Your First Patient

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DropkickMurphy

DropkickMurphy

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Suffering from insomnia as I do, I have been trying to think of something to occupy the next few minutes and I thought it would be interesting to hear everyone's stories about the first patient they ever treated. So here's mine to get everyone started

It's often said that EMT's meet people by accident, but I stumbled across this career field by accident. I never intended, desired or even considered a job in the medical field growing up- my plans were to become a Presbyterian minister. Growing up in a very rural part of Indiana, it's not easy to get around until you turn 16 and can drive, but my friends and I were bound and determined to not let that stop us from going where we wanted. The summer after I turned 15, I must have rode the equivalent of the Tour de France back and forth to my grandparent's house (which was nearly 30 miles away from my parents house).

One afternoon my friend Justin and I were out riding and we heard a loud crash, breaking glass, rending metal. As we went to investigate the sound we found a car that had hit a telephone pole. Being inexperienced and not knowing any better we walked up to the car not realizing how bad things were- the starred windshield, the bent steering wheel, the combative drunk guy in the driver's seat. My mother had insisted that I carry a first aid kit with a couple of gauze pads, some gloves and band aids. I put gloves on and climbed into car, and told the guy to hold still so I could stop his head from bleeding. The response was less than positive- if I recall correctly my mother's virtue and the word "f--k" featured quite prominently. It became apparent the 4 gauze pads wasn't going to cut it for the gaping wound on his head, so I wound up pulling my t-shirt off and holding it to his head. Justin grabbed him by the shoulders and held him in the seat.

A few minutes later, the ambulance arrives and out climbs my cousin Danny. I had forgotten in the excitement that he was a paramedic and I've never been that happy to see someone in my life. He took over and I got out of the way. Needless to say I hightailed it away from there, and headed towards home, but as I walk through the door my mother stops me and goes "What did you do?! Danny just called me....something about a car accident. He wants to talk to you. Give him a call." To make a long story short, he told me thank you for stopping to help and that we had done probably kept that guy from being in a wheelchair. It turned out he had "broken his neck" (to use the term Danny used, to be honest I don't know any specifics) and if we hadn't kept him down in the car, things would probably have been a lot worse. He encouraged me REPEATEDLY over the next few months to take a first responder class because he thought I had a knack for this type of thing and I finally did to basically shut him up. Needless to say I fell in love with it.

I've never had the heart to tell Danny or anyone that the only reason I was holding his head and trying to stop the bleeding was because I was getting nauseous at all the bleeding and I wanted to make it stop before I threw up. The reason I left so quickly was so I didn't puke in front of Danny. What a glorious way to get into the business eh? :laugh: :laugh:


Anyone else have any good stories about their first EM patient?
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My first patient as a medical student in M1 year was a really hot 22 year old female with a sore throat. I had absolutely no idea what I was looking for or looking at, so she probably thought I was the biggest dork on earth. Plus I had the stylin' hot short labcoat.

First patient as an ATTENDING was a 50 some year old AIDS patient (CD4 30s), CHFer (Class 4), COPD (on home o2), ESRD dialysis depedent, guy comes in via EMS on NRB breathing at abotu 40, one word dyspnea. I look at the guy's neck and he has a nice fat trach scar there, well healed.

Nice. Thanks. How much do I get paid? :)

Q
 
DrQuinn said:
My first patient as a medical student in M1 year was a really hot 22 year old female with a sore throat. I had absolutely no idea what I was looking for or looking at, so she probably thought I was the biggest dork on earth. Plus I had the stylin' hot short labcoat.

First patient as an ATTENDING was a 50 some year old AIDS patient (CD4 30s), CHFer (Class 4), COPD (on home o2), ESRD dialysis depedent, guy comes in via EMS on NRB breathing at abotu 40, one word dyspnea. I look at the guy's neck and he has a nice fat trach scar there, well healed.

Nice. Thanks. How much do I get paid? :)

Q
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haha, yeah the short white coat is very 'studly'. Especially when you dont' know anything and shine the light around in the mouth like you know what you're looking at.
 
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My first was pretty boring in retrospect, but exciting at the time. We had ~ 60 yo female with chest pains come in, pmhx of angina. Pain was relieved with 2 sprays of nitroglycerin. :sleep:
At the time though with absolutely no experience, I was thinking more to the tune of "OH MY GOD SHE'S GONNA DIE!!!" :scared:
 
My EMT-Basic program made us hang around the ER before we could begin our ambulance student rotations. Since we were pretty much useless at that point in our EMS education, the nurses would ask us to take patients to X ray, fetch blankets, etc.

My first night, a nurse ask me and another very female EMT student to help a patient from his bed to the bathroom adjacent to his room. The patient turned out to be a ~ 50 year old male wearing red nail polish with weaping cellulitis all over his body and cheif complaint "I'm incredibly horny".

Begin a good little student I asked him to elaborate at which point he growled "look!" lifted up his gown and revealed that his testicles were each the size of a cantalope. :eek: This presented a problem as when we tried to help him pivot off his bed to stand up, he would scream (loud enough for the entire ER to hear) "Sweetheart, you're yanking on my balls!"... "honey, easy on the balls!"..."Can't you girls treat my nuts more gentle-er!!!"

We finally get him off the bed, help him over to the bathroom, close the door and tell him to let us know when he's finished so we can come back in. A few minutes later he screams "I'm ready for ya". I made the mistake of walking through the door first where I saw that he had peed all over himself, the floor, the walls and then took aim and peed on me :mad:

Lesson learned: If you can't/ don't want to use a urinal, the alternative is a Foley and always always always bring a change of clothes with you
 
DropkickMurphy said:
Suffering from insomnia as I do, I have been trying to think of something to occupy the next few minutes and I thought it would be interesting to hear everyone's stories about the first patient they ever treated. So here's mine to get everyone started

It's often said that EMT's meet people by accident, but I stumbled across this career field by accident. I never intended, desired or even considered a job in the medical field growing up- my plans were to become a Presbyterian minister. Growing up in a very rural part of Indiana, it's not easy to get around until you turn 16 and can drive, but my friends and I were bound and determined to not let that stop us from going where we wanted. The summer after I turned 15, I must have rode the equivalent of the Tour de France back and forth to my grandparent's house (which was nearly 30 miles away from my parents house).

One afternoon my friend Justin and I were out riding and we heard a loud crash, breaking glass, rending metal. As we went to investigate the sound we found a car that had hit a telephone pole. Being inexperienced and not knowing any better we walked up to the car not realizing how bad things were- the starred windshield, the bent steering wheel, the combative drunk guy in the driver's seat. My mother had insisted that I carry a first aid kit with a couple of gauze pads, some gloves and band aids. I put gloves on and climbed into car, and told the guy to hold still so I could stop his head from bleeding. The response was less than positive- if I recall correctly my mother's virtue and the word "f--k" featured quite prominently. It became apparent the 4 gauze pads wasn't going to cut it for the gaping wound on his head, so I wound up pulling my t-shirt off and holding it to his head. Justin grabbed him by the shoulders and held him in the seat.

A few minutes later, the ambulance arrives and out climbs my cousin Danny. I had forgotten in the excitement that he was a paramedic and I've never been that happy to see someone in my life. He took over and I got out of the way. Needless to say I hightailed it away from there, and headed towards home, but as I walk through the door my mother stops me and goes "What did you do?! Danny just called me....something about a car accident. He wants to talk to you. Give him a call." To make a long story short, he told me thank you for stopping to help and that we had done probably kept that guy from being in a wheelchair. It turned out he had "broken his neck" (to use the term Danny used, to be honest I don't know any specifics) and if we hadn't kept him down in the car, things would probably have been a lot worse. He encouraged me REPEATEDLY over the next few months to take a first responder class because he thought I had a knack for this type of thing and I finally did to basically shut him up. Needless to say I fell in love with it.

I've never had the heart to tell Danny or anyone that the only reason I was holding his head and trying to stop the bleeding was because I was getting nauseous at all the bleeding and I wanted to make it stop before I threw up. The reason I left so quickly was so I didn't puke in front of Danny. What a glorious way to get into the business eh? :laugh: :laugh:


Anyone else have any good stories about their first EM patient?
Click to expand...


Where is Panda Bear, we know from his personal statement his first patient was his mother when he was coming out of the womb (where he threw in two or three quick lac sutures when he came out into the world) haha still makes me laugh that personal statement!
 
My first pt as an EM intern was a belly painer who pulled his IV and eloped while I was working up my 2nd patient. My residents said that was strong work for a newbie. ;)
 
My first day on an ambulance was rough. First call, two minutes after shift started, was a woman who died in her sleep.

The second call (my first official time of patient care) took three helicopters, five ambulances, and three fire engines. My patient had an open tib/fib through an an approx 2"x4" open wound where I could appreciate some lower limb anatomy :D, shattered ankle, and a tennis shoe full of blood. He was stable, but the shocker was pulling up to the scene with bodies everywhere.
All because of a lady on a cell phone while driving, one died (diaphragmatic tear I heard later), one paralyzed, one crushed pelvis, my patient won't ever walk on that leg again, and one completely unscathed. She wasn't wearing a seatbelt and came from the back of a suburban to eat dash. Not a thing wrong with her. :confused:
And it was my patient's friend that died. :(
The day didn't end there either.

My nickname started to be "Dr. Death". I blame the fire chief who, shortly before the call said, "It's been quiet lately. We haven't had to use our extrication equipment in a while."
 
Hell, I've earned the nickname "**** Magnet" or the "MCI Magnet" because I have a tendency to be around when mass casualty incidents occur
 
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DropkickMurphy said:
Hell, I've earned the nickname "**** Magnet" or the "MCI Magnet" because I have a tendency to be around when mass casualty incidents occur
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"Oh, I heard Wackie's on shift. I'm going to swerve into a ditch and take out a few others while I'm at it. It'll be fun!"

It sucks when you have a headache.
 
Wackie said:
"It's been quiet lately. We haven't had to use our extrication equipment in a while."
Click to expand...
NO! Never say the 'q' word! I'm serious, the second you say it, a person will instantaneously walk through the sliding doors of your emergency department. And then 5 more will come in after the first one. And then another 15 more. It never fails.
 
DropkickMurphy said:
Hell, I've earned the nickname "**** Magnet" or the "MCI Magnet" because I have a tendency to be around when mass casualty incidents occur
Click to expand...
It seems to go in cycles for me. One month I will have a dark cloud over my head and **** hits the fan when I'm on shift. The next month, it is frightingly quiet.
 
My for EMS patient was a 70's YOF who fell out of bed a local nursing home later turned dorm for the college I went to at the time. That night we ran about five calls in six hours and I thought to myself "wow, but what the heck was I thinking?".

First clinical rotation patient for medic school in the ED ended up being some crack head who tried to elope without his shoes. Lets just say welcome to the city.
 
My first patient during MS1 year was a 4 year old bronchiolitis.
I can't remember my first patient as a tech. I remember there being a code that night though, and I remember learning CPR on a recently deceased patient.
 
My reputation as the reigning local **** magnet was sealed the first day of my EMT-I clinicals......25 calls in in 24 hrs, including 4 FDASTW's.
 
My first patient (on my own) when I was a phlebotomist was a fairly large guy who knew he had no veins. I didn't want to ask for help on the first one I was allowed to try on my own, so I acted like I knew what I was doing (mistake 1). Anyway, I knew about where the veins should run, so I stuck the needle in praying for blood. Somehow, I actually got the blood. I was pleased, but then thought maybe that was normal, so I told someone about it. Their response was "I've been here for years and haven't been that lucky." Made me smile :)

As for my first patient as a med student, I was helping with a race. The first to come up and need bandaging just had to be a physician, of course. At least he was nice and told me it didn't really matter how well I did because he just needed something to get him back home to fix himself up.
 
GeneralVeers said:
At some hospitals (Duke) they make interns wear a short coat as well.
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And the surgery interns (and PGY-2s) have to wear white pants. I know these kinds of things shouldn't matter but it's humiliating, walking around looking like the ice cream man.

We didn't have to wear the bitch coat at teh Family Medicine Clinic and on a few rotation but I wore it all all the time because it was too much of a pain keeping track when it was expected and when it wasn't.
 
GeneralVeers said:
At some hospitals (Duke) they make interns wear a short coat as well.
Click to expand...

I think wearing labcoats should be banned! It only attemps the patient to want to "touch" and "do" things to the doctors.
 
Anuwolf said:
I think wearing labcoats should be banned! It only attemps the patient to want to "touch" and "do" things to the doctors.
Click to expand...
Speaking of banning...... :rolleyes:
 
My first patient as an EM intern (aw just a couple months ago - and already the jadeness has set in) Drunk homeless guy who got the f^#* beat out him and comes in screaming and agitated. They bring him in as only a level 3 trauma and he comes to EM side, not trauma. I ask some questions, but quickly becomes apparent that is useless, so I ask the paramedics a couple of things and then yell at the guy to calm the F^#* down. He quites down a little and I go to examine him, and the sneaky bastard flails his arm and smacks me in the face, it really only hurt my pride, but I am uber pissed now, so in comes the haldol, ativan and wrist restraints. He has a bunch of lacks and eccymosis with sh^* all in them on his face and head.
I finish, primary survey, things are okay, secondary survey with multiple facial lacs (one on forehead I explore - not the best idea in retrospect) - there's skin, there's galea, there's bone, there's broken frontal sinus, there's brain, there's CSF on my glove - oh sh^#. Face is crunchy on zygoma and maxilla and nose. Neck is tender at c2-3, ribs tender on right, left wrist with swelling and tenderness (we took retraint off that one);)

Turns out - subdural bleed, open skull fracture, c2-3 fracture without cord impingement, B broken maxilla, L orbital fracture, broken ethmoid, broken jaw, right T6-7 rib fractures, pnuemothorax on R, smith fracture type II on L wrist, TB on CXR, phimosis of foreskin (found that out after trying foley.)
I had to consult Nuerosurgery, ortho, plastics, general surgery, Infectious disease, and Urology.

As patient was stable and as I was his resident I got to make dorsal slit of prepuce for phimosis, help put in chest tube, intubate, put in central line and reduce wrist. ALL this under C-spine and TB precautions.
Welcome to St. Louis Dr. Mishka!

I did a follow-up case on him recently and he lived, I couldn't believe it. And I was shocked to see him again this month alive and ticking and he came in for appendicitis, what an unlucky bas#^$*. He is still alive and kicking though, he is like a cockroach, you just can't kill him!

The Mish
 
Apollyon said:
Your information is partially out of date. The EM interns (since last year) get to wear the long coat.

It's not uncommon for medicine to wear the short coat for interns (or the whole program, at that).
Click to expand...

Still it represents a culture of arrogance and humiliation that shouldn't exist. I don't even think med students should wear the short coat.

Personally I never wear any white coat unless I'm told to do so.
 
With or without a coat, you can still pick out who's a doctor and who's a nurse. It's by the way they carry themselves. Also, doctors tend to tuck their tops into their scrub pants. I'm not sure why, though.
 
Wackie said:
With or without a coat, you can still pick out who's a doctor and who's a nurse. It's by the way they carry themselves. Also, doctors tend to tuck their tops into their scrub pants. I'm not sure why, though.
Click to expand...

Cause we're all geeks at heart. Most of us also pull the scrub bottoms up to the nipple line.
 
I remember my first patient as an emt was a little old lady at a con home found aloc and fever nothing particuraly unique. I do however remember the first code i worked was a 45 yo man with a long cardiac history who also became the first person i saw pass away.
 
GeneralVeers said:
Still it represents a culture of arrogance and humiliation that shouldn't exist. I don't even think med students should wear the short coat.

Personally I never wear any white coat unless I'm told to do so.
Click to expand...

I think you put too much value on it (sort of). The long white coat is earned, just like the butter bar, or captain's bars, to oak leaf, to crow.

The short coat as "arrogance and humiliation"? I think that humiliation is more aimed at the person in the coat, versus the person wearing the coat (i.e., no matter what a person was wearing, if they are going to be humiliated, it will happen - if it's generally aimed at students or interns, it's nonspecific and generalized, and should be easily recognized as such).

I wear an open collared shirt (usually tropical) and the white coat. It works for me (and I don't even button it, which southerndoc has gradually been conditioned to tolerate without absolutely losing it - that is reserved for stethoscopes around the neck).
 
All this stuff about short and long coats is strange to my Canadian self. At least in the EDs around here, only a few of the EPs wear coats and usually the medical students and the majority of the staff come in a casual shirt and khakis or something similar. The only other people I notice who wear the white coats all the time are the male nurses.
 
Just like with Sphincter, the first patients I saw were on the night I spent shadowing in the ED for my EMT course.

There was a trauma patient who spoke Spanish only, and the resident spoke only en poquito de Spanglish. Hearing him explain the Foley was an education: "necessito... un tubo, in su pene..." To which the patient said, with a perfect cartoon-stereotype rhythm and tone, "ohh, noooo..." And because I was standing waaay in the back and had no responsibilities, I was the one to notice the Foley, once it had been placed, was now slipping out... as if in slow motion... I said "the cath! The cath!" but it was too late. So the poor guy had to be re-Foleyed. Knowing what I know now, the resident had completely neglected to inflate the balloon, so maybe I was not the most clueless person in the room (relative to training).

There was a teenager who went over the handlebars of his 10-speed and needed sutures to his face. I got to help a med student by suctioning the saline that dribbled down the kid's face so the basin didn't need constant re-emptying. I also dabbed blood and saline out of the kid's eyes. I screwed up the sterile field when I grabbed 2x2s from the pile, but I also talked to the kid, calming and distracting him, and demonstrated my knack for bedside manner. So essentially nothing much has changed in over three years. :D
 
I can't honestly remember my first patient. I do, however, remember something about my first run as a paid paramedic.

My pager went off about 2 minutes after walking in the station for the first time. We went to a run of the mill MVC. For some reason, I brought out my soon-to-be-trusty LifePak 5 and hooked it up to the patient (did I mention I was really new at this stuff?). We prepared to move her out of the car and I unhooked the monitor, 'temporarily' placing it in the backseat of the car.

As I was in the ED working on paperwork, my partner asked me where the monitor was. Oh, what a sick feeling that brought.

Take care,
Jeff
 
Jeff698 said:
We prepared to move her out of the car and I unhooked the monitor, 'temporarily' placing it in the backseat of the car.

As I was in the ED working on paperwork, my partner asked me where the monitor was. Oh, what a sick feeling that brought.
Click to expand...

I, likewise, have forgotten all of my "first patients", but, I do have a question - ever take a call without the stretcher? I have - 3 times...including a 20 y/o female abdominal pain.

Eh, what can you say?
 
Apollyon said:
I, likewise, have forgotten all of my "first patients", but, I do have a question - ever take a call without the stretcher? I have - 3 times...including a 20 y/o female abdominal pain.

Eh, what can you say?
Click to expand...

Twice (**Cringes**)

The first, an assault. My partner opens the doors and bursts into laughter...I looked in and recalled thinking "Something is wrong with this picture". We hoped that the patient didn't notice the ambulance was extra roomy. The second... chest pain at a local rest home. I wanted to cry. Could not deny it, I had to call another unit. I even wrote myself up...

Note to self: Never close ambulance doors without a stretcher in back.


(I thought I was the only one that remembered the LifePak 5...what a marvel of technology that was...)
 
Of course, in retrospect, it's not all that bad. I had a coworker that forgot his drug bag on a trauma arrest...hehehe. Radio call: "Ummm, we're having technical difficulties with equipment...can someone meet us enroute?"
 
a_ditchdoc said:
Of course, in retrospect, it's not all that bad. I had a coworker that forgot his drug bag on a trauma arrest...hehehe. Radio call: "Ummm, we're having technical difficulties with equipment...can someone meet us enroute?"
Click to expand...
We would have just called it.
 
Apollyon said:
ever take a call without the stretcher?
Click to expand...

Yup. When I worked in Yonkers, some of the other crews thought removing the stretcher (or hanging it from the oh **** bar on the ceiling) was a great innovation in the ongoing "ambulance wars".

When it was hanging from the ceiling, it became pretty obvious, pretty quickly. I didn't notice that it wasn't there anymore until I arrived on the next scene.

Yeah, just a little embarased.

Take care,
Jeff
 
a_ditchdoc said:
I had a coworker that forgot his drug bag on a trauma arrest...hehehe.
Click to expand...

We used to carry our narcs on our belt. I can't remember how many times I was already at home (45 minutes away) when I realized I still had my narcs with me. Groan. Back in car....

Take care,
Jeff

PS, I still love the LP5. Distant memories are always so much better than reality!
 
Apollyon said:
ever take a call without the stretcher?
Click to expand...



Ever on a call and have the stretcher stolen? :mad:

At a MCI, get the patient on a backboard, pick him up and..."where's the f-ing stretcher?"

We carried the bastard to the truck to treat him. Eventually, had to break apart the team to go find our stretcher. On scene time was 33 minutes. :mad:

One of the fire fighters took it. "We needed it" *shrug*

Oh, and we didn't?
 
Wackie said:
Ever on a call and have the stretcher stolen? :mad:

At a MCI, get the patient on a backboard, pick him up and..."where's the f-ing stretcher?"

We carried the bastard to the truck to treat him. Eventually, had to break apart the team to go find our stretcher. On scene time was 33 minutes. :mad:

One of the fire fighters took it. "We needed it" *shrug*

Oh, and we didn't?
Click to expand...

That's why they drilled it into our heads - "ambulance, driver, stretcher" - never, EVER separated.
 
Ever lock yourself out of the cab of the truck while on scene?

We have Fraizers (with the teeney tiny window connecting the cab to the back) and if someone accidently hits the autolock button while getting out of the front, there's no way to unlock the doors from the back. :oops: (we leave the truck running and the keys in the ignition while on scene)

We tried to reach the unlock button by sticking splints etc through the window, but nothing was quite long enough. Ultimately, my partner had to distract the patient while I (not so gracefully) wriggled through the window...
 
I, however, do not have such fond... or distant... memories of the LP5. A private ambulance company I worked for used the LP5 up until only 2 yrs ago. Going from LP12 at my county job to that hunk of **** kept me grumpy on many a mornin'. The only reason why the company finally invested in LP12s is because all of us medics got together and threw a coup at 4 straight staff meetings. Two medics even got permission to take LP12's from the county and used them at this other company for about three months before THE GREAT SWITCH OF 2004.
 
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