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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 I can...

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Police: Sadness tempered with pride

Written by RSS Poster CC Dave Thompson

The last few weeks have seen many reasons to feel pride in the force. Some incredibly sad, some exciting.

PCSO Holly Burke’s tragic death has touched a great many of us because of its sudden nature and the fact it happened during a police operation. It has been hugely tough for colleagues and those involved in the case. I was pleased to see a significant turn out at her funeral from colleagues.

No less loved was PC Rakesh Sond who also sadly died. Again colleagues attending to show their love and support. Sad times often unify us.

Chief Constable David Thompson

Last week we saw the launch of the National Sikh Police Association here in the West Midlands. The new national association has been born out of our own Sikh Police Association who have used the great work they have done here to stimulate work across the country and now a new staff network. It was an inspiring day. Staff networks are vital for our force. They not only advocate for under-represented groups but they also invest huge time in bridging the links...

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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 antidotes in the setting of cardiac arrest due to opioid...

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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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Police: THE SUN SETS ON LAY MAGISTRATES

Written by RSS Poster The Justice of the Peace
The government departments which have the greatest influence over the manner of the work that Justices of the Peace undertake are, surprise surprise, the Home Office and the Ministry of Justice. In May 2006 a previous Home Secretary John Reid admitted that when he was the incumbent the department was "not fit for purpose".  His honesty then has been borne out many times since.  The current prime minister oversaw so many failings when she was Reid`s successor it should have been a red light to her colleagues when she was placed in Downing Street purely as the least objectionable of a rum lot. But the lemmings in the Tory Party allowed themselves to be led towards the inevitable cliff where her and their incompetence are likely to bring at the best,  years of political and economic problems and street violence and a Marxist government at worst. 

Faced with the problem of the Isis teenager from East London telling the media she has no regrets over her actions and expecting public sympathy the current Home...

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Fire: Don't let your Valentine's Day go up in smoke

Written by RSS Poster Merseyside Fire & Rescue Service - Latest News
Don't let your Valentine's Day go up in smoke


Police: A 10 Point Plan for Policing

Written by RSS Poster policecommander

I’m sitting on a train bound for Cardiff where, later today, I will have the privilege of spending a bit of time in the company officers and staff from South Wales Police. I’ll be talking to them about the day I fell seriously ill and the reasons why I think it happened. I’ll be telling them about the long, long road to recovery.

I love policing with all my heart and soul – I always have and I always will. It’s a heck of a job though – placing the kinds of demands on people (body, mind and soul) that most of the rest of us would struggle to imagine, much less endure. Police officers go where most wouldn’t and they do what most couldn’t. I love them for it.

But as I look round me in policing at the moment, I see more good people operating under substantially more strain than at any previous point in my lifetime. Crime is rising – certainly crime of the most serious kinds. Levels of recorded knife crime are now the highest they have been since the end of World War II. Demand is rising too, not least as a...

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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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