4 and 1 for the night, but OH what a 1

Lab last night (IV’s, drug math, SQ, IM, IO, drip, and ETT drug admin stations). At the IV station I stuck the “dummy arm” four times. Everything went just fine. Lab ended a little late and after a stop at the store and the 45-minute drive I didn’t make it back home until about 2315. I was on the board from 0000-0600 as EMT.

Tones dropped at about 0130 – Intoxicated male down and bleeding in front of the hardware store (if you draw a line from one of the bars in town to campus the hardware store is a point on this line). We roll with a paramedic, EMT (me), a driver and a “significant other” (a helper with no official training). We arrive to find a surly crowd of intoxicated college students. Seems they wanted the police to transport the patient, as they were worried he would bleed to death from his wounds. Not a valid concern, but it made for a semi-hostile environment

As we climb in the rig the paramedic turns to me and asks “You have your IV lab yet”? I reply that for the last 3.5 hours I have been ready to rock. He gives the nod and I try my first stick in the field (and my first stick of a human ever). While it would have been nice to get consent from out patient, he was in no position to give it. Given our protocol calls for him to be ALS’d, he does NEED to get stuck, so why not me under the supervision of an experienced paramedic? Indeed.

Funny thing about the dummy arm (the practice arm in lab, not my patient’s…):
It isn’t in a moving ambulance
It doesn’t jerk around as its owner pukes on you.
Lastly, and this difference was important to me at about 0145, the dummy arm’s other arm doesn’t appear to belong to an unconscious person and then SWAT at the hands of the provider , right as said provider was trying to disconnect the needle and protective sheath off where it connects to the cannula (after having seen the blood “flash” in the chamber and sliding the cannula into the vein). DRAT! Drat, drat, drat. The swat sends my hands, and the whole works, away from the patient (and the cannula out of the arm). DRAT!!!!

At this point I STILL don’t know why the paramedic thought this was funny. Really, IT WAS NOT FUNNY. I could have been 5 for 5 for the night, plus been able to say I got my first stick I ever tried. Not only did the paramedic laugh, but he seemed happy for the rest of the call. Sadist.

Obviously our patient was intoxicated. On a school night. To the point that it impacted his life in a negative way. Liz (see link to her blog at right) asked in comment about my thoughts on ethanol abuse and college students. Liz, I started to write something on this, but as it grew to two pages I realized that I don’t’ have a quick take on this VERY complicated problem. If I get a chance to finish it maybe I’ll post it prefaced by a warning about its length, but I don’t feel I can address the issue in a paragraph or two and am not sure it is worth my long diatribe. It is a complicated issue and I have a lot of thoughts but few answers.

As we left the station last night the paramedic said to me that he didn’t plan on starting another IV until I was done with my class. I hope I can manage to get the next one.