She lay on her bed, coughing and having an asthma attack. The bronchospasms in her lungs had woke her up, in spite of the diphenhydramine and albuterol she took hours before. She sat up, which did little to help her breathing. Turning on the light, she saw her arms were covered with hives. Her hands were swollen, as were her feet. She got up to get her albuterol inhaler, that was in her backpack. Then she saw her face. The swelling. It was hours earlier that she began to have trouble with her voice. It was a little hoarse, but not bad. That was in the late afternoon, about 12 hours before. Over the next few hours, it got worse and worse, but her lungs had remained clear, and she was able to breathe in and out without any difficulty. She knew that this was most likely an allergic reaction… she had them before… But to what? There was nothing that she knew of that did this, with the exception of bee stings. And she had not been stung.

She made a decision. She walked out to the living room. Instead of her albuterol inhaler, she grabbed her nebulizer and set it up quickly. She opened 2 of the 3mL doses of albuterol, and placed them in the nebulizer chamber. She sat there for 15 minutes, breathing it in, letting the drug get into her lungs. It worked. She could breathe again without audibly wheezing. She drank water. Lots of water. The diphenhydramine had made her very thirsty. But she also knew it was good to stay hydrated at this point. It had been more than 6 hours since the last dose of diphenhydramine, so she took more. She went back to bed, propping up some pillows, so she wasn’t lying flat. Eventually, she went back to sleep.

She woke up 2 hours later, soaked in sweat. Again, she was coughing and wheezing, however it was not as bad as before. But now, the swelling in her hands and feet had gotten worse. She got out of bed, and walked out to her living room. Again, she used the nebulizer. And again it worked. This time, she also took some prednisone. Her doctor had written the prescription for her, and she had filled it some months before. She started on the burst therapy schedule that they had arranged if she had an asthma or allergy problem that was severe. Well, she thought, this qualifies. During the next few hours, she continued to use the nebulizer, and took more diphenhydramine to counteract the histamine reaction that was going on in her body. And slowly, the symptoms began to go away. The swelling started to go down, the hives were less pronounced. Her lungs were still tight, but she could take in enough air that she didn’t feel like she was suffocating.

Finally, the battle was ending.

—–

That was me very early Monday morning. The symptoms had started on Sunday afternoon. By early evening, I knew it was more than just some wind-related laryngitis. I even had a bad taste in my mouth, especially when I drank or ate something. Yes, I knew I was having a reaction. Yes, I was traveling at the time, although I was with the rest of my EMS team. And they did know about the vocal cord issues. I felt if I started having problems, I was in good hands. I did get home without a problem, per se. And yes, I had taken a lot of diphenhydramine to try and stop the histamine reaction. It worked, sort of. At one point Monday morning, I did give some serious thought to using my Epi-Pen, but decided against it. I have had fast anaphylactic reactions, and slow ones. This was clearly in the latter category.

In hindsight, I probably should not have self-treated, and instead got myself to the ER (Or better yet, gotten transport there), but I can be rather stubborn at times (No!!!). Or perhaps started to self-treat, but gotten a friend to get my behind to the ER.

In either case, I am sitting here, doing well. My voice is pretty much normal again, angioedema is gone, and my lungs are happy.  I am taking the last tapered dose of the very short prednisone burst tomorrow morning.

I am working in the same location this weekend, so I am definitely going to remain aware of my body and any reactions I have. And yes, I carry my epi when I am on duty. Right now, it is my best friend. The culprit may be a pollen I know I have seasonal allergies to (I hope not). Or it may be a food I ate that day (I had tried a vegetarian taco salad for lunch that day. Something in the spices???). Or it may be something totally unknown. But I do want to find out what it was, if possible.

Allergic reactions suck.

Note: There has been an update to part of this story. The paramedic referred below as being stabbed to death did in fact die from a myocardial infarction when he ran after the patient. Although I am posting this update, I feel the information in the post is still relevant in terms of scene safety. My condolences to his family, friends, and co-worker.

How many times have we heard this during training, re-training, and when we are teaching new EMTs? How many times have we ignored it?

The news today included two articles, one detailing a paramedic who was punched by a patient (Read the article here: http://www.wivb.com/dpp/news/crime/Paramedic-tries-to-help-gets-punched), and another who was apparently stabbed to death by an emotionally disturbed patient (Read the article here: http://firefighterclosecalls.com/fullstory.php?103256).  The latter article doesn’t elaborate on what exactly happened, and in the next few days I assume we will hear more, but it is a stark reminder that we all need to remember to keep our scenes we work as safe as possible. Some things to remember:

• Don’t go into a potentially dangerous situation until you have been cleared to enter.
• Stage appropriately for issues involving potential violence or emotionally unstable patients.
• Always approach a scene (any scene) with caution. Look around. It might not be a patient that is dangerous, but something or someone else around. I work around moving vehicles (primarily bikes, but cars as well), but I have been hit by a bike while working on a patient before. I could have approached that scene more carefully, and avoided the problem.
• Know your agency or provider’s protocols. Adhere to them.
• Ask for backup or PD involvement  if you feel you need it.
• Always keep your eyes on an emotionally unstable patient. Even if you have a good relationship with a patient, they can turn on you in a heartbeat.
• Watch your partner. Remind them if they are doing something that places them (or you) in potential danger.

Stay safe out there!

Things are getting busy again, EMS-wise. Been working A LOT lately, especially as mountain biking season is really here. People are getting on their bikes again, ready or not, and having fun in the hills riding around at MTB races. Its great to see! Problem is, mistakes happen, riders crash, and we are there to find them, stabilize their injuries, and then either have them transported by a nearby agency or provider, or they go to the hospital themselves sometimes. Then there are those who won’t go no matter what. Yes, they are hurt, but they will self-treat.

Last weekend, I saw both of the first two types of patients. Had a patient with an injury from a bike crash that I felt really needed transport to the hospital by ambulance, but he “AMA’d” (Against Medical Advise) on me. Basically, we have a document that explains that we feel he should be transported, but that he declined, knowing it could cause worsening injury or illness. It happens. And it is his right to do so. I had no reason to believe that he was not able to make his own decisions at that time. I did let him know that if things got worse, he could still be transported. He went to the E.R. with a family member driving.

The other was also a bike crash, but in this case, due to his injuries, I assumed control of this patient. In essence, he didn’t have a choice about going. Certain criteria, such as a positive loss of consciousness, or being under the age of 18, among others, allow us to make decisions for a patient. He wasn’t in a position to argue, unlike my first patient. We stabilized him, and transferred care to the transporting ambulance service, who delivered him to the hospital for further emergency care.

The third type of patient is one that causes me some angst. Many times, I know they don’t have insurance, and really cannot afford to get seen, yet they need to be. I’ve seen some self-treat HIGHLY SUSPECTED fractures. As an adult, they have this right, unless I have cause to make decisions for them. It still leaves me with an uneasy feeling when it happens. Sometimes, even weeks later, I manage to convince them they need to be seen. With the type of EMS I provide, I see many of my patients at multiple events (and yes, even treat them multiple times… we have our own “frequent flyer” (no pun intended) club of sorts. So, frequently, I get followup on many of my patients, either through them, or friends who are racing with them. I have to admit, its odd being on a first name basis with a lot of them. But a good sort of odd.

So, a question for you… Do your patients who AMA or self-treat get you thinking, and yes, worrying? Or do you put it out of your mind once you are done?

My arm is better and better every day. I worked this past weekend, and didn’t even give it second thought when we lifted a patient that we had c-spined. I just sent an email to my ortho asking if I can start riding and strength train my arm again. Here’s hoping for good news!

I miss being on my bike.

I miss the wind in my hair.

I miss the feel of the trail as I ride.

I miss the sounds all around me.

The stationary bike just doesn’t do it for me.

Soon, we will be reunited.

And I will ride again.

Maybe tomorrow.

Definitely tomorrow!

GREAT!

Fantastic!

Incredible!

Well, maybe not incredible, but great and fantastic. I saw my orthopedist today, had more x-rays of my elbow, and I found out that:

• The bone spur (called an osteophyte, by the way) is resorbing (going away).
• The contusion was significant. I saw the MRI myself today. It takes time for that to go away, especially in an area that isn’t known for a good blood supply.
• It will take another 6 weeks for this to completely heal. It IS, after all, a fracture!
• By being compliant and staying in the brace until he let me out last week, I really made it possible for my elbow to heal the fastest and the best. In fact, the MRI and most recent x-ray PROVE I was compliant. It was in not moving my elbow that it began to remove that fractured bone spur. The doctor was quite impressed that I didn’t “cheat”.

So, the upshot is, I am clear to work EMS now. I still have to build back muscle and strength, especially in the triceps muscle. My arm will continue to improve, and should be “normal” by the end of the next 6 weeks. My doctor was impressed with my mobility and that I didn’t jump off the table in pain this time. I did let him know that it is hard to sleep at times, and that it still seems “stiff” (remember, I am normally extremely flexible). That will improve. and go away. I need to encourage blood flow to my elbow (i.e. heat and massage), and use ice massage after exercise. I need to keep working my arm out, and can now start using weights (slowly increasing them). I want to get back on my bike, but I do need to follow what my doctor tells me and continue to be patient. Within a week or two, maybe.

Thank you to everyone who has been so supportive during this time for me. It really is nice to know how many people really care! And it is very much appreciated.

For a while now, I have been meaning to move my blog from Blogger to Wordpress. And I procrastinated. For years. However, a recent email from Blogger made me re-think my procrastination. They let me and many other Blogger members who use their FTP function to post our blogs on our own domains that they will no longer support FTP as of March 26, 2010. I guess they figured out that it didn’t make any money for them, so that feature is being taken away.

No problem. So, last night I created my Wordpress blog, and populated it early this morning with my entire blog from Blogger. It took a few extra steps, as FTP import from Blogger is not supported by Wordpress. Some very creative individuals discovered that you can take your blog back to Blogger (use a blogspot.com domain) temporarily, then import it, and it works. Sure did for me! It looks like everything is behaving.

If you see something now functional, let me know. In the meantime, I will begin to add “sidebar” content, and make the site more to my liking over the next few days.

I hope you like the new look!

Renee

I went to a massage appointment today, mostly to get the crud out of my muscles. I picked up a bug recently, and was left pretty sore everywhere by it. But I had the CMT work on my left arm as well (not around the elbow, but all the muscles around it), and my shoulder. By the time she was done, I had more comfortable movement in my arm in a long time.

So, I fired off an email to my orthopedist, letting him know that I had really good range-of-motion, and that the massage really opened it up. I also asked if I could start going without the brace, as I didn’t think it was making much of a difference right now. About 30 minutes later… I got his blessing to remove it.

Yep! I am hardware-free! While I have it if needed, I am working slowly to get my arm back to its norm, and hope to never wear it again. I still need to wait on major strength work until I get cleared on the 11th, but this is a significant step forward for me. My mobility is really good. With increased range-of-motion, I started feeding myself with my left arm again this week (Thankfully! Try using chopsticks with your non-dominant hand!), which has improved my muscle tone a bit, and my arm is no longer shaky when I hold something.The back of my arm is still tight near the elbow, but I suspect that will improve as well. Muscle-mass… um, yeah… there isn’t any right now. Once given permission, I will be doing some serious strength training again, to get that back. My poor right arm has been a victim of overuse syndrome, so I am sure that will improve as well.

Marching onward! I will be back on my bike soon! And working more hands-on in EMS again.

On January 25, 2010, I became a student again.

No, I didn’t quit my day job; I am still working for the State of CA. What I did do was to sign up for two classes at a local community college this semester. The first is Introduction to Investigations. I have had an interest in criminalistics and forensics since before “CSI: Crime Scene Investigation” debuted on television. After all, I am a microbiologist by training. I’ve been thinking about incorporating criminal investigation into my CV, so I figured this was as good a time as any.

The second is one that is the real love… it is a pre-paramedic class. Basically, this class gives students a “leg up” with paramedic training, something that I am absolutely going to get. The program is totally different than when I got my EMT-II back in the early 1980’s… I am effectively starting over. We didn’t have 12-lead EKG. We didn’t have the autonomy that paramedics now have. We didn’t have most of the drugs that are now in the arsenal (And some of the ones we used are no longer there, or are not frontline meds.). We weren’t allowed some of the advanced airway techniques that are now in use. Yes, we did endotracheal intubation, and we had esophageal airways (Those were actually in the EMT-I scope of practice at the time).

Twice now, the part-time program I wanted to take was canceled. One way or another, this WILL happen. I will find a program. Somewhere.

I don’t normally share other blog’s posts here, but this one deserves a special place:

http://6yearmed.blogspot.com/2009/05/quiet-place.html

She gets it. She REALLY gets it.

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