Patient

Howdy everyone,

Duty is coming up this Friday. Last week I had a syncope (fainting) patient. Blood sugar was 121 (normal). No history of hypertension. Blood pressure confirmed this...in fact he was hypotensive with a BP of 94/68 (if that). Pulse rate was slightly elevated at 94 and a decreased SPO2 at 89% on the pulse ox. Respirations were 12 and normal. No further information available. No medical history at all actually except for arthritis (and he's 84 years old!!!). Astounding. I placed him on a NRB (non-rebreather mask) at 10 liters per minute (lpm) and kept him on the monitor. The transport was uneventful and the SPO2 rapidly rose to 95% and pulse decreased to 82. Currently the reason for the syncope is unknown as we have not received any feedback from the ER. It could've been a cardiac related problem which he was probably monitored for a recurring event. Blood labs would've been interesting to see too. I'll try to find out from the ER. By the way, the patient reported no numbness or chest pain/discomfort. Anyone else have any possible ideas? Cardiac origin seems to be the most likely.

In other news, a stroke magnet is available for free as well as information to educate the general public. I would recommend that you sign up for one here and stay informed. Time = brain. WebMD also has some basic guidelines for detecting a stroke which can be found here. We actually use some of the same tests in order to help us make the diagnosis (or prehospital provider diagnosis). Read up, it might come in handy some day.

Stay safe everyone,
Bravomedic out.

Free CPR Classes

The AHA (American Heart Association) will be offering FREE CPR classes throughout "CPR Week" which is on April 1st-8th. I encourage you all that aren't already certified to sign up at your nearest location and participate. It's well worth it and will put your mind at ease (at least somewhat). If you enjoy the class then consider taking a first aid class or even a first responder class. You might even consider going into an EMT class someday (make an informed decision though and do a ride along first before you invest the time in it).

For more information on the free CPR class go here or call 1-877-AHA-4CPR .

In other news, I have duty today at the squad. Maybe we'll get something tonight (not that I am hoping for it, because that comes at the expense of others) since the last few duties have been really quiet.

Stay safe everyone,
Bravomedic out.

CPR Guidelines

Salvete omnes,

As you may or may not know, CPR protocol has changed according to the American Heart Association (AHA). New guidelines can be found here. I would recommend reading it and refreshing yourself with the topic. I would also recertify as soon as possible.

I went book shopping today and bought a few books including:
-Fundamentals of Logic Design by Charles H. Roth- Electronics book that covers...guess what...logic design! Basically this covers the digital circuits that we know and love today.

-The Ancient World by Scramuzza and MacKendrick- Comprehensive guide to the classical world.

-The Republic by Plato- A discussion by the philosopher Plato about the meaning of nature and justice as well as the ideal state and ruler.

-The Ancient World by Pareti, Brezzi, and Petech- Part of a series on the history of mankind. This particular book discusses the ancient world in reference to religion, politics, economics, and historical events.

-The Limits of Medicine by Edward S. Golub, Ph.D.- This liber (Latin for "book") discusses how medicine evolved when science actually became part of medicine a mere 150 years ago. Golub argues that we need to change the way that we look at noninfectious diseases (such as cancer, heart disease, and Alzheimer's) which cannot be attributed to a single cause as can be done with many infectious diseases and therefore there may not be that "magic bullet", not a single one anyway.

I also bought some medical supplies today including some 3" elastic gauze (wrap), a 3" self-adhering gauze roller, and a pack of 4x4" dressings. I also bought a few dextrose tablets for diabetics (raspberry flavored).

To give you an idea of what I'm up against, I'll bore you with my school schedule. Currently I'm working on my AP US History (APUSH) review project. This is going to take a while (try days), but it is a great review. I also have a 27 weeks review test (2.5 hours long) in APUSH which is basically a series of essays as well as a quiz on the recent material (on the same day). I have a few neurology chapters to read for AP Biology. At least that's one thing I can look forward to. I then have to answer a packet on the material. In AP Stats I have a few problems to do and then a test on Wednesday. In AP English I have to read my weekly 300 pages of literature (I'm currently reading The Things They Carried by Tim O'Brien). In Electronics II, I have a quiz on counters using flip-flop circuits including D, J-K, and S-R flip-flop inputs. In AP Latin V I am translating the "Amores" by Ovid. I think that sums it up. There's probably more that I'm forgetting, but it helps me to see it all written out. Wish me luck!

Take care everyone,
Bravomedic out.

Educational Lesson Part II

Salvete omnes,

Today I will post another educational lesson for my loyal reader, and everyone's favorite fool, seeingdouble. "Seeingdouble" recently left me a nice little comment:

"Darlin'... I hate to break it to you but my reading comprehension is not the problem. The NREMT requires you be at least 18n yeaers old, which you are admittedly not, therefore you are NOT certified. It's a damn shame anyone believes your [explicit word removed]. www.nremt.org, go ahead, check for yourself."

Anyone who writes "Darlin'" but if you're going to cite a source...you should at least make sure that the source that you give doesn't prove you wrong...

The NREMT merely certifies you. It does not license you to be an EMT. Only a state can license you. Just because you are an NREMT does not make you an EMT because a the National Registry is merely a certification agency, it cannot give you a license because it has no jurisdiction to do so. To quote your source, seeingdouble:

"The NREMT certifies individuals by issuing a certification. The NREMT does not issue a license or permit to work. EMTs must have a state license or state certification to work." - http://www.nremt.org/about/mission_statement.asp

Thank you for yet again proving my point about your inaptitude in the field of reading comprehension.

I am licensed by my state and therefore I am an EMT. When I turn 18, I merely have to pay the fee for National Registry certification because I am already a licensed EMT and thus have passed all of my tests.

Thanks again for the comment seeingdouble. I always get a kick out of stupidity. From your previous comments in the past which have all been incorrect and demonstrate your education, or lack thereof, I believe you should leave logic to people that have two neurons to rub together.

I apologize to everyone here who is intelligent for having to sit through that. Now we can move on. I'm sure you've read in the news that there is a growing concern about TB resistance to both first, and second line antibiotics. A fact sheet can be found at http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35815. I hate to be the one to say it, but antibiotic resistance kind of goes with the territory. If you give out the medication and people use it, the bacteria will eventually build up an immunity to it. It's called natural selection. There are only two ways to stem the tide either a) cut down on antibiotic use (which I would not consider in TB patients) or b) start researching new antibiotics and hold them in reserve for extreme cases.

The American Thoracic Society (ATS) and World Health Organization (WHO) have released new guidelines for the treatment of tuberculosis:

'Led by the American Thoracic Society (ATS) and the World Health Organization (WHO), a consortium of international health agencies today published on the World Wide Web the first International Standards for Tuberculosis Care (ISTC). "The purpose of the ISTC," said Philip C. Hopewell, M.D., who co-chaired the committee that produced the standards and who is a past president of the ATS, "is to establish a widely accepted level of care that all practitioners, public and private, should achieve in managing patients who have, or are suspected of having, tuberculosis." '

Stay safe everyone,
Bravomedic out.

Blood Circulation

Howdy there,

I hope everyone is doing well. As you may or may not know, I look at my blog stats to see what people have been coming to my site for, in an effort to serve my readers. I have noticed that recently people have been coming to my blog looking for the general path of blood as it circulates throughout the body so I will post on that tonight.

Circulation of blood, as the name says, doesn't begin at a specific point because it is a circuit. It is constantly flowing in a circle, so I will arbitrarily begin with the right atrium. The right atrium receives unoxygenated blood from the vena cava and then contracts, forcing the blood through the tricuspid valve into the right ventricle. The right ventricle then contracts forcing the blood through the pulmonary valve and on into the pulmonary artery (the only artery in the body that carries unoxygenated blood; an artery is just a vessel that carries blood away from the heart). The pulmonary artery carries the blood into the lungs (the capillaries in the alveoli) where the blood becomes oxygenated. The newly oxygenated blood is then carried back to the heart via the pulmonary vein (conversely, the only vein in the body that carries oxygenated blood; veins merely carry blood back to the heart) and then enters the left atrium. The left atrium then contracts forcing the blood through the bicuspid (also known as the mitral) valve and on into the left ventricle. The left ventricle then contracts and forces the oxygenated blood through the aortic valve and on into the aortic arch (which leads into the aorta) where the blood is pushed into the systemic circulation. After flowing into smaller arteries, then arterioles, capillaries, venules, and then into the veins, the now unoxygenated blood (it has already delivered oxygen to the tissues) flows into the inferior and superior vena cavae which return the blood to the right atrium where the circuit continues all over again.

I hope this helps.

Good luck students!
Bravomedic out.

aPWV

Salvete omnes,

Yesterday I went to a biomedical engineering seminar on aortic pulse wave velocity (aPWV) and how it measures aortic stiffness. It also covered the value of this test in the diagnosis of cardiovascular disease. Two methods of determining the aPWV are under research and includes using an MRI or an ultrasound and then matching the results up against the EKG (specifically the QRS complex since that is what creates a pulse, the QRS complex indicates the depolarization of the ventricles). The advantages of using one of the above methods is that it is both noninvasive and relatively cheap.

Here is a quote from a Medscape article titled, "Aortic Pulse Wave Velocity" which is from the The American Journal of Geriatric Cardiology which explains the basic hemodynamic concepts involved:

"In the absence of widely used noninvasive aortic blood pressure measurements,[3] PWV may be an available method to evaluate the status of central arteries. During systole, the contraction of left ventricular myocardium and the ejection of blood into the ascending aorta acutely dilate the aortic wall and generate a pulse wave that propagates along the arterial tree at a finite speed. This propagation velocity constitutes an index of arterial distensibility and stiffness: the higher the velocity, the higher the rigidity of the vascular wall and the lower the distensibility.[3]
The pressure pulse generated by ventricular ejection is propagated throughout the arterial tree at a speed that is determined by the elastic and geometric properties of the arterial wall and the characteristics (density) of the contained fluid (blood). Since blood is an incompressible fluid and is contained in elastic conduits (arteries), the energy propagation occurs predominantly along the walls of the arteries and not through the incompressible blood. Thus, the properties of the arterial wall, its thickness, and the arterial lumen diameter are the major factors influencing PWV. The relationships between PWV, transmural pressure, wall tension and distensibility have been formalized in many mathematic models. In most of them, the arterial segment studied is considered as a tube either with a thin or a thick vascular wall. Inside this cylindrical tube, there is a positive relationship between the change in pressure and the change in volume (V). The latter is usually expressed per unit length and then evaluated in terms of changes in diameter or radius, considering the length of the tube as constant. In such conditions, PWV may be defined according to the Moens-Korteweg and the Bramwell and Hill equations.[3]"

Okay, well I thought it was interesting anyway...you all probably didn't. Hopefully you read the above article and learned something anyway though. If you are interested in reading the rest of the article, you can go to http://www.medscape.com/viewarticle/443202 .

Stay safe everyone,
Bravomedic out.

Summer Jobs

Salvete omnes,

Right now I'm looking for summer employment. No one will hire an EMT under the age of 18, so I'm kind of stuck under the given situation. I've applied so far to CVS as a pharmacy technician. I'm not sure when, or even if I will, hear back from them. It's nice to have burning money, I mean, savings for when I go off to college. Look, pictures!!!

The first picture is of the Rotunda while the second one is a picture of part of one of the engineering buildings during winter. I can't wait!

In other news, I've been asked to teach a virtual class on "Basic Medical Skills" at the "Virtual University". I'm almost done with the first lesson on anatomy and physiology. I'll make the course notes available here as I create them.

I also had my physical Friday as well as the PPD test (to check for TB exposure). Today I have to go back and have it looked at by the occupational health center. There isn't a bump so it looks like I'm in good shape.

I made a couple of textbook purchases this weekend including:

Mosby's Clinical Nursing - Preview Here - This book is going to be fun to read- over 1800 pages!!! I can't wait! (And no, there is no sarcasm there.)

An Introduction to Genetic Analysis

Time to go back to the salt mines. I'll post more later.

Stay safe everyone,
Bravomedic out.

Ride Along

Salvete omnes,

I would like to apologize (again! I know...) for not posting more often. I've been very busy between school, rescue squad, and various projects for school. This week I had to wire several IC chips on a breadboard for a digital LED display board. I first had to figure out the message that I wanted, then I had to draw out the K-maps for it and simplify the Boolean expression, which needless to say, is not so fun. It turns out that the project required 10 IC chips (7404, 7408, 7411, 7427, 7432) as well as a 555 timer. That was an absolute nightmare and to make matters worse, the teacher didn't allow us to wire the breadboard normally. We had to make each wire flush to the breadboard and at perfect 90 degree angles (which kind of ruins the point of a breadboard). I keep seeing wires everywhere now, I must be hallucinating.

As for the title of this post, I have a friend that is about to do a ride along tomorrow. That's going to be interesting. She wants to be a doc too, so it'll be a good experience for her at least. I have absolute confidence in her.

I'll post more later. Right now it's dinner time!

Medical News:

Coffee Consumption Linked To Increased Risk Of Heart Attack

'Individuals who have a genetic variation associated with slower caffeine metabolism appear to have an increased risk of non-fatal heart attack associated with higher amounts of coffee intake, according to a study in the March issue of JAMA.

It is not clear whether caffeine alone affects the risk of heart attack or whether other chemicals found in coffee may be responsible. Caffeine is metabolized primarily by the enzyme cytochrome P450 1A2 (CYP1A2) in the liver. Variations of the gene for this enzyme can slow or quicken caffeine metabolism. Carriers of the gene variant CYP1A2*1F allele are "slow" caffeine metabolizers, while individuals with the gene variant CYP1A2*1A allele are "rapid" caffeine metabolizers.

"In summary, consistent with most case-control studies, we found that increased coffee intake is associated with an increased risk of nonfatal MI. The association between coffee and MI was found only among individuals with the slow CYP1A2*1F allele, which impairs caffeine metabolism, suggesting that caffeine plays a role in the association," the authors conclude.'

Stay safe everyone,
Bravomedic out.