But I would walk 500 miles
And I would walk 500 more
Just to be the man who walks a thousand miles
To fall down at your door
The Proclaimers

Ok, I haven’t quite walked 500 miles, though a few days it’s felt like it. But I have reached sort of a milestone. I’ve worked over 500 hours as a tech in the Emergency Department. The PA programs I’m looking at require some sort of minimum number of “patient contact hours”. One only requires 750. The primary programs I’m looking at require 1000 hours. This has been the biggest single worry I’ve had in meeting my prerequisites. While there are a number of classes I need to take (and I’m almost done with those), this is the one that would take the most amount of time and was the hardest to line up.

But here I am, at the end of January and I’ve hit the half-way mark. This means that I’ll be well on my way to hitting the 1000 hours long before applications are due. So that’s good.

But, there’s more than that. Honestly, I’m loving it. Yeah, there’s a lot not to love. There’s cleaning up after patients. There’s being stuck in a zone with very little happening. One can get tired of doing their 20th EKG of the day and 17 nasal swab. But overall, I’m really liking it. And I think I’m getting better at it. I even “gave an order to a doctor” the other week.

Ok, let me be clear. Techs really don’t “give orders” to anyone. Sure we can ask another tech for help or even ask a nurse for help. But typically we’re the one being asked to do things. And we have no medical authority to “put orders into the system.” That said, we’re often closer to the patients and what’s going on with them than the doctors. This makes sense. We see the details, they see the big picture.

In this case though, several of us, including one of the residents, were cleaning up a patient that soiled herself. As I wiped, I noted she was raw and said she couldn’t feel when she was urinating, which meant she’d wet herself again without warning. This would only make things worse for her. When we were done, I turned to the resident and said, “I think you need to put in an order for a Foley (catheter).”

“Oh, you think so?”

“Yes, she can’t tell when she needs to urinate and ends up urinating without warning which ends up getting her skin irritated.”

“Ok.”

Sure enough about 30 minutes later a nurse was putting in a Foley.

I’ve said we often do the scut work. Which is true, and a few people have thought that I was saying that as a complaint. It’s not. It’s an observation. We’re doing the little stuff that needs to be done that the nurses and doctors don’t have time to do or often won’t notice. That said, actually they often do notice. A nurse will go in to do something and see the well stocked IV cart and thank one of us. Or they’ll ask for something and we’ll already have it in our hand, knowing they’ll need it. Again we’re thanked.

Last night for example, I spent probably close to two hours restocking IV cabinets. I’m not sure the last time that day they had been restocked, but some were pretty barren. When I was done, it felt good knowing that the next time a nurse went into the room to start an IV or do some other procedure, they’d have the tools they needed right there.

Then of course, there’s the big stuff. Helping out with a stroke page or a “leveled” trauma. This is where the experience comes in and I’m definitely 500 hours more experienced than I was just over three months ago. I still don’t have my “red badge” so I can work trauma’s on my own, but I’m getting the experience. And it feels good.

All this is a means to an end, getting the required hours to apply to PA school. But it’s also been great. I’m very grateful I’m getting the experience in an ED where my day can vary from restocking carts to handling not one, but two trauma patients in the same evening. And that was just one shift. In other shifts I’ve helped with multiple traumas.

Hopefully not just the quantity of hours, but the quality of the work will help my application. But no matter what, I’m still enjoy it.

Disclaimer: my works do not in any way reflect my Standard Disclaimer: my writings do not reflect the views of my employer, the Albany Medical Health System. In addition, any errors in the above descriptions are my own and nothing here should be taken as medical expertise or advice.

This isn’t a story about Sisyphus, but rather something very different.

There’s a saying in the EMS field that “Air goes in and out, blood goes round and round, any variation on this is bad.” It really reduces medicine to a very critical base level. If those things aren’t happening, your patient is in very bad shape. They may have broken bones, be in acid ketosis or have a variety of other major medical issues, but if they’re not breathing or don’t have a pulse, none of that matters. I’ve mentioned CPR previously and plan on writing a longer post on it in the near future (especially in light of Damar Hamlin’s collapse on the field). But today I want to talk about something that can only be done by experts and that’s intubation.

Before starting as a tech, I was aware of the general concept of intubating a patient, but had never seen it done, let alone assisted in any way. At a VERY general level, a patient is sedated and essentially paralyzed while a tube is inserted through their mouth and into their trachea. Once this is done, the patient is either ventilated by a machine or by the use of a bag-valve mask (BVM).

A patient may be ventilated for a variety of reasons, for example, they may be unable to maintain a patent (open) airway and the ability to breath on their own, or in a very recent case, the doctors made a decision to sedate a patient who was moving too much to be placed in the CT scanner. Given his risk factors, this meant that he’d probably lose his ability to maintain his own airway, so he was intubated as a precautionary measure.

I mention all this because there’s something important to to understand. Once a patient is intubated, basically the medical folks are breathing for them. The first few times I watched or assisted, this fact didn’t really register with me. Since then I’ve come to realize how important of a factor this is. In the recent case, the decision wasn’t made lightly. The patient actually was breathing fine, but the doctors couldn’t evaluate for other, possibly life threatening, injuries until he had been scanned. So they made the decision to basically take away his own ability to breath for a short period of time. That’s a pretty heady decision.

Roc is short for rocuronium, one of the common drugs used to help temporarily paralyze the patient. Its name sticks out in my head. There’s generally at least one or two other drugs all administered in a very short sequence (basically to relax the patient and then inhibit things like the gag reflex) period of time, generally under a minute and then the doctor has less than a minute to get the tube in. Once the tube is in, then either a BVM is temporarily attached to the tube, or a ventilator is attached immediately. In either case, we’re now breathing for the patient.

As a tech, obviously I’m not the one pushing the drugs or inserting the tube (I’ll get to that in PA School) but I’m often involved with squeezing and releasing the BVM to provide airflow. I also get to watch all this.

As for the actual placement of the tube, it’s definitely an acquired skill. Since Albany Medical Center is a teaching hospital, often it’ll be a resident or similar attempting it the first time around. Only once have I seen a failure (which was very quickly followed up by a success by a more experienced provider). Even this part is fascinating since they will use a tool known as a Glidescope. This is essentially a curved plastic piece with an LED light and camera at one end. This goes in first to help restrain the tongue and epiglottis. The image is displayed on an LCD monitor. Once it’s in place the actual tube is inserted. All this can be watched if you’re standing in the right place (which often I am.) I have to say it’s rather amazing to see all this. And to watch an experienced provider do a tube is amazing. They do it so quickly.

In any event, I have to say, it’s pretty amazing to watch as the providers take over the “air goes in and out” part.

In a future post I’ll cover the “blood goes around and round” part, which is something any of my readers can (and should) learn how to do anywhere they see someone in cardiac arrest.

Standard Disclaimer: my writings do not reflect the views of my employer, the Albany Medical Health System. In addition, any errors in the above descriptions are my own and nothing here should be taken as medical expertise or advice.