confirmed STEMI. The patient was assisted in standing, and sitting on the gurney. The patient was placed in a full upright position and loaded into the ambulance. The patient was placed on O2 via NRB at 12lpm per chest pain protocol. 324mg of aspirin was administered and IV access (1L Normal Saline TKO) was obtained in the left AC on the first attempt. Patient was transported Code 3 to County Hospital and a STEMI alert was called in @ [time]. During transport, Nitro was withheld due to low BP of 80/50. Patient was placed supine and the IV opened to full to increase BP. Subsequent BP read 96/54. Upon arrival at the ER, the patient was taken to Exam room 2 where report was given to [nurse's name], RN.


mpm.png

Paramedic Logan Sparks

Medic - 1


#77 Dr. Grant

Dr. Grant

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  • Character Hometown:Reno, NV

Posted 03 September 2017 - 01:53 AM

*I walk out of trauma bay 2 and throw my gloves into the trash can and proceed to wash my hands.*

This patient was very very sick. EMS brought him in with a terrible blood pressure and what is most likely an intracranial hemorrhage. After only a matter of minutes in my care his arms began to contract inward, known as decorticate posturing, which is a sign of brain injury. This guy's chances of survival are truly grim, and even if he does survive, brain damage is almost certain. WIth him stabilized and his blood pressure now back up over 90 systolic there was nothing more I could do for him in the ER. He was now in the hands of the Neurosurgery team who would be able to offer him the best chance of survival.  Cases like this always hit close to home. This guy is my age, and seemingly healthy. It's really scary to think about how quickly things can just change at the snap of a finger.

 

*I walk over to a nearby computer and sit down to begin charting on this patient*.

 

With no ID or anything to go on, we had no idea who this guy was. He probably has a family somewhere...mother, father, siblings, maybe even a wife and kids...and no one even knows that he's here and that he is at death's door. That thought is truly heartbreaking to me.

 

*I hear the commotion from the trauma bay and look behind me. The neurosurgery team is taking him upstairs to get a CT and then probably to surgery. The portable monitor beeps with every heartbeat. IV line and medications running all over him, its a mess of tubes and wires on the ER gurney. The 5 person team begins to wheel him very quickly down the hallway towards the elevator, with the portable respirator cart bringing up the rear. I turn back around and log in to the charting program. I search for "John Doe" and begin writing my notes*


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)

Attending Physician

Emergency Medicine
Shiloh County General Hospital


#78 Dr. Grant

Dr. Grant

    ERT Member

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  • Character Hometown:Reno, NV

Posted 12 September 2017 - 03:27 AM

Almost lunch time, and just as suddenly as things got busy, it looks like activity is just starting to level off. I think to myself:

'Just one more case and I'll sneak out to the cafeteria for a quick bite.'

*I look at the computer for my next case. I see that Exam 3 just got a new patient. I read the nursing/triage note:

Jaime Middleton

3 y/o male brought in by mom & dad with pain in the left elbow. Pain began suddenly when the patient dropped to the floor during a tantrum all while the father was still holding on to his left arm. Pain only with motion. No deformity, swelling, or ecchymosis of the arm or elbow. The incident occurred four hours ago with no improvement. No other injury or complaint.

Medical History: None
Medications: None
Allergies: Sulfa Drugs
Previous Hospitalizations/Surgeries: None
BP: 98/56
HR: 109
RR: 25
SpO2: 99%
Temp: 98.8F


'This seems easy enough, Fast Track must be full because this could totally be taken care of in Fast Track.' I say to myself.

*I take a drink from my water bottle, put the bottle on the counter next to my computer and logout of the computer. I stand up and walk towards Exam room 3. The door to the exam room is ajar, but mostly open. I knock as I push the door fully open and peak my head inside.*

As I walk into the room I see a young man, probably in his mid twenties sitting on the ER gurney with a young well dressed little boy in his lap. A young woman, around the same age as the man was seated in a chair next to the bed. Both adults, who I assume are the young boy's parents, looked visibly anxious, as did the little boy himself.

*knock knock knock* 'Hi there' I say as I walk into the room with a slightly cheery attitude. All three of them look up at me as I take some hand sanitizer out of the dispenser by the door.

'I'm Dr. Grant, one of the emergency physicians here today.' I say as I finish rubbing in the hand sanitizer and extending my hand to the mother first.

'Hi', she said happily, but obviously nervous, 'I'm Beth'

'Hello Beth, are you mom?' I asked

'Yes' she said smiling. I look over at Dad and extend my arm. '...and you must be dad.' I say as I shake his hand.

'I sure am. I'm Justin' He replied, also with a smile on his face.

I look at the boy in his father's lap. '..and what's your name big guy?' I ask in somewhat playful tone as I pull up a rolling stool and sit down in front of him.

The boy hesitated and looked up at his dad.

'What's your name buddy?' The dad said trying to coax him to speak.

'Jaime' the boy said softly.

'Well it's nice to meet you Jaime.' I say as reach for his right hand and squeeze it lightly.

I sit back and look at the parents. 'So what brings you all here on such a beautiful day?'

There was a small pause.

The mother spoke up first: 'Go ahead and tell him, you were there' she said to him.

*I look at the father*

'So I had to help my Dad with some stuff over at his house this morning, so I took Jaime with me early thing morning so he could see his his grandma and grandpa. When I was trying to leave, he wasn't having it and started throwing one of his temper tantrums. I tried coaxing him to leave, but you know how kids get at this age...'

'Oh yea,I know exactly what you mean' I say to him in understanding.

'So I wait a few minutes, let him calm down, then I grab him by the arm and start to lead him out of the house. As soon as he saw the front door he threw another tantrum and just dropped to the floor while I was still holding his arm and leading him out of the house.'

I interrupt him: 'So you were leading him out of the house and he was walking next to you when he all of a sudden decided to throw another tantrum by dropping to the floor?' I ask to clarify.

'Yah' responded.

'He pulled the good old "The only way I'm leaving here is if you drag me out", huh?' I ask half amused.

'Exactly' The father replied.

'Then what happened?' I asked to continue the conversation.

'I heard a little pop when he dropped to the floor and he began crying real loud. Not like a tantrum cry, but an in-pain cry...so I immediately let go of his arm.'

'...and that's his left arm you were holding on to and heard pop?' I asked to clarify.

'Yea his left'

'Ok, has he been able to move his arm?' I ask.

'No, every time he moves his arm it looks like it really hurts him...but if he doesn't move it he is just fine.'

*I take a few minutes to gather his medical history and find that there is nothing that wasn't already stated on the nursing notes*

'Ok, well just based on what you're telling me about his condition and the incident itself, I'm pretty confident that I know what the problem is. It's a condition called Radial Head Subluxation, or it's often referred to as a pulled elbow.' I say as I reach for his left arm.

'Can I see you're owie?' I ask gently as I reach for his arm. He guards it with his right arm holding it against his body. I pull it towards me but feel him resist a bit. 'Please? I promise I'll make it all better'. I no longer feel resistance. 'Thank you' I say to him.

'So there's no swelling or deformity around the elbow, and it only hurts him when he moves his elbow or his arm. For this sort of thing we don't even need an X-ray, since if it was broken, I would be seeing swelling or deformity. Now what he has going on is sort of a dislocation. There are two bones in your forearm. Your Radius and your Ulna, and what happened is when he fell to floor while you were pulling his arm upward, it put a lot of stress on the elbow and caused the annular ligament, which holds the radius and ulna together, to slip into the elbow joint. So his pain is from the pressure of his radius on the ligament when it moves. Luckily the fix is really easy.'

*His arm is oriented palm side down, so I grab his hand and wrist with one hand and put the other had on the thumb side of his elbow, feeling for a bony outcropping in the elbow.*

'Ok, here we go' I say and begin the maneuver.

*I start to rotate his whole arm from the palm-down position to a plam up position fairly quickly*
'Ok, we're going to supinate his arm'
The boy begins to cry: 'Ow! Ow! Ow'
'I know, but it'll be over fast', I say as I start to flex his arm. He continues to cry, but just as I'm half way bending his elbow I feel a pop over the side of the elbow. Knowing that the technique was a success, I continue to flex his elbow until I can't anymore then I bring his whole arm back straight. 'There we go. I know, it hurts really bad when it pop's back in place but in 10 minutes you're going to be good as new. I promise.' I say reassuring the parents more than anything.

*I let go of his arm*

'Move your arm for me big guy.' I ask. Despite his crying, he is able to move his elbow freely now. 'See? It's all better now. How does it feel now?' I ask him. Jaime starts to calm down. and pouts 'It hurt'.

*I laugh and answer the parents questions and leave the room. I come back 10 minutes later to find Jaime running around the exam room twirling his sweatshirt in the air with his left arm*

This may have been an easy case, but it's the ones like these that make me the happiest. I chart this patient, and then sneak off to the cafeteria.

Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)

Attending Physician

Emergency Medicine
Shiloh County General Hospital


#79 Dr. Grant

Dr. Grant

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  • Character Hometown:Reno, NV

Posted 14 November 2017 - 07:18 AM

"THE NURSE IS GOING TO KILL ME!!!! THE NURSE IS GOING TO KILL ME!!!" the shouting of a frightened man rings through the halls of the busy ER. Everyone is silent. A few nurses crowd the doorway of room 6.

 

"THEY'RE ALL GOING TO KILL ME! PLEASE KEEP THEM AWAY!!!" The shouting continues and the man's voice breaks down into crying "I'm just trying to get you some medication..." a nurse said trying to reason with the man who squated in a defensive posture on the ER gurney. "NO YOU WORK FOR THE MAFIA AND YOU'RE GOING TO FINISH ME OFF!! SOMEONE PLEASE HELP ME!!!" he shouted.

 

I walked over to the room. Mr. Houser, is a 43 year old homeless man with a severe history of paranoia and countless other mental disorders. While he often keeps to himself, he does seem to wind up visiting us when he's having one of his paranoid episodes. This one appears particularly bad.

 

"So he's convinced you're going to kill him?" I asked the nurse outside the door. "Yeah, I just tried to get a line started on him and he went ape-shit." 

 

I smile a little bit and proceed to walk into the room. Two nurses are present trying to calm him down. "PLEASE DON'T KILL ME! SOMEBODY HELP!!!" The man screamed as he cried in sheer terror. 

 

"Mr. Houser....what's going on in here?" I asked calmly.

 

"PLEASE HELP ME, I WITNESSED A MURDER IN 2015 AND THE MAFIA KNOWS AND NOW THEY'VE SENT HITMEN DISGUISED AS NURSES TO POISON ME." he shouted as the thick dirty beard on his faced rolled with each word.

 

"Ok, why doesn't everybody step outside of the room." I say calmly in an attempt to gain control of the situation. One of the nurses turns around and start to walk out and whispers to me: "Should I call security?"

 

"No, I think we're good here" I say in reply. "Mr. Houser, what makes you think they're hitmen?" I ask.

 

He stands completely upright on the gurney, towering over me, and I get a wiff of the unmistakable stench of homelessness. "THEY TRIED TO INJECT ME WITH POISON. THE GODFATHER WANTS ME DEAD. HE KNOWS I WITNESSED HIM MURDER AN ENTIRE FAMILY ON 34TH ST! NOW THEY'RE GOING TO INJECT ME WITH POISON."

 

The last nurse leaves the room. "It's okay, they're gone. Why don't you sit back down before you hurt yourself." 

 

"THEY'RE GOING TO KILL ME!" 

 

I try again to get him to sit down. "Please, just sit back down and we can talk about all this."

 

Finally he sits back down.

 

"Please you got to help me, they're going to kill me. Call the state police, they're the only ones who believe me."

 

"I believe you. In fact, I'm going to help you out." I say reassuringly, "Let's just get you...." he interrupts me:

 

"PLEASE KEEP THEM AWAY! I WANT TO TALK TO DR KIROLOS...HE BELIEVES ME...HE'LL HELP ME"
 

Recognizing that Dr. Kirolos is one of the staff psychiatrists I jump for joy on the inside. Thank God.

 

"Okay, I'll tell you what. I'll give Dr Kirolos a call and see if he can come down to have a chat about your situation. In the meantime I'll post a guard outside your room to make sure no one comes in to hurt you."

 

"PLEASE! THE MAFIA KNOWS WHERE I AM...THEY'RE GOING TO KILL ME" he shouts again.

 

"I'm only able to help if you can stay calm. Can you do that for me?" I try to bargain with him.

 

"They're going to kill me dead, you've got to help me."

 

"I will, you just have to promise that you'll remain calm. Deal?" I cross my fingers.

 

"Please. Help me."

 

"Deal?" I try a second time.

 

"Fine, but please, help me...he wants me dead and they all work for him."

 

"Ok, no one will enter to room and I'll post a guard outside to make sure of that okay?"

 

"Please get me out of this death house" He begins to cry again.

 

"We'll get you taken care of, I promise" I say. He continues to sob and I walk out. 

 

Outside of the door I tell the nurse that I don't want anyone going into that room as it would only set him off again. I also instruct them to get security down here to wait outside the door incase he starts acting up again and we have to get him restrained.

 

I walk over to the nurses station and pick up the house phone and dial the operator. "Dr. Kirolos, psychiatry please." I say into the phone. It begins to ring.


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)

Attending Physician

Emergency Medicine
Shiloh County General Hospital





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