View allAll Photos Tagged 140bpm
Wednesday morning we walked 3800m using our clockwise route over Mt. Tolmie. Got the heartrate up to 140bpm at times so that's cool.
That's what Victoria's foremost heart specialist told me after my MI (that's a myocardial infarction to you lay people) in 2000:
"All you have to do is get out twice a week and get your heartrate up to 120bpm for twenty-minutes."
That's what we've been doing these past 16 years.
Well I was taken to the hospital last night around 4:30. terrible night. Woke up not being able to breathe and my heart rate over 140bpm. So I was taken to the hospital. The paramedics were worried about my heart rate being so high.. This has been , by far, the worst anxiety attack I've ever had.. I did manage to force my heart rate into the 80s/90s. Still not feeling so good. I'm going to take a break from everything.. I hope you all have a good day and have fun building!
-Joe
Our trauma MCQ is...atraumatic. The mocks that we've been given beforehand have armed us well, gaps in knowledge have been identified and plugged, foibles of the IHCD's questioning techniques are noticed and artfully sidestepped.
Our running order for the practical final exams are posted in the classroom, we gather around like high school students.
My name is second last.
That's going to be a long wait.
We drink coffee and slide headphones into our ears. There is nothing to be gained by questioning each other, chatting about possibilities, or dissecting each others' experiences. Music shuts it out and as long as we're ALL listening to music, nobody feels abandoned.
We all listen to music.
Kappa is called in for her first practical and returns after 14 minutes (yes, I'm sure, we record the times).
"Piece of piss."
Kappa is not the most confident student in the class. This is something of a revelation.
"For real?"
"For real. He never even asked me any theory, I was all ready to talk him through different presentations of shock and stuff when he went "Right, there's the boy there, it's a stabbing.""
An electric thrill zips through us all; no theory? A simple stabbing? Fantastic! 'Mon the schoosh.
We've been told to only return to classroom to collect our books once we've been assessed, so our numbers gradually dwindle. Midge, Stingray and I practice quietly in the corner while others read. I start making stupid mistakes, forgetting to perform the most basic checks, over complicating my treatment, getting ahead of myself.
Granny Chan pulls my shoulder away from the dummy andsets me straight.
"You're over practicing. Stop it. Chill out."
Headphones back in, Fratellis on. I stare out the window at the rabbits on the front lawn, my shoulders and head popping up and down. Holiday makers stare up at the window, bemused by the jigging ambulanceman.
Pumped up and ready, one of our tutors calls me through.
"The consultant's having a wee break, so I'll be running this one."
Even better news! This tutor has winkingly mentioned that he "Doesn't fuck about." with his scenarios.
"Nae drama, right?"
I nod.
Into the exam room, a plastic dummy on the deck, our instructing consultant sits at the top table. He was friendly and chatty and receptive on Monday, so I flash him a smile and greet him warmly.
He nods stiffly, returning to his paperwork.
Oh.
Exam mode, then.
"Right Kal, you're called to a firearms incident - I'm an ARU copper."
I get him to explain what's happened, a simple enough situation on the face of it, an eighteen year old male shot in the chest. Police don't have any further information, but are out looking for the gunman.
The patient is supine, not moving but making gurgling moaning noises . I clamp both hands over his ears to protect his C-spine and in the same breath get a cop (disguised as my tutor) to take over for me. I'm buggered if I'm spending the entire scene holding the punter's head still. The airway's full of blood, but it's nothing a little suction doesn't clear and I teach the cop to perform a jaw thrust on the patient. The gurgling stops and I'm able to move onto the breathing assessment.
Central trachea, distended jugular veins, 40BPM, shallow and irregular; far too fast to inflate his lungs properly and supply oxygen to his lungs. I shove a mask over his face and squeeze oxygen into him.
But now I really AM buggered.
Looking up at my tutor and the consultant, I shrug -
"I can't go beyond breathing. I need back-up to transport him and without another medic on site there's little I can do beyond here."
My tutor disagrees.
"What else can you do?"
I'm staring down at our four hands on the patient's head and face.
"I suppose I could teach this cop how to bag the patient..."
"Or you could find another way of immobilising him."
"Ummm...yeah, I suppose."
There's a beat while they wait for me to speak, my instructor takes pity on me.
"What's the most definitive C-Spine care?"
"Board, collar, head huggers and straps. But we can't do that with two people, we need a whole crew."
"Right. Ok. Let's say you've done that and he's on the board."
Eh? I'm not sure how the patient has magically levitated onto a spinal board, but I'm not about to look a gift horse in the airway.
"Cool. I'll teach this cop how to bag the patient and move on."
As I strip the patient's chest there's a small entry wound over his left nipple which is bleeding a little, but he's otherwise unscathed. I push his ribs and sternum together to no effect, but when I listen to his air entry there's nothing but dull sounds and gurgles in his left lung.
His chest is filling up with blood.
There's nothing I can do in the field to deal with a haemothorax, so my next step is circulation. The bloke's pale and sweaty, with a radial pulse at 140bpm. Too fast, but still producing enough pressure to perfuse his brain and kidneys. I prod and flex his belly, pelvis and long bones and confirm once more that there's no massive blood loss onto the floor.
The tutor shakes his head - "Nothing to note...but his crotch is wet."
Right, maybe he's bleeding from his genitals, or his arse, maybe he's been shot in the gut and is bleeding out through an orifice. Maybe I've missed a wound.
Or maybe....
"Blood, or urine?"
My tutor laughs.
"Looks like urine, smells like urine..."
"Probably urine then, huh? Well...he's 18 and he's just been shot...I'd say that's an appropriate response."
There's a snort of laughter from the consultant.
"Right. So he's got a diminished GCS, his airway's safe, his breathing's supported by the BVM, he's got a developing haemothorax but is otherwise stable. I'm going to reassess him from the top while I wait for my transport."
I do so, finding nothing. I'm beginning to run out of things to say.
"Let's have bilateral wide bore cannulae, just in case he loses his pressure..."
They both just stare at me.
"And...ummm...since I'm waiting for my transport, I'll get my Lifepak out and get a full set of obs. ECG, BP, SpO2, BM."
"His ECG is sinus tach at 148, his BP is 70/40, SpO2's 97% and his BM's 4.3"
"BP's down to 70/40?"
"Yup."
Right. I'm fully expecting him to have lost radial pulses, but still assess him starting at "response", working my way down.
He still has a feathery pulse at both wrists.
Shit.
Our aim in giving IV fluids in trauma is to maintain a systolic BP of 90mmHg. Below that your radial pulses vanish and as such we use this as a quick way to assess a patient's circulatory capacity.
This patient has a crap BP, but present pulses.
Yesterday I over infused a patient because I cocked up my assessment.
I'm terrified of doing the same thing today. Just for something to do while I think, I confirm a carotid pulse as well. My tutor just stares at me, I'm sure it's only his professionalism that stops him sticking his tongue into his lower lip.
Fuck it. He's losing blood, as I ausculate his left lung its now completely dull, all gurgles are gone. He's pissed a good couple of litres into his chest.
All or nothing time, I squeeze saline into his veins, 250ml at a time. A litre of fluids later he's still not responding. His BP still crap.
"You did say he wasn't lying in a pool of blood, right?"
"Yup."
This is weird, so I strip the patient right down, confirming that I've not missed any other injuries.
My tutor cuts in.
"The police say they've found a 9mm casing on scene. What does that tell you about the type of weapon he was using? A rifle?"
All I can think about is Schwarzenegger talking about uzis. They're not rifles, are they? Are they?
"That would be a smaller weapon, a pistol, or revolver?"
"Uh-huh. And if the patient was shot at a range of 15 metres with that weapon, what size of exit wound would you expect to find?"
What? *I* don't know! What am I, a fucking siege engineer now?
I plump for honesty.
"I don't know enough about ballistics to answer that question, I'm sorry."
He shrugs.
"Fair enough."
The scenario ends and I hand over to the consultant, summarising the patient's condition and my treatment before arriving at hospital. I try my best to gauge their responses to what I've done, but there's none. Just blank faces and a dismissive "thankyou".
I stomp off around the garden before having my lunch, double and triple guessing what I did against what i think i should have done.
Chan and I are cursing our instructor at the lunch table (she had a similarly grim scenario to face) when he wanders up, slaps us on the shoulder and grins.
"Did you guys enjoy that lot, then?"
Our responses are not recorded, but he shall be known from here on in as..."Uzi".