We have to document 5 actual patient cases on these (usually 12 hour) ride-alongs. I'd like to go at night, because as they say, the freaks come out at night.
And freaks are usually pretty crazy and up to some dangerous stuff.
And that = accidents and injuries and EMS.
I'd like to get my hands dirty. But not literally, because that's gross.
Don't ever get your hands dirty.
Not even when taking your gloves off.
But I'd like to get a chance to do more than just stand around and watch. We practice skills in class, though not as often as I'd like, but I've never been very good at acting. I feel ridiculous tapping a mannequin on the shoulder and saying 'Sir, are you okay?' and going through the steps of patient assessment.
I have to bite my tongue and try not to say the first thing that comes to mind while doing this,
so a basic assessment goes pretty much like this
Bega: BSI. Scene safe?
Instructor: Yes. The scene is safe.
Bega (thinking): Of course the scene is safe. It's a classroom.
And since I'm thinking that, I blank on the next part for a second, until I remember to ask
Bega: Mechanism of injury?
Instructor: Your patient has been involved in a motor vehicle collision.
Bega (thinking): Wow. How'd a car fit in here?
Bega: Number of patients?
Obviously one patient, as there is just one mannequin on the floor.
So, anyway, after that, I pretend to call for back-up and consider stabilizing the spine.
I don't spend too much time considering this, because mannequins are pretty rigid, I don't think the spine requires much stabilization. If it has a spine.
We segue into the initial assessment, and I ask my instructor to verbalize the general impression of the patient.
He'll say something like "You have a 24 year old male patient who has been involved in a motor vehicle collision, blah blah blah" I can't really give you a good example, because I honestly haven't been paying much attention.
To check for responsiveness, I should tap the dummy and ask if it's okay. But I usually just ask the instructor if my patient is responsive.
Most of the time, I get unresponsive 'patients', so we'll go with that.
I check for chief complaints or apparent life threats. Nothing is really threatening it's life, because it doesn't have one. But in this situation, just being unresponsive (especially after a MVC) is a life threat.
I assess the airway by looking for equal chest rise, listening for breath sounds, and feeling for breath when I bend down to listen. But, as you could probably guess, my mannequin doesn't breathe.
I hate acting.
Since my patient is a doll unresponsive, I'm going to assume his airway isn't patent, and he needs to be put on oxygen. But before I secure the airway, I'd like to know about his breathing, to establish a baseline.
I don't really know if that is exactly what I'm supposed to do. I get kind of flustered in front of the class.
Information about the patient's airway comes from the instructor.
Bega: What are the rate, rhythm and quality of the patient's respirations?
Instructor: 6 respirations per minute, even, and shallow.
Or something like that.
So, I verbalize opening the airway via jaw thrust (because it's a trauma patient) and inserting an OPA, and then I listen for lung sounds. Or I verbalize listening to lung sounds. It goes something like this
Bega: What are the patient's lung sounds like?
Instructor: They're clear.
Bega(thinking): Really? Because I don't hear anything at all.
Anyway, now that the airway is clear and the patient is breathing adequately, I can pretend to move on to circulation.
The patient has no pulse.
But I pretend.
The patient's skin color is beige and green and brown from too much handling, but I pretend he's cyanotic.
The patient's skin is room temperature, but I'm told it's really cool and clammy.
And so on and so forth.
I suppose I don't have the imagination to practice skills this way, and yet I still feel I could do it properly in the field. I'd like some human experience, which is why I really need that Doug guy to call me back so we can set this ride-along up.
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