"Battalion One to dispatch issue a level one recall for manpower." these words are not often uttered in a department which has multiple mutual aid agreements with other paid departments. This night it would serve as a reminder of the need to place good Pt. care above any drug or piece of technology. While other members of the department dealt with a working fire, myself and three others ran out of the "backup to the backup" ladder truck. On our way to our first call of the early morning, we quickly realized that there were no SCBAs on board. They had been stripped for the HazMat Tech refresher the week before and never replaced. This was a foreshadowing of later events.
Upon our arrival, we found a middle-aged woman lying on the floor complaining of abdominal pain. The patient had just been released from the hospital after receiving a kidney transplant. I opened the medical bag. To my dismay, it was nearly empty. I found a cheap stethoscope, a BP cuff, a penlight, and two bottles of expired sterile water. "What more could go wrong?" I thought to myself. One should never ask that question, both in ones head or aloud. We were then advised that the next closest Medic unit was 84 blocks away. The patient's lower abdominal was rigid and distended, her BP was low and her plus was high. For the next 20 minutes, I talked to her and heard about the amazing life she had led.
By the time the Medic unit had arrived, the patient's vitals had not changed, but her pain was significantly less. As I handed off Pt. Care to the other paramedic, I could not help but marvel about how in a world of modern medicine, a kind word and a listening ear can do so much to help the patient. I hope that I never forget that lesson as I move up the medical ladder. I want to be the practitioner who takes the time to sit down with my patients and listen. Some times the largest lessons come from the smallest gestures.

Your Patient Is Not As They Appear........

Throughout this blog, I will make reference to cases that I have had in the field or in the hospital. For obvious reasons, all identifying information has been removed in order to comply with HIPAA.

The other night, we were dispatched to a possible stroke. When the engine company arrived on scene, they performed a stroke scale and found the patient to have slurred speech and a sluggish right pupil. The patient was also hypertensive and repeatedly pointed to her head. Pt. vitals were as follows 168/92, P 118 Sinus Tach, R 24, LS clear. 12-lead normal.  Pt. was moving her mouth in a repeated manner that had the appearance of "guppy breathing" Pt. has extensive psych history and multiple medications that include Geodon and Ritalin. What would your differential be? We did not transport to the stroke center since the pt. had an inconclusive stroke scale and was know to have a similar episode last week.

Upon arrival in the ER, the physician having seen her before, took one look and knew what was the issue and gave her Diphenhydramine IV. Have you figured it out yet?

The pt. was experiencing side effects from overdosing on her Geodon. The slurred speech, warm and flushed skin, sluggish pupil, and "guppy breathing" were all a result of too much Geodon. The treatment for Geodon OD is 50mg of Diphenhydramine IVP. As soon as this medication was given her symptoms began to clear up. The "guppy" breathing action is called Tardive Dyskinesia ans is a preexisting condition that is exacerbated by Geodon OD. As you can see, the patient may not always fit you differential in the end, thus your patient may not always have the horses their hoofbeats lead you to suspect.