Krankenwagen

[krankycomics]

Hello, my name is Kranky. I'm a paramedic who's looking to create/share more silly content for other paramedics (and people working in EMS).

I have a weird and sometimes dark sense of humour, so this blog is (probably) nsfw.

~I'm struggling with how I want to arrange this blog, honestly. I'll have to think on this a bit.~ ~ ~

If you want to read my comic on Tumblr, click here: #krankenwagen. If you don't like Tumblr's format and would prefer to read it in a more chronological/convenient manner, I'm also putting the pages on a webcomic hosting site (which have "next" and "previous" buttons). The link is here: https://krankenwagen.thecomicseries.com

If you want to see my art, click here: #myart

If you want to see the memes, click here: #meme. This is content I have not created, but just found on other EMS sites and had a laugh over.

I talk about some of my calls sometimes: #medic-musings.

NOTE: If I have reblogged/reposted something of yours and you want it taken down, shoot me a message and will do. No explanation needed.

[ghost-of-frank-pierce]

Having been in both Fire and EMS… can confirm

[krankycomics]

As a new paramedic, it's always surprising to find out that the majority of your calls are not high-acuity life-or-death situations or dramatic traumas. They're mostly "BLS" calls, which stands for "basic life support". Having successfully completed what feels like a bajillion BLS calls, I find the higher-acuity calls quite exciting - I get to use more critical thinking, more tools, "test my mettle" so to speak. This is a higher-acuity call that was very unique in my career, and after picking the brains of my colleagues, perhaps unique even to my region.

We were dispatched to a possible stroke. We arrived, followed the family up a flight of stairs (stair chair to be fetched immediately after the initial assessment, I mentally noted). Patient was laying in bed with two family members present. I started to do a stroke screen but the pt interrupted it with a fit of retching; I stole a family member instead and picked up some information. Last Seen Normal (LSN) was difficult to pinpoint, but our window was just wide enough to make it to the distant CT scanner about 2 hours away. After the retching subsided I went back to finish the stroke screen. Weak grip strength on one side, pronator drift on the same side, unable to assess the legs because the patient had terrible cramps and kept moving/shaking his leg. Speech was normal, pupil sluggish. I had more than enough; I informed the family of where we were going, and we boogied.

Part of our stroke protocol is to attach a 12-lead to the patient en route. In case there is some underlying pathology throwing clots, we want to be able to monitor for signs of that. I attached the 12-lead, but my initial captures were garbage - the patient could not follow instructions to keep still and even when he did, his leg was going through a series of cramps/contractions. The only relevance to the leg cramps to this call was that it made him uncomfortable enough to stop him from being still; the print-offs all had wandering baselines and were diagnostically useless. But initially, the 12-lead held no interest for me anyways; my patient was deteriorating. For the next 40 minutes, every re-check of his neuros found increasing deficits, from his increasing lethargy to his inability to answer more than simple questions to a slight slur that became more pronounced. I kept asking him if he had pain anywhere, especially his head, but he kept indicating he did not. He had another fit or retching, but like before it was only sputum, no vomit.

At the 40-minute mark, he stopped deteriorating. I was initially baffled by this - I was extremely convinced I had picked up one of the uncommon hemorrhagic strokes - but in retrospect I had picked him up at the very beginning of an ischemic stroke. I had always picked up people after their symptoms have stabilized - we are quite rural - and I had never had a patient with an ischemic stroke continue to deteriorate. I called the hospital to update them about this slightly more optimistic presentation.

My patient's neuros remained stable for the rest of the trip. His leg cramps never really gave up. I printed off a second 12-lead with a baseline that was even worse than the first. I wondered about some of the depression. Was that all just random, from movement and artifact and a bouncing ambulance ride? Possibly. But possibly there was something there. Regardless, nothing that popped up was going to change our destination or our urgency level. Part of the initial assessment the nursing staff would perform immediately would be a new 12-lead anyways.

We arrived at the hospital, and were swarmed by nurses well-versed in their role at stroke center. Registration, blood draws, physician assessment, 12-lead. I coached the patient - it was very important to stay still, try not to move, try not to move your leg.

The hospital 12-lead printed off with a very clean isoelectric line. Very clearly, you could see the deep ST depression in the anterior leads. And glancing over, the tall tombstones in the inferior leads. Well. The nurses and doctor were all a little dumbstruck by this finding. Off to CT we went. There was no bleed; thank goodness. Back to the emergency department, and carefully we moved the poor patient into the bed. This poor patient, who was having both a stroke - and a heart attack - at the same time.

(Image from https://lightssirensactionems.com/blogs/news/pails-ems-cardiology)

Final Thoughts

I have been mulling this call in my head for some time. It honestly really bothered me that I was unable to flag the STEMI en route. But in retrospect - after pulling out copies of the EKGs several times and looking at them - what was the alternative? Even if I truly suspected some pathology of the heart, would I have wasted time to pull over, coach the patient into not moving (however long that took), taken my capture, then resumed transport? Of course not. That's not in the patient's best interest. What was in the patient's best interest was immediate and uninterrupted transport - and that's what we did.

A very curious combination, though.

[krankycomics]

I've been watching "Harley Quinn" recently on netflix, and there was a scene where a bipedal shark character was hooked up to monitoring equipment. I did a double-take because it looked like the SPO2 of the shark was reading 117. Part of me wants to create another tag to collect screenshots of silly medical examples from the media. Whether it's Venom's "normal vitals" or the blue IV tourniquet wrapped around a trauma victim in Dexter or "2 CCs of oxygen" the paramedics were discussing in Breaking Bad. I imagine someone has already compiled such a list, but I think I might make my own. =3

[krankycomics]

When in emergent situations, it's important to recognize the need for resources and obtain them as they, uh, present themselves. (Thank you for your service.)

[krankycomics]

[krankycomics]

I have written - on at least four separate patient reports - that my PPE was inadequate during the call because it was blown off/ blown away (I live in an incredibly windy area). Part of me is incredibly thankful the covid rules are finally receding, because holy crap, you would not believe how difficult it is to try to work with giant billowing dresses that catch on every nook and cranny while simultaneously trying to hold onto the flimsy masks and eye protection. Grabbing onto visors (to stop them from blowing off) with gloves contaminated from a possible covid patient just seem counter-intuitive, but such is life.

[krankycomics]

From time to time, the massive volume of cath lab patients sent off via air ambulance completely empties our local hospitals of pillows. Well, I mean it empties our ambulance of pillows and we replace our pillows from the hospital. Same difference.

[krankycomics]

Ambulance attendants have a weird relationship with food. We work long shifts and don't get "breaks" for food like other workplaces. As a result, we all have stories (some quite silly) about trying to inhale food on the way to a call.

[biomedmillie]

5 (more) books for aspiring med students...

1. War Doctor

By David Nott

Image Source: Pan Macmillan

This book is a real eye-opener for the extremes seen in medicine, and despite Nott’s department from the day-to-day NHS lives of other doctors, the relationship struggles and raw emotions depicted by Nott are something any healthcare worker can relate to. The book documents emergency surgeries, humanitarian crises, Nott’s own struggles with PTSD and even personal negotiations with an autocrat in an effort to relieve the life-and-death scenarios overseas we in the West often neglect. Unlike other author-doctors whose works I’ve read, you can feel the emotional investment and care Nott has for the issues he tackles with, and does not shy away from the emotional struggles that come entangled in the job. What’s more, the nature of Nott’s work makes this book an absolute page-turner, whether you’re invested in medicine or otherwise, so I recommend this book to all and everyone. If you are a medical student or are aspiring to be one (like myself), I encourage you to note the empathy Nott feels for his patients and colleagues, and try to mirror this in your everyday life. More often than not medical professionals are told to limit their emotions in order to deal with the tough nature of the job, but Nott directly challenges this; his work argues that, as medical decisions involve human life, the empathy we all experience as humans must be encompassed within our decision making due to the consequences such decisions could ensue. We must know the value of human life through empathy and emotion before making a decision which could affect it forever. This book is brilliantly written, and I encourage all to give it a good read!

2 & 3. Complications and Better

Image Source: The Guardian

By Dr. Atul Gawande 

I’ve recommended this author before due to his unique and captivating writing-style, and his former books from the bestseller ‘Mortal Beings’ are equally enticing! Unlike Mortal Beings, Complications and Better encompass a greater variety of medical issues, and I encourage aspiring medical students to give all of Atul Gawande’s books a good look. True to form, Gawande begins each chapter by discussing a new modern-day medical problem that healthcare institutions from all over the world face; this has ranged from chronic pain, to the obesity epidemic, the advent of new surgical techniques and much more. Gawande then uses scientific literature and his own personal experiences to give a more rounded view of the topic, and suggests new research opportunities to pursue in the future. Both of these books are fundamentally interesting reads (I polished them off in a week!), tackling the major issues of our time with a highly-engaging writing style. Honestly, Gawande could write about the most boring subject matter imaginable and still form an absolutely enthralling book! Recommend to those in science and the science-interested; you don’t have to be a medical professional to read his work! Gawande writes in such a manner that his work and meaning is clear to all, so if you’re just dipping your toe into the science pool, that’s okay and definitely give this a read!

4. T’was the nightshift before Christmas

Image Source: bookedupgirl.com

By Adam Kay

I’ve recommended this author before also, and I’m sure you know why; Kay’s writing is absolutely hilarious. I’m not going to lie, you won’t gain much medical insight from this little novella, but you will get ALOT of laughs about the ‘activities’ patients get up to when Christmas comes around. The book features the same bluntness about the harsh realities of medical life as Kay’s previous work, and so really does knock the naïvety out of the system about life as a doctor. This book, however, is more focused on getting the reader to laugh about the ridiculous cases NHS staff see around the holidays, and it really is a joy to read. I also hope this book convinces some to really appreciate the NHS and the staff that keep it afloat, and hopefully stops people binge-drinking around the holidays and putting enormous stress on the system. But this is not the main purpose of the work, which the book hilariously succeeds at. If you need a bit of cheering up, give this a read, and I promise you will not be disappointed!

5. The Sick Rose

Image Source: www.spectacularoptical.ca

By Richard Barnett

This is the only book on the list that could also be recommended to art students or those interested in illustration! ‘The Sick Rose’ is a book encompassing a culmination of illustrations depicting diseases long since forgotten, such as syphilis, measles, bubonic plague, smallpox and many more. With the advent of the anti-vaccine movement this could act as a harsh reminder of the deadly diseases are ancestors lives were often claimed by, and is a highly interesting read documenting a history of medicine, and providing a window into its past. For those interested in history, medicine or both give this one a good look; you’ll be stunned by the grisly yet oddly beautiful detail it encompasses. But if you have a weak stomach, I’d definitely give this one a pass: the author does not shy away from any facet of human anatomy, or the gruesome effects of these historical epidemics. Either way, this book is a highly interesting read!

If you are a medical student, aspiring to be one or are curious whether medicine is the path for you I highly recommend giving these books a good read. Not only are they all extremely well-written, but also document intricate details about the lives of extraordinary doctors, and give vital insight into the world of healthcare. I thoroughly enjoyed every one of them, and I hope you do too!

If you have any more suggestions for myself or others on the pathway to medicine, please comment them down below; we all need a good book every now and again!

[krankycomics]

These sound like some good reads

[krankycomics]

[pissandcigarettes]

I did my first VSA on my own the other day. First response vehicle. One paramedic

Woke up to the tones going off, stumbled out of my recliner with half a boot on, rushed over to the vehicle sitting outside and received details. So far, my underpants were still intact. More to come.

Scene was just down the street, massive apartment building that looked like it was designed by a drunk architect holding the blueprints upside down.

Hauled my gear all the way up, firefighters were already on scene so i thought to myself in between thoughts of terror...."alright, everything should be okay 🙏, i got more helping hands here"

However,

I arrive on scene to a middle aged gentleman w no pulse, stage 4 liver failure, purple liquid all up in his airway, presumably wine?

Firefighters all round with thumbs up each other's asses.

No CPR, no resuscitative measures, just standing around..

Had to give them a bit of shit because they shouldve been doing CPR (had to report it too)

After abiut 10 minutes I completed my first termination of resuscitation, pronounced on scene, didnt shit my pants. Kept my head.

Other EMS crew arrived as i was stopping the process, as it was futile to continue.

FF's scurried away. Police show up. Cleaned up.

Anyway, on to the next call.

[krankycomics]

Definitely a defining experience and milestone in the career of a paramedic. Showing up to CPR-in-progress and taking directions from a competent team leader is one thing - showing up and BEING the team leader is entirely another. And having to pronounce is a disquieting feeling. It gets easier. Hopefully the fire chief uses the report as a learning tool to do some drills. I've been blessed with outstanding firefighters and police - I'm delighted whenever they show up on scene, often before me and with a defibrillator of their own.

[only-tiktoks]

[krankycomics]

For the safety of patients, please put your adorable animals away. I have a compulsion to cuddle all of them and it's delaying patient care.

[krankycomics]

[krankycomics]

[amor4med-blog]

Doc: What brought you in tonight?

Intoxicated Patient: The ambulance.