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Police: TO REPORT OR NOT TO REPORT

Written by RSS Poster The Justice of the Peace
There are occasionally news events, major and minor, that resurrect in me and probably others events long forgotten.  When I read or see on TV that there has been a terrorist explosion in a city whether in this country or not it revives memories of when the first floor of a city multi story car park  in which I had been parked was the scene of an IRA car bomb about twenty minutes after I had left.  Similarly reading this report of a member of the public reporting a possible drink driver to the police I was reminded when I was in a situation regarding a professional colleague.  Another colleague had mentioned that unknown to me at the time that person had a drink problem and had been banned some time previously. A few weeks later when a client/patient/customer was pleased that I was advising her and not "that man who breathed alcohol fumes" I felt on reflection that as he was still driving I should not be merely a bystander to the situation.  After some hesitation and having taken note of his car number from my...

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Ambulance: Pearl # 4: CPR Coach

Written by RSS Poster Medic Scribe

Make certain the CPR and airway management are being done properly. When I started our protocol said to intubate immediately.  On arrival, I would turn my back on the code and take the two minutes it takes to get my intubation roll out, unzip everything, take everything out, open the packages, assemble everything and then finally approach the patient.  Now I watch the compressions and the ventilations.  If only one person is doing the bag valve mask (assuming we are not doing passive ventilations), I grab someone else to hold the seal while the other squeezes the bag.  Make certain they are not hyperventilating.  Try using a period ambu bag instead of an adult.  Make certain a properly seized oral pharyngeal or nasal pharyngeal airway is in place and that the airway is held open.  

Watch the CPR.  Are the hands positioned properly.  Are they compression to an adequate depth and at the proper rate.

Since compressions are what matters most, make certain your team is doing them properly.  You are the coach.  You are in...

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Ambulance: PEARL # 3: Make space for your cardiac arrest.

Written by RSS Poster Medic Scribe

You can’t work an arrest if you don’t have space to do effective CPR. I often come into a bedroom where responders are trying to work a code, and I will flips beds up on their sides, clear out couches, or if the patient is wedged in the bathroom, haul them out into the hallway, stopping so there is an open door in line with their chest.  Ideally you need room on both sides of the patient’s chest for compressors and room at the top for the airway management and space for your supplies.  Make use of your help.  In this age of stay and play for cardiac arrest, if you are going to be there for awhile, make certain you have the best conditions for an effective resuscitation.  

Stay Tuned for next cardiac Arrest Pearl # 4 CPR Coach



Ambulance: Pearl # 2 Precharge your Defibrillator

Written by RSS Poster Medic Scribe

Charge your defibrillator before looking at the rhythm. Whether you and your partner are the first person at the patient’s side or first responders or laypeople are already doing CPR on your arrival, initiate and/or keep CPR going while you apply your pads.  Then with CPR still continuing, charge the defibrillator.  Only then stop CPR to look at the rhythm.  VFIB or VT, shock!

If its not a shockable rhythm, simply dump the charge by pushing the speed dial button.

Make certain to tell the compressors you will not shock them as you charge.  When you order them to stop so you can see the rhythm, you want your gun loaded.  If you were a hunter and had a deer in your sights, you would want a bullet in your rifle, not to have to stop and load.  This should be the process all through the code.  Charge while CPR is in progress.  At the 1 minute fifty second mark, charge so that at two minutes when you see VF or VT, you can shock, instead of starting another ten seconds of CPR before being able to fire.

Limit...

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Ambulance: #1 Recognizing Cardiac Arrest

Written by RSS Poster Medic Scribe

Cardiac Arrest.  Pearl #1  Recognize cardiac arrest.

This sounds obvious, but it is not always so.  Early cardiac arrest can present like a seizure or syncope.  The patient’s eyes may be open and they may have agonal breathing.  Get the pads on!  Too many times I have shown up on scene to see first responders tell me the patient just had a seizure or they are breathing, and everyone is standing around.  I admit when I first started, I didn’t always instantly recognize what was going on.  When I was precepting, we had a patient with chest pain who all of a sudden he started seizing.  I reached for the valium (our benzo at the time).  My preceptor shook his head.  “Look at your monitor,” he said.  VF. 

Get the pads on!  Even if the patient snaps out of it before you can act, always get them on the monitor.  Be vigilant.  Several times early in my career I have had witnesses tell me the patient had stopped breathing and needed CPR before coming around.  Those reports did not seem consistent with the alert, talking...

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Ambulance: Cardiac Arrest – Pearls

Written by RSS Poster Medic Scribe

Paramedics all take ACLS every two years, and we all have roughly similar protocols. We all know that the key to resuscitation is high quality CPR and early defibrillation. I love this graph I found on Rogue Medic‘s blog a number of years ago.

This graph is the answer to the test. We read about the latest gizmos and approaches over the years – everything from high- dose epinephrine, the ResQPOD, CPR machines, double sequential defibrillation to the latest head up CPR, but despite their early promises, few innovations make a difference beyond the basics. Those basics will likely always be good CPR and early defibrillation.

What I will offer in a series of posts is not a new way of doing CPR or a new device, just some pearls that I have learned to include in my resuscitations over the years that work for me.

Pearl #1  Recognizing Cardiac Arrest



Police: Are We There Yet?

Written by RSS Poster Hogdayafternoon
I'm really only posting this to remind myself of how to do it.
Much has happened.  Good people and old comrades have died.

I became a volunteer with the regional Air Ambulance. Mrs HD and I became international dog sitters over two years ago. I am studying drama. I am still riding my beloved motorcycle. It's dark... and I'm wearing sunglasses........

......and our mighty Government still hasn't managed to conclude Brexit. I'm betting there'll be a `Jocksit` before it's sorted.



Ambulance: Wallowing In It

Written by RSS Poster StorytellERdoc
"Sometimes shit just happens."

Just a few days ago, I finished yet another string of four hectic shifts in the ER of our incredibly busy trauma center. After saying my goodbyes to my coworkers and transferring the care of my remaining patients to my partner, I left the building through our ambulance doors, avoiding the main pedestrian entranceway where the hectic waiting room sat. 

It was a safe choice to leave this way, as it was 3 a.m. and both the ER and the waiting room were still swarming with much activity. Had I tried to navigate leaving through all the chaos of the waiting room, I would have been a target of many evil and angry stares from those patients who continued to sit there with non-emergent complaints, watching the lone TV that was looped with repeating segments regarding diet and fitness. Of course, who wouldn't want to learn the benefits of eating cauliflower and doing fifty daily sit-ups at 3 a.m., right? And I certainly didn't want to finish my night by getting the angry stink-eye from an eight year-old girl...

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Fire: HOME FRONT

Written by RSS Poster LONDON FIRE JOURNAL



Ambulance: Wallowing In It

Written by RSS Poster StorytellERdoc
"Sometimes shit just happens."

Just a few days ago, I finished yet another string of four hectic shifts in the ER of our incredibly busy trauma center. After saying my goodbyes to my coworkers and transferring the care of my remaining patients to my partner, I left the building through our ambulance doors, avoiding the main pedestrian entranceway where the hectic waiting room sat. 

It was a safe choice to leave this way, as it was 3 a.m. and both the ER and the waiting room were still swarming with much activity. Had I tried to navigate leaving through all the chaos of the waiting room, I would have been a target of many evil and angry stares from those patients who continued to sit there with non-emergent complaints, watching the lone TV that was looped with repeating segments regarding diet and fitness. Of course, who wouldn't want to learn the benefits of eating cauliflower and doing fifty daily sit-ups at 3 a.m., right? And I certainly didn't want to finish my night by getting the angry stink-eye from an eight year-old girl...

This ambulance blog continues, Read More...



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Emergency Shorts:
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