Thursday, April 2, 2009
I'm in the middle of what I term as "clinical sprints"; every day I work on a different 911 ambulance as the lead paramedic often for 14-24 hours per shift. This grueling schedule will go on for the next week or so until I graduate the course.
During these clinicals I feel myself learning and maturing as a new street medic. Today we responded to a 96-year old woman who had fallen outside on her deck and fractured her hip. When we arrived I found her sitting up against a hot-tub with her left leg rotated inward and shortened in length, a tell tale sign of a fracture. Normally these injuries are excruciatingly painful and have catastrophic results for the elderly. A week ago I would have splinted the leg, started and IV, and began pushing narcotics for pain management. Today I stepped back and realized that the woman was not, for some reason, in a great deal of pain. This is often the case with elderly women; maybe they've seen so much in their lives that pain is often relative.
I withheld the IV and the narcotics, realizing that I don't need to do some procedures just because I am able to, but rather its better to use my clinical judgment and make the best choice for my patient. There was no need to start what could have been a painful IV in the arm of my patient while bouncing down the road in the back of an ambulance for nothing more than to push a pain medication that this lady really didn't need in the first place. If the ER wants an IV they can start one themselves in a more clean and stable environment.
I was happy with my decision, and believe that it was a step forward for me; sort of an "ahhhh moment" Realization comes in small steps.