101 Things the Fire Department wishes you knew



Monday, April 20

...for the diabetic...


We're racing to back up a BLS engine who reports PD has a man experiencing a diabetic emergency. Under their guidelines, combined with the officer's, E.T. will also be needing transport.

THE EMERGENCY

PD has made a traffic stop and found a patient in distress. A BLS unit has requested an ALS response.

THE ACTION

Ever been watching some kids play, something happens and you say, "Oh they just don't know any better."
That phrase came to mind on this run.
*Disclaimer. I have the highest respect for anyone who chooses willingly to help others. I do not see my self as above other caregivers, just specially trained to handle certain situations that others are not. When my skills are needed, I use them, but I understand that a good Paramedic must first be a good EMT. And good EMTs I like.

This crew had their hearts in the right place. Much like the team of civilians forcibly restraining a man so the AED can analyze him, they're trying and they get credit for that.

Our patient was stopped by police after rolling through a stop sign and has told the officer the odor on his breath is because of a diabetic condition and could in no way be alcohol or liquor. Following his guidelines he activated a code 2 response for an eval more or less to get the "Nope, he's good to go to jail" clearance.

The first engine on scene is BLS and the EMT assigned to it either misunderstood the chief complaint or never covered diabetes in EMT school. The patient is munching on a bag of Reese's Pieces candies and in our system only Paramedics can take a blood sample for a glucose level. They have assumed that eating the candies is a sign of a diabetic emergency because, really, who eats those things like...candy?
So the call goes out for an ALS backup.

As I approach the car where the patient is still sitting, he's pulling the NRB aside to munch on the candies. Before asking for a report I reach over and grab the candies and place them atop the car.
"No snacking." I tell him as I ask the EMT for a report.
The snap of the stethoscope as he forcibly placed it over his neck was almost comical as he began to fumble through a report much the same way the doctors at the clinics do when they call us.
All the while the patient is alert, oriented and nervous. Three things diabetic emergencies seldom are.
I clear them from the scene and kneel down to speak to my patient.
"Hi there, what seems to be the trouble?"
"I have a blood sugar problem, that's why my breath smells, it's not alcohol." He says with not a slur, but with concentrated effort to avoid a slur, which is quite more obvious. All I could think of was E.T. eating those candies and am now waiting for my patient to say his name is L-E-AAA-T. He never did.

"Oh you have diabetes. OK, Is that Type A or type B diabetes?" I ask, baiting the hook.

For those of you not on the job, there are two types of diabetes, Type I - Insulin dependant and Type II - Controlled by diet and exercise. Any diabetic knows exactly what type and treatment regiment they are on. Back to the show.

"Oh, Type A and it's bad." He responds, biting the line and I'm not letting him go. I do enjoy catching the intoxicated in half truths and watching them get frustrated to the point of telling the truth. I find it helps truly assess their level of consciousness and teaches them that we know what we're doing.

"So Type A, huh?" I look to my officer who slows down the ambulance to code 2. "What's with the candies? Trying to fool the breathalyzer?"
"Noooooo," escapes his lips, "My sugar is low so I need the candies."
"I thought the odor on the breath was from Diabetic Ketoacidosis, a high blood sugar, which means you're only making it worse with the candies, but you already know that being a Type A Diabetic, right?" I tell him as I'm confirming the vitals given by the BLS crew. Then a normal blood sugar reading beeps below me and I show it around the crew like a card trick.

Altered folks tend to look at you confused or stare past you, clues that the brain and the eyes are not communicating, but this guy is looking around the car. He's trying real hard to come up with an answer. At least 30 seconds pass.

"I've got a bad bowel and need to get to my doctor's office." Couldn't have been more out of left field.
"What?" I say slowly placing the stethoscope around my neck.
"You heard me, bad bowel, what do you know about that?" He left out 'Mr Smartypants.'
"I know that's not a reason not to take field sobriety tests or any other exam the police deem necessary." I stood, thinking I had him, but you know my clientele, they know the law.
"I want to goto the hospital."

I let out a long sigh and eyed the candies on the hood of the car. As the ambulance arrived I gave my report and the Medic did his best to talk sense to the driver as we were sent back in service.

As I walked away I heard the EMT from the ambulance say, "Are you going to finish these or should we leave a trail so you can get back to your car in a few hours?"

I stopped in the middle of the street I was laughing so hard.

5 comments:

MotorCop said...

Had PD already cleared? If it wasn't a diabetic emergency and I overheard that Type A bullshit, I'd have thanked you for your time, apologized for wasting it and gone along with my inevitable DUI investigation.

In my neck of the woods, I don't think he would get to, pun intended, 'get out of jail free' card with a request to go to St. Farthest.

The Bus Driver said...

hahahahahahaha.... DG (Drunk Guy) Phone hoooommmmeeeee.........

Yes you get one phonecall :P

omg i'm still laughing... damn you for making me laugh!

The Road Doctor said...

I gotta agree with MC, and would have sent him on his merry way to the pokey. If they don't have a legit complaint here, they can be sent along in the custody of PD.

Something new I just heard about from a guy here at FDIC, is a crew initiated refusal. They guy was from West Virgina (no where near where I am from), and apparently they need a Supervisor to come out and evaluate each situation, but it is a tool in their box...

Little Girl said...

Hey HM you should know better, you shouldn't play with intoxicated people like that.

Okay, Okay, I admit that that took all my will power to say that with a straight face. :)

Playing with intoxicated people is one of our small joys in the this world.

I very much enjoy asking the intoxicated males who's c/c is 'I am going to have a seizure' - 'So are your pregnant?' - there is normally a silent pregnant pause as they think about the answer. I even got the answer 'yes' once, but that guys was completely messed up, and I don't know if he knew if he was coming or going.

Enjoy playing with drunk patients, there is certainly a never ending supply of them. :)

p.s - I like to eat Reese's Pieces Candies.

The Happy Medic said...

MC,
Yes the officer was still at the scene, but kept stepping back closer and closer to his cruiser.

Road Doc,
That used to be in our system until, as most rules go, it was abused and someone was left to die. My proposal for system changes includes a program similar to what you describe.

Little Girl,
Nothing, I just like saying that. See you on f'book.