More Musings

I know I haven't posted in a while. I usually try to post at least once a day.

I came across a couple of sites where you click a link to donate to a cause for free. (I guess the money is payed for by impressions.) Since I'm posting them, there is, of course, a medical theme. I'm not assuring their reliability though. I have no way of checking to see if the donations actually get through, but I figure (hope) they do.

http://www.giveaminute.org/donate1.htm - Donate 1 minute of medical care.

http://www.thebreastcancersite.com/ - Helps fund a mammogram.

http://www.thechildhealthsite.com/ - Helps take care of children and their healthcare.

http://cannecy.free.fr/solar//index.htm - Not sure if it is still active but worth a shot. Can't have a hospital without electricity, right?

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Have duty in another couple of days. The last two calls that I ran included a standby for a fire and a patient complaining of chest pain.

Both were fairly uneventful. Got chewed up by mosquitoes during the fire - eight bites on one arm. Mosquitoes are attracted to the CO2.

I'm tired, I'll post more details later. Goodnight everyone.

Stop Moving!

Good evening, just got back from a call. Kind of funny, kind of bad at the same time. So here's my day:

I'm sitting down in the nice, quiet day room watching TV (Over There) when I was rudely interrupted by dispatch.

The tones go off (sounds kind of like pager tones), followed by a loud beeping, and the lights flickering on and off. Apparently the people that designed our communications system thinks that they can get our attention by making the lights act like strobes and causing us to have a seizure. "Station 8, Station 8, respond for a BLS high priority illness."

I get up, put my boots on and run on out to the ambulance.

Our squad leader calls, "Dispatch, 184 acknowledges, enroute."

Dispatch crackles on the radio, "184 enroute at 1850."

This call is in one of the more remote areas of the county. Even though it isn't that far away, there are no roads that lead directly there. So we're responding code 3 (lights and siren) wondering what exactly the call is for. A "BLS high priority illness" could be anything from a stroke to a cold. A medic was also dispatched, but he was on the other end of the county and would be about 25 minutes away.

We arrive at the residence and go in. The patient is around 80 years old. Our initial impression is a man with a slightly altered level of consciousness (he doesn't even look at us when we walk in) and he is vomiting continuously. His wife hands me a piece of paper and as I look down at it, I read "transient ischemic attacks."

"Oh great," I think to myself. "Ma'am, you're saying he has a history of TIAs?"

"Yes."

"Alright, let's go ahead and get oxygen on him. He's a high priority." I don't take risks when they aren't needed. It's better to let the hospital deal with it as soon as possible than to be wrong and have to worry about it. The altered level of consciousness combined with the vomiting makes me wonder if he's having a real stroke this time. I run back to the ambulance and get one of the firefighters to help me get the gurney. Oh great...the ambulance is at the top of a gravel driveway on the side of a fairly tall hill. Anyone who has ever used a gurney in EMS on gravel, mud, or sand, knows how a farmer in the 1800's felt trying to plow a field. But it's not really the farmer's point of view that one experiences, it's the mule's; as you pull along. the wheels drag themselves deeper and deeper into the mud, until you finally reach the back door with a freshly plowed field behind you. "Would you like us to plant corn or soybeans there?"

Ah, but that's not all, this driveway terminated in a covered shed with a parked car in it. Luckily for us, the car was located in such a way as to almost completely occlude the path into the house, but not enough to keep us from trying. So Bravo, being the kind and courteous person that he is, places himself between the gurney and the car as we pull the stretcher on through. That kind of hurt because the thing kept shifting its weight onto me. I would still do it again though, it saved the car a lot of damage.

But just like a bad infomercial, there's more. At the front of the car is one of those concrete block-type things that you see in parking lots to keep the car from moving forward and just like those, it's anchored in the ground with rebar. We manage to overcome the obstacle course and get the gurney to the patient. It really didn't take as long as I made it sound, this happened over the course of 3 minutes.

We get the patient on the gurney and for some reason or another he keeps wiggling around. Even strapped down he manages to wiggle his way down the gurney. We keep moving him up again and again and he keeps moving down. After a while we manage to get him into the ambulance and begin our transport. He keeps wiggling around and time after time works his way to the bottom of the gurney. He has some aversion to not falling off.

As we're transporting code 3, we continue the ongoing assessment. Pupils are equal and reactive to light. Vital signs are in normal limits. Patient is coherent, but there's still something weird about the situation. He says he just feels bad in general.

We arrive at the hospital, unload the patient, and take him into the ER. We're told by the charge nurse to wait in the hall with him since all exam rooms are currently full. As we wait he's still continuing to move around on the gurney. We move him back up and strap him down even tighter to the gurney.

One of the nurses and one of the physicians came by to talk with us about our patient and various random topics. Then...

*THUD*

Yep, that's right. The patient finally managed to escape the gurney and fell clear off the stretcher. That wasn't the greatest scene in the world. At least both the physician and patient were laughing.

I'm still trying to erase that from my memory.

Goodnight everyone and remember, stay safe.

Quotes and News

"He is the best physician who is the most ingenious inspirer of hope."
-Samuel Taylor Coleridge

"Don't expect to learn about people from books; a person can't fit in a bookcase."
-Unknown

"A milligram of prevention is worth a kilogram of cure."
-John Robert Colombo

WHO declares Tuberculosis – ‘An Emergency’ in Africa

"The World Health Organization (WHO) has declared Tuberculosis as an emergency in Africa. It is killing more than half a million people every year. WHO Regional Committee for Africa comprising health ministers from 46 Member States has declared tuberculosis an emergency in the African region. The deaths have quadrupled in the last few years."

You don't hear about TB too much in America. If it wasn't for articles like this, one would believe that TB no longer existed. When we transport a patient with a productive cough (especially blood) we are required to wear a N-95 respirator to guard against TB. I'm surprised how many patients think that TB no longer exists and that it is a "long gone" disease like smallpox. Wrong.

Study: Newer Malaria Drug Saves More Lives

"LONDON Aug 26, 2005 — Treating adults with severe cases of malaria with the drug artesunate rather than quinine could save tens of thousands of lives in the developing world, new research suggests.
A study reported this week in The Lancet medical journal shows for the first time that artesunate is better at saving lives than the standard medication, quinine, reducing the chance of death from malaria by 35 percent. "

Problem is, Malaria is developing a resistance to quinine and the same will probably happen with artesunate.

Goodnight everyone.

Asystole Study

Found the studies and articles on damage caused by defibrillating asystole,

"...outcomes for asystolic patients had a tendency to be better when the initial therapy did not involve CS." (CS standing for countershock.)

Martin DR, Gavin T, Bianco J, Brown CG, Stueven H, Pepe PE, Cummins RO, Gonzalez E, Jastremski M.
Initial countershock in the treatment of asystole.
Resuscitation. 1993 Aug;26(1):63-8.

And then on: http://www2.nurseweek.com/ce/self-study_modules/course.html?ID=275

"Defibrillating asystole can stun the heart and produce a profound parasympathetic discharge, preventing natural pacemaker recovery and spontaneous cardiac activity.1,3"

1. The Automated External Defibrillator. In: Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiac Care: International Consensus on Science. Dallas, TX: American Heart Association; 2000:161-176.

3. Cummins RO, ed. Advanced Cardiac Life Support. Dallas, TX: American Heart Association; 2001.

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There's also another one, but the website's server is down. But as always there's the chance that it could be very fine vfib in which case the shock is appropriate.

Free Stuff, Surgery, and Rants

Howdy again everyone,

If you're interested in some free stuff, you can get a free sample of the SafeSeal for your stethoscope http://www.safesealdiaphragm.com/free.shtml. It's an antimicrobial diaphragm replacement; kind of important since there've been studies revealing antibiotic resistant bacteria on stethoscopes. I've used it and love it. You can't tell any difference between their diaphragm and the one it came with.

Also been watching some surgical videos: http://www.lifespan.org/staywell/videosurgery.html and http://www.websurg.com/index.php?url=toc/theme.php&s=2&id=2_2_1_1. Nothing like a good appendectomy.

I go back on duty this weekend. The day crew will probably have ER on when I walk in. There's nothing quite as irritating as ER on TV; you can't shock asystole. On ER you can. If you shock asystole the chances of the patient surviving go from slim to even slimmer. But I guess it's more glamorous to defibrillate the patient than to do CPR for half an hour pushing epinephrine and atropine in. Also precordial thumps don't work half as many times as it does on ER.

Apparently the Army and the rest of the armed services are in need of field surgeons. Sounds like I might have a calling. Maybe the Army gives guaranteed med school? I've always toyed with the idea of becoming a field surgeon anyway.

Musings

I just realized something that should be sold, but for some reason or another, isn't. Go to the automotive section of any store and you'll find air fresheners of all types. But there is one scent that is missing. No, not deer urine. Hospital/ambulance scent! I mean, wouldn't you want that smell in your car? I know I would. Some people don't like the smell, but I do. What smells more clean than the smell of a hospital?

I also decided to try another vinyl protectant on my stethoscope. You're supposed to use it to keep the tubing from becoming cracked and dried out. I usually use Armor All but the towels that we have of it are dried out and so I've started using "Nu Vinyl," I think that's the name of it. It seems to do a lot better of a job.

In further news I've added the word verification to the comments section. Sorry, I know it takes longer, but it does keep the comment spam to a minimum and it doesn't add much more time.

Latest Duty

Si hoc legere scis, nimis eruditionis habes.

Don't worry about the quote above. It's just something that I wanted to post.

I just came off duty. Patient complaining of acute abdominal pain and had a cardiac history so we responded code 3 (lights and sirens) to the far point of our distric. Decided to transport the patient. Vital signs were normal (for him anyway, BP was 150/90); many of my patients have hypertension (high blood pressure). Gave him some oxygen for a while, he was vomiting so it was more of blow-by oxygen (where you just hold the mask in front of the face). Other than that, not much happened.

I'll post some more later,
Bravomedic out.

New BVM

I was contacted about a new type of ventilation device which I had never heard of before and am now considering getting. The White Pulmonary Resuscitator (WTR), which has the advantages of a pocket mask combined with an oxygen reservoir. I've always stuck to the BVM because of the fear that when using a pocket mask that the patient will cough up vomitus and get me with it. I've never trusted the filters, there has to be some kind of holes in it and to be able to move air as easily as it does they must be pretty big holes. Not worth the risk.

However, it looks like with the WTR that I can keep my mouth a reasonably safe distance from the patient (trust me, you never want to get your face too close to the patient's face- conscious or unconscious) and if an ET tube is in place then CPR can be done with one person (nice advantage). Another advantage is that like the pocket mask, if you are resuscitating a hypothermic patient some heated (from your breath) oxygen is getting to the patient. Core rewarming. I can also operate it two-handed instead of just with one hand like the BVM.

That's what's running through my mind right now. Specs and info can be found at:

http://spaces.msn.com/members/phillydan/

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1899984

http://www.boundtree.com/

http://www.med-worldwide.com/BT-531206.html

BVMs and News

Good morning everyone,

In the latest news at my blog, I'm deciding whether or not I want to put up ad listings for the "Buy Bravo a Ventilator Campaign." It's not actually a ventilator I'd be buying but a BVM (Bag Valve Mask) such as the one seen here. Currently I'm leaning against no though.

In further news:

Foetus gets 'earliest blood op'

"An unborn baby has become one of the youngest recipients of a blood transfusion.
Ruby Doland had the treatment when her mother, Kelly, from Bedfordshire, was just 17 weeks pregnant because of a rare blood condition.
A needle was inserted into the umbilical cord of Ruby - now 12 weeks old - to give her blood to stop her developing anaemia and heart failure."

Medicine never ceases to amaze me as to the things that it can do.

Ambulance service is 'too slow'

"A report claims paramedics are too slow at administering clot-busting drugs to heart attack victims in the region.
The Royal College of Physicians said the East Midlands Ambulance Service (EMAS) had failed to meet targets for administering the drugs.
Ambulance bosses said staff are trained but the drug was not suitable for all."

I don't see what they're complaining about, most places in America, except for the very progressive ambulance services, don't give thrombolytics.

Violence plagues ambulance staff

"Ambulance workers suffer more violence and bullying than other NHS staff, research finds.
They are also more likely to be disatisfied with their work-life balance, and level of managerial support than other NHS workers."

Violence kind of comes with the nature of the job. It's in a highly stressful situation. As for the work-life balance, the shifts aren't the greatest because again, that's the nature of the job.

British doctors gear up for bird flu pandemic

"LONDON - Doctors offices and clinics across Britain will receive instructions next month to prepare for a feared pandemic of bird flu amid concerns the deadly disease could spread across Europe."

New Diseases- Where do they come from?

A powerpoint presentation on how "new" diseases come to exist.

Pig-borne disease found in mainland China

"32 farmers have died since June from illness; some 163 cases confirmed- BEIJING - A slaughterhouse worker contracted a pig-borne disease in southern China, a hospital official said Saturday. He was the first mainland case outside the Sichuan province, where 32 farmers have died since June from the illness.
Some 163 confirmed and suspected cases blamed on the bacteria streptococcus suis have been found in Sichuan in China’s southwest, where farmers who handled or butchered infected pigs have been sickened in dozens of villages and towns."

Second drug may be effective against bird flu

"WASHINGTON - A second influenza drug, GlaxoSmithKline’s Relenza, should be stockpiled in readiness for a feared global pandemic of avian flu, researchers said Thursday.
The drug, known generically as zanamivir, is inhaled and some doctors have worried that patients may not be able to use it correctly, but the team of Asian doctors said it will be important to have as many antivirals on hand as possible.
The H5N1 bird flu virus has killed 62 people since late 2003 and is affecting flocks from Vietnam to Kazakhstan. Although it is not yet easily transmitted from birds to people or from person to person, experts fear it will acquire this ability and cause a worldwide disaster."

So we're not totally defenseless.

Hemostats

To answer a question, I'll give a synopsis of hemostats. Hemostats look like a pair of scissors but without the sharp blade and are usually made out of stainless steel. They're blunt at the end and also have teeth (for lack of a better word) so that the hemostats can lock in place. Their purpose is for clamping off blood vessels in order to prevent the patient from losing more blood and going into shock. One of the big worries with trauma is that the pump may run dry, hemostats help to prevent that.

There are many different types of hemostats. The main types are Kelly, Halstead, and Crile. There are either curved tip or straight. Some have small grooved teeth at the end while others are flat.

Price of a pair of hemostats is probably ~$5.00 - Mine came in a holster along with a pair of trauma shears and penlight which can attach to my belt.

A picture can be found at http://www.northerntool.com/images/product/images/1501519_lg.jpg

Lag Time Happenings

Hello again everyone,

Just wanted to tell you (not really remind, because I never told you in the first place) that I am open to suggestions for content. So if there is anything you want me to talk about let me know by leaving a comment. I also added a favicon (little picture thing that shows up next to the URL) when you bookmark this site.

Also please leave comments. I'd like to hear from my readers.

I ordered a new penlight today. One of those "you know you're in EMS when..." jokes. You can never have too many penlights and if you ever think that you do you might as well have dumped all of them into the trash because you'll never find one when you need it. This one also has replaceable batteries. Most are disposable. For those who don't know what the penlight is for, it's mainly for checking pupil response and pupil size. This information can help determine if you have a head injury or not. They're also pretty handy for checking people's mouth, nose, and ears.

I also cleaned up my hemostats (dumped them in rubbing alcohol) just because they haven't been cleaned in a while (they haven't been used either though). Cleaned up my stethoscope and put some Armor All on the tubing to help keep it from cracking. I love my Littmann Classic II Special Edition.

I also read an article on amniotic pulmonary embolisms. This occurs when amniotic fluid travels into the veins and then ends up lodging in the pulmonary artery or arterioles which cuts off oxygenated blood to the heart and eventually to the rest of the system. The article discussed how to identify it, treat, etc.

Again, feel free to leave comments.
Bravomedic out.

Aneurysms!

Here's some more articles that I came across tonight, in case you're interested.

Doctors Try New Device to Block Aneurysms

"A device that resembles a child's finger trap toy is being used to treat a type of heart aneurysm that often grows without any symptoms until it bursts, usually with fatal consequences.
The Food and Drug Administration in March approved the stent, and the University of Pennsylvania has now begun FDA-required training for surgeons nationwide on how to use it. A flexible tube that comes in a range of lengths and diameters, it can be used for a specific kind of aneurysm that pops out from the aorta the body's main artery. "

Wow! That would be great. If you want to scare someone in an ambulance then show signs of AAA (abdominal aortic aneurysm).

Fake blood hope for transfusions

'"Fake blood" molecules could revolutionise transfusions, doctors behind the research claim.'

That would be nice.

US to require flu shots for nursing home patients

"WASHINGTON (Reuters) - U.S. nursing homes must vaccinate all their patients against the flu and pneumonia starting this fall or risk being kicked out of the Medicare and Medicaid programs under a new plan made public on Friday."

As always, thanks for reading.

Personal Statement and My Feelings About Medicine

Just got off duty. Not really tired though. I don't know how people can get tired doing this job (medicine). There's no greater job in the world; I'm convinced of that. How many other jobs can you say that you honestly made a difference in somebody's life everyday? I don't like calling EMS a job either. For me, it's a passion. Any healthcare job for me would be called my passion.

There's one thing that I like to do and seems to get my patients to open up to me more than they do for most people. I can look at their background (either by what the nursing home has on their papers or by looking at pictures around the house) and talk about their interests.

An example is seeing the picture of a pilot on a nightstand and asking the patient if they were in the Air Force. I've done this with a patient before. He looked like he was in so much pain and suffering and then I ask him about his interests and hobbies (after obtaining the information for the important medical examination of course). He just glanced away and then looked back at me like what I had just asked registered with him. He honeslty knew I cared, and for a couple of minutes, I could see that all the suffering and illnesses just vanished.

That's the point of my post tonight. Time for me to go to sleep now, goodnight.

New Site Image, X-rays, and Hemothorax

Just added another graphic to the blog (thus the picture in the upper right corner of your screen). This is the chest x-ray of what appears to be a male suffering a right hemothorax. For those of you that do not know what a hemothorax is, it occurs when blood starts to fill up in the pleuritic space of the lung. (For all practical purposes, pleural membranes are membranes that surround the lung and the chest wall and leave a space so that the lung does not rub during respirations). Anyway, a hemothorax is bad because as the pleuritic space begins to fill with blood, there is less and less room for the lung to expand. If left uncorrected, the lung will collapse causing respiratory failure and eventually death. The best way to treat it is with a chest tube which is usually installed only in the ER. (I am told that in the military sometimes the medics are allowed to insert a chest tube.)

Now, as for the x-ray interpretation. If you look at the left lung (on the right side of the x-ray) you will notice how it is black. That is because what you are seeing is mainly air (a good thing in the lungs). Denser tissue is white. This is how a normal lung is supposed to look. Now look at the right lung (on the left side of the x-ray) and look at the bottom of the lung. You will see how much whiter that area is. This area is blood. There is a lot of blood in this area and hopefully a chest tube was inserted.

The insertion of a chest tube is shown below:

Studying

Right now I'm reading the required summer reading for school. Everyone finds it funny that I hate to read fiction books with "actual stories and plots" but enjoy reading medical/science textbooks. I don't see it as really being odd. I enjoy learning everything that I can about medicine. I like being the only high schooler that can interpret at 12-lead EKG or capnogram.

I honestly feel that I owe it to my patients to read these articles and keep my medical knowledge up-to-date. It is my responsibility to provide the best medical care possible. Period. I'm constantly looking for different ways to perform a technique or faster ways to do them. In EMS one thing is for certain- every second counts.

Just my thoughts again, thanks for listening.

News Articles

Just some news articles that I've been reading:

Study: Painkiller-women's blood pressure link

"DALLAS, Texas (AP) -- Women taking daily amounts of non-aspirin painkillers -- such as extra-strength Tylenol -- should monitor their blood pressure, doctors say following a new study suggesting a link between the drugs and hypertension."

Well, that's interesting. Never heard of that.

Superbugs Found in Chicken Survey

"Of the British-grown chickens analysed, over half were contaminated with multi-drug resistant E.coli which is immune to the effects of three or more antibiotics.
More than a third of the 147 samples, which included overseas and UK produced chicken, had E.coli germs resistant to the important antibiotic Trimethoprim which is used to treat bladder infections.
The Health Protection Agency scientists testing the meat also found 12 chickens had antibiotic resistant Campylobacter. "

I'm telling you, I don't want to have to use 8th generation antibiotics one day to treat a patient. We really need to be careful about this stuff.

'Double diabetes' puzzles doctors

"Doctors are seeing a new phenomenon dubbed double diabetes that makes it harder to diagnose and treat patients -- especially children. The mix can strike at any age, and comes in various forms: Children who depend on insulin injections because of Type 1 diabetes gain weight and then get the Type 2 form in which their bodies become insulin resistant, for example. Or someone with classic Type 2 symptoms isn't responding to therapy, and tests reveal they also are developing the insulin-dependent form of the disease. Or they may not fall clearly into either category."

Researchers: Tamiflu works against bird flu

"WASHINGTON (Reuters) -- Roche's influenza drug Tamiflu suppresses the often deadly avian flu strain seen in Vietnam, which experts fear will soon cause a human pandemic, U.S. government researchers said on Monday.
They said tests in mice showed the drug, licensed for use against influenza in general, could suppress the newest strain of H5N1 virus that is sweeping though flocks of poultry in Vietnam, Cambodia, China and elsewhere in Asia."

Folic acid 'cuts dementia risk'

"Eating plenty of folic acid - found in oranges, lemons and green vegetables - can halve the risk of Alzheimer's disease, a study has suggested."

Introduction

Introduction

Howdy,

This is just an introduction of myself. For the time being, I'll go by the name "bravomedic." I am 16 years old and am a volunteer at the local volunteer rescue squad in a small town on the east coast of the USA. I hope to test out and become an EMT-B (Emergency Medical Technician- Basic) soon. My aspiration is to one day become a trauma surgeon.