Allergic reactions...that turn into Codes.

You can call me a coward, but there are some situations I hope I never have to face as your friendly neighborhood paramedic. I'll train for them so I'll be prepared if they come, but I pray they don't happen when I'm on duty. Firefighters, EMS personnel and law enforcement officers come across extremely sad and often gruesome situations as a regular part of the job. So often, you show up and even with all of your training and expertise there are situations where you don't know what to do and sometimes there is absolutely nothing you can do. These kinds of situations take an emotional toll on those entrusted with handling them. 

Wildflowers

Running cardiac arrests is a fact of life as an EMS provider. We call them codes. Usually, if they are dead when we get there, they tend to stay dead. We do our best, but few un-witnessed codes actually end in a "save." In my five years with the Rescue Squad, I've been on at least 6 codes, not counting the one described below. Only one of them made it to the ER alive, but he died in the ICU a couple days later. The one that died in front of us...well, he had a massive Pulmonary Embolism (blood clot in the lungs) and never had a chance. I've never truly had a cardiac arrest "save" who made it home from the hospital...until this week.

This past week, I was on duty as the regional medic in the west end of Loudoun County--Region A. Think of this as being the EMS equivalent of a K-9 unit. In the 1/4 of the county that I cover, there are a lot of ambulances with EMTs, but I'm the only medic--or ALS provider. If I need a medic for backup, they are about 15 minutes away. To continue the story...I'd gone out to dinner with the ambulance crew from my station. It was a hot, muggy day and a large storm center had just hit the town we were in. Thunder, lightning (lots of ground strikes) and a huge downpour. 

In the middle of this, our food had just arrived when the tones were dropped at 19:28 for a 15 year-old-female having and allergic reaction w/trouble breathing at another restaurant in town about 1/2 mile away. I had a bad feeling about this one, and beat the ambulance to the scene by about a minute. As I pulled into the parking lot, the mom came running out into the storm to tell me the girl was barely breathing. I unlocked the drug cabinet on my chase vehicle, grabbed my drug bag and went into the restaurant. The girl was lying there on the floor next to the bench near the entrance breathing like a fish out of water. I didn't have enough time to give her anything before she stopped breathing. Praise God the ambulance crew came in just then, because respiratory arrest very quickly turned into cardiac arrest. We did CPR for about 2.5 minutes before we got her back, and went through the allergic reaction protocol. 

Another medic just happened to be at the restaurant and jumped in to help. I was incredibly glad to have him there helping because the next closest medic was coming from 12 miles away and I needed help yesterday. We got her to the hospital alive (she was complaining that her chest was sore), although three minutes out from the hospital the medications wore off and in less than a minute she breathing like a fish out of water again. We were assisting her breathing with a BVM again by the time we arrived. She was quickly sedated, intubated and placed on an Epinephrine drip by the ER doc before being transferred to a children's hospital. She was extubated about 11:30 that night, was discharged from the hospital later the next day. For me, this allergic reaction code was a big deal. Not only was it the first severe allergic reaction I have run since getting released as a medic, not to mention the first code, but the patient was the same age as my youngest sister. Very scary. All things considered, the call went well. Praise God this one ended so well!

I've found several ways to de-stress after a significant call like this one. Usually after a call like this, I end up reviewing and criticizing the actions performed on scene to see what can be done better the next time. But when that's over, it's time to deal with the stress. Some form of exercise usually works, running, swimming, hiking, taking a ballet class. I also like to make a trip to the library for a new book and will spend hours working on my garden while listening to music. This time around, I picked up a book on the science behind the Sherlock Holmes stories. As for music, I'm currently into a CD of harp concertos I picked up from a thrift store and the soundtrack for Captain America: The Winter Soldier that I found on YouTube. The garden looks lovely now after a bit of cleaning up.

On Thomas Jefferson, Peas, and Getting Called Out of Church

I remember reading that Thomas Jefferson was an avid gardener (of course his garden was gigantic compared to mine!). One of his favorite vegetables was English Peas and he had a friendly competition with his neighbors to see who could have the earliest ones. So I looked it up--he grew 15 different varieties! (Check it out here: http://www.monticello.org/site/jefferson/fun-fact-peas). I planted peas this year, on April 5th. Too bad I only have space for one variety. And they started poking their little leaves up April 16! I meant to take a picture several times, but kept getting distracted and forgetting.

I did not forget to take pictures of the cherry blossoms in Washington D.C. this year. Unfortunately pictures like the one below cannot do them justice.

This particular tree in full bloom was located next to the tidal basin near the Jefferson Memorial.

I've been enjoying the privilege of being the regional medic and having a chase vehicle. It means that if I run on a Sunday day, I can take the ALS chase car and go to church.  I take a radio or minitor and my phone, turn the volume down as low as I and sit near the back so I can get out fast without disturbing too many people. Unfortunately this plan has backfired on me a couple times and I have had to leave the service rather abruptly. Like on Palm Sunday.

I heard that one go out about halfway through the sermon. It was for a hand injury--initially BLS. Some guy was doing training and got the tip of his finger pinched off. I had a feeling I'd be going on that one and sure enough, they called for ALS. Nothing really I could do when I got there. It was a frustrating call on numerous levels. Turns out the hand doctor was not able to reattach his fingertip. Oh well. You win some and you lose some. All you can do is your job to the best of the ability God has blessed you with.

Have had some "good" calls the past few weeks. Let's start with the typical definition of a "good call" from the medic's standpoint. A bad call is one where things do not go smoothly. And average call is one where things go well, but the reason you were called is not notable. Like getting that 3am "I stubbed my toe 4 hours ago" or also at 3am "I've been short of breath for 3 days and nothing has changed but it's now an emergency because I can still talk your ear off non-stop for 5 minutes without getting short of breath" call. Yeah. Then you have calls where the illness or injury is genuine. That finger amputation call was good except that things on scene were a bit messy. Seems like I've been going through a steep learning curve after being released.

For example, there was the first time I gave pain medication after being released. This tough little lady fell off her horse in the middle of a field. The ambulance got there first and if a) someone hadn't showed me where to go and b) the ambulance crew hadn't been standing right next to her, I would never have found her. The grass was at least a foot tall and you couldn't see her. She'd broken her ankle. It was extremely painful, swollen and deformed. I wasn't able to completely remove her boot and there really was no good way to splint it. I started my IV and gave her pain medication out there in the deep grass. Unfortunately it didn't do her much good. We eventually got her to the hospital and even three doses of pain medication later it barely took the edge off her pain. In all honesty, she warned me she had a high tolerance for pain medication. I wish I could have managed to splint her ankle better, but she refused to let us touch it and it was going to take us forever on scene. I have a feeling it would have helped with the pain though. Next time.

So much for that. Been rather busy with hospital rotations for paramedic class lately. Speaking of paramedic class, I'd better get going. More homework to do.

Starting a Garden on an Apartment Patio

Everything begins somewhere. My gardening experience started when I was a child helping my mom and younger siblings plant a garden in sunny southern California--where there are two seasons: the sunny season and the rainy season. My medic experience began Spring 2009--not long after I was first one scene when my youngest brother was hit by a car in front of our house and broke his arm.

 I didn't realize how much I'd miss gardening until I left for college in Virginia. Within two months I had a pansy growing on my windowsill. Six months later I had a small herb garden and a long-suffering African Violet. During my second year of college, I started volunteering with a local rescue squad and became an EMT. I loved learning about the anatomy and physiology, but unfortunately, they didn't cover enough of it to satisfy my curiosity. So after graduating from college and volunteer fire school (yay for being a smallish girl in turnout gear kneeling on top of the hose to control it), I got a job with a local ambulance transport company, moved into a small condo with two friends from college, and went to school for EMT-Intermediate Spring of '13 and graduated last summer. Finally I learned more about anatomy and physiology! To help deal with the stress of class, I started running and expanded my small potted garden. My schedule was ridiculous, and I only had a few hours here and there to work on the garden.

Last year, the garden began with a packet of tomato seeds. I found a dwarf tomato variety that was perfect for a pot. This is a different variety, but ended up in a pot on my patio as well.

Our condo is on the ground floor and includes an approximately 8x10 ft concrete patio outside a sliding glass door. There was a small area of grass between our patio and a neighbors patio (3.5x4ft) that I decided to turn into a small vegetable patch. 

As soon as the ground thawed in February, I started by removing the top layer of sod. Turned out there was a 6in layer of gravel 4in beneath that layer of sod...yay. It took me two months to painstakingly pick out pieces of gravel out so I could dig up another 8in of soil. 

Sometime in May, I found a beat up old rocking chair by the dumpster in the apartment complex. It soon had a permanent home on my patio. It was so relaxing to come home after Intermediate class or a long hospital rotation, go for a run on the trail, spend half an hour working on the garden, and then sit in the rocking chair watching the sunset and the fireflies after dinner.

By the end of the summer, I had about thirty-eight pots of varying sizes containing a variety of flowers and vegetables.

I choose to use a mixture of organic and commercial fertilizer and pest control products. They worked for the most part, but I still had a big problem with mealy bugs. A swallowtail caterpillar made it's home in my Parsley and two praying mantises took up residence in the garden in April, and helped with pest control.

 In late June, I started to get my first harvests. The most difficult thing was keeping everything watered. There is no outside hose. So it was a daily thirty-minute chore to haul the requisite eight gallons of water using a watering can (I have two of them: a 1/2 gallon and 2 gallon) from the kitchen sink to the garden. 

By August, the place was starting to get overgrown. The tomatoes were too tall for their stakes--eventually breaking the stakes and my zucchini plants were trying to knock down the little wire fence surrounding them.  

My cucumbers had reached the top of their trellis and were going down the other side. I started giving produce away because my roommates and I couldn't eat it before it went bad.

 By October, pretty much everything I'd planted was done. By then I was precepting as a medic at work and with my volunteer rescue squad, had just begun an Intermediate to Paramedic bridge course and was taking a condensed (8-week) college level Anatomy & Physiology class. The cold weather had killed off most of the annuals, so I left the pots sitting out for the winter.

As soon as the ground thaws enough for me to dig in it, (hopefully later this month) I'll start turning it over getting ready for planting in the spring. I can't wait.