Clear!

And the Countdown Begins...

2006-07-16T22:54:00.000-04:00

Move-in day at UVA is coming up (August 19th) so I now have that to be looking forward too. I've been saving my money to last me through the upcoming year. Orientation is now also done with and I've registered for my engineering classes. I've decided also that I'm going to take the EMT-Intermediate class, or at the very least, the EMT-Enhanced class at the first chance that I can safely do so.

I'll post more later, I just got off from work. Take care.

Bravomedic out.

"Ditch Medicine"

2006-06-03T09:44:00.000-04:00

I guess I'll start of this post with my usual apology for not having posted in a while. School for the past two months has been a nightmare with AP and IB exams going on (and the last minute preps for them that our teachers give us. I wouldn't necessarily just call it supplemental work, that word is too benign; it was more like a forced march). Now that these exams are over though there's nothing else to do (this hold especially true for seniors) and so we eagerly await the next two weeks in the hopes of suturing closed this part of our lives. In my case, I have mixed feelings- I'm going to miss the friends I've made in high school and my accomplishments, I have no regrets about anything I've done. On the other hand, I'm ready to move on and hopefully come one step closer to med school.

As far as college goes, I'm thinking I might decide to switch over to chemical engineering with a minor in BME at UVA. I bought a textbook on organic chemistry which I plan to read this summer (we'll see whether or not that happens- it probably won't).

Yesterday was our "senior trip," in which the senior class went to a large park. Some of us brought water guns. I formed a fire team which we will designate as "Bravo" consisting of Adam, Will, and myself. Bravo's mission was to locate and take out (well, soak) an enemy civilian which we will designate as "Echo" (hey there Emily!). On the first encounter, Echo was spotted taking the point and heading east-bound on one of the trails. This trail happened to intersect another trail where a large tree was found. As Echo rounded the trail we opened fire. She can slap pretty hard and thus we were forced tactically to fall back. We then lost contact with Echo and had to decide on which direction they went. Deciding that they were again heading east-bound, Bravo team took one of the higher trails which would cut off the east-bound trail and give us plenty of time to dig in. After about twenty minutes of marching we reached the engagement zone. An unarmed scout (Will) was then deployed to find the target. An enemy fire team found us first though and proceeded in our direction. We fired a few cover shots and then were forced yet again to make a tactical fall back (12 against 3 are not good odds). Thankfully the enemy fire team consisted of drama students and thus did not pose any real danger (as it could not exceed the speed of 2 mph and even with that would be forced to sit down and rest). Having again lost the target we moved to the base camp (where the buses were) as this is where the target would have to come eventually. Sure enough, the target arrived about 20 minutes later and the mission was completed (at the cost of my arm after being slapped repeatedly).

As for the title of this thread, Ditch Medicine is a book by Hugh Coffee which describes the role and procedures of the PHCP (pre-hospital care provider) in a combat zone, thus it kind of relates to the story above (though no casualties were sustained). It's actually a very good book and describes basic surgical procedures (including wound debridement) and small wound care/repair, needle thoracocenteses, chest tube thoracostomies, IV therapy, advanced airway procedures, amputations, burns, psychological support, nutrition, and anaphlyactic shock. I would thoroughly recommend it to anyone interested in combat medicine (or EMS).

Stay safe everyone,
Bravomedic out.

Valedictorian

2006-04-26T16:01:00.000-04:00

They announced class ranks today and there was a ceremony for the top 20 in the class. I was announced as valedictorian for my senior class. Things are looking up for me now, I was also voted "most likely to succeed" for the senior superlatives.

My mom is also going to allow me to take my EMT-Intermediate class in college in addition to my regular engineering classes at UVA. I can't wait, I'm really excited about the EMT-I class.

I went out with my friends today for lunch. Apparently another friend had said, "You three are going to lunch together today? Are you insane?! If that restaurant blows up there goes the [insert high school name here] Brain Trust!" Okay, well I found it funny.

My AP Biology class (all eight of us) took a practice AP Bio exam. I thought it was pretty easy but we shall see what the results are.

I shall post more later tonight, but for now I'm going to sleep.

Stay safe everyone,
Bravomedic out.

Happy Easter!

2006-04-16T09:47:00.000-04:00

Happy Easter!!!

A man was blissfully driving along the highway, when he saw theEaster Bunny hopping across the middle of the road. He swerved to avoidhitting the Bunny, but unfortunately the rabbit jumped in front of his carand was hit. The basket of eggs went flying all over the place. Candy, too. The driver, being a sensitive man as well as an animal lover, pulledover to the side of the road, and got out to see what had become ofthe Bunny carrying the basket. Much to his dismay, the colorful Bunny was dead. The driver felt guilty and began to cry.
A woman driving down the same highway saw the man crying on the sideof the road and pulled over. She stepped out of her car and asked theman what was wrong. "I feel terrible," he explained, "I accidentally hit the Easter Bunny and killed it. What should I do?" The woman told the man not to worry. She knew exactly what to do. Shewent to her car trunk, and pulled out a spray can. She walked over tothe limp, dead Bunny, and sprayed the entire contents of the canonto the little furry animal. Miraculously the Easter Bunny came to back life, jumped up, picked upthe spilled eggs and candy, waved its paw at the two humans andhopped on down the road. 50 yards away the Easter Bunny stopped, turnedaround, waved and hopped on down the road another 50 yards, turned, waved,hopped another 50 yards and waved again!!!! The man was astonished. He said to the woman, "What in heaven's nameis in your spray can?" The woman turned the can around so that the mancould read the label. It said:
"Hair spray. Restores life to dead hair. Adds permanent wave."

Money!

2006-04-13T12:23:00.000-04:00

I had my Target interview today and I got the job. I am now a Pharmacy Technician/Cart Attendant/Cashier. I'm happy though that I now have a job. It pays off to be a valedictorian and going to UVA because it helps to distinguish you from the rest. My base pay rate begins now at $7.00 an hour. Yay for me! I think I shall go on a spending splurge and buy some more books. Yesterday I went book shopping and bought (let me get out the list):
-Weiten's Psychology: Themes and Variations
-Study Guide for Weiten's Psychology
-Single Variable Calculus (already had the class but couldn't resist buying it anyway)
-Mosby's Clinical Manual of Health Assessment
-Mosby's Health Assessment (different book from above)
-C++ Interactive Course

I have been augmenting my medical kit further by adding a 4" elastic wrap (ACE wrap type) and a roll of 3" Coban gauze (self adhering). The bag is getting fairly large now and I need to find a way to reinforce the bottom of it which leaves me one of two options: a) stick a piece of cardboard down into the bag (not very aesthetically pleasing) or b) sew a piece of foam into the bottom. I think I'll also spray the bag with a waterproofing compound. Again, I shall post pictures when I am done constructing the bag.

In Other News:

Antibiotic, Telithromycin, Can Help Some Asthma Patients
'According to an international study of 278 patients in 70 centres, an antibiotic called Telithromycin reduces asthma symptoms and enhances lung function. Researchers also found that the drug improved recovery times.'

Stay safe everyone,
Bravomedic out.

Fortune Cookie

2006-04-12T13:33:00.000-04:00

Salvete omnes,

I went to a Chinese restaurant the other day and ordered my usual- beef fried rice. I don't even have to really order anymore, the waiter just walks over and asks, "The usual?" to which I give my nod and off they go to fix my food. I also get my egg drop soup featuring my favorite protein (and yours too) albumin and is a major protein component of your blood plasma. Albumin functions to maintain the osmotic transmural pressure differential which ensures proper mass exchange between the blood and the interstitial fluid when at the capillary level. It also serves as a transport molecule for certain hormones and some metal ions. But that has nothing to do with fortune cookies, so moving on to fortune cookies, I received mine and it said "You will reach the highest possible point in your business or profession." Sounds good to me, looks like I'm on my way to Chief of Trauma Surgery (one day anyway, hehe). I do like the sound of that. Heck, lets add Chief of Trauma Surgery/Associate Professor, that sounds even better.

In other news:

Stem Cell Research News- Stem Cell Transplants Improve Recovery In Animal Models For Stroke, Cerebral Palsy
http://www.medicalnewstoday.com/medicalnews.php?newsid=41331

'A single dose of adult donor stem cells given to animals that have neurological damage similar to that experienced by adults with a stroke or newborns with cerebral palsy can significantly enhance recovery from these types of injuries, researchers say. Using a commonly utilized animal model for stroke, researchers administered a dose of 200,000-400,000 human stem cells into the brain of animals that had experienced significant loss of mobility and other functions. The stem cells used in the study were a recently discovered stem cell type, referred to as multipotent adult progenitor cells, or MAPCs. '

Biology/Biochemistry - Don't Hold Your Breath: Carp Can Manage Without Oxygen For Months-
http://www.medicalnewstoday.com/medicalnews.php?newsid=41326

'Article Date: 12 Apr 2006 - 5:00am (PDT)How long can you hold your breath? Scientists at the University of Oslo have recently discovered how the Crucian Carp, a close relative of the goldfish, is able to live for months without oxygen. The researchers hope that understanding how some animals cope with a lack of oxygen might give clues as to how to solve this problem in humans. "Anoxia related diseases are the major causes of death in the industrialized world. We have here a situation where evolution has solved the problem of anoxic survival millions of years ago, something that medical science has struggled with for decades with limited success", says Professor GÃ¶ran Nilsson who will be presenting his latest results at the Annual Meeting for the Society for Experimental Biology on Friday 7th April [session A9]. The researchers have found that this extraordinary fish can change the structure of its gills to avoid becoming anoxic. In addition its blood has a much higher affinity for oxygen than any other vertebrate, and it makes tranquilizers and produces alcohol when oxygen supplies are limited. These mechanisms allow the fish to survive for days or even months without oxygen depending on the temperature, whilst still maintaining physical activity. ### '

Stay safe everyone,
Bravomedic out.

Sallying Forth

2006-04-11T13:46:00.000-04:00

Salvete omnes,

I'm on spring break here and you know what that means (or at least you teens know what that means)- that's correct. It's that time of the year when we must emerge from our caves and sally forth into the great unknown that is the summer job search. I'm looking at Kroger and Target (but I don't think the local Target is hiring). We shall see though. If I don't get a job with either then I shall just have to find another job at one of the greenhouses. Volunteer jobs just don't provide the same level of income that being a grocery store clerk does. I had to abandon the idea of getting a job as an EMT because I'm under 18. I had to abandon the idea of becoming a medical assistant because I am capable of independent thought. Oh well, at least I shall be able to read my Principles of Anatomy and Physiology or Clinical Cardiac Electrophysiology during the dead time. Wish me luck!

In other news, I gained a CME credit hour from the Department of Defense for sitting through one of the lectures for combat medics. I was very impressed and I did learn some things from it. It was well worth the hour spent and I'll go to more in the future.

Time to go to mentorship now.

Stay safe everyone,
Bravomedic out.

Plant Biology

2006-04-08T23:10:00.000-04:00

Guess what I get to spend my Spring Break working on...That's right! An AP Biology packet! Sadly the packet is on plant structure and growth- easy stuff, but boring beyond all belief. I mean, memorizing the endodermis in a plant and its various functions is only but so much fun.

I hope everyone is having a good break (for those of you who are out now) and I hope that everyone has a happy Easter! I asked the Easter Bunny for medical supplies! I do hope I get them, the kit can always use more supplies. What I really need is an oxygen tank and regulator, but I don't think that is going to happen (I didn't even ask bother asking for one). I also asked for some classical music CDs.

Right now I'm practicing for world domination by playing the classic game, Colonization. One can never start too early these days. I have also signed up for my orientation day at UVA to meet with my advisor on course registration. I might take 18 credits for the semester in an attempt to get some of my medical school prerequisites out of the way.

I shall post more later tonight.

Valete omnes,
Bravomedic.

Funny Joke

2006-04-05T21:49:00.000-04:00

So a friend IMed me about UVA:

Mufasa: Look, Simba. Everything the light touches is your campus. A student's time here at UVa rises and falls like the sun. One day, the sun will set on your time here.
Simba: What about that dark, shadowy place?
Mufasa: That is e-school, Simba. It is forbidden; You must never go there.

That's funny! I'm in the forbidden place! Woohoo!

Just wanted to post that. Now back to bio...

Bravomedic out.

What Happened to America's Pattons?

2006-04-02T22:59:00.000-04:00

Today I'm going to deviate from my normal course of topics. Normally I go on about medical topics but tonight I'm going to make the rare exception.

I'm tired of the liberal press crying over the deaths of five Iraqi civilians by insurgents. That part would not normally bother me, it's just the way the press tries to turn the blame around and does not place it on the insurgents, but instead tries to pin it on American troops. I don't know how, but they always do. I don't know how the "reporters" (if that's what you can call them) can sleep with themselves at night. Now lets look at the contrast, when American troops are killed, it barely makes two sentences in the news and when it does, it's to go on about how all of Iraq hates us. Disgusting, when in fact very few of the people in Iraq actually hate us, they love us, we just have the occasional insurgent who wants to ruin the people of Iraq's one chance at democracy. But using the liberal way of thinking we go from 10% of the population disliking us somehow equals 90%. I guess that's why they're reporters, they couldn't do math so that shut off every other field.

Now this brings me to my question...what ever happened to the Pattons of America? Has our wealth really made us this spineless and weak? Since when did it become cool to be a pansy? What is wrong with today's society? Teens are squirting out kids faster than rabbits. I blame the parents. Why can't they raise more Pattons? If World War II were to occur today I'm pretty certain that we would eventually be speaking German because the press would be attempting to undermine the American defense. Half of America (especially the adolescent population) would still be thinking that we have no right to defend ourselves because war is "never justified". What a joke. What happened to the Pattons of America?!

Why don't we have people that say things like:

"May God have mercy upon my enemies, because I won't."

"Wars may be fought with weapons, but they are won with men. It is the spirit of men who follow and of the man who leads, that gains the victory."

And my personal favorite:

"It is foolish and wrong to mourn the men who died. Rather we should thank God that such men lived."

May there be better days ahead for all of humanity. At the risk of using another cliche, keep fighting America, anything worth having is worth dying for.

Good luck people,

Bravomedic out.

Patient

2006-03-29T20:38:00.000-05:00

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

2006-03-26T13:18:00.000-05:00

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

2006-03-25T21:40:00.000-05:00

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

2006-03-24T09:52:00.000-05:00

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

2006-03-23T19:37:00.000-05:00

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

2006-03-22T09:52:00.000-05:00

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

2006-03-20T09:47:00.000-05:00

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

2006-03-10T20:10:00.000-05:00

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.

Biomed

2006-02-22T10:43:00.000-05:00

Howdy everyone,

Things have been really slow around here lately. I haven't had a single decent call in a long time; just the usual routine transports. Oh well, I guess no calls are good calls.

I invited a friend of mine to do a ride along sometime in March so that should be interesting. I always get a kick out of the look that the novices have on their face on the first ride along. I'm not sure how she's going to react to it. Some take it easy and seem to be rather stoic about it, but the vast majority "freak out" and become really panicky. I'm going to opt for that latter with her.

The jump bag is still under construction. I'll have to have it fully ready before I move off to college. Again, I'll post pictures when I'm done.

I also went to my biomedical engineering mentorship which I really enjoyed. I have a few ideas for my engineering topic when I go for my undergrad which I can't wait to start. We also went over a presentation on electrospinning and the effect of various concentrations of collagen (actually in this case gelatin was used) on fiber size and pore diameter. That was actually pretty interesting. I want to make my own one day so that I can use it to make the blood clotting bandages. That would be useful.

Well, I'll get back to work now. Stay safe everyone,
Bravomedic out.

It's Finally Over...

2006-02-05T12:00:00.000-05:00

I got my report card back yesterday. The semester is officially over now which means that our class ranks are set in stone and guess what that means! I got all As! This means that I am now, officially the valedictorian of my senior class. Woohoo!!! I'm so happy. All of the late nights staying up to do my homework and studying has finally paid off. It's finally over. It's nice to be the valedictorian because you know that in the future you have the bragging rights to tell your kids and grandkids that.

Sadly enough though, senioritis has not set in on me. I'm still going to stay up late (as I will probably end up doing tonight) to finish my homework. I would just feel bad if I didn't do my best in everything anyway because of my conscience. But at least it still takes a load off of me in terms of stress because I don't have to worry about my rank anymore.

In other news, I'm still working on my jump bag. I haven't done much to it recently since I haven't had any time. I did order a free Foley catheter and that's on the way in the mail (hopefully) which I will put in the bag. For those of you that don't know what a Foley catheter is, consider yourself lucky. It's a tube with a balloon on the end of it that you push into the urethra to guide it into the bladder upon which you inflate the balloon. It's used for monitoring fluid output and for allowing patients to urinate when they otherwise cannot. Now aren't you glad you asked?

Well, I'm out. Back to the salt mines.

Stay safe everyone,
Bravomedic out.

Reading Comprehension

2006-01-30T18:53:00.000-05:00

Now, the same commenter, "seeingdouble," has recently posted a new comment on my blog in which she states that I did not answer her question about being certified. Check again.

So I have a new lesson today for her on "Reading Comprehension." Enjoy!

---

I just got back from duty- 24 hour shift! Woohoo! Glad that's over. Nothing major, just your routine transports. I had a few patients that were friends of mine, thankfully they weren't seriously hurt.

I spent the day with my biomedical engineering mentor. We went over the electrospinning process and I read part of the textbook on tissue engineering. Pretty interesting stuff. Basically, what an electrospinner does is make cotton candy (but out of collagen, or whatever substance you want to use). First, though, you have to refine the collagen from a source, such as rat tails, and this process takes a while. Then you mix the collagen with an aqueous solution and load it into a syringe. You charge the needle (giving it a positive charge of, I think, 28000 volts) and then you place a metal rod a few inches in front of the needle which is connected to a ground. The syringe is then depressed at a constant rate and as the solution shoots out of the needle, the base evaporates (it's very volatile) and you are left with a fiber that wraps around the metal rod. This same process can also be used with a different protein, fibrinogen, and used to make gauze that can be used as an instant bloodstopper. It's pretty cool.

Right now I'm being forced to read "All the King's Men" for my AP English class. I'm really getting tired of reading these stories. Is it really so bad that I refuse to think that America and its democratic-republic is evil? I'm tired of reading about political agendas.

Stay safe everyone,
Bravomedic.

Exams

2006-01-27T12:36:00.000-05:00

Yeehaw! Exam week is finally over! I really think that this has been the most stress-free week of my entire life though. I had to take an exam (midterm) for AP English (Literature), AP Biology, AP Statistics, AP Latin (Literature), and AP US History. I thought they were all pretty easy *knocks on wood*.

In further news, in 6.5 months I'll be going off to UVA! I can't wait, and the major that I'm planning on seems so cool (biomedical engineering). A lot of people have asked what biomedical engineering actually is and what it does so I will use that as a topic in a future post.

It's nice to know that the job also has a future. At UVA, a job fair is held for employers to come and try to recruit students. There are so many employers that UVA actually has to turn some down. At least I know that when I graduate, even as an undergrad, I'll have job security.

I have also noticed one of the recent comments on my blog. It was great, my station and I got a good laugh out of it. We printed it out and it now proudly hangs on the "wall of stupidity," so congrats "seeingdouble," you're actually known for something. Now, normally I would not justify such inanity by commenting on it but I will make an exception this time. Perhaps she truly does not understand in which case I will point out the error in her ways.

First of all, I did complete the required courses and I am a registered/licensed EMT. Now here comes the kicker, "Anyway, getting your own jump bag together seems like a bit of a waste of time. If you are working on a box, they'll have the supplies you need." So you think that I'm going to put together a jump bag to carry into duty on an ambulance that already has a jump bag? Amazing. I'm going to let you in on a little secret. Throughout much of the country are these regions known as "rural" areas. It can take anywhere between 20-30 minutes for a truck to get to the scene. Thus it's important for emergency medical care to reach the scene sooner. That's where a personal jump bag comes into play. I'll review what can happen in even 10 minutes, in case you don't realize how important this is:

-A patient in an MVA has stopped breathing- without being ventilated, within 10 minutes, this patient will go into cardiac arrest and become brain dead; needless to say, there's no coming back from that.
-MVA patient/unresponsive patient/altered LOC- needs help maintaining an airway; it doesn't matter if the patient is capable of breathing on his own if he doesn't have a patent airway
-MVA patient/assault victim is cut in the throat- an occlusive dressing and bleeding control will keep this patient from having an embolism or exsanguinating.
-A diabetic patient has overdosed on insulin or forgotten to eat- Glutose (glucose paste) can be given to keep the patient from becoming totally unresponsive so that he can be transported to the hospital and have D50W administered. This saves the patient from the complications (brain damage, organ damage, etc.) of hypoglycemia.
-A patient overdoses on a drug/poison that would normally cross the stomach membrane barrier rather quickly- Charcoal can bind to this poison and help prevent it from being from being absorbed into the organism.

But wait, there's more, "If you are planning on happening upon an accident and playing hero, I doubt you'll need that big *** bag of supplies." [Edited to remove curse words for people that are more intelligent than that.] There are more emergencies than just trauma calls; kindly see above.

Here comes the funny part (again), "I'll have to check with my husband, but as a EMT-B I don't think you are allowed to administer glucose and charcoal without the supervision of a EMT-I or P." Maybe you should leave the thinking up to people that are capable of it, okay?

EMT-Basics do not operate under the licenses or supervision of Intermediates or Paramedics. EMT-Bs, Is, and Ps, all operate under the license of a medical director (who is an MD). I hate to tell you this, but not only can I administer glucose and charcoal, but my medical director has also given me permission to administer: epinephrine (in an IM injection), nitroglycerin, oxygen, aspirin (ASA), and albuterol (via nebulizers which are kept on the truck).

Thanks for the comment, "seeingdouble." It was a great opportunity for an educational case!

Jump Bag- Part II

2006-01-19T23:03:00.000-05:00

Howdy again everyone,

I'm getting slammed this week as the semester closes. I've had to complete several AP biology labs, take two AP Bio tests (covering metabolism, respiration, photosynthesis, and biochemistry), finish several essays for AP biology, take an APUSH test on Reconstruction with included Document Based Question (DBQ), as well as several write-ups for my mentoring. Ah, I'm glad I work well under pressure. In fact I usually can only function effectively under pressure. I love the stress.

I'm still getting the stuff together for my jump bag but I really haven't had a chance to yet. I need to still order some gauze and cravats; you know, consumable medical supplies. My supply list of things that I will place in the bag includes:

Trauma:
-8 Rolls of 3" Gauze
-20 4"x4" Dressings
-4 Occlusive Dressings (medium size)
-2 Rolls of 2" Tape
-1 Bottle (500 mL) Sterile Saline
-5 Cravats
-1 Pair of Hemostats
-50 Bandages (assorted sizes)
Airway/Breathing:
-1 Adult BVM (bag valve mask)
-1 Set of Oropharyngeal Airways (Oral Airways)
-1 Set of Nasopharyngeal Airways (Nasal Airways/Nasal Trumpets- this is a maybe)
Medical:
-1 Bottle of Activated Charcoal
-2 Tubes of Glutose (glucose paste)
-1 Obstetrics Kit
-1 Glucometer Kit (Glucometer, lancets, test strips, alcohol prep pads, etc.)
Diagnostics:
-1 Adult Blood Pressure Cuff
-1 Stethoscope
-1 Penlight
-1 Wind-up Watch
Miscellaneous:
-2 Medium-sized Notepads
-4 Patient Care Charts and Tracking Information
-1 Cell Phone

I will post pictures as soon as I get the thing set up. Keep in mind that this is not all of it, just things that I remember off the top of my head.

I figure I'll keep it in my car and also keep it in the dorm when I go off to college. I also have an iron-on star of life which I might put on the bag so that it is more identifiable.

Will post more when I have time.

Keep safe everyone,
Bravomedic out.

Jump Bag

2006-01-14T21:02:00.000-05:00

Watch out everyone, I just received a new jump bag!

The other day at the rescue squad we were all given duffle bags. I already have one duffle bag for my clothes so I decided to turn it into a jump bag for myself to keep with me. The duffle bag is really nice, its dimensions are 24" x 12" x 15" which gives me a whopping 4320 cubic inches. It also comes with a shoulder strap for those extra heavy loads and it has reflective stripes on the side of it. There are also pockets on the sides which allow me to categorize some of my supplies (such as diagnostic equipment, wound care, personal protective equipment, etc.).

I'm thinking about making some modifications to the bag however. Here's my list of things to be done to it:

-Reinforce the bottom of the bag; the bag's underside is kind of flimsy and I really want it to hold some form when I start to put things inside of it, I also want the bottom reinforced so it won't get torn up.
-Internal frame- I was thinking about adding some kind of internal frame like they put on hiking backpacks so that the jump bag will hold more of a form.
-Cargo netting- I'm going to add some cargo netting on the inside of the main section of the bag so that I can place certain things (such as non-rebreather masks, supply tubing, and extra supplies) into more categorized areas and just so that the bag is all-around more organized (read, I don't want the jump bag exploding when I open it).
-More reflective strips on the side- I think the bag needs more reflective strips on the side...I don't like the idea of getting hit by a car while helping someone on the side of the road.

I've also started stocking up the kit. I'll post more about that later. So what do you guys think? What suggestions do you have for a jump bag?

Stay safe everyone,
Bravomedic

Summer Job

2006-01-12T10:30:00.000-05:00

Howdy everyone. I hope you are all doing well.

I'm currently scouting out jobs for summer employment before I go off to UVA. There are a couple of ambulance services that are hiring EMT-Basics (which I am now by the way). The problem is probably going to be my age since I'm under 18 (just turned 17). However a lot of physician's offices are trying to recruit me because they need medical assistants (big time RN shortage around here).

We had four MVAs last duty and not a single transport. On one hand I'm glad they weren't serious enough that they would require transport, but on the other hand I enjoy transporting patients. I feel sorry for one of our patients who took a brand new Corvette right through a chain link fence. Scratched the car to pieces and destroyed the light covers. I don't know how the driver managed to do it. I suspect some alcohol involvement though.

Medical News:

How Mental Stress May Raise Heart Disease Risk

'Most people believe that stress plays a role in heart disease. A study published in the latest issue of Psychophysiology finds that large rises in blood pressure during mental stress are associated with higher levels of activity in the regions of the brain associated with experiencing negative emotions and generating physiological responses in the rest of the body. The research suggests that exaggerated activity in the cingulate cortex during mental stress may generate excessive rises in blood pressure that may place some individuals at a greater risk for heart disease. Most of what is known about the brain and its links to stress and heart disease has been taken from research on animals. This study on humans used functional magnetic resonance imaging (fMRI ), a non-invasive technique for imaging brain activity. While they were inside an MRI scanner, twenty healthy men and women performed a computer task to create mental stress that, consequently, increased their blood pressure. This allowed the researchers to correlate simultaneous changes in blood pressure and brain activity during stress. This study is published in the current issue of Psychophysiology.'

I don't stand a chance then...

DinB DNA Polymerase Is A Key Player In DNA Repair

'A quarter century after they discovered it, researchers have identified the job of one of the most common DNA-damage response proteins. The enzyme has puzzled scientists because it is present in nearly every organism, which suggests that it is crucial to life, and yet, in laboratory experiments, its function has remained a mystery. The discovery suggests that the enigmatic enzyme known as DinB DNA polymerase is specialized for proficient and accurate replication of a particular kind of damaged DNA, reports Graham Walker, an HHMI professor at the Massachusetts Institute of Technology, and his colleagues in the January 12, 2006, issue of the journal Nature. HHMI professors are leading research scientists who received $1 million grants from the Institute to bring innovative teaching to the undergraduate classroom. DNA is assaulted daily by toxic chemicals, metabolic byproducts, sunlight, and other forms of radiation. Most of the nicks and dings are quickly fixed by the cell's fleet of precision DNA repair processes, which can surgically excise and replace a faulty section. '

The sad part is that I understand that and understand the processes going along with it...

Holiday Update

2006-01-01T16:58:00.000-05:00

Well, I hope everyone had a merry Christmas and a happy new year!

I got a ton of books for Christmas including "The Making of a Surgeon in the 21st Century," "Bedside Manners," and "Principles of Anatomy and Physiology." They're really great books, thanks Mom and Dad! And yes, I'm well aware that books are supposed to be underlined but oh well.

In other news I transported a patient with suspected meningitis at the rescue squad. I so called that one, the rest of the crew thought I was just being paranoid until the physician confirmed my suspicions. The guy had a fever of 101.7, generalized headache, his neck was sore and he couldn't touch his chin to his chest. He was also photophobic, classic signs of meningitis. I'm still sterilizing everything I own. I really hope those N-95 respirators work.

I also just created a new forum at http://medicus.z42.us/index.php
Check it out, I hope you like it. I'd like some input on it and hopefully you'll become a user. It's meant for discussing medical topics and all aspects of patient care.

I was also thinking about creating another forum that's more of an RPG (role playing game for you non-techies) where you follow different patients around and make decisions on their care. Let me know what you think about this too and if you'd be interested.

I'm out, I'll post some more later, stay safe,
Bravomedic.

Mentorship

2005-12-20T21:15:00.000-05:00

Tomorrow I get up bright and early to begin a shift in the OR at one of the hospitals. I'm doing a mentorship there with a friend, so it should be fun. I'm looking forward to it and I get to wear scrubs!!! Thanks Emily, see you tomorrow!

I have rescue squad duty Thursday, so I'll keep you posted on that too. Last duty I bagged someone all the way to the ER. We were dispatched for a "difficulty breathing," patient was on a ventilator, had CHF, and I disconnected his ventilator for two reasons: a) you can't transport the ventilator with him and b) the reason we were dispatched in the first place was because the ventilator was no longer adequately ventilating him. So I connected the BVM (bag valve mask) directly to his tracheostomy tube. Everything turned out well, his O2 sats went from 78% to 88%, a pretty significant increase.

As for the anonymous poster that has kept me updated on the Intermediate class at UVA, I thank you for the information. I'll be sure to check it out when I get there. The sites were very helpful. I appreciate it.

I was looking at my site statistics and someone came to my blog looking for the nine abdominal quadrants. Its probably too late for them but here it goes anyway:

Superior row: right hypochondriac, epigastric, left hypochondriac
Middle row: right lumbar, umbilical, left lumbar
Inferior row: right inguinal, hypogastric, left inguinal

Other News:

Deaths From Heart Attacks & Strokes Could Be Significantly Reduced With New Guidelines, UK

'Deaths from cardiovascular disease (CVD), which kills nearly 250,000 people every year in the UK1, will be significantly reduced if the tougher cholesterol and blood pressure targets of 4.0 and 2.0 mmol/L and 140/85 mm Hg, outlined in guidelines published today2, are followed. The new guidelines will also decrease patients' likelihood of experiencing severely debilitating non-fatal CVD events. For the first time, UK practice in this area will be ahead of Europe as a result of the Joint British Societies' Guidelines on Prevention of Cardiovascular Disease in Clinical Practice (JBS2), developed by doctors from the leading professional societies in the field including The Primary Care Cardiovascular Society. If implemented, the guidelines will significantly improve the way people with and at risk of developing CVD are treated in this country, resulting in thousands of lives being saved and disabilities avoided.'

An ounce of prevention is worth a pound of cure.

Strong Link Between Tooth Loss And Heart Disease

'There is a strong, progressive association between tooth loss and heart disease, researchers report in a study published in the latest issue of American Journal of Preventive Medicine. Heart disease was present in 4.7 percent of those without tooth loss, 5.7 percent of those with 1 to 5 missing teeth, 7.5 percent of those with 6 to 31 missing teeth, and 8.5 percent of those with total tooth loss, reports lead investigator Catherine Okoro, epidemiologist in the Division of Adult and Community Health at the Centers for Disease Control and Prevention.'

That makes sense...but I really don't believe what they're trying to say. Statistically it's horrible....too many confounding and lurking variables. There's also the nonresponse and response bias since it was conducted over a phone.

Stay safe everyone,
Bravomedic out.

Bad Moon Rising

2005-12-17T10:52:00.000-05:00

I see the bad moon rising.
I see trouble on the way.
I see earthquakes and lightnin'.
I see bad times today.

Don't go around tonight
Well it's bound to take your life
There's a bad moon on the rise.

Full moon tonight...and you know what that means...no not werewolves, but trauma! Okay, so it's not actually a full moon, only 96% of the face of the moon will be covered in light...close enough. I have duty tonight as I have said before, so I'll keep you updated.

For the space geeks here, if you're interested, you can get your name programmed into a microchip that will be on the Dawn spacecraft by going here.

As for those of you who have asked me about UVA: I did apply early decision and was accepted through that route two weeks earlier than the specified decision date. Good luck to the other applicants!

I was actually thinking about joining the rescue squad in Charlottesville and in addition, taking the EMT-Intermediate class since I will be 18 by then. Any suggestions for where to look for the class? I think UVA might actually offer one through its prehospital education program. I also have heard that the rescue squad was great down there; I'm looking forward to it, but I'll never drive an ambulance. Ever. I refuse; too much responsibility for everyone on the truck and other vehicles that are around.

Today I volunteered at the Christmas Mother which was really nice. For those of you who don't know what that is (I didn't know myself before I went), basically people bring in food and gifts and we then distribute the food and gifts to families in need of them in the area. I'm glad I participated in it; I really love serving people.

Other News:

New Dementia Case Arises Every Seven Seconds

'The number of people that have dementia is set to double every 20 years, according to a report in this week's issue of The Lancet. The study reveals that 24 million people have dementia today, and this is set to rise to 42 million by 2020, and 81 million by 2040. Researchers from Alzheimer's Disease International (ADI) combined data from published reviews on the prevalence of dementia for the major regions of the world. They found that of those that live with dementia, 60% live in developing countries, with this number rising to 71% by 2040. The numbers in developed countries are set to increase by 100% between 2001 and 2040, but in India, China, and their south Asian and western Pacific neighbours rates will rise by more than 300% during this period.'

Oral HIV Tests Not the Last Word

'THURSDAY, Dec. 15 (HealthDay News) -- When an HIV test tells someone they are infected with the virus that causes AIDS, most would probably assume that's the end of the story.
However, as doubts emerged this week as to the accuracy of one rapid oral HIV test, experts noted that "false positive" results aren't as rare as people might think.
In fact, doctors consider a result on the oral HIV test to be only a preliminary finding, because of the risk that the screen may be inaccurate. Most physicians routinely advise patients to go for a more accurate HIV test if they turn up positive.'

Stay safe everyone,
Bravomedic out.

Busy Busy Busy

2005-12-16T09:47:00.000-05:00

Howdy,

I hope everyone is doing well. Christmas is almost here!!! Merry early Christmas everyone!

Busy weekend coming up...tomorrow I volunteer at the local fire department for the Christmas Mother event, after that I run off to volunteer at the hospital, and once I pull a mini-shift at the hospital I have rescue squad duty. I'm getting slammed with homework now in preparation for next week when we get our Christmas break. I have an AP Biology test covering four different chapters on genetics, an APUSH (AP US History) test covering four chapters, and an electronics test covering various types of IC chips. At least the college admissions process is over now for me. I got into UVA!!! Looks like I might make it to medical school afterall.

I'll let you know how duty goes this weekend. I have the feeling that there will be something interesting this time. I also completed the National Incident Managements System (NIMS) course which is now required for EMTs...that was fun. I want those five hours of my life back!

My parents want to know what I want for Christmas...I don't really know. I'm perfectly happy with what I have now; I don't really need anything. I'm thinking though an EMS star of life decal for my car and some kind of anatomy textbook. Any suggestions? I'm currently looking at Essentials of Anatomy and Physiology.

In Other News:

What The Public Needs To Hear During A Disaster

'Katrina revealed the impact of poor communications on the public during a disaster: chaos, distress and alarm. For future disaster communications, a new Temple University survey of Pennsylvanians* bears important findings, including how people prefer to get information during an emergency, which public agencies they're most confident in, attitudes toward emergency preparedness and actual preparedness. The findings will be presented today at the American Public Health Association meeting. "The catastrophic failure of the emergency response system in the wake of Hurricane Katrina reinforces the need to better understand the public's concerns and to include the public in emergency planning and response. This will help state and local officials effectively communicate important information before, during and after disasters," said researcher, Sarah Bass, Ph.D., assistant professor of public health.'

Genetic Clues To Sodalis Deepens Knowledge Of Bacterial Diseases

'By sequencing the genome of the symbiotic bacterium Sodalis, which lives off the major disease-transmitting insect, the tsetse fly, researchers at Yale School of Medicine have come a step closer to understanding how microbial pathogens cause disease. Led by Serap Aksoy, professor in the Department of Epidemiology and Public Health at Yale School of Medicine, the team was highly interested in Sodalis because of its close relation to human bacterial pathogens like E.Coli, Salmonella and Yersinia.'

Ah!!! Genetics!!! They said the "G" word!

How Stem Cells Become Brain Cells, OHSU Discovery

'Researchers at the Oregon National Primate Research Center at Oregon Health & Science University (OHSU) have discovered one key gene that appears to control how stem cells become various kinds of brain cells. The finding has significant implications for the study of Parkinson's disease, brain and spinal cord injury, and other conditions or diseases that might be combated by replacing lost or damaged brain cells. The research is published in the current online edition of the medical journal Developmental Biology. "In the early stages of brain development prior to birth, brain stem cells, also known as neural stem cells, will differentiate into neurons," explained Larry Sherman, Ph.D., an associate scientist in the Division of Neuroscience at the Oregon National Primate Research Center and an adjunct associate professor of cell and developmental biology in the OHSU School of Medicine. "In later stages, these same stem cells suddenly start becoming glial cells, which perform a number of functions that include supporting the neurons. We wanted to find out what factors cause this switch in differentiation. We also wanted to determine if the process can be controlled and used as a possible therapy. What amazed us is that it turns out a single gene may be responsible for this incredibly important task."'

Neuregulin-1 Protects Brain Cells From Damage Resulting From Stroke

'A naturally occurring growth factor called neuregulin-1 protects brain cells from damage resulting from stroke, according to an animal study conducted by researchers at Morehouse School of Medicine (MSM) and the Atlanta-based Center for Behavioral Neuroscience (CBN). The finding, reported in the online edition of Journal of Cerebral Blood Flow and Metabolism, could lead to the development of new stroke treatments. Stroke, the third leading cause of death in adults in the United States, occurs when blood flow to the brain is interrupted. Deprived of oxygen, brain cells die within minutes, causing inflammation and further damage to tissue surrounding the site where blood flow is obstructed.'

Reporting In

2005-12-11T17:58:00.000-05:00

It's been a while, I've been so busy with school recently that I haven't posted. I kind of abandoned the plan on moving over to a new host. There's no money for it for one, and then I would have to relocate everything, redesign, and I would have to change my search engine listings.

I'm not saying that I won't move in the future, but it just won't be in the near future.

Right now I'm sick with the flu which has actually turned into bronchitis. It's been a bad year for me....I almost never get sick and now I've been hit twice in the same year.

I'll post some more later when I'm feeling better.

Hope everyone is doing well,
Bravomedic out.

The Tables Have Turned

2005-10-22T15:21:00.000-04:00

So two nights ago I ran to the emergency room, but not in an ambulance. It was for myself. Around 2200, I had a sudden onset of pain in my abdomen, just above the navel. The pain then radiated down my right side and into my right lower quadrant and eventually into my groin. I palpated my abdomen and sure enough, it was tender down in the RLQ. I was guarding against my own touch. It was different from the other three quadrants where I was not tender and not guarding. “Great,” I thought to myself, “Appendicitis.”

So I decided to call the insurance company’s nurse hotline. She suggested that I go to the ER as soon as possible since she agreed with me that it could be appendicitis. So I went to the ER and was first in line to go in for treatment. Appendicitis is something to be taken seriously. After a while the pain got more and more intense and a CT scan was scheduled for me.

Ah, you have no idea how much torture a CT scan is. I had to drink one and a half canisters of Barium, let me tell you that was not fun. There is not a worse flavor in the world, period. So after stomaching that I went to the CT scanner where they hooked my IV line up to an iodine solution. That really felt weird, and yet cool at the same time, because I could feel the heat that it created in a reaction with my body all down my back and in my throat (I assume at the thyroid.) CT scan was done, and I was taken back to my room in the ER. The radiologist was then sent my information but could not read it because the Barium had not finished absorption at my appendix. So I had to return to the CT scanner for another attempt. I’m surprised I’m not glowing in the dark. Luckily, the radiologist was able to read this one and saw what she described as early acute appendicitis. A general surgeon was then called in.

After a while the surgeon arrived. He agreed to remove the appendix. I asked how long he thought the surgery would take and he gave me a valuable piece of advice, which I will always remember and will hopefully repeat someday. “A good surgeon will never give you a certain amount of time. I will take the time to do a good job.”

An hour later I was being prepped for the open appendectomy. I will take the opportunity now just to say that all the staff that I have encountered was absolutely amazing; you couldn’t have asked for better healthcare providers. There was both an anesthetic and an anesthesiologist who told me what they were going to do when I entered the room. The next thing I know, I was wheeled into the operating room, a mask was put over my face. They said it was just oxygen and then I assume they pushed the drug because I woke up in the post-operative ward. I don’t remember a thing about the surgery and I don’t even remember being wheeled into the OR. After the surgery they made sure that I was in no pain. I appreciate everything they did for me. The nurse told me that the general surgeon had said that the appendix was on the verge of bursting. That would’ve been bad, very bad. A septic nightmare. Thanks again everyone for everything that you’ve done.

After that I waited in the post-op ward for a couple of hours, sleeping off and on while they tried to make room for me on the med-surg floor. That’s where I am now, writing about it on the laptop. I’m on an antibiotic now for prophylaxis and also lactated ringers and 5% dextrose which is running into me now at 100mL/hour.

They call me the “doc” here and “EMT.” I took an interest in reading my own EKGs. Their machines show U waves! My vital signs are currently: blood pressure (BP)- 98/58 and pulse- 106. Guess that means I’m in compensated shock considering my normal BP is 114 systolic and my usual pulse is 64. I’m going to be out of action for a while. That means no power-lifting (that’s what we call the technique we use to lift our patients) for me for a long time.
I’ve still got to see if they’ll let me keep the appendix in a jar. Some hospitals will let you, but I doubt they will at this one. They’ve probably already gotten rid of it.

"Healthcare"

2005-10-20T10:46:00.000-04:00

Last night I had duty. We were dispatched for a patient complaining of chest pain at the local long-term "healthcare" facility. If you can even call what they do there healthcare. In case you couldn't tell, I was really annoyed by the staff that received us when we got there. They didn't even actually receive us.

We showed up, lights and sirens, air horns blasting and went to the ambulance door. We knocked on the door and rang the doorbell thing they have there. No response. We repeat the process. We've now been standing outside the door for five minutes. Finally, a VISITOR opens up the door. We walk in and there's the nurses all standing around doing nothing. They had totally ignored us. We see our patient sitting in a chair (or what we assume is the patient, the staff still has not told us anything). We approach her and, as we approach, one of the nurses grunts that she is a visitor. None of the nurses offer any help to us at all.

The patient then leans out of her chair and tries to lay on the ground; we let her. I go back out to the truck to get the stretcher and have to get another visitor to hold the door open for me so that I can get back in. Nobody at the facility would help except the visitors. I'm really angry about this, but then again this place has a reputation for it. I would never send a family member there.

Overall though, I had a good night. That was our only call and I was able to get all my homework done and I also was able to go to bed early. I need the sleep, especially since I think I now have a cold and the four or five hours of sleep I get per night has been wearing on me.

Today I'm getting my TB shot checked. No bump has formed and it's now been 48 hours, so that's good.

News/Articles in the Rest of the World:

EU influenza pandemic preparedness

"EU preparedness against an influenza pandemic has improved over the last six months, but Member States need to step up their efforts to strengthen their pandemic preparedness, according to Markos Kyprianou, European Commissioner for Health and Consumer Protection.
The European Commission is preparing a number of initiatives which aim to help Member States co-ordinate their actions in this regard. There will be an EU-wide command post exercise to simulate a flu pandemic and the publication of a revised policy paper on pandemic preparedness before the end of the year. The Commission and the European Centre for Disease Prevention and Control (ECDC) have also been reviewing Member States' national plans ahead of an informal meeting of EU health ministers (20-21 October in Hertfordshire, UK) and a European Commission - ECDC - WHO expert conference (24-26 October in Copenhagen), both of which will discuss pandemic preparedness. "

Comparison of the risks and benefits of fish consumption

"A comparison of the risks and benefits of fish consumption suggests that government advisories warning women of childbearing age about mercury exposure should be issued with caution.
The study warns that if advisories cause fish consumption in the general public to drop out of fear about the effects of mercury, substantial nutritional benefits could be lost. The study will appear as a series of five articles in the November issue of the American Journal of Preventive Medicine.
"Fish are an excellent source of omega-3 fatty acids, which may protect against coronary heart disease and stroke, and are thought to aid in the neurological development of unborn babies," said Joshua Cohen, lead author and senior research associate at the Harvard Center for Risk Analysis at HSPH. "If that information gets lost in how the public perceives this issue, then people may inappropriately curtail fish consumption and increase their risk for adverse health outcomes." "

Well, I'm out, stay safe everyone,
Bravomedic

Direct Hit!

2005-10-17T23:44:00.000-04:00

Okay, so I'm getting slammed this week. Tests everywhere, quizzes everywhere. So much to worry about and study for.

There's one thing that keeps me going, well, two things. Taking everything day by day for one. "Live to fight another day." The other is that passion for medicine. I don't care that I have to pull all-nighters to study for a test. If it means that I get into med school one day, and get to pursue my dream of becoming a physician then it was worth it.

I also acknowledge that what I have typed may also be incoherent. That's a side effect of fatigue.

In other news, I pulled duty last weekend. Not a whole lot, happened; just one call, which wasn't really bad off. We were dispatched for an "eye injury." Patient had gotten hydrogen peroxide in her eye. I've done this myself (using AOSEPT with my contacts) and let me tell you. It really hurts, you literally have to force your eye open; it's not easy to do because the eyelid goes into spasms that force the eye closed. It takes some real self control to get it back open on your own; I know it took me a while to do it myself before I could rinse it out.

This patient apparently wasn't so lucky. She couldn't open her eye so I had to grab the eyelid and force it open. I know that sounds terrible, but it has to be done, you have to get that stuff out of there. It's only going to do more damage in there. You'd be amazed just how strong the eyelid actually is, it takes a lot of force. I pulled it open and poured a 0.9% NaCl (sodium chloride or 'salt') solution in so that it flushed from the medial part of her eye to the lateral part. After thorough flushing we transported. I spiked an IV bag and hooked it up to a drip set and some IV tubing and used that the rest of the way to flush her eye. Everything turned out well. Not terribly exciting, but oh well. Not everything is.

Well, I have some more studying to do for AP US History and AP Biology.

Goodnight everyone, and remember, stay safe,
Bravomedic.

Studying...

2005-10-12T14:37:00.000-04:00

Tomorrow I have my AP Biology test. That's going to be fun...wish me luck. So many darn names to remember with cristae, and thylakoids, grana, stroma, microtubules, microfilaments, intermediate fibers, desmosomes, what the smooth ER produces vs the rough ER. Plus what protein makes up each, such as microtubules are made up of tubulin, microfilaments are made up of actin, and intermediate fibers are made up of keratins. I plan on rereading my notes and rereading our labs.

I have duty Friday night, that's at least one thing I can look forward to it and it lasts until Saturday. Maybe there will be some action. Last Friday's game was absolutely miserable, even beyond miserable. Our team was winning until the end of the third quarter. Add to that, it was raining, and when it wasn't raining, it was just misting. Everything was wet, there wasn't a whole dry spot in the entire area, even in the inside of the ambulance was wet from us entering and exiting it. I'm glad that I don't have to do that again.

In other news:

Avian flu vaccine against H5N1 strain to be tested on humans next year after promising tests on birds, Vietnam

"After carrying out successful bird flu vaccine tests on birds, Vietnam will probably carry out tests on humans next year. The vaccine protects against the H5N1 strain of bird flu, the most virulent one. Tests started in April, 2005. Results have been successful on monkeys as well. The vaccine has been developed by Vietnam's National Institute for Hygiene and Epidemiology. It is applying to authorities for trials on humans. It is also seeking approval for the production of vaccines."

Ibutilide Appears Safe, Effective for Treatment of Atrial Flutter or Fibrillation in a Pediatric Setting: Presented at AAP

"WASHINGTON, DC -- October 12, 2005 -- Ibutilide, an intravenous agent approved to treat atrial fibrillation and flutter, appears safe and effective in a pediatric setting, according to a study of 19 patients who received a total of 53 doses of the drug.Though the research team used a more stringent definition of treatment success than that used in the initial clinical trials of the drug and required patients to convert to normal rhythm within 45 minutes, the study showed success rates close to or better than those seen in the drug's registration trials."

Atrial flutter is a pretty easily recognized rhythm, on an EKG it shows up with its classic saw-tooth pattern. Atrial fibrillation is also pretty easily recognized, just kind of hard to describe; it looks like a lot of artifact if you know what that is.

I'm out, stay safe everyone,
Bravomedic.

It's Finally Friday!

2005-10-07T14:03:00.000-04:00

Free again...I always think of that song on Fridays. Tonight I'm covering the football game for my high school. I'm not sure if it's going to make or not due to the weather. If it does, I'll let you know how it turns out.

I still need to clean up my trauma shears from the last game. I was too tired to clean them up last week. I also have duty this weekend, more fun.

School dinner kids healthier than packed lunch kids, UK

"Researchers from St George's University of London examined the eating habits of one thousand secondary schoolchildren in England and Wales and came to the conclusion that school dinners offer better nutritional value than most packed lunches. The researchers said the nutritional problem may be more in the home than at school."

Apparently this is only in the UK. Here in America, I seriously doubt that there is anything more unhealthy than the school lunch. It's preserved in grease (not that grease is bad, it adds flavor.)

Drug can reduce risk of death, heart attack, and stroke in patients with diabetes

"A diabetes drug called pioglitazone can reduce the risk of death, heart attack, and stroke in high-risk patients with type 2 diabetes, concludes an article in this week's issue of The Lancet. Patients with diabetes have a two to four-fold increased risk of a cardiovascular event compared with non-diabetics. Until now there has only been indirect evidence suggesting that pioglitazone could reduce cardiovascular-related deaths and illness in diabetics."

Neural stem cells are long-lived

"New studies in mice have shown that immature stem cells that proliferate to form brain tissues can function for at least a year -- most of the life span of a mouse -- and give rise to multiple types of neural cells, not just neurons. The discovery may bode well for the use of these neural stem cells to regenerate brain tissue lost to injury or disease. Alexandra L. Joyner, a Howard Hughes Medical Institute investigator at New York University School of Medicine, and her former postdoctoral fellow, Sohyun Ahn, who is now at the National Institute of Child Health and Human Development, published their findings in the October 6, 2005, issue of the journal Nature. They said the technique they used to trace the fate of stem cells could also be used to understand the roles of stem cells in tissue repair and cancer progression."

Genomes of more than 200 human flu strains reveal a dynamic virus

"In the first large-scale effort of its kind, researchers have determined the full genetic sequence of more than 200 distinct strains of human influenza virus. The information, being made available in a publicly accessible database, is expected to help scientists better understand how flu viruses evolve, spread and cause disease. The genomic data already has enabled scientists to determine why the 2003-4 annual influenza vaccine did not fully protect individuals against the flu that season. The new genomes are the initial results of the Influenza Genome Sequencing Project, a joint effort of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), and multiple partners including NIH's National Center for Biotechnology Information (NCBI), the Wadsworth Center of the New York State Department of Health in Albany, NY, and The Institute for Genomic Research (TIGR) in Rockville, MD. The report was published online in the journal Nature on October 5."

I would've thought that the several centuries of information that we have on the flu virus would've been enough to show that it was a dynamic virus.

Valete omnes,
Bravo.

And have a safe Friday night.

Update

2005-10-05T11:01:00.000-04:00

Howdy everyone,

This week never ends. Everytime I turn around I find that I have a whole new assignment to do.

I ran three calls at the football game last week. Only one was a transport (fight had broken out). Nice laceration to the upper lip and gum.

Medical News/Articles:

Most Americans will become overweight, 90% of men and 70% of women

"According to a study that has just come out, the vast majority of Americans will be fat. Even half of the men in the study who were of normal weight during a good part of their adult life eventually became obese. According to the study, 70% of American women and 90% of American men will eventually get fat. "

Immunization at global level maintains strong performance made in last quarter century

"Immunization at the global level has progressed very well during the past 25 years, but further increases in coverage would save the lives of millions more who do not yet benefit from this protection, said a group of immunization partners at the World Vaccine Congress in Lyon, France."

I'm out.

Today's the Big Day

2005-09-29T14:17:00.000-04:00

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

2005-09-21T14:42:00.000-04:00

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

2005-09-16T20:26:00.000-04:00

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

2005-09-15T15:43:00.000-04:00

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

2005-09-13T18:17:00.000-04:00

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

2005-09-09T14:18:00.000-04:00

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

2005-09-06T21:06:00.000-04:00

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!

2005-09-05T20:22:00.000-04:00

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

2005-09-05T19:03:00.000-04:00

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

2005-09-05T11:38:00.000-04:00

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

2005-09-04T00:04:00.000-04:00

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

2005-09-03T18:43:00.000-04:00

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

2005-09-01T22:16:00.000-04:00

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.

More Musings

2005-08-31T23:08:00.000-04:00

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?

------

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!

2005-08-27T21:42:00.000-04:00

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

2005-08-26T22:28:00.000-04:00

"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

2005-08-26T19:35:00.000-04:00

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.

--------------------

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

2005-08-25T20:15:00.000-04:00

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

2005-08-24T17:45:00.000-04:00

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

2005-08-24T10:40:00.000-04:00

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

2005-08-23T14:09:00.000-04:00

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

2005-08-22T10:19:00.000-04:00

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

2005-08-21T15:28:00.000-04:00

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

2005-08-20T22:10:00.000-04:00

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!

2005-08-19T19:52:00.000-04:00

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

2005-08-19T00:22:00.000-04:00

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

2005-08-17T19:58:00.000-04:00

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

2005-08-16T20:52:00.000-04:00

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

2005-08-16T11:18:00.000-04:00

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

2005-08-15T13:20:00.000-04:00

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.