Dislocated Shoulder Day

I’ve noticed that Emergency Medicine is a “feast or famine” job.

Either nothing happens at all or everything happens at once. Which really isn’t a bad thing if you think about it. When everything happens at once, that’s when you get those interesting calls you’ll be talking about for years to come – the diabetic who passed out behind the wheel and slammed her car into a tree; the arguing boyfriend/girlfriend couple that winds up with her getting punched in the face and him getting stabbed with the kitchen knife; the guy with two dislocated shoulders. And when nothing happens at all, you get a chance to catch up on your reading, surf the web (we have wireless Internet at the squad) or get some studying in.

The majority of the time when I get to the squad, it’s a famine day. Actually, the majority of days in upstate New York are famine days unless the weather is bad, the roads are slick, or we have some level of stupidity happening somewhere that contributes to an interesting call. (Like the guy who hit his head on his own backhoe, knocking himself out. Or the school bus that drove right into a lamp post in the high school parking lot.) And, on famine days, I do all of the above. Actually, that’s when I get most of my studying done for the undergraduate certificate I’m working on currently.

And sometimes, the days fall somewhere in between. Usually when I’ve had little sleep and lots that I need to get done or would like to get done. Like today, when I got up with only about two hours of sleep, to head out early in the morning to have my Jeep inspected. That’s always cause for rising blood pressure (mine) because it’s a Jeep and while it doesn’t have any functional issues as far as I can see, it can’t be counted on not to develop them during inspection just to piss me off.

The other big issue I’ve found with getting a vehicle inspected – Jeep or otherwise – is that there are plenty of shops willing to rip off women who bring their cars in for inspection. I’ve heard it from just about everyone at the squad – for some reason, all the women have needed new brakes on their last inspection. Even if they didn’t. And because I drive a Jeep, I think most mechanics assume that I’m driving my husband’s car. (Actually, some of his soldiers assumed the same thing yesterday, when I popped by his unit’s training on the way home from getting stuff done. They told him “nice Jeep.” He told them it wasn’t his, it was mine. I suppose it never occurred to them that it would be mine before they said something because it’s a Jeep and women just aren’t into those kinds of things.)

Last year, I had it inspected at my dealership where they knew me well because I’d been putting a lot of money into upgrades – shocks, rocker guards, and the like – and where they knew I’m no idiot. This year, we live more than an hour away from there, so I needed to find a new place. Smartly, I asked the guys at the squad and was pointed to a small dad-and-son operation down the road, and assured they wouldn’t rip me off. They didn’t. They were very pleasant, very fast, and kept up conversation about both cars and dogs during the process. It was pretty painless, actually.

So after getting that out of the way, I headed to the squad and pulled in just as 2 was pulling out with lights and sirens. I contemplated going after them for a minute and then turned around and parked since I hadn’t gotten the page. Apparently, I didn’t get the page because it came from Lewis County, the next county over but still somewhat in our service area, and I only get the Jefferson County pages until Mat sets me up to get them both. And besides, they ended up getting disregarded and returned about five minutes later.

The first two hours at the squad were pretty boring with no emergency calls or transports of any kind coming in, but I’d been warned that there’d probably be a few transports going out that day, and I figured I’d get some online reading done before that happened, if I had the time. I recently stumbled across the EMS Basics page, which has some good info, and I wanted to read more. I really like the pocket cheat sheet he’s come up with and mentioned to MBF I may want to put one of those together, and she thought that would be a great thing for everyone to have.

We had a student at the squad from a High School program that runs through the local BOCES. In the program, high school students get a chance to take regular classes but also go to various medical-related jobs to observe and learn, which will help them decide what direction they want to take after graduation. The girl doing ride time with us is thinking about becoming an anesthesiologist. She’s had a chance to check that job out, along with some others, and really liked it. She hated physical therapy. (I found it entertaining when I did it, but to each their own.) And I don’t think she was terribly interested in emergency medicine, at least not the kind we do at the rescue squad. But that may have had more to do with the fact that she hasn’t had a lot of calls to observe and was seriously wondering if “things were always like this.” I suppose at age seventeen, I wouldn’t have found a job where you spend the majority of your time sitting there, waiting for a call to be very interesting, either. She was pleasant, however, and had plenty of questions.

Our first call ended up being a transport from the medical floor of our local hospital to the bigger hospital in Nearby Big Town, which is a pretty routine thing we do since our resources at the local hospital are pretty limited. They turned out to be even more limited today, as the ER was literally overflowing into the hallways with patients in all of the rooms and nurses who hadn’t had a chance to go out to smoke or get a bite to eat since starting their shift at 06:30. I don’t know what Fort Drum’s been doing, but half the ER patients were soldiers, most of them still in PT uniform from that morning’s PT.

Our first patient was ready to go when we arrived on the medical floor, but the nurses weren’t quite ready to let her go; with everything that’s been going on that morning they were just as behind as the emergency room was. We spent a bit standing around, waiting for them to get her IVs disconnected, give her a pain killer to make her transport more bearable, and get her paperwork ready for the other hospital where she was being sent for an MRI. Lucky for us, one of our squad members was actually in the room next to hers – he had emergency surgery the other day for an obstruction – so it was nice that we got a chance to visit with him, his wife, and his adorable little daughter. He, too, was waiting on the nurses to get his paperwork done, but he was getting released, not transported.

Although stressed, the nurses were being very nice and very funny, and we eventually got our patient loaded up and headed to the hospital. My patient was a little grouchy, as could be expected from someone who’s in pain and taking a trip to another hospital just for the purpose of an MRI, but turned out to be quite pleasant on the ride. She was fairly talkative, although her medical history was confusing to follow, particularly as it didn’t match up with the medical history in my paperwork (which yes, was hers). Thankfully for me, her attending doctor did a really nice job in his documentation which allowed me to fill in the blanks and get the two stories to match. Actually, I kinda wish they’d give us a copy of the history that was included in her packet as it had everything from past history to medications to current pertinent history. And in a nice format, too. I wish they’d automatically give us those on our transports.

Fat P made every effort to bounce us around in the back of the rig the entire way to the hospital by taking the back roads instead of the main roads. I realize most people don’t like driving in the city and hitting all the lights, but if your patient is already in a fair deal of discomfort, it may not be the best choice. I think this was the first time I told my driver to slow down and try not to hit every pothole. I’m usually not the type to, but they usually don’t drive this badly. You know your driver is doing a bad job if you can’t read MY handwriting. All the nurses comment on how nice it is, normally, because I write nicely even in the back of an ambulance. Not so much if someone is trying to bounce that ambulance from pothole to pothole, however.

The hospital in Nearby Big Town turned out to be just as busy as the one we’d come from, which, coupled with the fact that it’s under construction for changes and upgrades, didn’t make things any easier for us. We had to ask directions twice to find our way to radiology, and due to the construction, had to go up one story in the elevator to go over into the building annex to go back down one story in another elevator, since the ground-level connection was under construction. This was overly complicated but we eventually made it, dropped our patient off for her MRI appointment, and then tried finding our way back. We ended up taking the most complicated possible way, but it was nice to get a little bit of exercise.

When we got back to the rescue squad, I went upstairs to file my PRC and, of course, we got another call just about immediately after I got started. I made it to the page on vital signs before the pagers went off for a “traumatic injury” and MBF came looking for me to see if I wanted to go on that one. Sure, why not. I’ve had two hours of sleep since yesterday morning and three pages of paperwork to enter, but I’m always up for a good trauma call.

I hopped in the back and we headed out, with Fat P driving and MBF in the front passenger seat as the EMT in charge. (This mainly so that we could do our paperwork at the same time on return, rather than me having to do two sets of paperwork.) As our patient lives about 10 minutes out of town, I got a little bit of shut-eye on the way there, in the jump seat behind the stretcher. It was pretty refreshing, actually, and I was ready to go when we got there.

Our patient was waiting for us in the driveway and got into the ambulance as soon as MBF pulled the side door open, so I scrambled to raise the head of the stretcher up and clear it of the airway bag and extra blankets. The patient’s position of comfort was sitting up, with his legs on either side of the stretcher, which was awkward for everyone but worked for him. He was in a fair bit of pain, having obviously put his shoulder out of its socket and just wanted to get to the hospital quickly. Getting vitals on him proved to be a challenge as, of course, the arm we could take vitals on was on the opposite side of the patient from where I was sitting. MBF tried getting blood pressure using the monitor, but as our patient was in so much pain he was shaking, this proved to be impossible, so I got a manual pressure, which was still hard but do-able.

In EMT class, they teach you to sling and swathe for a fractured or dislocated shoulder. Pretty much like in this Army manual illustration below.

That’s all sorts of fantastic when you do it in class on someone whose shoulder isn’t actually dislocated, but wasn’t even an option in our case because our patient couldn’t bend his arm without going into spasms of pain and, in the end, we decided it would be easier to just try and get him comfortable and drive the 10 minutes to the hospital than mess around. I did find that using a blanket to pad the area between his arm and his body relieved some of the discomfort, as did putting the head of the stretcher into a 90 degree position for him to sit straight up.

The patient was well-familiar with what worked for him since this was the third time in about as many weeks that he has popped his shoulder out of place. Previously, he had it popped back in at the hospital in Nearby Big Town as well as at the VA Hospital in Much Larger City an hour-and-a-half south of us, where we take a lot of our patients for advanced care, trauma centers, heart surgery, and just about anything else that requires a specialist. He originally screwed up his shoulder while deployed overseas … getting stabbed in the shoulder will do this. Looks like this time around, he undid any repairs that had previously been made, so I expect he will be on a transport to Much Larger City before long.

I got to talk with this patient for quite a while because our local hospital was still very busy and MBF took a long time to accomplish her paperwork. Fat P and I reassembled our airway bag, restocked what we used (or attempted to use), and got the cot made and back into the rig. And then we mostly stood and waited. Had some cake. Talked to some nurses. Apparently, it’s been real busy for them with several heart attacks and a slew of post-Valentine’s Day overdose attempts. And dislocated shoulders.

Actually, in the room next to our patient was another … another soldier, of course, since this seems to have been the day for all of Fort Drum to seek emergency care at our little hospital. This one had managed to break both clavicles and dislocate both shoulders. He would have been in a fair amount of pain, I suppose, but was knocked out and waiting for a transport to Much Larger City for surgery, which, of course, he wouldn’t get for hours because he required ALS-level care and we’ve had on nothing but Basics all day – and the next bigger ambulance squad had nobody free for transport for at least another three hours. (Gotta love being in a small area with small resources.)

So, yeah, another fun day in paradise. Let’s see what we’ll get tomorrow.

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Oh, goodness … I suppose the world will end if there’s a TYPO in my blog posts. Yes, of course it’s feast OR famine. Thanks. That could have probably be pointed out a little more nicely, being that it’s just a typo.