Today's the Big Day

Today's the big day. Today is my trauma practical. Wish me luck. I feel confident in my skills.

I think this is the longest stretch I've gone without blogging. I've been so busy, getting homework done that I haven't had a chance. Tomorrow I have a project due, as well as an essay, and a quiz. I also have rescue squad duty tonight. So right after I take my test, I head over for that. It's pretty sad when you can honestly say that rescue squad duty is a stress reliever.

In other news:

Study challenges standard for treating heart attacks

"BOSTON, Massachusetts (AP) -- In a study colliding with established practice, recovery from small heart attacks went just as well when doctors gave drugs time to work as when they favored quick vessel-clearing procedures."

Inhalable insulin gets FDA panel OK

"WASHINGTON (AP) -- Federal health advisers on Thursday recommended government approval of the first inhaled form of insulin, offering some diabetics an alternative to many of their daily injections."

Report: SARS link to Chinese bats

"WASHINGTON (Reuters) -- Bats found in Hong Kong carry a virus very similar to the severe acute respiratory syndrome or SARS virus and might be able to spread it, Chinese researchers reported on Friday."

Well, I'm out, have to get ready, wish me luck!

-Bravo

Drifting Off

Hey everyone,

I haven’t updated in a while again. I’ve been really busy, so far I’m operating under 4 hours of sleep. It’s been this way for the past two weeks. I was expecting this to happen again just like it did last year. Nothing like homework; sleep deprivation does wonders for the mind.

I haven’t been to duty in a while either. So no more rescue squad stories for now. We’re on our week-long break. I’ll be coming off of it at the end of the week though, so I’ll update you then.

Medical news/articles:

West Nile virus infecting fewer people, 1,299 cases so far this year, 1,386 cases same period last year, USA
"Scientists are not sure why the number of West Nile Virus cases across the USA has fallen. Despite the disease spreading across most of the nation. Figures for the last three years are: January-September 2005 - - 1,299
January-September 2005 - - 1,386
January-September 2005 - - 4,137"

Fighting malaria with DDT in South Africa
"As the United Nations gathers to discuss anti-poverty measures, the BBC News website assesses how Africa could meet the Millennium Development Goals (MDGs) in 10 years' time. Here Mahlatse Gallens reports from northern South Africa on how the battle to tackle malaria is going. "

Personalised drugs 'decades away'
"Individually tailored medicines have been "over hyped" and are still many years away, leading scientists say. A report from the Royal Society said they were still at least 15 to 20 years away."

Valete omnes, and stay safe,
Bravo

Detective Work

Howdy all,

It's finally Friday. Been a long week. I was able to use my EMS Field Guide though, which was pretty cool. The guy could only remember a few of the things he had so I looked up all of his medications in the book and was able to find out what else he had missed. For example I found a drug which was for arrhythmias. I asked him if he had had any arrhythmia and he couldn't remember. I then checked his pulse (for myself, it had already been checked earlier) and noticed that it was irregular. So that's a check for positive history of arrhythmias. Probably nothing more than a sinus arrhythmia if he had been hooked up to an EKG though, which would look something like this:

Sinus Arrythmia

It's a pretty common rhythm. It was just more pronounced in this patient. To an extent, almost everyone has some kind of sinus arrythmia. Their pulse increases when they inhale, and slows when they exhale, but very rarely is it ever noticable.

Yes, I've finally sold out, I added the ads to the side of blog. I know. The shame. But I'm putting together a medical kit and hopefully that'll help somewhat. I made sure that they were in as an unobtrusive place as possible and they don't really add to load-time.

I came across this today, while visiting another blog. It's a life expectancy calculator which can be found at http://gosset.wharton.upenn.edu/~foster/mortality/perl/CalcForm.html
I've never put too much stock in these things though. It's still something fun to try out.

On the same site I came across an Acute Coronary Syndrome Calculator.

Medical News:

U.N.: Cholera ripping through west Africa

"DAKAR, Senegal (AP) -- A cholera epidemic spreading across west Africa has sickened tens of thousands of people this year and killed nearly 500 amid a long-term deterioration in health services in one of the world's poorest regions, the United Nations said.
Cholera has stricken 31,259 people in nine west African countries since June and 488 are reported dead in what the U.N. said was an "unusually high incidence" of the disease. Statistics from a year ago were not provided."

Vale! Stay safe.

History Lesson and Practice Trauma Practical

On this day in history in 1928, Sir Alexander Fleming discovered the antibiotic, penicillin. Anti is the Greek word for "against" and "bio" meaning life. So literally it means "against life," thankfully that word applies to bacteria. Fleming originally discovered it when he found that a culture of Staphylococcus aureus had been contaminated with a species of Penicillium and was inhibiting the bacterial growth. A great day in the history of medicine and in many ways, the world.

Anyway, tonight I have my practice trauma practicals. Wish me luck!

The break down as far as I can remember is like this:

• Scene Safe/BSI (Is the scene safe? And I am taking Body Substance Isolation protocols.)
• Get partner to grab C-spine (partner manually stabilizes patient's neck to prevent further injury to the spint)
• Check patient's response level (Alert, Verbal, Painful, Unresponsive)
• Check Airway
• Check Breathing (and apply oxygen if needed)
• Check Circulation (assess for rapid pulse, skin temperature, skin color, and check for/treat any major bleeding.
• Declare patient a load-and-go or stable patient.
• See if anyone is on-scene that can give SAMPLE history(signs&symptoms, allergies, medications, pertinent past history, last meal, and events leading up to injury).
• Relieve partner of C-spine stabilization (could do this earlier) by turning C-spine over to an imaginary EMT.
• Begin rapid trauma assessment beginning from head down. Get partner to take vital signs in mean time (BP, pulse, respiratory rate, pupil response).
• Check for DCAP-BTLS (deformities, contusion, abrasions, penetrations, burns, tenderness, lacerations, and swelling) while doing the rapid trauma assessment. Check every part of the bone (especially facial) and check 4 abdominal quadrants. Apply C-collar after neck is assessed. Also listen to breath sounds. Treat any life-threats as you come upon them.
• Finally check extremities, couldn't hurt to have checked the extremity you are using for vital signs before taking the vital signs.
• Assess in extremities CMS (circulation, motor function, and sensory functions).
• Log roll patient, check the back of the patient, running you fingers/hand down their spine, and pull the backboard behind patient.
• Roll patient onto backboard. Apply spiders. Then put headblocks on each side of the patient's head. Use the straps across the patient's head and under the chin.
• Recheck CMS after patient is attached to backboard.
• Transport (say it!)
• Reassess enroute (vitals) and treat any injuries that need treating. Do detailed trauma assessment. Detailed trauma assessment is almost exactly the same as the rapid trauma assessment. It is to make sure that you haven't missed anything. You redo all the steps of the rapid trauma, except now you shine the penlight in the eyes, ears, nose, and mouth of the patient to check. Check for tracheal deviation or JVD (jugular veinous distention) in the neck. Reassess CMS.
• That's pretty much it. Fill out the call sheet and you are done.

Update

I got a book today Introduction to Biomedical Engineering by Michael M. Domach. I've skimmed through it and it seems like a pretty good book. I like how it relates physics to biomedical engineering and gives a good all-around introduction.

Today I also gutted a portable phone. The most interesting/useful parts that we managed to get out in one piece are the Ni-Cad batteries, LCD screen, microphones, and speakers. The simplest things that amuse us. I'm planning on charge the Nicads with a few solar panels that I have. While on the subject of electronics, I'm thinking about making a pulse ox or attempting to. It seems like it would be a fun and worthwhile project.

That's all I have to say tonight.

News/Articles:
High intravenous vitamin C dose fights cancer

Goodnight and stay safe,
Bravo.

Charting a New Course

I've decided to take the advice from Corpus Callosum and write about things other than medicine. Medicine will still be the main focus, but I will also write about other things going on.

My main academic interests besides medicine are anything math or science related. I'm the salutatorian of my class and I've taken AP Calculus, AP Physics, and AP Environmental Science and enjoyed them all. I really enjoy working with electronics and thus I am in the second year of an electronics class which is an elective where we do circuit design and general electronics tinkering. I want to create a pulse ox in that class this year. It'll be my year-long project. I'm sorry, but I enjoy these kinds of things. I want to major in biomedical engineering for my undergraduate. Yes, I know, everything comes back to medicine with me.

As for extracurricular activities, beside the rescue squad, I'm a member of several clubs and I am also on my school's tennis team.

As for classes in liberal arts, I take a couple just to become a better-rounded person in general. I'm in Latin V and thus some of my posts will have Latin quotes in them. I will also use the word "thus" just out of habit; it's actually quite a useful word. Latin does that to you. I also read a lot, even though I prefer nonfiction.

So that's more about me in a nutshell. I apologize for you having to endure it.

Salvete Omnes

Salvete omnes,

I've got a lot of Gmail invites now (probably around 200 or so). If you want one I'm giving them away free. Just email me by either clicking the link at the side or emailing me at bravomedicblogger@gmail.com If you want, please bookmark or blogmark my site.

In other news, I signed up to cover a few of my high school's football games at the rescue squad. I also have duty tomorrow night so I'll post what happens as always. I don't always post everything though for moral and ethical reasons. Patient confidentiality is an important thing. If they don't trust us, they won't call us. Never betray a person's trust.

Medical news/articles:

Anthrax stops body from fighting back, study shows
"University of Florida researchers have uncovered how the inhaled form of anthrax disarms bacteria-fighting white blood cells before they can fend off the disease, which kills most victims within days. The lethal toxin in anthrax paralyzes neutrophils, the white blood cells that act as the body's first defense against infection, by impairing how they build tiny filaments that allow them to crawl throughout the body and eat invading bacteria."

Hand sanitizer gel works
"Using an alcohol-based hand sanitizer gel significantly reduces the spread of gastrointestinal infections in the home, according to a study in the September issue of Pediatrics. In a study of 292 Greater Boston families -- half of which were given hand sanitizer -- those that used the gel had a 59 percent reduction in the spread of GI illnesses."

You mean the stuff actually works?! It's actually been considered an acceptable way of cleaning your hands when conventional washing was not available for a while now.

Well, goodnight everyone. Stay safe!

It's On My Arm!

I learned a very important lesson today. Never get between a wheelchair and a wall.

We ran a call for a high priority fall. The patient had right-side paralysis and couldn't get up so we needed to move him off the floor and into his bed. As always, nothing is ever that simple. The room, as it turns out, wasn't big enough to fit all the people in the room in order to effectively move him because the wheelchair was in the way. It was one of those electric wheelchairs with a joystick to control it. Well, it turns out these wheels sort of lock and you kind of have to drag a 200+ pound wheelchair out, but not only is the weight an issue, the wheels are actually more like tires and are made of rubber with extra traction. Using the physics formula for static friction, where the wheelchair is around 80 kg (I'll round on the low side), acceleration of gravity is 9.8 m/s/s, and the coefficient of friction between wood and rubber is 0.8, the static friction force is 627.2 Newtons. So it's the equivalent of pushing a horse (not really, but you get the idea).

But that's not all; we get the idea of just using the joystick to move the wheelchair out. Unfortunately, it's hard to navigate the thing from the front facing the back and the doorframe is narrow as it is.

Before I know it, I hear "Ouch! Would you mind moving this off my arm?"

I had accidentally pinned one of my crewmember's arm between the door and wheelchair. Not a particularly pleasant feeling, I'm sure. So I reverse it and push it just enough out of the room to run it completely out of the way.

Ah, the joys of EMS.

Vale omnes.

Preventative Medicine

I'm really dreading going back to school. I hate the stress.

While surfing at engadget.com, I came across a link for a project done by UC Berkeley. Its purpose is to purify water by exposing it to UV light. It's called the "UV-Tube" Project and directions on how to build it can be found at http://ist-socrates.berkeley.edu/~rael/uvtube/uvtubeproject.htm

How the process actually works can be found here. Basically, the UV light from the lamp is used to punch holes in the DNA thus keeping the pathogens from reproducing. This reminds me of the cabinets in science labs that are used for cleaning the goggles.

I've been flipping through my EMS Field Guide again. There really is quite a bit of useful information. It has sections dedicated to: airway, trauma, ACLS (advanced cardiac life support), general emergencies, poison, medications, pediatrics, and prescribed drugs. It even has lists of EKGs and quick Spanish translations. I can't wait to try it out next duty.

And for the latest in medical news and articles:

Sudden Death - Arrhythmias and Sport

The intriguing problem of arrhythmias in competitive athletes

Dengue vaccine in three years: report

Reducing Antibiotic Use Lowers Rates of Drug-Resistant Bacteria

I'll post some more stuff later, if not, goodnight everyone and as always, stay safe.

Toughbooks Have a Sick Sense of Humor

Howdy again everyone, hope you're all doing well. I know I haven't posted in a while. I've been kind of busy getting ready for school.

Have you ever noticed how there are certain keys or points on your computer's screen that always gets hit? There definitely is on our Panasonic Toughbook, which we use to fill out our call sheets. There's a program on it called EMS Pro. Now, don't get me wrong, EMS Pro is a great program, but sometimes it has its moments. Today was one of those moments. I kept trying to click "other" under "provider impression." (Provider impression is basically the diagnosis but in a non-legal way, EMS providers aren't allowed to diagnose, only an MD can.) But for some reason it kept jumping to vaginal bleeding. Kind of annoying. It did the same thing for signs and symptoms too.

Has anyone else had this problem?

Shopping List

Just going through my shopping list. Can't ever have too many medical supplies. I'd be in New Orleans now if it wasn't for school. At least if I have a good amount of supplies, I can offer assistance if needed if anything should ever happen here.

Today I got an "EMS Field Guide- ALS Version" by Informed. It is excellent! It includes every topic you can think of in a condensed version and best of all it has a list of common drugs and medications at the end and gives a brief description of what they are. Very important when playing that great game of "guess a history" which is familiar to everyone in EMS.
EMS Field Guide- ALS Version

I also received the PaperMate FlexGrip Elite pens. It came with a free iTunes download and best of all, it has anti-bacterial pen protection!!! That's the best part.
PaperMate FlexGrip Elite

DT explains it well on his blog which has its link on the right side.

So far my shopping list includes:

-Sublimed Sulfur USP
-Povidone-Iodine Scrub
-4x4" Sterile Gauze
-3" roller
-5/0 Prolene Suture (optional)

There's still a lot of things that I need to get, but these are the major things that I need.

It's late. Sleep well everyone.

And as always, stay safe.

Twas the Night of Refusals

We had three calls last night. All of which we obtained a patient refusal for. Two patients had fallen and couldn't get up so we were called. Even though our on-scene time was pretty low, it took forever to fill out the paperwork. Yay! Paperwork!

The third patient was a walk-in who came to our station while we were out at dinner. They called 911 when they got there, and so we made a run back to the station code 2 (just lights). It was code 2 because the caller said it wasn't an emergency, just not "feeling right." We showed up and ran in, but there was no one there. So we called dispatch back, told them the situation, and they called the patient back to the building. We took the BP and other baseline vitals and then took her blood sugar. Everything was within normal limits (WNL). The patient then refused transport. Yay! More paperwork!

In other news I've found various other medical articles. In case you haven't noticed, emerging diseases are kind of my interest.

One 'cure all' flu jab for life

"Scientists are making a vaccine that could give lifelong protection against all types of flu in a single jab.
Currently, at risk people in the UK - the elderly and ill - need annual flu jabs, and there is no jab available yet guaranteed to beat bird flu.
Biotechnology firm Acambis, in Cambridge, the UK, says it hopes its jab will target numerous mutations that presently allow flu to evade attack.
However, the work is very early and is years off being tested in humans."

Looks like those who are afraid of needles are in luck. I'm not afraid of needles, but it would be nice not having to remember to get another vaccine every year.

Coil can cut aneurysm death risk

"Treating burst aneurysms by blocking them with platinum coils could offer patients better long-term survival than major brain surgery, researchers say.
Tests of the technique in an international study were halted early in 2002 because results were so good.
Now a longer-term follow-up confirms it does boost the chances of patients - who risk a stroke without treatment - surviving without disability."

Read the "how the coiling method work" clip at the bottom. It's quite interesting.

Statin Treatment Within First 24 Hours After Heart Attack Cut Mortality By Half

"LOS ANGELES, CA -- August 29, 2005 -- In the largest clinical study of its kind, University of California - Los Angeles (UCLA) researchers found that early treatment with a statin drug within 24 hours of having a heart attack reduced in-hospital mortality rates by over 50%.The new study, published in the Sept. 1 issue of the American Journal of Cardiology, demonstrates that early statin therapy may be essential for reducing mortality and other complications in heart attack victims."

That's good to know.

Comparison of three fluid solutions for resuscitation in dengue shock syndrome

Musings and News

I've been reviewing my EMT-B chapters in order to get ready for the test. Wish me luck!

Medical news/reports:

Encephalitis Death Toll Hits 352 in India

"LUCKNOW, India Sep 1, 2005 — Japanese encephalitis killed 44 children overnight Thursday in northern India and the government deployed pig catchers in the worst-hit areas to round up swine, which carry the disease that has now claimed 352 lives since midsummer.
Japanese encephalitis is spread from pigs to humans by mosquitos, and the government also said it plans to hand out 200,000 mosquito nets to poor villagers, who often sleep outside on hot summer nights.
Most of the dead in the outbreak in Uttar Pradesh India's largest state and one of its poorest have been under 15, state health officials said."

That's really sad. Especially when you consider that this disease can be prevented with an immunization, but as it says in this article, there is no money for it in this particular area. Very sad that money is the determining factor in almost everything in life. I don't blame the vaccine companies since their point is to make a profit, but still, it is sad.

Father With Asthma Is Key To Child's Airway Constriction

"Children with asthma whose fathers have a history of the disease are at significantly greater risk for serious airway constriction than children whose father have no such history. In reporting the results of a 5-year study, the investigators said that paternal asthma was strongly associated with childhood airway hyperresponsiveness (AHR), an exaggerated constricting response to various stimuli that characterize asthma."

Interesting statistic.

Tungsten Bullets Cause Cancer In Wounds

"Unfriendly fireArmy's new 'green' ammunition, may pose health hazards too
By AMANDA LEHMERT

STAFF WRITER, Cape Cod Times

CAMP EDWARDS - In 1997 when the Environmental Protection Agency called a cease-fire at Camp Edwards, it marked the first time in U.S. military history that training was halted because lead and other chemicals from munitions threatened public health."

Eh, that's not good.

Blood pressure reduction cuts stroke risk in patients with atrial fibrillation

'NEW YORK (Reuters Health) - Routinely lowering blood pressure helps reduce the risk of stroke in most patients with atrial fibrillation, including those who are receiving anticoagulant therapy, new research shows. The results suggest that "clinicians should have a low threshold for initiating blood pressure-lowering therapy among patients with atrial fibrillation."
Patients with atrial fibrillation "obtain substantial benefit from anticoagulant therapy," co-author Dr. John C. Chalmers, from the University of Sydney in Australia, commented in a statement. "However, the risk of serious vascular complications remains high. These findings suggest that routine blood pressure-lowering is likely to provide additional protection against major vascular events, such as stroke."'

That's good to know too. Patients with a-fib have always had an increased risk of stroke. Thus why you're not supposed to cardiovert (shock) them after so many hours (I think it is 24-48 hours.)

Rabies warning over minor bites

"Experts have warned travellers not to be complacent if bitten by an animal in a country where rabies is common.
Writing in the British Medical Journal, they describe how a woman from Greater Manchester died after a nip from an infected dog left only a tiny graze.
The University of Liverpool researchers advised travellers to seek urgent attention if bitten or scratched."

Most people just brush it off saying "it's nothing." It's not worth the risk.