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Ambulance: Common Cardiac Arrest Mistakes: Sodium Bicarbonate

Written by RSS Poster Medic Scribe

This is the second of three posts about common cardiac arrest drug mistakes some EMS personnel make on a routine basis.

You have been working a cardiac arrest for a 54-year-old male with no prior medical history who collapsed after grabbing his chest.  You shocked him twice for fine vfib, but now he is in a PEA. It’s been 20 minutes since you started ALS interventions and another medic suggests you try sodium bicarb.  What do you do?

Remember it 2019, not 1979, 1989, 1999 or 2009.

Unless the patient has preexisting metabolic acidosis, hyperkalemia, or tricyclic antidepressenat overdose, (which this patient clearly does not) sodium bicarb is not recommended by the AHA.  In 2010 sodium bicarb was made a Level 3 Recommendation.  Level 3 means it is not helpful and may be harmful. In 2015 that recommendation was reviewed and maintained.

While you should always follow your protocols and your local medical direction, in Connecticut, sodium bicarb in cardiac arrest is reserved for “suspected...

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Ambulance: Cardiac Arrest Mistakes: Amiodarone

Written by RSS Poster Medic Scribe

You and another medic are on the scene of a cardiac arrest. You find the patient in ventricular fibrillation and immediately defibrillate him into a narrow complex rhythm. You have pulses back and while you take a blood pressure – 130/84, the other medic inserts an IV. The other medic then says to you, “Pass me the amiodarone.”

What do you do?

A. Pass it to him.
B. Say, “No.”
C. Say “Why?”

You go with C. The other medic says, “To give to the patient (Dummy!). He was in v-fib.”

You say, “No, it’s not indicated.”

Who’s right? You or the other medic.

It is amazing how many medics have different views on this question, and some of this depends on when they were trained and how well they have kept up on changing guidelines. It also depends on their local medical control and the protocols they operate under.

Here in Connecticut our state protocols for cardiac arrest call for amiodarone or lidocaine for patients “unresponsive to CPR, defibrillation, and vasopressor therapy.” There is no...

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Ambulance: It's Not About The Pus

Written by RSS Poster StorytellERdoc
To Dr. Sandra Lee. Heartfelt thanks for humanizing medicine and for inspiring along the way...

Several years ago, my daughter Emma introduced me to some videos on YouTube of a dermatologist from California who posted her sometimes shocking but always intriguing encounters with patients who suffered from a variety of dermatologic issues. Of all of these videos, it seemed like the ones which made Emma happiest to watch were the videos in which this doctor's treatment resulted in gallons of pus draining from some part of the patient's body.

Well, okay--Emma liked pus and blackheads. Well, pus and blackheads and massive lipomas (fat-based tumors). Well, pus and blackheads and massive lipomas and big hairy moles. Well...

You get the picture.

With some great finesse and skill, and with a good mix of humor and learning, Dr. Sandra Lee, better known as Dr. Pimple Popper, was able to help many embarrassed patients survive their dermatologic issues, all the while captivating my daughter's interest. "Eewww, gross," Emma said. "Let's...

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Ambulance: 4, 3, 2, 1 And 90.

Written by RSS Poster StorytellERdoc
Everyone you meet is fighting a battle you know nothing about. 
Be kind.
Always.

One of the largest problems in our ER, it seems, is that there is a subset of patients who visit us on a routine basis. Commonly known as "the regulars," these familiar faces are sprinkled throughout our day between all our other patient visits. Whether it be for chronic pain, for chronic illness, for companionship, simply to have a place to hang out for a few hours, or to get some food, we are often inundated with these patients at the most inopportune times. Three trauma patients, four chest pain patients, two stroke patients, seven respiratory distress patients, three lacerations, two compound fractures, and five sick kids--and arriving between all of this organized commotion of providing good care are Johnny, Sally, and Herb, with a combined total of over two hundred visits between them.

It is a real problem in our ER. It is a real problem nationwide.

Of course, the most compassionate thing to do would be to sit down and spend some time with...

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Ambulance: Service Dogs for First Responders

Written by RSS Poster Medic Scribe

A fellow paramedic here in Hartford, Greg Shovak runs a great educational program called EMS and PTSD – Learning from Combat Veterans to Understand PTSD.  I attended one of his sessions a few years ago and thought it was excellent.  I learned a lot of PTSD, and also had my first introduction to service dogs.

Here is his organization’s facebook page, which has lots of great information:

EMS and PTSD

Service dogs are not just for combat veterans, but also for first responders.  Several of the medics I work with (including Greg) have them and they often bring them to CMEs.  Their dogs are awesome and that means something coming from me (see my dog history below).  I can see how the dogs bring them great comfort.

Greg has been a true leader in helping those in EMS recognize and seek help for their PTSD.

Here are a couple articles he recently wrote on PTSD, including one that mentions his own service dogs.

https://www.emstoday.com/emerging-voices-content/2018/12/makingstrides.html


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Ambulance: To Care Or Not

Written by RSS Poster StorytellERdoc
I dedicate this to each of you who have cared for or are currently caring for an ill parent or family member. 

Recently, due to the stress that several of my dearest friends have been experiencing in caring for their elderly parents, I am even more appreciative and respectful of my privilege in caring for elderly patients who have attentive and loving adult children who accompany them to our ER.

Although this may seem like it should be the standard, you would be surprised at just how many elderly patients present to our emergency department alone. At times, it is heart-breaking to hear their shared stories of being the lone survivor of their family, of being estranged from their children, or of having geographical factors contribute to their aloneness in presenting to me for care. So when an adult child is present, I make it a point to not only introduce myself to them, but also to thank them for being available for their parent. Including them in providing more history and in discussions about testing and treatment plans for their...

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Ambulance: I Feel Things...

Written by RSS Poster StorytellERdoc
I'm  back! Thanks to the many people in my life for their support and encouragement upon my returning--you know who you are! Please feel free to repost, share my return, and visit my archive!

Well, well, well...hello my long, lost friends. I missed you!

It seems like a long, long time since I have written a post for my blog, StorytellERdoc, and I am excited, nervous and humbled to be reentering your lives while returning to my baby.

What started as a small adventure and challenge from my writing group, with my first posting on November 19, 2009, turned into quite an amazing ride throughout the literary and social media world. The number of friends I met was staggering. I received recognition and awards. I won prizes. I was interviewed and contacted for my opinions. I got over a million hits. All of these things, though, were secondary to my intent. I simply wanted to pull you into my world, through my words, to focus on obscure life and ER moments that possessed a level of rawness and realness that connected you and I as fellow...

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Ambulance: PTSD

Written by RSS Poster Medic Scribe

I attended a critical incident stress debriefing (CISD) a few years ago. I thought I had been invited to an informal get-together of folks from another service who I had been on a upsetting call with the day before. Had I known it was a formal CSID debrief, I wouldn’t have gone, as I had always avoided them in the past. Not that CSIDs don’t help some people, they are just not for me.

I have been in EMS for thirty years now, and I have been on traumatic calls. This one ranked up there, but since I wasn’t the first medic in, I didn’t catch the brunt of it. For me the worst calls are not always those that make the news.  I take it hardest when my patient dies in my care, when I have to witness a sudden deterioration and  feel helpless to stop it or feel like maybe had I done things differently I could have possibly affected the outcome for the better. Other calls where the patient’s fate has already been settled before I arrive are less taxing to me than they used to be.  This was such a call.

Each of us processes trauma and stress...

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Ambulance: Beautiful Boy: The Movie

Written by RSS Poster Medic Scribe

Beautiful Boy, a father’s story of his son’s drug addiction, is now streaming on Amazon Prime. The movie, based on the real life stories of David and Nic Sheff, a father who witnesses his son’s addiction to methamphetamine and heroin, is forced to make artistic plot choices.

I wondered how the movie director was going to handle the son’s seemingly endless relapses chronicled in the book. A typical Hollywood story has the hero slay the monster and then when everyone thinks the monster is dead, the monster comes back to life and the hero must slay it again after coming perilously close to death yet again. The problem with the real life plot of addiction is that one relapse is rare. In the book, the young man had more than I could easily count. He had so many, I felt like flipping the pages to get to the end and some resolution. Enough already! I get it!

In the movie, the director makes the artistic choice of stopping the movie after the second relapse. The father’s love for his son is apparent. The son’s...

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Ambulance: Calm

Written by RSS Poster Medic Scribe

When I first became an EMT, a friend asked me why I liked the job so much. When I come through the door, people look at me like I am an angel, I said. What is it like driving lights and sirens? Another friend asked. Awesome — I feel all powerful. I hit wail and the cars part for me like the red sea parting for Moses.

If you asked me then if there was anything wrong with what I described, I would have been seriously puzzled by the question. I didn’t quite understand the true nature of the work.

When I became a paramedic I quickly learned to be a circus ringmaster, barking orders to partners, other first responders and even bystanders. All eyes were on me as I orchestrated getting vitals signs, med lists, moving furniture, putting on oxygen, getting an IV, delivering medicine, extricating the patients, even determining who could ride with us to the hospital. Eventually I brought that same leader of the band approach to running cardiac arrest (compressions, shocks, IV access, drugs, intubation, post-ROSC 12-lead, dopamine to support...

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Ambulance Blog List

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