He is walking down a side street off Park when he freezes in place. He sees the slow moving black Toyota blink its lights, then he sees the station wagon. Before he can take a step to flee, he sees the barrel come out of the back window. He feels the impact against his shin and another in the hip. He dives behind the bus stop shelter as more bullets splat against the wall of the boarded up store behind him.   He scrambles up and runs into the street. He takes the orange he has in his pocket and heaves it at the car. Then he holds up a double barreled middle finger. “Fuck you! “ He shouts. “Your product sucks!”

“Five times I’ve been ambushed this week,” he explains to me that afternoon. “He hit me eight times. Hurts like a mother. Look at me, I’m covered in paint. He uses a different car for his shooters every time.  He flicks his lights to give them the signal, the bastard.”

Mickey is a homeless addict who is a fixture on Park Street. He is short and wirey and missing most of his teeth. Every six months he disappears for awhile, going...

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If you ever get a chance to take a 12-lead class from Tim Phalen, Don’t miss it. Tim has been teaching 12-lead classes across the country for over twenty years. I first took a class from him about that long ago. He is a great presenter with the gift of making complex concepts seem easy.

When I first took his class, he told a story about Elvis the janitor, who he and his buddies taught how to read 12 lead ECGs. Elvis would be mopping the ED floor and then peer over the shoulder of a medical resident intently studying a new ECG. “Inferior MI,” Elvis would say, and then continuing mopping. A few hours later, he would glance at another ECG the resident had just obtained. “Anterior.” And back to the mopping, He became a legend in the ED for his savant-ability to read ECGs. How did he did he do it?

Simple. Tim and his buddies taught him Big and Tall is Bad. Lower corner is inferior, The right side of the page is Anterior.

Wallah!

Phalen, of course, teaches to a level of detail far greater than Big and Tall is Bad, but if through simple...

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We’re sent to the courthouse where a marshal takes us back to a holding cell. A thin bearded man with cuffs around his wrists and his legs chained is bent over in the bare cell, grimacing.

“Guess he got nervous about seeing the judge,” the marshal says to us, “Developed himself some back pain.”

“I’ve had back pain all day,” the man says. “And I’m not ducking anything. I’m in here for panhandling for Christ sakes! I can’t fucking sit up.”

“You didn’t tell that to the officer who brought you here?”

“He knew I had pain. I was sitting on the side of the road, holding my sign. I couldn’t even stand up. He had to help me into the god damned squad car. He brought me right here. I’ve got a warrant for failure to appear for another panhandling charge. Big bad criminal, that’s me.”

There is a term called “jailitis” that implies that prisoners are faking sickness to get out of jail, knowing they have to be brought to the hospital, and even though they know they will be returned to their cell eventually, the trip breaks up...

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I had three people tell me to read this obituary a woman wrote about her sister who died at thirty-two after a long struggle with addiction.

Madelyn Linsenmeir, 1988-2018

Powerful.  

While I am most moved by the first part that describes Madelyn and shows the clear love of her family for her, I am excerpting the end below because it contains a message for us as health care professionals.

If you yourself are struggling from addiction, know that every breath is a fresh start. Know that hundreds of thousands of families who have lost someone to this disease are praying and rooting for you. Know that we believe with all our hearts that you can and will make it. It is never too late.

If you are reading this with judgment, educate yourself about this disease, because that is what it is. It is not a choice or a weakness. And chances are very good that someone you know is struggling with it, and that person needs and deserves your empathy and support.

If you work in one of the many institutions through which addicts often pass — rehabs, hospitals, jails, courts...

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I see Maria outside the Spanish market, squatting against the building. She is a tiny woman in her fifties who was introduced to heroin thirty years ago when she was living in New York. The father of her son used it occasionally and when he used, she was obligated to sniff some as well. It didn’t take her long to get addicted. She has grandkids, but she never sees them. Her father is still alive, but even though she misses him terribly, she doesn’t want him to see what she has become. She says she would like to quit, but she has no help. She stays here and there, and is dependent on people coming out of the market and giving her their loose change. She doesn’t beg or ask or bother people, she is just squatting there. People who know her and know what she needs hand her some change. When she gets four dollars, she walks a block and goes behind a cafe and buys from the guys in the back lot. “No Fentanyl,” she tells them. She just wants heroin, enough to keep her from being sick.

I’ve taken her to the hospital a couple times. Once when she fell...

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“EMS personnel and physicians involved with protocol development for EMS systems in the United States, United Kingdom, and similar settings with limited exposure to advanced airway management should reconsider the routine use of endotracheal intubation as the first-line strategy for airway management in out-of-hospital cardiac arrest.”

This is the conclusion of an editorial in the August 28, 2018 edition of the Journal of the American Medical Association.

The editorial, “Pragmatic Airway Management in Out-of-Hospital Cardiac Arrest,” is in response to two major new prehospital randomized, controlled airway studies published in the same edition of the journal.

In the first study, the Pragmatic Airway Resuscitation Trial (PART), researchers found initial insertion of a laryngeal tube (King-LT) in victims of cardiac arrest “was associated with a significantly greater 72-hour survival compared with a strategy of initial endotracheal intubation.” The authors found that a King LT Airway outperformed the endotracheal intubation in every...

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The opioid overdose epidemic continues to rage in Connecticut, although numbers again show the carnage may be plateauing.

The Connecticut Medical Examiner’s Office just released the overdose death numbers for the first six months of 2018.

Connecticut Medical Examiner’s Statistics

 515 people died in contrast to 500 and 538 in the two previous six month periods.

The numbers continue to show the rise of fentanyl as the cause behind the overdose deaths,

Source: Ct. Medical Examiner’s Office numbers.  Graphs by Canning.

Connecticut Overdose Deaths Plateau

A walk in the park to stretch the legs while on post. The medic walks past a row of port o-potties from a weekend event.

One port-o-potty is not fully closed.  A sneaker blocks the door door. On second glance the sneaker is attached to a foot.

Open the door and an unresponsive man tumbles out. A syringe and empty heroin bags lay on the ground. The man is blue and breathes only on stimulation. One shake, one breath.

The medic radios his partner who drives the ambulance across the sidewalk to the scene and bring overs the house bag. No more one shake, one breath. A proper ambu-bag is applied while the naloxone is readied.

A man sprint frantically across the park directly at EMS scene.

The running man stops and stands a few feet away, looking hard at the overdose victim, whose face is covered by a mask.

The medic lifts the mask briefly to let the man look. “You know this guy?” the medic asks.

“No,” he shakes his head. “I thought it was Doug.”

A moment later, another porto-potty door opens and a man stumbles out. He looks dazed and...

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Check out this web site to read about eleven people affected by the opioid crisis, including a paramedic who injured his back on the job.

The Opioid Chapters

The next drug to add to the EMS formulary should be water. That’s right. H20. How many times have you been on a call and the patient has asked for water only to be told by every EMS responder in the room, “No! You can’t drink anything!”

Really?

The reason we don’t let people drink water is so they don’t throw up and aspirate while the anesthesiologist is trying to intubate them at the start of surgery. This all comes from two cases in the 1950’s where pregnant woman aspirated during delivery. If you are going to have scheduled surgery, the surgeon will often tell you, no liquids after midnight. The problem with this was they were telling this to old ladies who go to bed at seven at night.  Their surgery wouldn’t be until three in the afternoon.  They were going into surgery dehydrated and hypoglycemic.  Nowadays, many progressive surgeons just say no liquids for two hours before surgery.

Research Suggest Drinking Before Surgery Helps Recovery

New Rules: Eating, Drinking, Anesthesia

Research shows people who are allowed to drink water, apple juice...

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