Tag Archives: Versed

Sexual Tension 2/3

As we’re pulling up behind the BRT, Louis and I recognize the SRO from last week. This time we were called for chest pain – one of the EMS bread and butter calls. Standing in front of the lobby is a man in his late sixties wearing a camouflage jacket with a heavy-set woman standing next to him. A few firefighters are standing with him while the engineer sits in the cab. He’s old-school – he doesn’t go on medical calls.

Walking up I catch the eye of the fire medic. He tells me it’s a chest pain call and asks our unit number for his paperwork. Seconds after giving him my number their engine is pulling away. The patient and I are still standing on the sidewalk. That’s the way it is sometimes in the Big City – fire crews are tired of medical calls and take off as soon as they can.

I look at the fire sheet that the LT handed me before they bugged out to get the patient’s name. “Hey Jessie, so what’s going on today?”

“It’s my chest man, it just don’t feel right.” Louis is getting the gurney because if this is an actual chest pain call I don’t want to walk the patient and put more strain on the heart.

“Okay, so how bad is the pain?”

“No pain, man, it just feels like it’s thump’n too fast.”

I reach down and feel his radial pulse. Just a quick look but it’s upwards of 150 beats per minute. Would’ve been nice if the fire department had actually taken some vitals.

I’m getting Jessie settled on the gurney, “So what were you doing when this all started?”

“I was having sex man!” He’s got a big smile on his face; he’s proud of this proclamation. His wife, standing next to him holding his medications in a bag, hits him on the shoulder. “Hey cut it out!” he chides her, then back to me, “It’s the first time in a year.”

Despite the fact that this is an “emergency” he’s in a good mood and joking around with us and his wife. He knows something is wrong but he’s a playful man and won’t let it get him down. “Well, I’m sorry you didn’t get to finish you’re business.”

“Oh, I finished my business, don’t worry about that. I called y’all after I was done.” We all have a laugh as we’re wheeling him towards the ambulance.

I look over at the wife as we’re about to load the gurney in the ambulance. “Can’t you see this is a fragile old man, don’t you know you have to do all the work?” I’ve got a mock-accusation tone to my voice – I’m having fun with them as I sense they’re okay with it.

In the way that only a heavy set African American woman can pull off with credibility, she puts her hands on her hips, leans towards me, and with head bobbing for emphasis, “I WAS doing all the WORK, just ASK him!” Jessie just smiles…Louis and I are attempting to maintain our composure, but we’re only half effective.

I put Jessie on the heart monitor and run a 12-lead EKG. He comes back with Atrial Fibrillation with Rapid Ventricular Response at 162 beats per minute – no chest pain and no heart attack that my monitor can see. So basically, he’s got a fast and irregular heart beat – the electrical impulse reaches the ventricles of the heart and starts over sooner than it should. It’s not really a lethal rhythm that would require shocking him right now as his blood pressure is fine for the moment. It’s a rhythm that will either subside on its own or persist until he fatigues and becomes unstable. I can help it start subsiding by administering a sedative to help him relax. Some counties have beta blockers and anti-disrhythmics for use in this situation but unfortunately we don’t have that in our protocols. If he becomes unstable I can shock his heart back into a decent rhythm, otherwise it’s just best to help him relax and hope that it’ll resolve on its own.

As we’re driving to the hospital I start an IV and give him four milligrams of Versed to help sedate him and relax the heart. Because of his age and potentially unstable condition, he gets immediate attention at the ED, and a room close to the front where the nurses can keep an eye on him. The 12-lead that the ED runs comes back the same as my monitor’s interpretation and they pretty much just keep an eye on him until he calms down.

After a few more calls I take a patient back to the same hospital and get a chance to check on Jessie. He’s smiling and putting on his camouflage jacket as he’s getting ready to go home. “You doing a’right Jessie, ready to head out?”

“Oh yeah, I’m all good. I got me a fine woman to go home to!”

Sexual Tension 1/3

sex·u·al

1 – of, characteristic of, or involving sex, the sexes, the organs of sex and their functions, or the instincts, drives, behavior, etc. associated with sex

 

ten·sion

1 – the act or process of stretching something tight

2 – a force tending to stretch or elongate something

3 – mental, emotional, or nervous strain: working under great tension to make a deadline

4the interplay of conflicting elements in a piece of literature, especially a story

Louis and I are taking a leisurely drive to the call as it came in as a Code-2, which means no lights, no siren, and we obey the traffic laws. Being sent to the call Code-2 doesn’t always mean it’s non-emergent; it just means that the call taker in the 911 center was unable to find any critical problems during a brief conversation. I’ve had many Code-2 calls that resulted in a Code-3 trip to the ED. This happens either because the caller is unable to fully convey their problem to the call taker, or the call taker is unable to interpret what is really going on. I don’t fault anyone for this. I mean seriously, I sometimes have a hard time understanding what’s going on even when a patient is explaining it to me in-person. If anything, I’m surprised that calls aren’t mis-lebeled more often than they are.

This call came in as a possible dislocated shoulder. Now granted, this isn’t the most critical of calls, but I would think it deserves a full response of Fire and EMS running Code-3. But I have to follow the directions of the dispatcher; I can’t go upgrading or downgrading a call based on my intuition. I’ll just have to apologize to the patient for taking fifteen minutes to reach him if it turns out to be a real emergency.

We roll up to the converted hotel in the middle of downtown Big City. The address is for an SRO (single room occupancy) and the room is on the fourth floor. When tourism dropped off the older hotels became vacant as people wanted the newer, more modern ones. Developers came in and converted the older hotels to SROs and classified them as low-income housing, for which tenants pay by the day, week, or month. Having been in the majority of them in the city I know what to expect – dirty, unkept hallways and tiny little rooms with a hot plate and mini fridge. There’s a shared bathroom on every floor.

Fortunately, as we drive up to the lobby, it appears my patient made it down to the street and is walking towards the ambulance as Louis puts it in park. My new patient seems to be a man in his late forties being supported by a woman in her mid thirties. I hop out of the ambulance and walk up to him.

“Hey, what’s going on today?”

“I think I threw my shoulder out. It hurts like hell!”

I take the coat off that’s draped across his shoulders so I can get a better look. Sure enough, anterior rotation with deformity. “Yeah, looks like it’s out, this ever happen before?”

“Yeah, just last week; same thing. It happens a couple times a year.” The woman is just standing there holding his coat and caressing his head as he’s in pain. Louis is pulling the gurney out to bring it to us so my patient doesn’t have to walk any further.

“What were you doing when it went out?”

“We were fix’n to have sex!” She slaps him on the good arm. “Hey, stop it! The man asked.” He’s just a little bit proud of the situation; she’s a little embarrassed, at least I think that’s what’s going on. “I was about to climb on top, supporting my weight with my arms, when I felt it slip.” She actually starts to push him to the gurney as Louis is almost here.

We get him loaded into the rig and Louis looks at me with anticipation. “Yeah, go ahead, it’s all you.” Louis dives into the cabinets and grabs the triangle bandages to make a sling and swath to support the shoulder. We’ve had a couple of shoulder dislocations in the last week; it’s a common injury in late summer as the first few football practices start up at the local schools. Louis has been working on his sling/swath technique so he’s excited to get this one perfect.

I take a set of vitals and start getting set up to administer some Morphine for pain and some Versed for sedation. If I can relax him now the muscles will stop pulling against the shoulder and make the reduction a little easier when we get to the hospital. In his current state the muscles and tendons are actually contracting to apply tension to the shoulder, and that keeps it out of the socket. It’s got to be excruciating! 

Just making conversation while I’m getting things set up, “Is your wife going to be coming to the hospital with us?” I noticed that she kissed him while we loaded him in the rig but had since disappeared.

“No she’s not coming, and she’s not my wife. But she might as well be – I’ve been seeing her for about eight years.”

Louis finishes up the sling and swath with an ice pack on the shoulder about the same time as I sink the IV in the vein on the other arm. Louis did a great job; it’s always a good feeling to get the same call just a week apart so you can do things better the second time.

As we’re leaving the curb for the five minute ride to the hospital I inject the pain killer and sedative. My patient is feeling much better now and he asks for his coat so he can get his cell phone. I have the lights turned down and I’m just working on my paperwork as I hear him on the cell phone.

“Hi honey…yeah I’m going to be a little late tonight, my shoulder went out again and I’m on the way to the hospital…yeah, I love you too.”