The First Day

First and foremost I apologize I have fallen behind with this Blog, and I'm sitting down now attempting to play catch up. It has been two weeks now that I have been assigned to my precepting shift, the end of the week overnights. I had to make a few significant lifestyle changes in an effort to adapt to this schedule, and I'm still making changes in an attempt to "adapt". The days leading up to January 31st, I spent all of my spare time, attempting to know my protocols cold, to master all of my drugs to the best of my ability, preparing myself for the onslaught of questions and challenges ahead. I attempted to get as much sleep as I could the hours before my shift, but I found it extremely difficult, my nerves just wouldn't cooperate and I also wasn't feeling the greatest health wise, i felt as if I was on the verge of coming down with something, or perhaps this too was just nerves and would pass. I woke up and put my uniform on, putting as much detail as possible into looking professional, shined my boots up, shaved, and actually did my hair, no hat the first day of precepting I told myself. As I drove to work I couldn't help but be nervous and frightened about what lied ahead, what the city would bring me my first weekend on the overnights as a precepting paramedic. I punched in and went down to our "fishbowl" conference room to meet with my preceptor and Education Dept Supervisor who would also be my supervisor on this shift. I was handed my preceptee manual and quickly told what was expected of me and of course the usual "good luck welcome to precepting" handshake and I was off to check out my gear for the first time. As I sat in the back of the ambulance nervously checking out my ALS gear for the first time, attempting to be both punctual and accurate, I was quickly interrupted half way through. My preceptor had heard a call go out for a unresponsive on the side of the road and he wanted it, signing on the air "220 we'll take that call".

Arriving on scene I found HFD and bystanders w/ an appx 40-50 year old male lying face down on the side walk, with a bottle of vodka next to him, his presentation screamed ETOH, however I must think my way through this as a Paramedic, now this is called Altered Mental Status. As I got closer, my Pt was snoring, either he's in a deep sleep, or he's so inebriated he's compromised his airway! He fails to respond to my voice or my attempt to arouse him via a painful squeeze of the earlobe, on to the stretcher he goes. Sitting him up in the stretcher manages to open his airway and rid the snoring, he's slightly awake now however still very much so oblivious to the world. I start my ALS work up, putting the Pt on the monitor obtaining my vital signs, everything fits in place, and then I find his BGL to be 68, manageable enough, a quick IV and a lil Dextrose can fix this. This proved to be harder then I thought as my nerves quickly played a role, I attempt my first IV and he pulls his arm away, as hard as I struggle to hold onto his arm, it blows. My second attempt again with a struggle blows. My preceptor manages to go right above my failed attempt in the Pt's arm and lands me a solid line, in goes the Dextrose, up he comes swinging!! We transport him to our closest facility and sure enough, another busy day has filled the usual area for our local ETOH's and Pysch's, they ship us to the hallway! I give report to the RN who looks at me amazed that I actually put that much effort into giving an ETOH Dextrose "Your precepting aren't ya" she jokingly says and she takes the rest of my information. I later come back to drop of my PCR and find her fighting with my now fully awake but highly confused and agitated Pt who's attempting to the eat the gauze I bandaged my failed IV's with. The night went on, w/ another highly amusing ETOH who had the majority of the staff at our local ED triage area grabbing their stomachs laughing with his antics, followed by a few routine ALS calls nothing exciting for night one, but we are after all just getting started.