Monday, July 28, 2008

A Sharp Increase in Sphincter Tone.

I hit another benchmark today. Today I had my first cardiac emergency patient!

We got the call to pick up a guy at a little outpost over an hour away. The only information we got was that it was a US Army male and "unconscious and clenched jaws". That was all. Thanks a pantload people. About five minutes out from the pickup we were radioed that the guy wasn't breathing anymore and they were going to do an emergency cricothyrotomy. That means cut a hole into the trachea through his neck and push a tube down into his chest. We were still getting ready for that when we landed. So we loaded him up and took off while we hooked him up to a ventilator (that only worked for 10 seconds- we did it manualy after that) and a cardiac monitor that told us his heart wasn't beating. Instead of coming back to Bagram we flew really really fast to a closer base. After 5 or 6 minutes of CPR, two shots of adrenaline, some atropine and 200 joules his heart started beating on its own again. After the first few minutes I didn't think he was going to make it. I thought he had a head injury because he had some bruising and blood was coming out of his mouth and nose- but that blood was actually from the hole he had cut in his neck being pushed up to his mouth because of the CPR. Cardiac arrest cause by head trauma is a really bad injury. The base we went to was only about 15 minutes from the place we picked him up. I kept bagging him until we got into the hospital and then someone else took over. I also learned there that his condition was caused by a drug overdose of sleep aid and other unknown drugs, not head trauma. He looked like he was doing pretty under the other doctors care by the time we left the clinic.

It was a good thing I was flying with a more experienced flight medic and a very experienced trauma doctor. That dude was a handfull. He would have been screwed if it was just me and the crew chief. I learned a lot from that one patient about cardiac care. And about messing with sleep aids. It's too bad because I know that is a problem that a lot of soldiers struggle with here. That guy was just trying to get to sleep and nearly went to sleep forever. Plus having to wake up with a hole through his neck, subcutaneous emphesema, multiple broken ribs and an assortment of other aches and pains to be sure. Maybe he will get legal action against him by the Army as well; for drug abuse and destruction of government property. I'm glad that I'm not that guy.

So to sum it up. Yay for me for getting to learn some cool stuff about patient care and gain some awesome hands-on medical experience. Yay for the other medic and doc for saving the guy and teaching me to do awesome life-saving stuff. And yay for the patient for only being dead for a few minutes.

Sunday, July 27, 2008

Bilbo Finds a Bomb.

A couple months ago we brought a patient to the hospital. He was a US Army guy that got a little banged up. The emergency room is always loosely organized chaos to begin with. There are a million hospital workers that pour into the tiny room whenever we send them a patient. Half the people that go into the room aren't even doing anything, they just want to watch the show. On the peticular day I'm thinking of: one especially excitable little guy makes an interesting discoverey. This doctor - who I will call Bilbo because he kindof looks like a hobbit- is going through the unconscious patients gear (presumably because he has nothing improtant to do) and finds a grenade inside a grenade pouch on the said patients vest.

I want to pause the story for a sec. Here is what I would have done: Nothing. Most people would have thought- cool, a grenade- and went on doing whatever it is they are paid to do. Our patients carry all kinds of neat toys on them and the protocol doesn't change for any of them. The clinic staff makes a big pile of all the patients stuff and leaves it in a corner until the patients unit comes and picks it up.

What this guy did was different. He pulls it out of its perfectly safe pouch, grasps it tightly in both hands, holds it alofts and fairly screams "GRENADE!" over the mass of bustling doctors, nurses, techs and patients. Everything stops. All eyes go to little Doc Bilbo. For about two seconds nobody moves. That's how long it takes the room to see that the pin is in, spoon is secured with 4 or 5 wraps of electrical tape, and there isn't anything to worry about. After that, everyone goes back to doing what they were doing- except for Dr. Bilbo and me. I think he expected his coworkers to swarm the exits at his pronouncement because he kept looking around the room and calling out "Grenade! I have a grenade in my hand! Look out everyone! Grenade!" evey few seconds. He was in arms reach of me this whole time and I thought about taking it from him at this point. I almost did but I had this nagging thought that if I did, he might misunderstand my actions and shoot me. He was pretty wound up. So I just watched, open mouthed, as he slowly walked to the door. You couldn't even really call it a walk. Each step looked like it was an enormous effort. His arms were holding the little ball out as far from his body as possible. His bulging eyes were fixed unblinking at the object in his hands. From the look of him, you would think he was holding on to his own beating heart. And still shouting out "Grenade! Move aside for the grenade! I have a grenade here, in my hand!" as he slowly made his way to the exit. I saw him about 10 minutes later outside the hospital. He was still holding the 'thing' out at arms reach. (I can hardly bring my self to say it anymore- it's so retarded) He was telling everyone who walked in, out, or by- "Please, be careful everyone. I have a grenade. Just go on about your way. I have a grenade."

I'm sure that he called his wife and told her how he saved the entire hospital from an abrupt and firey death. It was nothing though, just doing his duty to humanity, just doing his job. Just a grenade. I and my fellows at the hanger went around the rest of the day holding up ordinary objects and yelling in terror- "Oh my gosh! I have a muffin! A muffin in my hands everyone! Look out for my muffin!" And wetting ourselves.

Thursday, July 24, 2008

R and R

I'm back!

My vacation was awesome. I can hardly describe how great it was to be back in Alaska for the last 20 days. I didnt get to do all the things I wanted, and I didnt get to see half the people I wanted, but still had such a wonderful time.

Before I left Bagram, and again in Kuwait, we were repeatedly warned that things will have changed while we've been gone. Expect things to be awkward for the first few days. These little pep talks were always at least an hour long and included a detailed list of activities that were prohibited. Ironicly, I always had the impression that they expected us to go out and do them all anyway. Such as- drinking and driving, going to jail, doing drugs, spousal abuse, murder, tackling and detaining american citizens of middle eastern ancestry. Personally I never had a desired to do any of these things. In fact, once I landed in Anchorage I didn't feel any akwardness at all. It was great.

I had such a good time. I could go on and on about all the fun stuff I got to do- but I won't. I will say that I got to eat great pizza and other wonderful foods, I went kayaking in Seward, 4-bying in Palmer, rafting in Denali, rollerbladed through the solar system, and hung out with some of the best people you would ever want to meet.

I'm not happy to be back in Afghanistan. But it's not so bad.