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Ambulance: Update: Nursing School Failed To Kill Me!

Written by RSS Poster Minimedic's Musings

Soooooo…where do I start?

Oh yeah, survived two years of an associate degree program in nursing, set to take that lovely NCLEX within a month now…and it only became two years because the beginning of my final semester started off with a divorce hearing…

*sigh*

It was a divorce that was a long time coming and not wholly unexpected for me, but it is a complex story of a woman thinking she could fix a man…

…ignoring red flags of anger management issues…

…discovering he may have classic narcissism…

…hey, awesome, it’s domestic violence without physical violence…

…get. me. out. of. this. marriage.

For now, I am somewhat functional with a job and preparing to more baby steps towards financial independence, but I’ve definitely become a different person over the past few months.

I’m back, kids. For better or for worse.




Ambulance: Cat Burglar

Written by RSS Poster Medic Scribe » Medic Scribe

One of my greatest joys on the job is the opportunity to play cat burglar. By this I do not mean the opportunity to break into homes to steal jewelry and works of art. I am talking about the chance to break into homes to rescue people (with police permission).

The person has fallen and can’t get up or, perhaps, it is a medical alarm, and no one knows if there is a person in distress or merely a false activation. We arrive on scene. All the doors are locked and there is no key under the flowerpot (almost as good as doing a second story entry is being the guy who finds the key under the flowerpot. Brilliant!).

I have broken into dozens of homes over the years. I consider myself a top tier cat burglar second story man. My three advantages are: 1) my height(and thinness), 2) my ability to lift myself up with my arms, and 3) my quickness to volunteer. After a boost from my partner or a police officer, I usually go in head first, my legs high in the air, providing a chuckle for the earth bound. I hit with arms...

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Ambulance: Sinners and Saints

Written by RSS Poster Medic Scribe » Medic Scribe

As each of us will ultimately find ourselves before our god, many will find themselves before their paramedic. But unlike their god, their paramedic does not sit in judgement. We treat all of our patients the same. That is the creed. The man in the Mercedes Benz gets the same care as the man pushing the shopping cart full of cans. The model gets the same priority as the toothless crack whore, the All-American the same careful assessment as the bed sore ridden amputee, the police officer the same professionalism as the thief.

Most of my patients are anonymous. But sometimes they are not. I have cared for famous politicians, athletes, entertainers, scholars, businessmen and criminals. Sometimes I like to talk to my patients. I ask them about their lives, how they ended up here on my stretcher, what lessons or regrets do they have from their journeys. When my patient’s public history is known to me, and I suspect my letting on that I know who they are will make them uncomfortable, I try not to let on...

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Ambulance: Conrad Castonguay

Written by RSS Poster Medic Scribe » Medic Scribe

Conrad Castonguay died this week at 81. In 1992-93, he helped teach my paramedic class. Pharmacology was his specialty. He wasn’t a paramedic, but he knew what he was talking about and we paid him mind. He was a challenging instructor, and took his work seriously. It became an honor for paramedics to say they were his students.

Conrad Castonguay

That was 24 years ago when he was 57. The last time I saw him was in 2003 at a funeral for Dr. Philip Stent who was the medical director of my paramedic class. Dr. Stent was also the state OEMS Medical Director, and I had worked with him when I was the Executive Assistant at the State Health Department from 1991-1995, just before I started full time as a paramedic. He was instrumental in creating our state trauma system and in moving paramedicine into the modern era.

Dr. Philip Stent

There are many paramedics still out on the street today who remember both men, and are grateful for having known them. We, as paramedics, are a collection of all the knowledge and...

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Ambulance: EMS Sports Pages

Written by RSS Poster Medic Scribe » Medic Scribe

When I started in EMS, the term “EMS Sports Pages” referred to the Obituaries. It was where we turned to see how our critical patients did. Get pulses back on a cardiac arrest or bring in an unresponsive patient with multiple trauma from an MVA or a seizing patient with left sided paralysis, you checked the obit section each day. It might be day three or day five or sometimes, day 13, but in most cases, you’d recognize the name,and you’d feel a little down. Never see the name and you’d wonder if maybe it appeared on a day you didn’t check. Followup at many of the hospitals was hard to get.

This was around the time Rescue 911 was on TV. In that show heroic rescues were reenacted, and afterwards the victims came by the EMS station for a celebratory picnic with their rescuers. We didn’t have a station. We went from street corner posting to street corner posting. And we never got a picnic.

Once I got called for a stroke. I found a man sitting on a neighbor’s garbage can, where he had been talking...

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Ambulance: My thoughts on the junior doctor contract vote

Written by RSS Poster Garth Marenghi
This post may be unpleasant reading for some of you but frankly it needs to be said given the way some of the 'debate' is heading. Firstly I'm not going to spin cheap sound bites and propaganda in order to push your opinion into voting 'Yes' or 'No'. It has been clear throughout all this that we are all big enough and ugly enough to analyse the evidence to make up our own minds. Secondly be


Ambulance: Tell Me Exactly What Happened

Written by RSS Poster Medic Scribe » Medic Scribe

New Picture (2)

I just finished reading an interesting book, Tell Me Exactly What Happened, which will be published soon by the Minnesota Historical Press. It is the second book by Caroline Burau, a former 911 call taker/dispatcher from Minnesota. It was not what I expected.

When I was in EMT school, I read every book I could find about EMTs and paramedics. I wanted to know what this new field I was considering was like. I wanted any story or tidbit that would help me find my way through the unknown. I never read or even thought about reading a book about 911 dispatch.

I understand the value of the 911 dispatcher, but as a field provider, like I think most field providers (at least in commercial EMS), my relationship with dispatch is at times, more one of annoyance than true camaraderie. That is for two reasons.

Dispatchers

1) Tell us what to do and we have to do what they say. They sit in front of their consoles and play us like we are a video game. They are the proverbial messengers in the don’t kill...

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Ambulance: BLS Skill Creep

Written by RSS Poster Medic Scribe » Medic Scribe

When an ambulance shows up at your house or an EMS scene, they ought to be able to take care of the most common complaints like pain, nausea, and difficulty breathing, to go along obviously with vfib arrest and anaphylaxis. I want the first ambulance to be able to take care of the problem, not say, “OH, shit!, we need to call for the Calvary!”

That’s why I have been a strong proponent of enhancing the BLS level when there is an intervention that can be done safely by BLS that will have a proven benefit to the patient. Starting back with AED, adding epi-pen, and right on through CPAP, Narcan, and as I mentioned in a recent post, Fentanyl (either as an SQ injection or perhaps as a Fentanyl Lollipop). I could throw in oral Zofran and Benadryl, and maybe also include albuterol nebs. Our state recently approved BLS 12-lead for chest pain. The BLS crew doesn’t interpret the 12-lead, but transmits it to the local hospital and if it shows STEMI, they may divert to a PCI center in a farther town. Like Narcan and...

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Ambulance: BLS Fentanyl

Written by RSS Poster Medic Scribe » Medic Scribe

A new article* published in Prehospital Emergency Care  (on-line April 8, 2016), concludes that Basic EMTs can safely give subcutaneous Fentanyl for acute pain in the prehospital setting.

*Subcutaneous Fentanyl: A Novel Approach for Pain Management in a Rural and Suburban Prehospital Setting

BLS EMTs in Canada received a four hour training course, and then were permitted to administer a maximum first dose of Fentanyl 1.5 mcg/kg for patients between 14 and 70 who had a pain scale of 7 or greater.  Patients over 70 could receive a maximum first dose of 50 mcgs.  Both the EMT and the patient had to agree that pain medicine would be given and the EMT  had to obtain permission from the on-line medical control MD prior to administration.

In the study,  284 patients recieved Subcutaneous Fentanyl.  Pain scales decreased significantly and there were no major side effects.  42.9 % of patients had relief of greater than 3 points.  38.6% of the patients received the Fentanyl for pain caused by trauma, 28.1% for abdominal...

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Ambulance: Narcan Dosing and Delivery

Written by RSS Poster Medic Scribe » Medic Scribe

The heroin epidemic continues to rage in Hartford and across our state and nation.  While nearly every other day there seems to be an article in the paper about fatal overdoses in various towns, most of the overdoses we see on the EMS streets, even the fatal ones do not make the news, though they certainly add to the growing statistics documenting the unprecedented epidemic.

My fellow medics and I often share our preferred routes and doses, and the pros and cons of each.  With so many calls, we are all able to experiment with various dosings and delivery.

When I first began in EMS, I gave narcan always IV as my first choice.  Usually, 1.2 mg to start.  I considered this conservative as a paramedic instructor had demonstrated for us his preferred method.  Draw up two of narcan, put in the lock, as you came through the ED doors, slam it so the patient would vomit on the battle ax triage nurse.  I kid you not.

In my then limited experience with narcan, I tended to be impatient, and yes, I will take a...

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Ambulance Blog List

Hampshire & Isle of Wight Air Ambulance (806)
InsomniacMedic (219)
Trying My Patients (194)
Trauma Queen (178)
Street Watch: Notes of a Paramedic (158)
Garth Marenghi (119)
Xf (92)
Minimedic's Blog (71)
Medic Scribe » Medic Scribe (60)
A Life In The Day Of A Basics Doc (57)
StorytellERdoc (50)
Brian Kellett (dot) Net (49)
Medic ScribeMedic Scribe (46)
Jerome Mowat (26)
Emergency Egg (19)
BrianKellett.net (18)
ambcontrol999 (16)
Hampshire and Isle of Wight Air Ambulance (14)
Purpleplus (11)
Minimedic's Musings (11)
Random Acts Of Reality (6)

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