What was your first "DUH" moment on a call.

[Happiness]

I cant remember my first real DUH (i do but am way to embarrassed to say it) but here is one that I thought was good. Now i do not normally do night shifts but will occationaly leave my pager on in case there is a second page for a code 3. Of course it comes in a 4:00 am and it is an unresponsive female. So off we go and I start to wake up, go into the house and realize that my patient is the sister in law that is not allowed into my house (for various reasons im not allowed to say). So trying to be a proffessional I check her out and listen to the story and then I take her BP and it is through the roof. It takes me a half hour with the help of her sister (who likes me by the way) to convince her to go to the hospital. So after being professional and listening to the crap comming out of her mouth she says to me "You dont like me, you think I'm a whore, a drunk and drug addict" with out missing a beat I responded "I know your not a drug addict" Her sister looked at me and started to laugh so hard I thought she was going to pee her pants. To this day I just say it in my head and hope to hell it never reaches my mouth

[DwayneEMTP]

No idea what my first would be as my medic career seems to be a never ending string of 'duh' moments, but one that stands out...

55 or so year old woman, called for altered mentation. One of my first calls stateside. Also it's been a while so the specifics might be skewed, but the gross facts should be close.

Arrive and she's obviously altered, breathing poorly, bent in half on the couch, resps challenged by posture, on home O2. RR around 8-10 shallow, brady but not terribly so, skins flushed/diaphoretic, obese and shows muscular wasting of those that are chronically inactive, SPO2 in the 60's I think (it's been a while.)

I'm with a partner that I adore, but makes the mistake of trusting that I won't have my head buried completely up my ass so simply does what I ask without questioning.

Fire is there, has gotten an IV but hasn't really dealt with the breathing issues so I jump into super medic mode and lift her up straight to try and improve her breathing, (I mean, who thinks of posture to improve breathing!! Ok, so now I know most do, but at this time I was the only one smart enough to do something so progressive) which it does, call for a non rebreather which doesn't improve her skins or SPO2 enough, have my partner start to assist vents with BVM. Lung sounds wheezy, diminished, so I start to bag in a neb treatment, load her and transport.

Run into billygoatpete at the hospital dropping another patient and am pretty friggin proud that one of my first calls went so great! IV access, fluids, assisted vents, bagging in a neb (all of this seemed very glorious to me at the time) and can't wait for him to see me in all of my medic awesomeness...

He says, "Wow, I'm surprised Narcan didn't get her up and around." I look at him like an idiot. He says kindly, "Oh, you didn't try Narcan?" (See, it's not his way to call an asshole an asshole sometimes)

I said, "Uhhmm, no, I didn't think of that."

He says, "You didn't see all of the narcs on her med list?" (Well, no, I was to busy being heroic to think of her med list.)

I say, "Uhhmm, No, I didn't check her med list."

He says, "That's ok man, you'll get it."

I'm not completely sure that he's right about that....

Dwayne

[Mateo_1387]

Dwayne, I hear ya on that one brother.

This was a call during my early days as a no0b paramedic, aw hell, what am I sayin', I'm still a no0b.

We were sent to a local store for an unresponsive person in the parking lot. Arrived on the scene to find a 30-40 year old male laying on the ground with apnea, cyanosis present, and still having a heart beat, slow, but regular. We immediately began BVM ventilations along with obtaining a history form the driver of the vehicle the patient was with. She reported a recent stent in prison, that he has some blood pressure problems, and that he has a brain aneurysm.

I thought BINGO ! Being a new paramedic I jumped to the conclusion that my patient had a ruptured aneurysm, since he suddenly became unresponsive, had bradycardia, and apnea. Feeling confident about the conclusion, I figured we had to secure an airway and proceeded to have the patient intubated. An attempt was made to intubate which produced a gag reflex. The patient started breathing on his own during the attempt so we opted to continue and use the BVM only. An IV was placed. My coworker, not a paramedic, suggested that we administer Narcan. The thought honestly had not crossed my mind.... Narcan was administered and within two minutes that patient was awake and chatting with us. I felt about 1 in. tall. Come to find out, in the midst of my excitement, the patient had a brain aneurysm, that was repaired. DUH. I learned an important lesson that day about the differential diagnosis. It was a great learning opportunity, and although not one of my better calls, one I cherish just because of the lesson learned. I guess the old saying goes, we're no better than our last call....

[DwayneEMTP]

...I learned an important lesson that day about the differential diagnosis. It was a great learning opportunity, and although not one of my better calls, one I cherish just because of the lesson learned. I guess the old saying goes, we're no better than our last call....

Man, these thoughts get my vote for post of the month...(wouldn't let me + it Matty, I was over my limit. But it deserved it.)

Dwayne

[uglyEMT]

My DUH moment.....

Go to a call for chest pain. Male in his 50s sitting on the bed clutching his chest with his right arm. Talking 2 words per breath and saying an elephant driving a bus filled with concrete (his words not mine) was on his chest. So my partner tells me to take BP. I am so wraped up in the call, thinking of everything to do with a possible MI, that I have my blinders on. I reach for the patient's left arm to put the cuff on and ooopps didnt see the fact he was an amputee from the shoulder I get the whole deer-in-headlights thing going and my partner finally says,

"Why not try his good arm"

I felt like a total moron from that point on with the patient.

Now I have learned to actually look at the patient before I walk over to the patient

[uglyEMT]

wierd. tried to edit and it wouldn't work. Oh well

here is my first and biggest pucker moment...

Working a 45 yr old male, feeling dizzy. We get there has slight right arm pain, no SOB, no crushing chest pain. BP was 175/80, pulse was 68 RR 14 normal. Has a history of stents but no MIs. We decide on ALS just to be safe but unfortunatly none are available. So we ask which ED he wanted to go to and he said *&&%$#$ , which is our normal ED anyways, but also because thats where is heart doc is and where the stents were done. Transport is going uneventful and we think all is well.

Pt then turns to me and says he doesnt fell well. By the time I ask whats wrong he is unresponsive, check for pulse NONE!!!! Grab the AED while my partner gets the airway secure and starts compressions. We hook the pads up and the unit comes back no shockable rythem!! We get to the ED and he is pronounced

I couldn't believe from normal one minute to gone the next. Made me loose it enough that the crew cheif sent me home as I was uneffective from that point on. Almost made me give up on being an EMT.

Thankfully my crew and partners helped me get back to normal and a few sessions with the counsoler I was back on the rig.

[bltnemt209]

My partner and I responded to a bradycardia. I had been on the truck for two weeks. We got into the bedroom and my partner asked for an IV set up while he put her on a NRB. I went to the truck and spiked a bag, and laid everything out in a very pretty row. Feeling good about myself, I went back in to let my partner know that not only did I have the IV setup ready, I had thought ahead to bring in the stretcher. Imagine my surprise when I saw a 16 gauge catheter in her left AC hooked up to a bag!!! DUH!!!!

[Richard B the EMT]

Rockaway, New York has an elevated subway train line, the southern end of the "A" train made famous in the Duke Ellington song. The pillar beams holding the tracks up are encased in concrete, and run over the local road called Rockaway Freeway. The Freeway ran 2 lanes each direction (now reduced to 1 and a left turn lane), eastbound under the tracks, westbound not.

Local folk tales say that one out of each 7 pillars is rubber encased, so any car hitting that lucky 7th one would just bounce off. I've never seen any car hit the 7th, in all my 37 years on ambulances.

On my first day loose on the streets as an EMT, and with my VAC, there was a single car accident, car into the pillar. Municipal EMS had 2 of the 3 persons from the accident already on board, and the 3rd was ambulatory on scene. We got her down onto the spinal long board, and that onto the stretcher, and into the ambulance.

All of us on the ambulance were fresh out of the carton EMTs, as it was both a newly operational VAC, and our first time without an EMT from a neighboring corps riding as mentoring "Crew Chief". Keep that in mind.

On arrival at the hospital less than a mile away, the first thing that happened was, nobody remembered to pull the handle to release the stretcher's "landing gear". Then, whoever had the handle forgot to release it to lock the stretcher in the raised position.

After we finally figured out that problem, we brought the woman inside, and the ER staff did a preliminary exam of the woman. They then suggested we move her to the ER examining bed. We undid the straps, and tried sliding her, on the board, to the exam table, but she didn't slide. It turned out that we had undone the straps, all right, but to the long board, not the stretcher. I think we were strangling that poor woman.

We finally undid all the straps, and succeeded in moving her, on the board, to the ER bed. We then asked the ER crew if we could remove her from the long board, and told that we could. Somehow, we managed to get her off the board, but in doing so, we pulled off her wig! Damn, we thought we'd somehow scalped her!

Somehow, both my crew, and the ER crew, managed to maintain some level of decorum, and we got our equipment, and ourselves, out of the examining room and into the corridor, before we collapsed to the floor in laughter, just as the LEO from NYPD Highway Patrol, investigating the accident, walked in, and looked at us like we were some kind of fools, which that night, we probably were.