Root Beer Float

Home laptop went to shit earlier this week. The cop can't get it to start except in "safe" mode. Dell is going to have some answering to do on this one. Computer is less than two years old!

Flying today. Have been out of service for weather and mechanical so its nice to be UP. I'm on a run of scene flights... WHOO-HOO so life is good. Did two scenes the last shift we flew. One motorcycle vs a tree. Nice vietnam vet who ran his harley off the road into a tree. Maybe rib fractures but otherwise ok. He was covered in scars from what was probably a major major burn some years ago. I asked if it happened in Vietnam and he said no. It happened a couple months after he got back. How sad. To be 18, make it outta there and have this life changing injury once you finally get home.

Second flight that day was an SUV that ran into the back of a trailer being pulled. I got the unrestrained passenger with sternal bruising, fractured ribs. fractured wrist and (on CT a small pneumo and liver lac). Went smoothly except I was not with my normal partner and the guy I was with doesn't play TEAM well. He's been doing this forever, why does he need to listen to a fuckin newbie flight nurse???

So today we were chillin in the ED when the Code Blue buzzer sounded. We had nothing else to do, so we went on up with the ED doc and ED nurse/medic. Old old OLD guy on a tele floor had aspirated and then gone into cardiac arrest. I figured I should have a shot at the tube and asked the ED doc if he cared. He said yes.... "as long as you don't pass the tube unless you see the cords." Hmmm..... thats the idea there buddy, and if I don't see it... we are going to do some tracheal manipulation and get it. My view was at best an airway with shaken up root beer all over it. Foamy, brown disgusting. A little suction and I got a great view of the cords. Tubed on the first try with no issues. Def an ego booster.

We were just recounting things back in the ER when we got punched for (another) scene. Lady was riding a 4-wheeler and rolled it backwards onto herself. Possibly some fractured ribs and a full dose of status dramaticus. We gave a bunch of "please shut up," aka Fentanyl and life got better. Still the night is young... maybe 2 scenes and a tube tonight!!!

Broken Baby

So, Baby has been broken since Tuesday afternoon. Something abut torque and cyclic. I understand it a little, but not enough to describe using words other than thingamajiggy and dohickey. There was something about a cam and some other part that had to be shipped in, so work didn't start until Friday. I imagine there were mechanics crawling all over like ants by the time they got going. I called at 8, 1, 5 and 7 to check status and see if I had to go in. I had to be available for whenever they were ready. After 7 I decided to say fuck it and go to dinner with the cop. Naturally, we were going to dinner when I heard we might be up and running soon. I got the "time to come in" call at 1130 last night. After all that waiting, I was a little pissed. The medic I was working with lives over an hour away, so we weren't in service until 1am. What a fucking waste of time.

So on my break between shifts I worked in the ED. The first night I planned on going in for a "princess" and staying late. We were busy as hell, on diversion (no ambulances except for multi-system trauma) and the waiting room was full. I planned on staying until at least 3am..... until the evil British coordinator found out. She told me (at 10pm) that they no longer needed me to stay. Nobody could figure out her rationale except that she and I don't get along and she is known for letting personal feelings interfere with professional judgement. I felt really bad leaving the Green Mile in shambles..... they really needed the help.

Did 8 hours the next night. Easy easy easy in yellow. No traumas at all, lots of drunks sleeping on stretchers in the hall. New SOCM medics trying to figure their ass from a hole in the ground. Finally did a 12 hour Wednesday night. Hell on wheels on the Green Mile. Had a vented asthmatic who kept waking up with versed and propofol drips, a dislocated shoulder who took two attempts and almost 500mg (and 250mcg fentanyl) of propofol to reduce. Then every psych patient and little old lady in the department started screaming. It was like a round of "Row, row, row your boat" just more obnoxious. The little asian lady kept throwing herself on the floor. I just made sure that the nurses head was still in the air and didn't worry much beyond that. The self proclaimed "drunk hippie" in police custody laughed hysterically at everything I said and at 3am a drunk guy came in to be "checked" since his girl had a wart on her..."you know" (that's exactly how is was described to me.

Wow, that place is still insane. I was happy to get outta there.

Hogan's Goat and a Soup Sammich

Hot and humid as hell Saturday morning. My partner went goose hunting (ugh) before coming to work and had a truck bed with 6 dead geese in it. He went out to pluck and cut them and I had the bright idea that geese have really long necks, so really long trachs for me to practice on. So while he plucked the feathers and cut the breasts out (yes, it was as nasty as it sounds, plus a couple dozen flies) while I get to their necks and practice crics over and over. I'm a pro now!


Finally we got a flight. Transfer from the city out to the mountains to another teaching hospital/trauma center. This guy showed up to the ER a few days ago with rectal bleeding...and oh, a tumor the size of a grapefruit in his tracheal/laryngeal area. We sort of got report, the ICU nurse says "I've never done this (transfer a patient?!?!) before." Never a good way to start. It sounded like he crumped out on a tele floor, gt transferred to the ICU and then to the OR to fiberoptically intbate and do a bronch. They got a tube with some difficulty and when they started to bronch he started bleeding like shit into his lungs and the sub-q space. When I first assessed his airway his tumor had deviated his trach like a goiter and (to quote my sister) his upper chest was "soggy." With all of the bleeding his pressure had begun to crap out and h was on neosynephrine for BP. (Ummm.... blood anyone?)

So we got packaged, on our stretcher and out the door without incident. We loaded onto the aircraft stretcher and were getting ready to secure the skid when the RRT reached forward to bag the patient (after being told not to) as we slid the skid forward. All of a sudden a difficult to bag patient became "really easy" (her words). That's because the ETT cuff is in the patient's FUCKING MOUTH! Yes, she extubated the patient. There was a serious butt pucker moment when the medic, who was in the airway seat, did laryngoscopy and couldn't see shit. We tried the bougie, and a styletted 7.0 tube without success. He started pouring blood out of his nose, which was EXACTLY what we needed right then! There was no way in hell that we were going to "goose cric" this motherfucker. It would have been like popping a HUGE zit.... blood everywhere. So we decided to go with our backup airway device.. a KING LTD. Success!!! I taped that tube like it was gonna escape (1001 uses anyone?) and we got the hell outta dodge.

No issues in flight, thank god! We debriefed with the clinical manager, ops manager, base supervisor and medical director when we got back. As well as the poor pilot who watched the whole situation with an "Oh shit" look on his face. We decided that on the Oh SHIT O'Meter that this was a 7/10. Described as fucked up as Hogan's Goat or a Soup Sammich.

We swung by the ER later that night to check things out.... it was a full moon after all! There was a guy who fell on a pair of scissors and had a radial artery bleeder. The doc was WAY out of his league trying to tie this thing off. We were just waiting for him to say "fly him." Poor guy had a pressure in the 70's, was anxious, diaphoretic and a little confused. He was the picture of hypovolemic shock. I'm sure the artery was still leaking when he closed the skin. He had a hematoma that continued to grow under the skin. I'm sure he was back the next day when that thing blew.

Drama Drama Drama..... and I get to work a princess in the ED tonight. The moon is still full! Can't wait!

Skills Day!!!

We had all day skills stations for the flight crew today. We played with pig trach's (lots of them) ribs for chest decompression and the coolest Sim-Man I have ever seen. Hal breathes, talks, blows pupils, has tongue/airway edema.... he can even seize and has pulses. Really cool shit. Our medical director came out to play, and we even got our pilots involved. (Surgical Crics, so easy a pilot can do it!!!) For me it was a little bittersweet. I am the least experienced with airway/intubation and do not have the technique that others do (yet).

Have you ever practiced something over and over and over that you become completely frustrated? I was shaking from the effort and just DONE with the whole situation. Its hard going from where I was "good" at everything... to to a new role where I am actually having difficulties. I didn't want to make an ass outta myself in front of the rest of the crew. Grrrr.....

In the meantime.... we got a phone call from our "squirrels on the street." (If you do EMS long enough, you have friends on the inside that keep you in the loop). Check out www.cnn.com. As of 1545 there is some "breaking news" nearby. The building collapse is about 5 minutes from our base. They haven't sent any helicopters yet, they haven't found anyone yet. Hopefully everyone made it out ok.

My partner and I are convinced that we are going to get me a tube tomorrow. Cross your fingers for me!

Baby

This hitch I finally got settled with my permanent partner. He's young, but has been flying for about 2 years so we are a pretty good match. On Wednesday we did a flight from the coast area back to the city. Poor old guy with Parkinson's that was having an MI (his troponin was over 40). During our 25 minute flight he pulled an IV (I got it re-started), brady'd down to the 30's and started hitting me, my partner, the window (ativan fixed that). When we offloaded I thought the saline from the pulled line had leaked on the skid.... ummmmm no. That motherfucker HOSED down the inside of the aircraft! It took almost 30 minutes to wipe the inside down.

The next morning the oncoming crew was just getting signover when the phone rang. It was a flight from one city hospital to the teaching hospital. Not a big deal at all.... until dispatch needed to talk to the nurse... It was a IABP (balloon pump) patient, tubed, vented on 4 pressors. AKA: Sick As DOGSHIT. My partner was pissed it wasn't our flight... I was relieved. I don't like doing balloon pumps. That same shift had an organ flight that afternoon. Surgeon going from the coast, to the western part of the state to recover a heart. The pilot then had to return to the base and switch out with the night pilot.... he then went back west to pick up the team (and the heart) and flew back to the coast. We usually sent a crew member as well, but the team was 3 people this time and there wasn't room. The pilot made the drop-off and went for fuel..... thats when Baby died. (we call the aircraft Baby)

The pilot and mechanic worked all night trying to get Baby fixed.... then the weather went to shit (there is a hurricane coming). So they came home and left Baby sitting at the executive airport about 2 hours from the base. So my last shift involved a roadtrip with my partner and the pilot (squirrel and sharkbait). We were scud running at 500 ft just to get home before Hannah kicked our asses. I took some video of us flying over the beach with my partner's camera. (I will try to get it from him) We made it back, offloaded the medical equipment and then took Baby to the hangar (just on time).

So am home now.... waiting out the storm. Not as bad as I thought it would be but poor Maddux has been hiding in the corner since I got home.

Labor Day Weekend Show!

I feel like I am starting to find my stride as a flight nurse. I don't feel like I have four thumbs and two heads (that frequently bump into stuff!). The "flow" is starting to work itself out. I don't have any super interesting flights to mention... but I have definitely seen some beautiful parts of the state. I couple of weeks ago (not long before the DNC) we did a flight from southern Va to Norfolk, Va. It was that beautiful time of day where you are going from night to early morning and watching the sun rise over the Chesapeake Bay. We stopped to get fuel at the executive airport.... you never know who you will see at these places. During race week you see driver's private planes, the governor flies in a helicopter out of one too.... so when we landed and there was a 737 on the tarmac, it was no big deal. I looked a little closer and saw something a little interesting.....

Yes, it was Barrack Obama's plane. I was maybe 100 yards away, and there were black secret service SUV's all over the place. Let me say that I do not want to start any political debates here. The point is, my job has given me so many opportunities and this was another really really cool one.

So am on my five day break.... we road tripped to Charlotte to watch the Va Tech opener vs ECU. We went with a co-worker of the cop's (another cop) and his wife. They are, unfortunately, having some marital discord. You haven't lived until you have ridden 5 hours with a couple who are not getting along. It didn't help matters that it was 90+ out and Tech was playing like (pardon the expression) a monkey FUCKING a football. They lost in the fourth quarter due to a shitty defense and a quarterback that lost his shit about 10 minutes in. It was embarrassing. The saddest part??? I missed Buffett show to be there. He is actually playing the "Labor Day Weekend Show" tonight. We had several opportunities to get tickets and I passed. Too expensive for us right now! So I will have a Corona and listen to radiomargaritaville.com on the deck tonight. Its weird, with Gustav making landfall over Labor Day. The last time there was a hurricane and a Labor Day Buffett Show the cop and I were in Chicago and got engaged. That was....... 3 years ago at Wrigley Field. Maybe we should raise a glass for that tonight too!!!!