Hello EMS friends!
I am the medic that invented the Turley Backboard Pad. I am now trying to get a grant to develope other complimentary products. I need 160 more votes in 12 days.
Just go to www.missionsmallbusiness.com Hit Login & Support, then enter Turley Backboard Pad Co, state of WA, city of University Place, Search, then hit Vote.
Thank you so much to all my peers that want to help me make a realy improvement in patient care.
Hello everyone, I've been a member of emtcity for quite sometime, although I don't come around here too often. I just would like to fire a shot in the dark and see what I hit. I am currently serving as a FMF corpsman in the US Navy. I have 1 combat deployment under my belt as a corpsman with a Marine unit in Helmand, AFG, I was an instructor for Marines in combat life saving and Im currently working in the ER at a Marine base in California. I had my paramedic cert prior to joining, I had been working about 3 years of 911 prior to enlisting, including time in post Katrina New Orleans area. Im in the process of getting my EMT-P back with NREMT and the state of CA. As of now, I have a year and a half left but im trying to find a contract somewhere out there that is about 3-6 months. My goal is basically to make enough to survive 3 months of the fire academy out here financially. The GI bill is good but is a bit low for where I live. Any information, ideas, or contacts dealing with overseas paramedic contracts would be greatly appreciated. I don't care if it's Afghan, been there done that, my mom might be a little upset but thats okay. Thank you again to anyone who can help.
Welcome back dear Readers!
I know it's been far too long since we've spent any quality time together, so I'm going to try to rectify that now...
For those that don't know, I was in the hospital for about a month with diverticulitis/diverticulosis. I presented to the local E/D unable to walk into the triage area because of severe abdominal pain. I thought that I had suffered a abdominal herniation due to having to help move a rather 'portly woman' who was brought into the same E/D in cardiac arrest. While in the hospital, I was taken off solid foods, and when the clear liquid diet didn't produce the desired results, I was taken off all foods by mouth and recieved nutrition from a PICC line in the right upper arm......
Well, because of the month long stay at Hotel Hospital, I ended up falling too far behind in class, and was forced to withdraw from the paramedicine program once again; this time in my last semester.......(nsert heavy, sad sigh here).
Well, after all that, one would think that I'd earned a break through all this and MAYBE something would go my way for a little while.......wrong!
As it turns out, I'm back in the hospital for apparently the same thing. Looks like a relapse or maybe just a 'flare up' of the original condition that never really went away. Either way, docs are tossing around terms like 'surgery', 'ostomy' and 'resection' far more than I feel comfortable with....considering it IS MY colon they're talking about hacking into.......!!!
I'm at my wits end, and have actually thought about giving up on ever getting my Paramedic license. Ive worked my ass off TWICE now, only to have it snatched out of my hands (first the motorcycle wreck, now this).....
l honestly don't know if I've got what it takes to go back 'one more time'.....after all, I'm closing in on 50 years old far too fast for my liking, and would REALLY hate to finally accomplish the degree in Paramedicine, only to find out that I can't use it .......
Right now, I'm searching for a reason to 'hang in there' on getting my degree; but I'm coming up empty.......
I just saved hundreds of dollars on car insurance, simply by selling that POS car!
You just never know what may happen...
I am having a little medical problem and am trying to keep it quiet in my circle of family and friends but I am really struggling so I thought maybe my EMT City friends could offer some advice or words of encouragement.
I have had a small growth on my thigh for about 5 years. I went to my PCP a few years ago and he said it was nothing, it had probably been there longer than I realized and i shouldn't worry about it.
Well a month ago I took a spill from a horse and the area around my growth appeared to have a huge bruise around it but it didn't feel like a bruise. In one of my follow up appointments for the back injury I asked my PCP to look at it again. He became very concerned and scheduled me to come in the next day so he could remove it. No big deal, he cut it out, left a stitch to close the incision, sent it to pathology because he nor anyone in the office had ever seen anything like it before.
The first pathologist called him and told him he thought it looked like a liposarcoma but he had never seen it before so he was sending it to a second pathologist. The second pathologist said it looked like a different even rarer form of sarcoma but when he stained the slide it didn't act like it should. His recommendation was to remove the rest of the groth with a large section of healthy tissue just to be cautious. I was sent to a general surgeon who told me he wouldn't touch it until he had approval of an oncologist. The oncologist wouldn't make a definitive diagnosis but thinks it is sarcoma. He ordered a CT of my chest, abdomen, and pelvis as that is where this particular cancer spreads. I had the CT today so I am just waiting for results. The oncologist said that the tumor in my thigh will need to be removed regardless and next week he and the surgeon will discuss how much needs to be removed.
Does anyone have experience with liposarcoma or any other forms of sarcoma? Does it sound like I'm on the right track? Any suggestions for me? I am very worried and the more I google the worse it gets.
Today was my first day back from an 11 day vacation. I had a bad feeling all night last night and had a hard time getting moving this morning. BUt I got my son off to school, got dressed and went to work. The morning was pretty uneventful....quiet actually for a Monday. But I still had that nagging bad feeling. We took our first call at about 11. A dialysis patient who's electrolytes go wonky pretty easy. He actually called for an ambulance before he was really bad...sure enough his K was off.
So we get back to station, get lunch watch some TV and the phone rings..."need you central until I get another crew freed up". So we get in the rig and head central. We get told that we can 5-4 station 2. On the way back, dispatch calls...."Head for Millerton, on Bailey Creek Road, about a mile up from 549, for a motorcycle into a barbed wire fence". Keep in mind that PA has no helmet law.
So on the way out there Im thinkin...ok this might not be so bad. But that bad feeling was ever present. We get on scene and in front of the firetruck is a Harley on its side. No driver in sight. Then I look and see firemen kneeling on the road on the left side of a large tree. So I get out, ask what they need and they say "just need some help to get him up this bank." So I grab the backboard and as he is coming up, feet first, I'm looking at him. His right leg is slightly askew but there are no obvious injuries. They get him up the bank and set the board on the ground and I start my survey. He has an abrasion around his eye, maybe from sunglasses and an abrasion on his forehead, over the right eye. His left arm is doing funny things...multiple fractures of the humerous and a radius/ulna fracture. Chest is clear, right arm is clear, belly is soft and non tender, pelvis is stable, lower extremities are clear. He is gazing to the left and he is combative. C-collar is placed and I leave the fireman to strap him to the backboard. I spy the helmet in the field about 30 yards from where they brought him up from. Unknown how long he had been there or who finally came along and saw the bike in the road. PA State Trooper shows up as I am telling my partner to haul ass.
So I do my thing as best I could...he is covered in dirt, pale, diaphoretic and wont leave his right hand tucked into the spider strap. I ask for another set of hands while enroute. Meanwhile I am tryng to get the left arm splinted, and he is pulling the O2 off with his right hand. Monitor shows he is tachy..rate of 150ish, get a pressure...its high too. He is also tachypnic. Pupils are equal and reactive but he is still gazing to the left. Redo the trauma assessment which remains negative. (No he doesnt have his pants or shirt anymore) Stop to pick up my extra set of hands and get an 18 in his right AC and run ringers KVO. His pressure is till high and his pulse is falling but still in the 130's. So I call in to the ED...they give me a room and notify of any changes.
We get him there and the team is there and after helping get him over to the bed, I stand back and tell the nurse who didnt hear the radio report, what I thought had happened. Next thing I know the Doc is doing RSI and he is on a vent. Once that happened, his pressure started to come down and there was all kind of running. I finish my paperwork, ask if there is anything else they need and out the door I go.
This is about 13:45.
At 1630, the phone rings. Its dispatch. I need to call the ER and talk to Missy. My patient died. I was floored! So I call the ED and ask for Missy...she gets on the phone and says that the family was asking what happened, was there any officers there. So I gave her my best guess at what may have happened and tell her that there was a state trooper there, but I didnt talk to him or get a name....I was kinda busy. I asked her what had happened. She tells me that they sent him to CT for the Head injury....he didnt have one., No bleed, no bruise no nothing. But he decompensated further, so they sent him back for a full body CT and found a huge pelvic fracture. I told her that I had checked his pelvis and it was stable. I checked his belly and it was fine. She told me that they missed it too and only really started to try to get to the bottom of why he was crashing with the CT of his whole body. She said he could have been eviscerated inside and bled out....she didnt know for sure. Just that the fracture was big.
I've been going over and over it in my head...did I miss it?? Did the right leg kind of bowed in to the left leg mean something, kind of like an inner rotation hip fracture? Was that the clue?? My pelvic exam revealed a solid result.....what did I miss dammit!!? I can beat myself up until the cows come home but it doesnt change the fact that he is dead. I cant change that...I wish I could...for his family.
In going over my assessment in my head...I didnt miss anything. I cant treat what I cant see. But I still feel awful and I cant shake the feeling. This is the 4th fatal accident that I have been on in the last 3 months...when does it end?? When does God say...enough is enough. Or will it end with me saying...I cant take anymore. I'm not making a difference...I just....cant do this anymore. I just cant.
I have been handed the short hand of the stick. I have been working with part-timers as one of our full-time employees has been out on medical leave.
A little back ground info on my service-we are a rural 911 service and the closest hospital is at a minimum 30 miles away.
I have been working with one part-timer who is male and older than me so he thinks he is entitled to be king. He is an Intermediate and his only other EMS job is for a transfer service where he has worked for about a year. The first time I ran a call with him I realized he is very green to the emergency part of things. I thought no big deal, I don't mind teaching him a few things...HA. You can only teach people who want to be taught.
He was unsable to take a blood sugar, or even locate the glucometer. He questioned my judgement on an unconscious diabetic that I gave Glucagon to. Everything must be explained to him. He apparently has never backboarded a patient before. He refused to listen to me when I told him we were going to the ER without lights and sirens with a drunk patient. He refuses to actually take a patient himself. It is so stressful to know that the only extra pair of hands you have is unwilling to make any effort to learn anything. Knowing I could be working a cardiac arrest with him is terrifying. The fear that I could be stuck with him having multiple patients is even more terrifying. Sometimes working for a rural service really sucks!
I have had a really stressful week this past week. Bad falls in which one guy ended up with an open tib/fib. STEMI's, stokes, flash pulmonary edema and 3 full arrests. 2 of the full arrests will most likely walk out of the hospital....I'm pretty proud of that. Today's arrest ended up with a tension pneumo and has a chest tube in and he is on a ventilator. I dont know how good his prognosis is, probably not very good at all. He was down 20 minutes before we got to him and it was another 20 before we got him to the ED. But family started CPR almost immediately so there may be a chance for him.
Its funny how the cycles work. Some weeks its diabetics...others its respiratory problems. This week people were seriously ill and needed intervention to stay alive. But, this week, it's taken its toll on me for some reason. I'm mentally exhausted...short tempered and moody. Every muscle in my body aches and my head hurts. Guess its a good thing I'm off for the next 2 days. I'm turning my phone off and hiding for 2 days. Maybe it will be enough time to recuperate a little....maybe. I hope......
With today being Christmas Eve, I am humbly beseeching the EMS Gods to be good for the next 40 hours. I want everyone to be safe and healthy for the holidays.
I dont want to tell 80 yr old Grandma that her husband of 60 yrs has no pulse and that it is hopeless, all the while doing CPR and pushing drugs.
I dont want to tell the father of 3, that the accident that his wife was in took the lives of her and thier 3 children.
I dont want to tell the 3 yr old that Mommy isnt ok but I'll keep trying.
I dont want to take any premature babies to higher level of care so that they can die an hour after I get them there.
The next 40 hours are for celebrating the birth of our Savior Jesus Christ...not for mourning the death of a loved one.
I dont want anyone to have to remember Christmas as the day they lost everything. So no fires either, please.
Amen and thank you.
A stroke occurs when the blood supply to the brain is cut off by an artery in the brain that either ruptures or is blocked, cutting off critical oxygen supply to neurons. Approximately 80 percent of neurons die within three hours of the time that oxygen is cut off; therefore, rapid action is critical to prevent irreversible brain damage. Healthcare professionals working with adult patients have developed a catchphrase—“Time is brain”—recognizing that acute stroke recognition and treatment is of premier importance to preserve brain tissue, limit the amount of disability patients suffer in the long-term, and increase the stroke survival rate.
In order to save time—and potentially brain function—in patients that have suffered a stroke, the American Heart Association and the American Stroke Association have developed a community-oriented “Stroke Chain of Survival” that links specific actions to be taken by patients and family members with recommended actions by stroke prehospital care providers, emergency department (ED) personnel and in-hospital specialty services.
The “Stroke Chain of Survival” is characterized by four sequential stages, including
Rapid recognition and reaction to acute stroke warning signs;
Rapid emergency medical services (EMS) dispatch;
Rapid EMS system transport and prearrival notification to the receiving hospital; and
Rapid diagnosis and treatment in the hospital.
These four stages within the “Stroke Chain of Survival” include the execution of seven distinct steps in acute stroke diagnosis and treatment, also known as the Seven D’s. The seven steps also highlight the key points at which delays can occur, necessitating organized and efficient care at each step to avoid needless delays. The Seven D’s of stroke care, as well as the major actions to be performed in each step, are:
Detection of the onset of signs and symptoms of acute stroke. Early recognition of hallmark signs and symptoms of acute stroke is critical to improved patient outcomes.
Dispatch of EMS by telephoning 911 or another emergency response number. This communication activates EMS systems and ensures prompt EMS response.
Delivery of patient to a medical facility. Patients should be transported to a stroke hospital or other facility capable of providing acute stroke care, and advanced prehospital notification should be given to the selected medical facility.
Door of the emergency department (ED). Immediately upon arrival, the patient should undergo general and neurologic assessment in the ED.
Data collection, including computer tomography (CT) scan and serial neurologic exams, along with reviews of patient file for potential fibrinolytics (tPA) exclusions.
Decision regarding stroke treatment. If the patient remains a candidate for tPA therapy, review risks and benefits with patient and family and obtain informed consent for tPA therapy.
Drug administration as appropriate, and post-administration monitoring.
The window for administering treatment after a stroke is very limited. From the onset of stroke to the administration of treatment at a hospital or other medical facility, the Institute of Neurological Disorders and Stroke (NINDS), a branch of the National Institutes of Health (NIH), recommends that no more than three hours elapse to ensure improved patient outcomes and maximize the chance of stroke survival.
"Time is brain" is more than a catchphrase—it is a call to arms in acute stroke care. Healthcare providers, hospitals and communities must rally to develop streamlined response systems to execute the Seven D’s of stroke survival and give stroke victims the best care possible, the best chance of survival and the best chance for resuming a normal life.
For more information on stroke certification, stroke training, or acute stoke certification, visit Health Education Solutions’ overview of stroke courses offered online.
Health Education Solutions additionally offers ACLS, PALS and BLS certification courses, as well as CPR and AED certification.
The information included in this article is based on the 2005 guidelines for CPR, first aid and advanced cardiovascular care.
Well I went ahead and did it. Became a subscriber to the City. Only took 6 years but its worth it for the plethora of info that I gain everyday. I also have changed my name. Again, about time, since its been 3 1/2 years since I got my medic card.
I am still in awe of the fact that I actually got my medic card. Every so often I say to myself "self...your the medic,you cant sit back and wait for someone else to make the decisions". I kick myself in the arse for making mistakes, harder than anyone else could, learn from them and move on.
If I dont see some of you before Thursday to say this...
Happy Thanksgiving to all of you! May your holiday truly be blessed!
Could it be? The day is near where I finally test for my emt-paramedic. Nervous? Yes. Excited? Yes. Blogger? No. I have no idea why I am writing this, and no idea who will ever read it. But whatever, why not. It's past midnight, I am losing my mind, and instead of studying I am reading EMS forums and looking up videos on rebuilding transmissions. Priorities may be more mixed up than salt in saline.... I guess I am all studied out. I have asked everyone I know who has passed the NREMT-P what to expect, and I get differant answers from everybody.
"It's so easy bro..."
"It's so hard man..."
Study this, study that...
Study more cardiology than peds...
Study more peds than cardiology......
Study more pediatric cardiology than respiratory.....
Enough to make your head spin. I guess I just have to take this test and see firsthand. The scariest part though? It's not this test. It's not any test. It's actually finally becoming a paramedic. No longer the student, but a full on, patched, med pushin', scene controllin' paramedic. I think I am ready. Not yet comfortable, but definatly ready. I was comfortable as a waiter... but then again I did that for almost a decade. My EMS career is in it's infancy.
This should be pretty awesome.
If you just read this, YOUR pretty awesome too. I guess I am a blogger now too. emt-b. emt-blogger.
In my head, I understand the reasons why you did what you did. I have been there many times myself. Parts of me admire the fact that you had the guts to do it and then I get so sad that you felt that was the only option you had.
Dammit! Why didn't you just pass out? I know you have a million times before.
I wish you would have told me goodby. You told other people (in your own way) and you acted like you didn't even have a sister. I know we haven't really talked in years, but you were my twin brother. We were together in the womb. You have always been in my world. I don't understand why you waited till I got to town and then killed yourself without ever contacting me.
Was it my fault because I didn't call you right away? I think it might be less painful to believe that I had something to do with your decision than to accept the fact that for you, I didn't even exist.
Have you any idea of the wreckage you left behind? You think your life was a mess. Your death was way worse. I worry about our little brother. Yeah, he's 44 years old but he's the one that got to clean out your place. He's got the cap with the .22 hole in it. He dragged bags and bags of your shit out of your house. He's also paying off your credit card bills because he wants to keep that pile of crap you called a house and build a legacy.
How about our 82 year old mother. You treated her like shit and yeah - you had your reasons, but I was the one holding her as she wailed by your coffin.. you heartless son of a bitch.
I love you so much... and I am so mad at you. I already forgive you and I miss you
So I sure have had a lot of learning experiences so far as a Medic. I had a status epilepticus that had been seizing for 40 minutes, STEMI, MVCs, and the most memorable so far, running my first code as a medic. We were called actually for an intercept for report of a "person down". We make intercept and the EMTs are just hysterical. We literally have to make them stop yelling and shouting at the patient as they are doing CPR. Come to find out it was a fellow EMT. I actually did well at focusing on the task at hand, running the code. After butting heads with the other medic (He wanted to use new ACLS standards and I have not been taught them so I wanted to run the old ones), we made it to the hospital. We ran the code for a little bit longer before calling the time of death. That was when I got a really good look at the patient. It suddenly hit me that the patient was a co-worker. I am trying to be the one that maintains my composure at this point because the EMTs were really upset and the family was just devastated. So I get everything cleaned up and ready to go for the next call. Well once things calmed down I went and apologized to the EMTs for yelling at them (but they needed to calm down) and it kind of hit me that I worked with this person. They were healthy and no medical history. SO long story short I have been working my way through all that. I am not letting it bring me down though. We had the debriefing and I know that I did all that I could do. Still was a tough call to deal with.
Other than that things are going well. I have officially been named "shit magnet". My co-workers just make me laugh. They enjoy picking on me and torturing me with this creepy plastic hand. Thats just part of working in this job though. You are going to get picked on....a lot!!!
Well I suppose I better get some work done. I just wanted to let you all know that I am still alive and kicking. Things are going great and I am learning a lot!! I am starting to get more comfortable in my skills slowly. :
Until next blog,
Health Education Solutions, a leading provider of advanced cardiac life support (ACLS) certification and pediatric advanced life support (PALS) certification, today released a new Florida and Arizona Health Trends Special Section to help medical professionals, nurses, first responders and other healthcare workers in these two states learn more about industry data, health trends and training options. This series of articles is available in Health Education Solutions’ online research library.
“Recent health trends have led to an increased demand for healthcare professionals certified in resuscitation techniques,” said Melissa Marks, president of Health Education Solutions. “In Health Education Solutions’ online courses for PALS and ACLS certification, Florida and Arizona healthcare professionals – as well as those from across the nation – can learn valuable skills and advance their careers with industry-focused resources and convenient online certification courses.”
Florida (FL) loses more children under age 5 to drowning than any other state, according to the Florida Department of Public Health. In Arizona (AZ), more than 65 percent of adults are overweight or obese, putting the population at a higher risk for cardiovascular disease. These health trends underscore the need for healthcare professionals in these states to be skilled in lifesaving care.
The resource section is free and available for individuals seeking information about ACLS and PALS certification, Arizona and Florida healthcare professionals and anyone who simply wants to be prepared to provide care in an emergency situation. Highlights include:
PALS Certification: AZ Pediatric Health Trends Every Nurse Should Know About
Recent Health Trends and ACLS Certification: FL
Health Education Solutions offers ACLS, PALS and basic life support (BLS) certification and recertification courses for first responders and healthcare professionals, as well as first aid courses, CPR certification and automated external defibrillator (AED) training for individuals seeking lifesaving skills.
Health Education Solutions’ ACLS, PALS and BLS courses incorporate the most up-to-date first aid and life support guidelines and are available in convenient online formats. The ACLS certification and PALS certification courses were developed in partnership with Union College.
For more information about ACLS certification, Florida and Arizona health trends and other healthcare certifications, please visit http://www.healthedsolutions.com/articles/acls-pals-florida-arizona.
This is how my day started yesterday. How can you be "under the influence" before 8 am?
In 2010, the American Heart Association released new guidelines for first aid and life support courses. With a new set of ACLS modules and ACLS test questions, 2011 certification courses will have some distinct differences from those based on the 2005 guidelines. Does this mean that individuals certified under the 2005 guidelines need to recertify right now?
Michael Huckabee, PhD, PA-C, director of the Union College Physician Assistant program and curriculum developer for Health Education Solutions, explains it here:
Do I have to complete the ACLS test questions again?
Individuals with certification under the 2005 guidelines won’t be required to recertify until their two-year ACLS certification expires. Course completion cards continue to be recognized as valid for two years, regardless of science changes. If you were certified under the 2005 guidelines, you should continue to perform ACLS tactics according to the 2005 standards until you’re trained under the new 2010 guidelines.
Are my ACLS test questions and answers no longer accurate?
The new recommendations don’t suggest that earlier guidelines and ACLS test questions were unsafe or ineffective; they’re simply more up-to-date. As Huckabee explained, these new guidelines represent the state-of-the-art of resuscitation science today. The routine protocols of ACLS have undergone the greatest scrutiny in the review process, and the evidence-based approach to the new guidelines is refreshing and relevant. While the previous standards remain acceptable, it’s reasonable to conclude that the new guidelines stress a more informed quality of care in typically life-threatening situations. The sooner healthcare professionals have all been trained in these standards, the more likely the medical team can efficiently respond to emergencies with effective treatment.
When will instructors begin to teach the new guidelines?
Health Education Solutions’ ACLS online training will reflect the new guidelines in the first quarter of 2011. Instructors will teach 2005 guidelines until they have received training on the 2010 guidelines.
Health Education Solutions offers online certification and PALS and ACLS recertification, as well as a variety of other life support and first aid certifications, which can be valuable tools for healthcare professionals and other individuals looking to be prepared in an emergency situation. ACLS and PALS courses were developed in partnership with Union College. Courses, which can serve as both a PALS or ACLS study guide online, will reflect the new science guidelines in the first quarter of 2011.
There have been many times in my career that I have been told of a colleague's death. All of them moved me to some kind of emotion. Today I have been moved to tears, sobbing into my pillow, my heart in my throat and my stomach feeling like its being squeezed by an icy cold hand. I know that this isnt what he would want. He would want us all to keep fighting the good fight. To continue educating ourselves...being better than we dreamed we could be....to take the torch and light the way for others, to pass on what we know and continue to better the EMS field.
While we are feeling the pain and sorrow of Rob's passing, it is hard to remember that he suffered horribly. He didnt want us to know, whether it be pride or wanting to spare us and himself from pity and being treated differently, only he knows. I knew he was sick but I didnt truly know how sick. None of us did really.
I am dedicating these poems to Rob...our Dustdevil. We will miss you deeply. Shine your light Rob, guide us to where we need to go.
The medic stood and faced God.
Which must always come to pass.
He hoped his uniform was clean,
He'd gotten dressed kinda fast.
"Step forward now, paramedic.
How shall I deal with you?
Have you always turned the other cheek?
To my church have you been true?"
The medic squared his shoulders and said,
"No Lord I guess I ain't,
cause those of us who wade in blood,
can't always be a saint.
I've had to work most Sundays,
and at times my talk was tough.
And at times I've been violent,
cause the streets are awful rough.
But I never took a penny
that wasn't mine to keep...
although I worked alot of overtime,
when the bills got far too steep.
And I never passed a cry for help,
though at times I shook with fear.
And sometimes, God forgive me,
I wept unmanly tears.
I know I don't deserve a place
among the people here.
They never wanted me around,
except to calm their fears.
If you have a place for me, Lord,
It needn't be so grand.
I never expected or had too much,
But if you don't I undestand."
There was silence all around the throne,
where saints had often trod.
As there medic waited quietly
for the judgement of his God.
"Step forward now, paramedic.
You've borne your burdens well.
Walk peacefully on heavens streets.
You've done your time in hell."
When God Made Paramedics
When God made paramedics, He was into His sixth day of overtime.
An angel appeared and said, "You're doing a lot of fiddling around on this one."
God said, "Have you read the specs on this order?
A Paramedic has to be able to carry an injured person up a wet, grassy hill in the dark,
dodge stray bullets to reach a dying child unarmed,
enter homes the health inspector wouldn't touch,
and not wrinkle his uniform."
"He has to be able to lift three times his own weight.
Crawl into wrecked cars with barely enough room to move,
and console a grieving mother as
he is doing CPR on a baby he knows will never breathe again."
"He has to be in top mental condition at all times,
running on no sleep, black coffee and half-eaten meals,
and he has to have six pairs of hands."
The angel shook her head slowly and said, "Six pairs of hands...no way."
"It's not the hands that are causing me problems," God replied.
"It's the three pairs of eyes a medic has to have."
"That's on the standard model?" asked the angel.
God nodded. "One pair that sees open sores as he's drawing blood,
always wondering if the patient is HIV positive."
(When he already knows and wishes he'd taken that accounting job)
"Another pair here in the side of his head for his partner's safety.
And another pair of eyes here in front
that can look reassuringly at a bleeding victim and say,
"You'll be alright ma'am when he knows it isn't so."
"Lord," said the angel, touching His sleeve, "rest and work on this tomorrow."
"I can't," God replied.
"I already have a model that can talk a 250 pound
drunk out from behind a steering wheel
without incident and feed a family of five on a private service paycheck."
The angel circled the model of the Paramedic very slowly.
"Can it think?" she asked.
"You bet", God said.
"It can tell you the symptoms of 100 illnesses;
recite drug calculations in it's sleep;
intubate, defibrillate, medicate, and continue CPR
nonstop over terrain that any doctor would fear...
and it still keeps it's sense of humor."
"This medic also has phenomenal personal control.
He can deal with a multi-victim trauma,
coax a frightened elderly person to unlock their door,
comfort a murder victim's family,
and then read in the daily paper how Paramedics were
unable to locate a house quickly enough,
allowing the person to die.
A house that had no street sign, no house numbers, no phone to call back."
Finally, the angel bent over and ran her finger across the cheek of the Paramedic.
"There's a leak," she pronounced.
"I told You that You were trying to put too much into this model."
"That's not a leak," God replied, "It's a tear."
"What's the tear for?" asked the angel.
"It's for bottled up emotions,
for patients they've tried in vain to save,
for commitment to that hope
that they will make a difference in a person's chance to survive, for life."
"You're a genius!" said the angel.
God looked somber.
"I DIDN'T PUT IT THERE" He said.
Well Dear Reader, I've done it now...
I had an O.R. shift today...and got my very first 'live intubation!!!!
Before you offer up the congratulatory statements and the accolades (not that I'm going to ignore any of them....), I have a confession to make.
For my first few attempts, I panicked and bailed out of the attempt. I don't know if that would qualify as a 'balk' or a failed attempt...
First off, the way they do things in the OR is completely foreign to me, and DEFINATELY different than how we do things in the field!
I watched the Nurse Anesthetists put their hands near the patient's ears and that is how they would tilt the head into the 'sniffing position'. We're taught to use either the head-tilt/chin-lift method or a jaw-thrust. They open the mouth by putting their hand on the back of the neck and lifting, while we're taught that the neck is pretty much a 'no touch zone' for that....we use the 'scissor method', but when trying to open the airway and start your laryngoscope blade, the right hand is in the wrrong position, because it effectively blocks sthe insertion of the laryngoscope blade along the right side of the tongue.
Another couple of reasons that induced the panic was that I was painfully aware of the 30 second time limit on setting the tube and being uncertain just how deep I could insert the laryngoscope blade into th oropharynx. I didn't want to go too deep and possibly injure the patient. It's nerve wracking as hell!!
I had a great team of a Nurse Anesthetist and Anesthesiologist to work with on my first successful intubation. One of the other attempts, I had both th NA and the Aestesiologist barking at me about how succinylcholine and propofol 'wear off' and other things I couldn't understand,
This team I was with during the first successful intubation, they spoke in low tones and were generous with the positive reinforcements throughout the entire procedure. The Anesthetist even applied the Sellick maneuver to bring those cords into view. Once they slid into my field of view, it was like having 'buck fever'!
I saw the cords, I saw the anatomy of the oropharynx and was completely awe-struck! I was transfixed by the view and hated to 'spoil it' by stuffing a tube in the middle of it! While the airway mannequins resemble the human anatomy, there are some MAJOR differences!
For example, no one tells you that a patient who is effectively under the influence of RSI (yeah, the combination of Propofol and Succs pretty much equals RSI), the patients tongue effectively occludes ANY hope of viewing the oropharynx! I would have sworn that his tongue swelled up!
Nor do they tell you that the patients tongue does a great immitation of bread dough.....pick it all up at once by grabbing the blob of dough in the middle and you'll fully understand what I mean....it tends to 'ooze' over the edges of our laryngoscope blade.....
They also neglect to tell you that the first time you attempt to insert a laryngoscope blade into a live person's mouth, you become painfully aware just how LONG that damn blade becomes! During the intubation practice drills on the mannequin, you don't care that you might inflict some sort of 'injury' to the 'soft tissue' of the dummy, but thinking about it during your 'live attempts' can paralyze you with fear of hurting your patient (at least it did for me).
Someone on the team 'pre-formed' the ETT as I was sinking the blade and exposing the cords. They offered it lying across the palm of their hand, as a knight would offer a sword to a Noble. I didn't take my eyes off the cords as I picked up the tube, so I didn't know that I had picked it up and had it positioned upside down.....DOH!
I flipped the tube and began the inseertion. During the 'practice drills' I wasn't able to 'drop a tube' in the mannequin without the use of a bent up stylet....but today I didnt need one.
Watching that tube and cuff slip between the vocal cords was an awesome sight to say the least!! I sunk the tube into the trachea until I watched the 'black mark' slide past the vocal cords. The NA attached the oxygen to the tube and began to 'bag' the patient. While holding onto the tube (they told me that they would secure it), I was watching for chest rise. For a minute, I thought I had either inserted it into the esophagus or had gone blind because I couldn't see a noticeable chest rise. The NA stated that the chest was rising. I watched the condensation 'fog' the end of the tube and got to see a wave form on the monitor confirming that it WAS in the trachea.
Dear Reader, I almost walked out of that OR on a cloud! I had several NA's that knew why I was there ask me if I' been successful yet, and they all were overjoyed that I had gotten that first tube.
To say that the mannequin is just like intubating a 'real person' is like saying that the Grand Canyon is 'just another big hole in the ground', or that the Empire State Building and Sears Tower are 'just a couple skyscrapers'....
I can only hope that my next OR rotation will see me hitting the last of the required intubations without incident and with more confidence and skill....
Until next time, Dear Reader.....