Gage and DeSoto were coming in at the beginning of a shift hoping that it would not a busy day. It seemed lately that every shift but theirs had been dead quiet to the point that other shifts were rearranging the equipment in the gym just for something to do.
A Shift, on the other hand, would like just to have five minutes to eat meals in between calls.Gage, especially, wanted to be able to get some sleep. He was working over time a Station 110 to save some money for a large ticket item he had his eye on. The busy shifts seemed to follow him to Squad 110. Which was making him all the more tired.He couldn't remember the last time he had a night's sleep without being toned out on yet another call.
***
John and Roy were dressed for the day and in the kitchen getting their first cup of coffee ...when the tones when off!
SQUAD 51 IN PLACE OF SQUAD 36 RESPOND TO A MULTIPLE TA WITH INJURIES ON THE 405 INTERCHANGE AT VALLEY, THE HIGHWAY PATROL IS ALREADY IN ENROUTE.TIME OUT 08:30 squawked the radio.
Capt Stanley acknowledged the call "Station 51 10-4 KMG-365.
Johnny grumbled, "Oh,Man! I can't even get sip of coffee before the county needs us AGAIN, this better be good or I'm going to be entirely pissed off!"
Roy responded to John's grumbling as they left the Station, "Oh well, partner,only twenty three and half hours to go.
Johnny and Roy knew it was going to take some fancy driving to get up to the accident scene because this was peak of rush hour traffic. The accident was on the 405 of all places.
***
As Squad 51 approached the scene they could see it looked as if some one had crossed the median and hit another vehicle head-on. That had stopped traffic in the far passing lane immediately, then several other cars had gotten caught up in the mess because they weren't able to stop in time.
Roy told to John to call for the engine and at least two ambulances if not more.
John signed them off at the scene "LA this is Squad 51 off at the 405...can you please respond engine 51 and at two ambulances to this scene?"
"10-4 Squad 51," the dispatcher replied.
Roy and John started triaging the patients while the CHP routed traffic around the accident. The engine was pulling up as John was getting to his third patient. He suddenly felt a SHARP pain in his right side forcing him to the ground. "UUHH!" winced John. Suddenly feeling short of breath He looked up to see a CHP officer tackling a teen-age boy with a knife in his hand. There was blood all over the knife. John realized it was his blood and that he had been stabbed. He tried to shout to Roy.
But Roy was to engaged in taking care of a female involved in the accident who was rapidly losing consciousness because of head injury from striking the windshield.
Capt Stanley picked up the radio as Chet,Mike and Marco ran to aid John. "LA this is Engine 51 we need another squad at this location...we have just had a fireman stabbed by a bystander."
That broke Roy's concentration."What?!" He said in disbelief as he began looking around for his partner.But he also realized he had someone depending on him right in front of him.
***
As Chet reached John on the ground.He saw a pool of blood beginning to form under his pal.
"I can't breathe!"John said to Chet looking for help.
Chet propped John up as he sat on the ground behind him.Chet began to hold firm pressure on John right chest just under his arm. Chet first ripped opened John s shirt to get a better look a his wound.
Marco and Mike ran to get Roy as Squad 110 pulled up to this rapidly deteriorating accident scene."Roy" Mike said, "John has been stabbed He needs some help right know!"
Squad 110 took over for Roy as he went to tend to his partner."What happened Junior!"
"I can't breathe!" John restated.
Roy started John on High flow O2 via a Non-rebreather mask and started two large bore 14 gauge IV's one in each arm with LR(Ringer's Lactate).He also had Mike grab the Defib from the Squad so he could place John on the cardiac monitor. John's color was draining from his face. Roy listened to John's s breath sounds they were unequal, not bad on the left but almost non-existence on the right, he had to do something! "Rampart, this is squad51 with priority traffic"
"Go ahead.,51, this Rampart"
"Rampart, I have a male patient who has been stabbed in the right chest.Vitals are B/P 92/60, RR32 labored and shallow. Pulse 140 and weak,Monitor showing sinus tach with occasional to frequent PVC's.Unequal breathsounds. No breathsounds heard on the right I have two large bore IV's started and patient on high flow O2. Request permission to decompress his chest and Intubate if necessary!"
Roy and John had just updated their skills with the new protocols Rampart was offering to its Paramedics but Roy never imagined he would be using them to save his partner.
"Go-Ahead, 51, and transport immediately!"
"YYEESS," said Roy after putting the biophone down. He wasn't sure Rampart was going to let him do this. "Marco, run and grab one the other Paramedics if they are free I am going to need some help with this."
Chet spoke up and said, "What can I do?"
"Nothing,right now, Chet. John appears to breathing better sitting up then lying down Stay right where you are," Roy said as he grabbed a 14 gauge 2 1/2 in needle to perform a chest decompression so that his pal could, hopefully, breathe a little bit better. Roy performed masterfully.
Capt Stanley thought, that training that the department paid for as really paid off.
Roy noticed that John was breathing better and the PVC's on the monitor had gone away. His heart rate was down to a tolerable level, but Johnny wasn't stable by any means. John was coughing and with each cough he was bringing up a little bright red blood. Roy grew concerned about John not being able to control his own airway so he knelt down beside John and said, "Hey, Buddy how's the breathing?"
John's reply was not unexpected. "It's a little better but not much,"John whispered because that was all he could muster.
Roy knew what he had to do.Intubate John and control his airway for him and make it easier for him to breath by breathing for him.
Johnny could see what Roy was preparing to do. He was trying to think like a paramedic but found it difficult. This was happening to him.
"Chet, lay John down," Roy instructed.
Chet gingerly laid John on the ground.
Roy grabbed a #7.5 ET tube and nasally intubated John. He nasally intubated John because that was better tolerated by someone who still conscious. Orally intubating him might have made John throw-up.
Roy handed Chet the Ambu bag and and told him to squeeze the bag every time John made a effort to breathe. Roy and Mike got the stretcher and lifted their pal onto it with Chet in tow.It seemed to Roy that it took a long time to get his partner packaged and transported but it had only been fifteen minutes from the time he heard Capt Stanley on the radio till now.
John seemed to be doing better on the way into the hospital.His color was pinking up and seeming to be going along with Chet as he bagged him. His vitals were better. Roy was feeling relieved that his "brother" was doing better.
*************************
The ambulance pulled up to the ambulance bay as the trauma team was waiting all gowned up and ready to go. They were shocked when they saw who it was!
Dixie sighed, "Oh no! not John."
On that note, the urgency to step up the assessment and get John to definitive care was heightened greatly. Dr Brackett started giving orders to his trauma team members, as Roy and Chet tried keep up with the stretcher which was at very quick pace headed for Trauma 1.
" I want a Chest X-ray to check ET tube placement and to determine right lung damage. I also want a chest tube tray and a Pleur-evac to drain the blood in John's chest," demanded Dr.Brackett.
The Respiratory Therapist was making the ventilator ready to put John on after Dr.Brackett had inserted the Chest tube. Chet had volunteered to keep bagging while the RT did this. The lab was drawing blood for their usual trauma profile. They knew that Dr. Brackett would want it yesterday. The RT drew a blood gas or (ABG) for the lab to take with them to determine how well John was breathing even with all this help.
The RT, as usual, and Dixie were the ones communicating with John as this was one their roles in dealing with the patient. RT had this role because they were always at the head of the patient. This was very important to John because he was still awake and it was nice to know before some poked or prodded him.
Roy was standing in the corner where Dixie had told him to stand, wanting to be involved but knowing the look he would get from Dixie if he moved.
*****
John was in ICU 7 connected to a Ventilator which was breathing for him and letting him take his own breaths as he was able. John woke up hearing the pleur-evac bubbling. This device was connected to the chest tube which was draining all the blood and air from John's chest tube and not letting anything into the space around the right lung so that it could re-inflate and do its job.It was calming a sound. He also heard the ventilator cycling every time he took a breath.
He saw Roy asleep in the chair in the corner. They had gotten Dwyer to cover the rest of his shift. John tried to speak but all he did was make the "vent" alarm sound and that got Roy attention.
" Hey, Pal," he said, "Glad to see you awake.This is a hell of a way to spend a shift."
John smiled, knowing that was all the interaction he was going to be able to accomplish until he was extubated.
********************************
Dr Brackett was monitoring Johnny's progress and saw continued improvement. He thought it wouldn't be risky to see if John could breath on his own and get that tube out his mouth. Being mechanically ventilated is just plain uncomfortable. There is a feeling of gagging if the tube is moved at all and there is a plastic retainer sitting on the patient's mouth holding it in place, or even worse it is taped in place.
John was definitely ready to have it removed and so were the nurses. John, while in his clear mind, had figured out that every time he "beared downed" or bit the tube, the ventilator would alarm, and when he was feeling playful, he would do just that. This was driving the ICU nurses NUTS! They would come in expecting to see their patient in distress, and something wrong, when just the opposite was true. Nothing was wrong. The nurses were not dumb to this tactic. Some patients have used this before to get attention or get a need taken care of, Instead of pushing the call bell, which was always only a finger width away.
Dr Brackett wrote the order, and Sara, John's nurse, was most happy to call respiratory and give them the orders.By the end of the day John was having no problem breathing by himself and his blood gasses (ABG'S) showed that John was ready to be extubated.
Roy stepped into John's room as this was about to happen. Sara stopped what she was doing and looked to see who had the gall to step into the room while the curtain was closed. She held her tongue when she saw it was Roy.
"Roy," she said "we were about to extubate John. Would you like the honors? If John doesn't mind of course." John waved his hand as if to say "Get over here." Roy had put many ET tubes in before, but had never had the opportunity to take one out. This would be a privilege. The RT inserviced Roy on how to properly extubate a patient. Roy did it just as if he had been doing this for a long time.
Sara said to John "Well, say something. I know you can't wait.!"
John's first words after being intubated for 3 days were raspy and coarse but understandable. "Hi, Sara," he said with a harsh whisper.
"You better speak up, John Gage, or I am going to think there is something wrong with your voice."
John cleared his throat and said, "Good Afternoon, Sara."
Roy, with a big smile on his face, said, "Hey, pal, its nice to hear you again."
*****************************
"New Skills" ©1998 Deb Flint. "Emergency!" and its characters © Mark VII Productions, Inc. All rights reserved. No infringement of any copyrights or trademarks is intended or should be inferred. This is a work of fiction, and any similarity to actual persons or events is purely coincidental.
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