"Warring Ideals in One Dark Body"

"I don't know any of you, but I know something about all of you. You're all adrenaline junkies."

That's Instructor Crash. He's tall and probably cuts his hair at home in 1 month intervals. He has sunken eyes with a 1000-yard stare and paramedic humor. I can see that he's seen a lot. His comfort is colder than Lead Instructor, but he chortled when I said you could do compressions to "Another One Bites the Dust."

Vital Signs and skills today. ABCs--Airway, Breathing, Circulation. Finding pulses and learning how to communicate them meaningfully. Everything is in a context, and we are learning how to interpret the picture of what is going on with a patient. Reporting a resting pulse of 76 describes one piece. Reporting, "Pulse is 76, weak, and irregular," says much more. We practiced with the stethoscope (called "ears") and the BP cuff (blood pressure). In my typically, atypical way, I feel pretty comfortable with taking a BP, which can be a little complicated (we'll see how accurate I am later), but I couldn't hear any lung sounds at all and didn't know what to listen for. I might have to find some mp3's of what messed up lungs sound like.

Health-care types love our little acronyms and mnemonics. Today's was SAMPLE. Signs/Symptoms, Allergies, Medications, Pertinent History, Last Oral Intake, Events leading to call. Combine that with Pulse, Respiration, Pupils, Skin, and Blood Pressure, and you've got a nice, little, pop-up book story to tell any other health-care providers that may suggest the problem and course of action, if it's not obvious. The trick is thinking outside the box. A 9 year old with lower right quadrant abdominal pain might have inflammation of the appendix, a tummyache, an ectopic pregnancy, or something else.

With the topics of the day, I wasn't surprised when Crash called for volunteers. We're supposed to step up because this is the time to make mistakes, so...I stepped up.

Instructor Crash psyched me out though. He handed me a BP Cuff and a stethoscope and told me to pick a partner.

Now, from martial arts training, I don't goof around looking for my best-crush-class-buddy to palpate or practice abdominal thrusts with or whatever, I just turn to the person closest. (After many years being away from the dojo, I still have to suppress the urge to bow.)

Today, it was Glitter Clips. She seems very sweet; I know that at some point someone is going to pull her aside and give her some cotton balls and nail polish remover. I'll put $5 on that one.

Instructor Crash asked the two of us out of the room. Glitter Clips asked if I want to practice taking BP and offers up her arm, which is really nice. I said that I did, but that we probably didn't have time, just as the door opened, and Crash handed me a bag-valve mask (BVM) and automated external defibrillator (AED). The mask of the BVM promptly fell to the ground, so I didn't see the setup right away. I then turned, and we weren't doing BPs, we were doing, "You've been called on an unknown medical to the BART station. You arrive to a crowd of people, and they're all excitedly pointing you to a figure supine on the ground. You have to do something, now. Go."

Go? I just looked at Glitter Clips' little friend, Giggly Clips, on the ground who promptly started laughing, which totally messed with my suspension of disbelief and would piss off any Hollywood director, but fine. (They swapped out Giggly Clips for an actual training dummy.) I tried to take in what Glitter Clips was doing (she got Look, Listen, Feel; she missed checking circulation, and she wasn't vocalizing or communicating at all) while Instructor Crash barked out variables, "No response! No breathing! No pulse! HE IS DYING!"

So. After I embarrassed myself saying I was to call 911 (per our drills from CPR the other night, which elicited nothing less than a roar, "YOU ARE 911!" and the squad laughed), I jumped on the BVM and told Glitter that I couldn't get an airway on the patient. I really couldn't. At first, we thought it was my grip, which I corrected, but nothing was going in, even after I re-tilted the head twice. I took over compressions. At one point I told my partner, "Other way" before she placed the AED pads incorrectly and delivered a shock to the patient's intestinal tract. She cleared me while the AED did it's thing. We did five cycles, ran the AED again, and called it quits, breathing audibly as we waited for feedback.

Personal Successes: Good counting out loud and communication. Also, we discover the mannequin is jacked, which is why my breaths wouldn't go in.

Challenges: Someone needs to take charge and run the scene/code. Who's doing what? Transitions need to be smoother. We didn't check for scene safety. We didn't don personal protective equipment. (We haven't learned segregation of duties yet, so none of this is totally unexpected, but it's clear I have to do more role plays.)

To that end, I will be buying a BP cuff and a stethoscope soon and would love it if locals would let me practice on you from time to time please? I'll warm the stethoscope and everything.

Am I an adrenaline junkie? More like a casual user, but that is something to consider. If it's true, it might be good to know that now.

I came home, made a nice stiff scotch sour, typed a post, decided to forgo any exercise, and slept for 5 hours.

Tip of the Day: If you take a lot of medications and they don't change too much, it is an awesome idea to write them all down with dosages and doctors and make a few copies. If you have to go to the hospital--especially in an ambulance--bring it with you or let your family/friends/health-care proxy know where you keep it so they can bring it. Otherwise, medics are going to sweep their arm across the table and put all those meds in a bag and take them to the hospital to be lost, stolen, left on the ambulance, or eaten by gremlins. Take as little as you have to with you to the hospital, because they are apparently places where things go missing quite a lot.