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Head Injury Management (Two Things)

admin — Fri, 10 Feb 2012 04:14:20 +0000

Managing head injury patients can be challenging. Actually they can be down right scary. Let’s face it, the closed head injury call can go sideways fast. They tend to be altered or unconscious. They can be angry and combative. They vomit. Their vital signs do weird things that are difficult to explain . They can breath too fast, too slow or not at all. (And sometimes they do all three.) The next time you’re in the middle of managing a difficult head injury patient, I want you to think about two things. There are limited things that we can do in the prehospital setting to fix a closed head injury. They need to be transported to an appropriate trauma facility. Our care is centered around managing them until we can get them to the definitive care that they need. With that in mind, here are the two cardinal sins of closed head injury care. These are the two things that need to be avoided at all costs. Two things… First thing. Never, ever, ever let a closed head injury become Hypoxic . Hypoxia will make a bad head injury become worse in a big hurry. Remember that respiratory status can be a moving target in the closed head injury patient. Anything goes with the rate and depth of respiration as a patient intra-cranial pressure rises

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A Better Way to Locate the Closest AED

admin — Thu, 09 Feb 2012 22:45:08 +0000

– In having to come up with games, or other methods of locating AED (Automated External Defibrillators), we are trying to solve a system design problem that might be as simple as an equipment design problem. Maybe the answer is to put RFID (Radio Frequency IDentification) chips in each of the AEDs. Last night I was discussing this with Brandi Winemiller and she suggested that I write more about this. RFID is usually short range, but the signal can be picked up at longer distances with the right equipment. Then it becomes a problem of where to place equipment to locate RFIDs or what type of mobile equipment to use and how to use it. RFID is easier to keep up to date than running the occasional contest. – Image credit. – If people willing to do CPR are encouraged in CPR courses to download an application that helps to locate the closest AED, that would bring the information to the target audience. The information might be from the AED itself, or from the mapping application, or both. Maybe RFID is the wrong technology, but it is certainly worth considering. – One application is AED4 US . – CPR only requires compressions (CPR/ACLS guidelines admit this is true for bystander CPR, but fear prevents the admission that the same is true for EMS and hospital personnel), so we could use a lot of the course time to teach AED use. Since teaching continuous compressions and AED use does not require a lot of time, we could shorten the courses significantly. – Click here to view the video on YouTube. – If the CPR course is shortened and simplified, then mobile CPR teaching might be a better way to bring the knowledge to the people who might use it. We need to get over our fascination with ventilation in cardiac arrest and the pit crew approach that is justified by the lack of understanding of the lack of benefit of ventilations

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Would You Know Where to Find an AED If You Need One

admin — Thu, 09 Feb 2012 03:00:49 +0000

– There is a contest in Philadelphia to map locations of all of the AEDs (Automated External Defibrillators) in the county –

Mysterious Tics in Teen Girls – What Is Mass Psychogenic Illness – Part I

admin — Wed, 08 Feb 2012 05:00:18 +0000

– How should EMS handle something like this? Last fall, when a dozen teenage girls in a single upstate New York high school developed a condition that looked like Tourette’s syndrome — complete with sudden verbal outbursts, uncontrollable arm motions and facial tics — it seemed likely that a chemical toxin or infectious agent was to blame. But none could be found. [1] – Lights and sirens? Activated charcoal? Ipecac? Naloxone (Narcan)? Flumazenil (Romazicon)? Sodium Bicarbonate? Coma cocktail? – I have had calls like this. My handling has been a thorough assessment (usually in the presence of parents, because they often seem to be called before 911 is called), perhaps cardiac monitoring (depending on the assessment), and a nice calm transport of all patients to the same hospital (in case there is a connection in the origin of the symptoms – chemical exposure, drug ingestion, food poisoning, whatever). How did things work out in the case being covered by the media? There is no mention of EMS response or treatment, so I don’t know. doctors have already diagnosed most of the girls with a disorder: mass psychogenic illness — otherwise known as conversion disorder or, to use an outmoded term, mass hysteria. [1] We act surprised when our minds do not do what we trust them to do – tell us what is real.

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North East Ambulance Service faces major reorganisation

admin — Tue, 07 Feb 2012 18:21:02 +0000

Major changes in the way the North East Ambulance Service NEAS is run have been announced. The service plans to introduce more ambulances across the region but the re-allocation of vehicle numbers and types in some locations has raised concerns.The MP for Berwick, Sir Alan Beith, said the loss of one of the towns two emergency ambulances would risk lives. NEAS said without changes it would “fail to meet response targets”.The plans include adding a new category of ambulance to the current rapid response vehicles and dual-crewed ambulances. These “urgent care” vehicles, with no paramedic, would deal with the majority of hospital and GP transfers and other non-emergency calls. Some places would gain one or more types of ambulance, while others would lose some of their current provision. via BBC News

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10 Assorted Thoughts, Ideas, and Resources Part 1

admin — Tue, 07 Feb 2012 17:00:43 +0000

Within 2 minutes of waking up I drink at least 8 ounces of tap water to immediately fill my tank for the day ahead. Local beer is always better. If you life in Milwaukee, St. Louis, or Golden, Colorado it might take a little effort to identify a true local beer. Walking a dog is a great way to meet your neighbors. Try to do something that is weird. This is the age of the micro-niche and it is easier than ever before to meet others that like the same weird things you do. Regardless of your job or profession the top two workplace skills are writing and presenting. We all have ideas that are powerful and need to be shared. The most important thing I have done to run faster is believe that I can run faster. I generally unsubscribe from blogs that don’t show the full feed in an RSS reader because I don’t like the extra step of clicking through to see if the content is worth my while. I also have a growing dislike for websites that request I click for the next page of an article. Put all the text on one page. As a kid I detested sweeping the garage when my dad asked. Now I find myself sweeping the garage almost daily to keep the dirt outside the house. Although it is electric, there is no “E” in lightning. Kaboom! 10 seems like a good number to conclude part 1 and start my next list of assorted thoughts, ideas, and resources. Also noticed I neglected to add a resource in the above list so try this one, Paramedic.Alltop.com for all the best EMS blogs in one place. Read related posts and tips: 25 Ideas to Celebrate EMS Week EMS week is about celebrating your individual accomplishments and recognizing… Tucson Mass Shooting – some thoughts on MCI Response Like many EMS professionals I have read media accounts from..

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No One Can Care For You

admin — Tue, 07 Feb 2012 03:46:40 +0000

Someone else can be committed to training you to an acceptable standard. Other people can require you to hold the proper certifications and minimal requirements to do the job. Field instructors can demand that you demonstrate a minimum level of competence before you are allowed to work autonomously. Quality assurance managers can confirm that you document acceptable treatment plans. Administrators can monitor your adherence to policies and procedures. Governments and institutions can demand your attendance at continuing education classes. Almost everything about your performance can be demanded and confirmed, except for your compassion. Nobody can force you to care. Nobody can demand your heart-felt effort or your empathy or your genuine kindness. If you choose to have it, it is your prerogative. The industry can demand that you perform a service, but nobody can command you to serve. You can’t be ordered to bring your passion, your spirit and your individual, unique contribution to your job each day. You have to choose to do that on your own. That’s what makes it so valuable. …That’s what makes it priceless. I’d like to know what you think about that

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What your doctor doesn’t tell you

admin — Tue, 07 Feb 2012 00:30:07 +0000

– An article in the New York Post spreads false information about the evidence base of science. In recent years, physicians have been slowly admitting that they don’t hold all the answers and that some of the dearest sacred cows in medicine — mammography, CPR, antibiotics — don’t work as well as we expect. [1] This is misleading. We are learning better ways to use mammography . The limitations of mammography do not mean that mammography doesn’t work. The limitations just mean that mammography is being used more appropriately as more is learned. Sacred cow? No. – CPR is being demonstrated to be more effective as we eliminate interruptions for treatments that are not based on evidence of improved survival. The more evidence-based, the better the survival. It is where bystander CPR rates are low, that the lowest resuscitation rates are found. Witnessed shockable rhythms have almost a 50% chance of survival in communities with high bystander CPR rates vs. less than 5% in communities with low bystander CPR rates. Almost 50% vs. less than 5% does not suggest a failure of CPR. Is CPR a sacred cow? No. Another problem with CPR is our fear of allowing anyone to die, as if this is not an inevitable part of life. CPR was never intended to prevent the very sick from dying, but only those with sudden arrhythmias that could be reversed by defibrillation. We have applied a treatment for one condition to all cardiac arrests and been surprised that people die for different reasons.

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I am the 0.045%

admin — Sun, 05 Feb 2012 17:00:27 +0000

According to a February 2012 Outside magazine article there were only 140,000 runners that completed two or more marathons in 2010. Assuming that it was the same in 2011 I was one of the few in a population of more than 312 million that completed multiple marathons. I ran the Green Bay marathon in May and the New York City Marathon in November. Right now I only have plans for one 2012 marathon, but since I love being weird (check out We are all Weird on Amazon) I might start planning to run a second. Before the start of the 2011 ING New York City Marathon. Verazanno Narrows Bridge behind me. Read related posts and tips: Marathon Running: 3 Lists of 3 Part 7 2 days until I am running in the ING New… New York City Marathon: 1 Word Race Recap FINISHER!… ING New York City Marathon 2011: Race Recap Part 3 Ten Lessons Learned at the 2011 ING New York City…

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It is better to NOT understand something true, than to understand something false – Example 1

admin — Sun, 05 Feb 2012 16:30:57 +0000

– Continuing with my explanation of the problems with wanting explanations for why something happens. Why something works. Why something doesn’t work. The why is not the important part. What we need to know are – What we can expect to happen. Under what circumstances we can expect it to happen, At what rate we can expect it to happen. What complications we should watch for. –