Everyone in the field knows how this goes.....Source.....Story from a Louisianian Paramedic....

P.S. Some naughty words,integral for verite. If your delicate sensitivies just can't withstand that sort of thing, stop here and GET OFF MY BLOG.

Punitive Advanced Life Support

"Aaaaauuuggggh! I'm dyin'! You muhfuckas got to help me!"

"Easy enough to do," I sigh. "All you have to do is stop screaming and tell me what's wrong."

"My muhfuckin' chest hurt, Goddamnit! Auuuuuuggghhhh! Mommmmmaaaa!"

"Tell me more about this chest pain," I prompt, but he ignores me, writhing on the stretcher and crying piteously. For someone insisting that he can't breathe, he sure has a good set of lungs on him. For a man whose heart is threatening to explode, his skin signs and color certainly don't reflect it. His blood pressure is better than mine.

"So tell me the story again," I order the guard perched on the squad bench beside me, watching the entire scene with resigned indifference.

"He'd just been brought in for processing," the guard explains. "busted by the SO on possession of drug paraphernalia and resisting by flight. We brought him through the south sally-port, and it was kinda busy, and he asked to use the bathroom."

"And you let him?" I ask incredulously. "Unescorted?"

"Hey man, we were busy and there was no place he could go," the guard protests. "So we hand him a jumpsuit and tell him to have at it. Anyway, he's back from the bathroom about ten minutes and he starts breathing funny and grabbing his chest. Then he fell out on the floor having a fit."

At the mention of the word fit, the prisoner's eyes immediately close, and his limbs start bucking. His back arches, and he writhes against the handcuffs and leg chains. He whuffs like a dog and spits foamy white sputum all over the front of his orange jumpsuit. I ignore him and casually put my hand on his chin, directing his head - especially the spitting part - away from me.

"And what makes you think he swallowed the drugs?" I ask, rolling my eyes.

"Told us he did. All the time he was rolling around on the floor having the fit, he kept saying, 'I swallowed the whole bottle.' That's all he'd tell us."

"Didn't anybody fucking search him before you turned him loose?" I explode. By way of reply, the guard shrugs in embarrassment, and then his eyes widen in fear.

"Holy shit, he's pissing on himself," he moans in disgust, backing away down the bench seat. "It must be the real thing, then. They say you piss yourself when you're really having a seizure."

"Not this time," I grunt. "Most seizure patients don't have the capacity to work a zipper and whip it out of their jumpsuit first, much less aim it. They don't usually close their eyes in a real seizure, either." I pick up the stethoscope - the unit scope, not mine - and whack the guy firmly on the dick with it. He yelps in pain and drops his talleywhacker and resumes calling for his momma at the top of his lungs.

I strap a non-rebreather mask to the kid's face, intending it as a dual purpose oxygen delivery device/spit-shield, and he snaps at my fingers as I cinch the straps tighter.

"Get over here and re-position these cuffs," I order the guard. "Don't give him enough slack to do that shit again."

"Uh uh," the guard demurs, holding up his hands. "I got no gloves."

"There's a box of extra-large gloves on the seat right behind you," I tell him mercilessly. "Put a pair on and help me out." Again the guard shakes his head, no.

"Dude," I threaten quietly, "either you fucking help me out with this guy, or so help me God, I'll aim his dick for him. And I hope he pisses all over those action adventure britches you're wearing."

Swearing under his breath, the guard gloves up, gingerly tucks the prisoner's johnson back into his jumpsuit, and moves the handcuffs to a point further down the stretcher frame, glaring at me all the while.

"Mommmmaaaa! The muhfucka's killin' meeeeeee! Mommmmaaaaaa! My muhfuckin' chest hurt! You gotta give me somethin'!" The prisoner kicks his legs, finding enough slack in the leg chains to make contact with the guard's left elbow as he kneels on the foot of the cot.

"Sonofabitch!" the guard swears, clamping one hand on the kid's shin and another on his thigh. He knees the kid viciously several times in the side of his thigh, just above the knee in a perfect common peroneal strike, and just like that the kid stops kicking. Even though his leg is dead for a few seconds, it does nothing to slow down his mouth.

"Muhfucka stop kickin' me! I need muhfuckin' help, and these muhfuckas beatin on me! Mommmmaaaaa! Mommmmaaaaaa! I ain't resistin'! I ain't resistin'!" the kid screams at the top of his lungs, all the while resisting like wildcat getting a turpentine enema. "I'm gone die, and these muhfuckas ain't did nothin' to help meeeeee..."

"FOR THE LOVE OF PETE, SHUT THE FUCK UP ALREADY!" I bellow, my temper getting the best of me.

The kid doesn't shut up, but he does quiet down enough that I can hear myself think.

"Last chance, kid," I offer, leaning over him, speaking softly in his ear. "Man up and tell me what the fuck you took, so I'll know what medicine to use to make it better."

"Don't know what it was," he moans, shaking his head wildly. "My bro just said, 'throw it out the car', but I couldn't even get da fuckin' window down, man! I didn't want 'em to find it on me!"

"So you swallowed the whole bottle while you were in the bathroom, is that it?"

"And I flushed the empty bottle down the commode," he confirms, tears streaming down his face.

"Jesus," I shake my head, "and it didn't occur to you to just flush the pills, too? What's your name, dumbass?"

"Dontrelle," he answers, panting like a Saint Bernard in August. "Man, you muhfuckas gotta help me! My chest be hurtin', man!"

"No shit, really?" I ask, feigning astonishment. "You think that might be because you swallowed a whole buncha pills? What were they, speed? Come on man, be honest. Your life might depend on it."

"Don't know," Dontrelle shakes his head. "Mighta...mighta been crack."

"Mighta been, or was?" I press. "Come on, Dontrelle. Pretty easy to tell the difference between a crack rock and a pill."

"Crack rocks, man," Dontrelle whimpers. "Bunch of 'em."

"Like how many?" I ask, eyeing the cardiac monitor. His heart rate is 160, but his blood pressure is still 130/88 - not bad for someone who swallowed a handful of crack twenty minutes ago. Dontrelle mumbles something I can't quite make out between the moans and pitiful whimpers. I lean close over his head and lift up the oxygen mask so that I can hear what he is saying...

...and the little bastard horks up a big loogie and spits it right on the side of my neck.

I recoil in disgust, and try to pull away, but he has managed to grab my right hand where it rests on the stretcher rail, and he clamps down, viciously digging his fingernails into the back of my hand.

Gritting my teeth, I calmly sit up, fish around with my left hand on the suction shelf and pull an antiseptic towelette from its canister, and wipe the loogie off my neck. Then, I reach over with my left hand and grab Dontrelle's right hand, thumb planted firmly in the back of his hand, fingers buried in his palm.

I twist counter-clockwise, and keep twisting until his grip loosens and he starts squealing like a little bitch. I keep twisting, holding his hand there, taut against the handcuffs, and nod to the guard. "If you're through sitting there with your thumb up your ass," I tell him solicitously, "perhaps you'd like to take the slack out of the cuff on this arm, too. We've got another five minutes before we're at the hospital, and I'm thinking little Dontrelle could use some medicine."

Flashing me a dubious look, the guard grabs Dontrelle's wrist and moves the other end of the cuffs down the stretcher frame to a position matching that of his left arm. I dig through my ALS bag and pull out the EZ IO - a little drill that we use to insert a large needle into a patient's tibia, in the event that all of their veins have collapsed. Putting the needle in isn't all that painful - I've volunteered for it myself - but flushing the fluids through it will make you suck the stretcher sheets right up your ass. We normally deaden it with lidocaine to blunt that pain, but I'm thinking I'd rather not risk it.

Dontrelle's not the most reliable historian, after all, and he might be allergic to lidocaine.

"Hey Dontrelle," I call cheerfully, "help is on the way, man." I lean over him and rev the drill several times, giving him my best sadistic dentist leer. "I'm gonna give you some medication that will make it all better - for me, anyway."

"Hey man, I'm sorry," he whimpers. "I di'int mean nuthin' by it, man. I can't do needles."

"That's okay," I assure him, "because I do needles very well. Just lie back and try not to scream too loud."

"Hey man, please don't...aaaaaaauuuggghhh!" he screams as I bury the spinning intraosseous trocar into the bone just below his knee.

"Did that hurt?" I ask. "Scale of one to ten, how bad?"

"TEN!"

"My friend," I assure him, "you're about to experience a new frame of reference for what a ten is." I attach a saline lock and flush the intraosseous line with twenty milliliters of saline.

"Aaaaaaaaaaauuuugggghhhhhh, Gawdamighty please stop!"

"I'm guessing we have a new record on Dontrelle's personal Worst Pain Ever scale," I observe mildly. "If you want sympathy, Dontrelle, you can find it between shit and syphilis in the dictionary."

"Please man, don't do this to me!" he begs. I'm an evacuee, man! You can't be treatin' no evacuee like this!"

"Waaaaaaahhhh," I sneer. "Mean old Gustav and Ike turned me into a dumbass crack dealer. The hurricanes made me do it! I can't collect my FEMA check in jail! Waaaaahhhhh...."

"Man, make him stop," Dontrelle begs the guard, who is suddenly engrossed in studying his fingernails. "You can't let him do this to me, man! He violatin' my civil rights!"

"By rendering medical care?" the guard yawns disinterestedly. "I ain't seen nothin'."

"You got any next of kin, Dontrelle?" I ask idly, drawing up 100 milligrams of succinylcholine into a syringe. "A mother who'd miss you?"

"Yeah, I got family, man! I got a girlfriend and a baby on the way!," he blurts, eyes widening in terror. His voice rises into a high-pitched, desperate scream, "I got a baby on the way, man!"

"Then that makes this much easier," I tell him as I inject the succinylcholine. "Better to have no babydaddy than to have one at home slinging rock." I reach for a vial of Versed, but think better of it. I want him to be wide awake for this.

Dontrelle's scream dies in his throat, and the muscle fasciculations start a few seconds later. His arms and hands twitch and the muscles of his thighs writhe like snakes, then go altogether limp. His chest stops its desperate heaving, and he exhales his last breath in a long, gentle sigh.

I lean over his face and stare at the peaceful expression. Only his eyes have life now. The paralytic has denied him the use of his extraocular muscles, as well as all of his skeletal muscles and his diaphragm. He lies there, eyes staring straight ahead, limp as a dead man.

But he's not dead. He's still wide awake.

I watch the heart rate rise inexorably on the cardiac monitor, no doubt due to fear and hypoxia. Perhaps pain, too. If he really was having chest pain, it has to be excruciating now, what with no breathing to suffuse his blood with life-sustaining oxygen.

"Dontrelle Mayeux," I intone softly, mockingly. "Twenty-three years old, died of sudden cardiac arrest secondary to cocaine-induced excited delirium. Paramedics tried heroically to revive him, but to no avail. Toxicology results showed high levels of cocaine metabolites, along with a slightly elevated serum potassium and elevated myoglobin levels indicative of skeletal muscle damage - all due no doubt to Dontrelle's physically combative state immediately prior to his arrest. Dontrelle is survived by a mother, girlfriend and an unborn child, and will be missed by...absolutely fucking no one."

I lean over him and stare into his eyes, dangling a bag-mask resuscitator just over his face. "You're probably really wishing you could breathe now," I muse. "You're probably wondering how, if you had a second chance, you could avoid being such a worthless asshole. Well, I got your second chance right here, Dontrelle. One second chance to..."

"...worthless little bastard would have never gotten a second chance with me," Bitchy Partner is saying. "I don't see how you keep your temper, AD."

"Huh?" I blink. "Sorry, I didn't hear what you were saying."

"I was saying how I don't know how you keep your cool when those little thugs are screaming and acting out like that," she repeats, rolling her eyes. "They get only one chance to behave themselves with me. I don't give second chances. But you roll them into the ER like that punk, cursing you like a dog, and you don't even act like it bothers you."

"Uh huh."

"You weren't even paying attention, were you?" she accuses. "You've been sitting there this whole time, staring off into space with that goofy grin on your face, and you haven't heard a word I said!"

"Sorry, BP," I smile apologetically, absently massaging the claw marks in my right hand. "I was just doing a little daydreaming. You were saying how much you admired how I can keep my cool?"

Hits home. I was a paramedic for a few years. You get to see the best and the worst of people night after night. Usually the worst. Glad I'm out.