Last week I got to use CPAP for the first time which was fun. If you looked up emphysema in the dictionary, there would be a picture of our patient.
emphysema: 1. a chronic, irreversible disease of the lungs characterized by abnormal enlargement of air spaces in the lungs accompanied by destruction of the tissue lining the walls of the air spaces. (dictionary.com)
2. Ellie's patient the other day.
He was on 4 liters of oxygen at home all the time and neb treatments every 4 hours around the clock. He was just finishing up a treatment when we arrived and it wasn't doing anything for him. Well, before he took his neb treatment, he just finished the other kind of breathing treatment: a cigarette. (I'm about to give up on understanding people) We got him in the truck, did a duoneb and an albuterol. After those he was wheezing more, which was actually a good thing. He was still struggling quite a bit, so, with about 10 minutes to the hospital we put him on the CPAP, which was awesome.
He got better, and was bumped into the most interesting call of the week slot.
We also had a gross GI bleed (but come to think of it, I've never had a GI bleed that wasn't gross,) some chest pain patients, kid with a concussion after he rolled his car, a lady with nothing wrong with her, and a lady with something wrong with her.
I'm not sure what was wrong with the one lady, but something was. By the time we go there she was conscious, but barely responsive to us. Didn't flinch at the IV, but managed to rip it out of her hand. Needed some oxygen, but managed to rip the cannula out of her nose. She wasn't violent, just didn't appear to know what was going on at all. My favorite question to the husband was "When did you last see her acting normally" "Well, she hasn't been normal for several years." he answered slowly. "Okay," says I, "then when was she acting normal for now." That's when I got the sad answer of about four days ago. (Now I have accepted that I will never understand people.)
Later, I had a chest pain patient whom I gave a nitro to, no big deal. My BLS partner at the time reported a normal BP after the nitro, but my LP12 was saying about 79 over something I can't remember. So, I palped one myself, and it was indeed, 80. Well, time for a fluid bolus! And no more nitro for you! I always strive to make my patients stay the same, or get better, not worse. A noble, and occasionally unobtainable goal.
Other than that, I got back out there, stabbed a box with a sword, had a great bike ride, and spent some pounds, (£) that is (but maybe some of the other kind too!)