I was on the second day of a 72, meaning I was going to be working for 72 hours straight. Our normal tour of duty is 48 hours, but I was going to work an overtime shift on my first day off. I had done a really tough workout on my first day and we had spent several hours drilling and training on the second day. I was tired and sore and not really looking forward to working an additional 24 hours. We had two medical calls already but the ambulance got on scene before us on both calls. The first was a 'nothing' medical and the second a decent car wreck. The lady on the nothing medical was staying with a relative and didn't know the exact address, but she took three stabs at it anyway, not one of them being correct. The only reason the ambulance was on scene at the same time as us was that we spent about ten minutes driving through the apartment complex going to each of the incorrect addresses she kept supplying.
There wasn't much in the way of patient care on either call though, so it was just as well the ambulance got to take those.
Just after dinner that evening we got toned out for a 70 year old woman not feeling well and vomiting. Didn't sound too promising. On arrival we found a non-english speaking woman in bed. Her daughter stated that her mother had fallen three days ago and had been weak ever since. She did not see a doctor after the fall and did not want to go to the hospital now. The daughter said that her mom was not interacting with her the way she normally does but couldn't really explain it any better than that. After some questioning it was determined that the woman was diabetic and that the vomit and her last bowel movement had been very dark in color and like "coffee grounds" which is indicative of a bleed. What was causing the bleed I didn't know.
I checked the woman's blood sugar and it was 'Hi' which is what the monitor reads when the glucose level is off the chart. I told the daughter to explain to her mother that she was indeed going to the hospital. We can't fix a high sugar problem in the field and the coffee ground emesis was troubling. I then began looking for I.V. access.
As soon as I put the tourniquet on I could see this was going to be tough. Thin, papery skin and no visible veins at all. I let the tourniquet and gravity do their work and thought that just maybe I could feel the slightest hint of an AC (ante-cubital vein in the crook of the elbow) or possibly it was just wishful thinking. The ambulance arrived and I gave the paramedic a rundown on what we'd found and what I was doing. In just that small amount of time I had totally lost any trace of the AC. I still felt like I knew it was there even though I couldn't see it or feel it anymore. I don't like to go "fishing" for I.V.s, that is, stick the needle in and move it around jabbing repeatedly in the hope of lucking into a vein. It's painful for the patient and just not a great technique, though sometimes it is the only option. I really felt like I knew there was a vein there though and I told the ambulance crew I would give it one try and then hand the patient off to them. I tried to, as a wise old wizard once said, "let go my conscious self and act on instinct". I slid the catheter in and was immediately rewarded with that flash of blood in the chamber that confirmed I was in the vein.
We attached the I.V. bag and it was flowing like a champ. I secured the line and we got the patient to the gurney and off to the hospital.
The I.V. wasn't going to save her life, there were no medications to give in the field, but she was going to need them soon and she would need the IV. It was just very satisfying to have so smoothly succeeded at the difficult stick. I used to pride myself on my I.V. skills in particular, the more challenging they were the greater my success rate, but I haven't had a lot of practice lately. And just that one small success completely raised my spirits.
Bring on the next 36 hours, I'm ready and I want to go to work.
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