Back from the hospital.

My first IV start on a real patient was on an inmate from the local state prison. Apparently the guy got into a fight with the guards; at least, that’s what I picked up from the paperwork that came with him. He cliamed he didn’t know how his shoulder got dislocated. Crazy world. Anyway, I popped a twenty gauge into his antecubital fossa. It went in easily, just like it was supposed to. I was stoked that I managed to occlude his vein with my pinky while advancing the catheter, perfect. Not a drop of blood spilled. I got the IV drip onto the hub and everything taped up.

My preceptor, a nurse, gave the guy some morphine through the IV drip set to sedate him. He was a wiseguy, mostly. Interestingly, he seemed a little embarassed about his situation and denied various things the two guards with him said in regards to his behavior back ‘at home’. Anyway, he seemed to like the morphine pretty much. The morphine, though, turned out to just be the beginning of the sedative. In order to do the heavy-duty second part, they had to bring in a respiratory tech just in case the guy went bad. The tech got out a bag-valve-mask and sized an oropharyngeal airway. They were ready. Then they dosed the guy with 3 mg of Etomidate via IV push, in other words, through the tubing.

After about ten seconds, the guy said, “Wow.” Then his eyes rolled back in his head. Poof, gone. The nurse and a PA put his arm back in, a task that took about a minute of pulling traction on the arm. The guy moaned a bit. Then we waited about two minutes and the guy’s eyes opened up again; back in the world. He had no idea his arm was back in until we told him.

The marvels of modern medicine.

I watched a guy have a wound in his thigh cleaned and sutured. Cool, but I must admit that I still have some habituation to do in terms of being able to watch that sort of thing without negative reaction.

I started my second real IV on a young woman with stomach issues. She complained when the nurse told her that she was going to have to have an IV; she said the last one she had had was very painful. A bit later, during the assessment, she noticed my photo ID that clearly states I am a student and asked if I was a student. I said that I was. She was fine when I came into the room with the IV gear and started setting it up. I got it in (pop!) and drew four tubes of blood for the lab, then started the drip. Unfortunately, I was not completely ready for the start (I’m new, still) and hadn’t got the tube dealie ready; while fumbling to get the cap off, my pinkie fell off the vein and consequently a bit of blood was spilled. It was messy, but the woman said the start didn’t hurt at all; was way better than the last one she had. “Props for the IV,” she said.

I like being able to sort-of read a cardiac monitor. I have a lot to learn, of course, but now I understand how to look at a tracing, I understand what is meant by different ‘leads’ (I am most comfortable looking at lead II), and can identify the different waves that make up the rhythm. We had a guy in for atrial fibrillation, but as far as I could tell looking at the monitor, he didn’t have it. It turned out that he identified it from the way he felt (having had it before) and drove himself to the ED. On the way, it went away. So I was right, the guy wasn’t displaying afib. He did have a lot of bizarre squigglies, but I figured they were non-organic artifact, and they were. Yea for me.

I got to listen to a geezer’s rhonchi. The geezer was awfully cute and told me about getting to hold a bunny at senior day care.

I saw a bunch of other cases; nothing that interesting.

I made myself useful at the ED; I changed several beds, swept out several rooms, and ran every errand I was asked to.

I saw a bunch of EMTs that I work with ‘in the street’ bringing in patients. Most of them knew I was going for EMT-I and were not surprised to see me in the ED.

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