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Ambulance: Beautiful Boy

Written by RSS Poster Medic Scribe

In the movies, the hero kills the monster after an exciting and lengthy battle. Then just as the winning team congratulates themselves on their great victory and now bright future, the monster raises its head again. It was not really dead! After a brief but tense battle, in which the hero almost dies, the final sword is plunged in the monster’s heart. The movie is over. The credits roll. Hooray. Peace on Earth. A predictable formula.

There is a new movie out about addiction. Beautiful Boy stars Steve Carrell, the comedian of The Office fame, who has made quite a number of excellent serious movies. The movie is based on the book Beautiful Boy: A Father’s Journey Through His Son’s Addiction by David Sheff about dealing with his son Nic’s addiction.

Nic is wonderful child, who suddenly turns into a crystal meth addict. It seems suddenly to the father, but it is a little more gradual. Unbeknownst to Dad, the boy starts smoking pot at 13. It makes him feel fantastic. He has some underlying and undiagnosed mental health—he’s...

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Ambulance: Cocaine with Fentanyl

Written by RSS Poster Medic Scribe

(Image from InspireMalibu)

When they can’t get a hold of their local dealer, the two young men come in to Hartford from the suburbs to buy cocaine. Bart boasted to a younger friend Milton that he could get any drug he wanted on Park Street. “Well, let’s do it,” Milton said.

It is true that Bart knows where to buy drugs.  What he hasn’t told Milton is that when he used to do heroin, he met a friend named Mark who would do the buying for him. And since he got out of rehab, he has only been using percocet.  He doesn’t inject anymore because his veins are hard to find because of his chubby arms.  Only Mark could hit his veins and Mark has been no where to be found, which is a good thing as Bart can handle the Percocets better than he could heroin. Bart has also never purchased cocaine in Hartford, though he knows the same guys who sell heroin have coke. Bart sticks with his boast.  “Sure, let’s do it.”

They park Milton’s car on Zion Street. They get out and start toward Park. “You sure, you know what you’re...

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Ambulance: Plateau

Written by RSS Poster Medic Scribe

Plateau -(noun) “ a usually extensive land area having a relatively level surface raised sharply above adjacent land on at least one side.

Plateau-(verb)- to reach a level, period, or condition of stability or maximum attainment

Merriam-Webster

***

The United States Health Secretary announced recently that the opioid overdoses deaths appear to be plateauing across the country.  While some states have seen a decrease and others an increase, the overall numbers appear to have slowed after a parabolic rise.

Opioid Deaths May Be Starting To Plateau, HHS Chief Says

The credit can go to harm reduction programs, public health and safety efforts and community organizations who have worked hard toward solutions.

Good news certainly, but not cause to disarm.  The death numbers, even if they plateau are staggering.  70,000 deaths in 2017. Many young people who would otherwise have many years of life, family and contributions to society left had they not been ensnared in this terrible epidemic.

Ensnare is another word for the day.

Here are some...

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Ambulance: Unforgiven

Written by RSS Poster Medic Scribe

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...

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Ambulance: In Praise of Tim Phalen

Written by RSS Poster Medic Scribe

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...

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Ambulance: Chains

Written by RSS Poster Medic Scribe

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,...

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Ambulance: Obituary

Written by RSS Poster Medic Scribe

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,...

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Ambulance: Spare Change

Written by RSS Poster Medic Scribe

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...

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Ambulance: Supraglottic Versus ET

Written by RSS Poster Medic Scribe

“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...

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Ambulance: Connecticut Overdose Death Numbers

Written by RSS Poster Medic Scribe

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

 




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