Down and Out in The Man Cave.

Lights and sirens to the scene for the engine and rescue who are dispatched to an unconscious male found in the shop behind his house. We arrive and are directed by police officers down a long driveway that leads to the two bay shop behind the house. The engine company parks out on the street and makes hast to the shop. While the rescue pulls down the driveway, grabs their medical bags and goes inside to the patient. As I enter the shop I see a pickup truck in the first bay, it's hood is raised and the front wheel is off. I smell exhaust from an engine. There is an empty beer can on the grill of the engine compartment and tools on the floor. I notice a 50 gallon barrel off to the side with crushed beer cans in it, it's completely full with a few cans on the floor next to it that did not stay on top of the heep. I walk through the doorway into the other bay where the rest of the team is gathered around a man laying on the cold concrete floor between snow mobiles. The man has fallen down and has a laceration on the back of his head, there is blood and vomited on his face. He is very slow to answer questions and is disoriented, cold and lethargic. I asked the crew what I hear beeping near one of the medics. He tells me it's the alarm on the airway bag. I asked what is was reading and he told me it was at 360. That's the CO alarm we clip to the airway bag for just such an occasion. I directed one of the firefighters to open the roll up doors and I told the rest of the team "we needed to expedite this excitation we are being exposed to high levels of carbon monoxide". We placed a c-collar on the patient and rapidly rolled him onto a back board. He was strapped down and moved to the cot just outside the door. The patent was then moved into the rescue ambulance where oxygen was administered by mask, an IV was established and the heart monitor was applied. During transport the man was passively warmed with blankets and by turning up the heat in the back of the ambulance. We arrived at the hospital and gave report to the emergency room nurse. Meanwhile, the engine crew monitored the air in the shop until is was ventilated and safe again.
Indeed, we were being exposed to high levels of carbon monoxide. The patient was found to have blood levels of carbon monoxide of 35 and was flown by medical helicopter to a hospital with a hyperbaric chamber for treatment.
Carbon monoxide binds to hemoglobin, which is the principal oxygen-carrying compound in blood, this decreases the oxygen-carrying capacity of the blood and inhibits the transport, delivery, and utilization of oxygen by the body. The affinity between hemoglobin and carbon monoxide is approximately 230 times stronger than the affinity between hemoglobin and oxygen so carbon monoxide binds to hemoglobin in preference to oxygen. Treatment in the hyperbaric chamber changes that and the carbon monoxide is released so the blood can return to it's normal function of transporting oxygen and releasing it to the cells.

I Don't Like Science Tests!

To the third floor of the business building on campus we respond for a 20 year old having a seizure. When we arrived the class room is empty of students except the one we're here to help. The professor tells us they were taking a test when this student started shaking and went to the floor. The patient is alert and oriented to time, place person and date and is now complaining of abdominal cramps and neck pain. The patient is not from this country and speaks good English except when answering certain questions, then she can't understand. We explain she needs to be scene by a doctor and should go by ambulance to the hospital and she agrees to being transported. A c-collar is applied and the patient is log rolled onto a back board with straps in place she is carried down the stairs to the cot. After the patient is loaded into the ambulance a detailed assessment is preformed, she is placed on the heart monitor and an IV is established. The lead medic calls the hospital and informs them we will be arriving soon and gives the RN on the line a patient report. Suddenly the patient decides she does not want to be transported. We explain the possible complications of not being evaluated by a doctor and the danger of further harm and even death as a result of this action. She insists and answers all questions appropriately. We have no choice because it's her choice. So after twenty-five minutes of work and hauling equipment up and down stairs, we put some clean sheets on the cot and tidy up the back of the ambulance. Ready for the next one!       

The Third Time...Really a Charm?

At about 2am we respond to ground level fall. We arrive to find an extremely obese elderly male who can not get up off of the floor. His sweet wife all of about 140 pounds, who has cared for him for many years, couldn't begin to lift her 380 pound husband from the floor. His legs and feet are purple from celluliteus and he is being treated by a doctor for it. He has lost about 100 pounds since my last visit when he fell in the tub and had taken a laxative to treat his constipation. What a mess. It seems to be the case, they are in a small room, a tight spot, in an older house usually upstairs or in a basement. This gentleman has huge laps of skin left over from weight loss, you always wonder what's lurking in them but never want to find out. It just adds to the difficulty of maneuvering the dead weight. We decide to bring his wheel char close and bear hug him from the back while my partner moves his knees then his feet under him until we get him in the chair. After his denial for any other treatment and a patient assessment we call the ER Doctor and gain approval for a scene release.
We return to quarters and crawl back into bed it's now 0315 and it takes a few minutes to winde down and fall back to sleep.
The next night the call came earlier. This time about 11pm a call to the same house for the same patient. He has decided his legs hurt too bad and he wants to be taken to the emergency room for treatment. His legs are a deeper purple and his feet are almost black. His wheel chair is too wide to get through the bedroom door so we move our cot into the hallway and carefully move him from the chair to the cot. That takes about 20 minutes because he is very unsteady on his feet even with our help he wants to move slow. Now comes the fun part. The hall way is narrow with two turns before we get to the front door. We only lift the cot about half way to keep a lower center of gravity as we roll it on the carpeted floor. We sit him up as far as he can tolerate so we can make the cot shorter and still the turns are very tight. I don't want to put gouges in the walls while trying to turn the corners so we very slowly make our way through them. Now the front door and down the  seven steeps with a landing between three and four, but don't think for a minute the landing is long enough for the cot to fit on. We had an engine company respond with us this time for extra hands. We four corner the cot (one person on each corner) and slowly move down the front stairs. The patent is loaded into the ambulance and transport is initiated. On the way to the hospital a set of vitals are found to be in normal range and the patient's condition is unchanged. Now we get to move him out of the ambulance and onto a bed. Again all accomplished with multiple people and lots of 1-2-3 go! He expresses his appreciation for our work and offers to make us brownies. A nice gesture but it conjures up some not so appetizing images of my first trip to his house. We politely decline and say good-by.  
I successfully predicted the next trip for our patient that was toned out at 0130. Now we pick him up at the emergency room and transport him home. Another trip up the stairs and through the tight turns of hallway and into the back bedroom. His good wife has changed the sheets on the bed and the patient is now resting on them. It's a work out but at least the man is appreciative of our help.
Back to the station to clean up and take a nap before the next call.