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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? 

As the sliding glass doors of the ambulance entrance opened up, a blast of cold winter air greeted me, daring...

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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? 

As the sliding glass doors of the ambulance entrance opened up, a blast of cold winter air greeted me, daring...

This ambulance blog continues, Read More...


Ambulance: Connecticut Overdose Deaths 2018

Written by RSS Poster Medic Scribe

The official death numbers for 2018 are out from the Connecticut Medical Examiner’s office.

Connecticut Accidental Drug Intoxication Deaths

1017 people died in Connecticut of accidental overdoses, down 21 from 2017.  This is the first decline (albeit minor) after six years of escalation.

746 people died in Connecticut due to the presence of Fentanyl, up 71 from 2017.

Still  much work to go before we can rest.

***

Here’s a town by town breakdowns of deaths by residence and deaths by overdose location.  95 of the fatal overdoses occurred in Hartford.

CT Drug Overdose Deaths Town-By-Town In 2018



Ambulance: Fleece Pajama Bottoms 2019

Written by RSS Poster StorytellERdoc
People will stare. Make it worth their while. 

Can someone please tell me the exact moment when fleece pajama bottoms became the fashion sensibility of America?

I can't pinpoint the moment exactly, but several years ago I began to notice that many of our ER patients were presenting for treatment wearing nice fluffy fleece bottoms. Men. Women. Old. Young. These fleece bottoms seemed to be enjoyed by a variety of the population. Most of these earlier bottoms for the younger patients were of superheroes and childhood figures, like kitties and ponies. For the older patients, it seemed like the characters from the adult-cartoons The Simpsons and The Family Guy were a big hit.

Being a new sort of fashion, I enjoyed the earlier era of these pajama bottoms. They seemed to be appropriate wear for some of our sicker patients who didn't have the energy to change out of their bed wear before coming to us for medical help. Especially the kids, who often had matching fleece blankets, I enjoyed the style of these pajamas and the...

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Ambulance: Cameras in Ambulances

Written by RSS Poster Medic Scribe

They have installed cameras in our ambulance just behind the rear view mirror. The camera records both the traffic in front of the ambulance and inside the front cab of the ambulance. It does not record the passenger compartment, and it (supposedly) is only a video recording.  Audio would be illegal in our state.

The camera is programmed to record in the case of an accident or sudden deceleration or swerve. It can also turn on if the driver or front seat passenger hit a button on the device. The camera will capture 10 seconds before and 10 seconds after the incident. In normal function the camera displays a green light. It will turn red when activated.

If you get in an accident and the recording shows you were texting or talking on your cell phone, much less drinking a beer, then you will have to accept your fate.

If you are driving safely and a distracted driver swerves into you, then the recording will be to your benefit.

I have only set it off once so far.

We were driving back to the base after a twelve hour day. There...

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Ambulance: Sepsis

Written by RSS Poster Medic Scribe

EMS has focused on trauma, stroke and STEMI in recent years with resulting improvements in outcomes.  Many health care systems are now turning attention to sepsis care and the considerable role EMS can play in early recognition and treatment.

Here in Connecticut we have Sepsis Alerts, which while rarely generating the full response of Trauma, Stroke and STEMI Alerts are important to help hospitals be able to quickly recognize sick people on entry and devote them more immediate attention than they might otherwise receive.

EMS can start the treatment soonest with aggressive fluid resuscitation for those who meet the indications.

Great material on sepsis is available at this web site:

Sepsis Alliance

Check out this excellent video:

Learn to recognize sepsis:

IDENTIFICATION OF POSSIBLE SEPTIC SHOCK

Suspected infection – YES

Evidence of sepsis criteria – YES (2 or more):

o Temperature < 96.8 °F or > 100.4 °F.

o Heart rate > 90 bpm.

o Respiratory rate > 20 bpm.

o Systolic blood pressure < 90 mmHg OR Mean Arterial Pressure...

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Ambulance: Goals and Globetrotters

Written by RSS Poster Medic Scribe

Saturday night saw one of the pinnacle achievements of my life.  Twelve months before, while attending a Harlem Globetrotters game with my daughter, I announced that I was going to learn how to expertly spin a basketball on my finger just like the Globetrotters do.   Ever since then, I have carried a basketball in the ambulance.  In between calls while at posting locations, I have taken the ball out and practiced.  At home I have a basketball in every room of the house.  I even found a heroin addict in Hartford who for $5 a pop would give me spinning lessons. He was an ex-basketball player, who I am pleased to say now has a handyman business and is no longer on the street. (At least that was his plan when a few months ago, he told me I wouldn’t be seeing him around anymore, and true to his word, he disappeared no longer to be seen at his regular haunts.  I can only hope he is doing well).  I practiced so much I developed tendinitis in my elbow and had to suspend all spinning for a month. The elbow is much better and...

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Ambulance: Common Cardiac Arrest Mistakes: Naloxone

Written by RSS Poster Medic Scribe

This is the third in a series of posts on common drug mistakes some EMS responders make during cardiac arrests.

You find the fifty year old man supine on the floor with the fire department doing CPR. Their AED announces, “No shock advised. Continue CPR.”

You set your monitor by the man’s head and connect the fire department’s pads to your monitor, while your paramedic student quickly places an IO in the man’s tibia. As you approach the two minute mark, you charge the monitor, and then order stop CPR. The patient is in asystole. “Continue CPR,” you say, as you harmlessly dump the charge by hitting the joule button.

Just then the man’s wife announces, “Oh, my God! He was using heroin.” She holds the empty bags she has just found in the trash can. “He used to use. He’s been clean for five years.”

What drug do you give?

***

Epinephrine.

According to the 2010 AHA Guidelines

There is no data to support the use of specific...

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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...

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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...

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Emergency Shorts:
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