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Ambulance: No BVM?

Written by RSS Poster Medic Scribe

A couple weeks ago, I heard a story about a paramedic, who in responding to a cardiac arrest, told the other responders not to use bag-valve-ventilation (BVM) to breathe for the patient.

Bag-valve mask ventilation is the manner in which we assist people’s breathing who are either not breathing or breathing inadequately. We hold a mask tight to their face, and squeeze a bag which forces air into their lungs. It is an essential life-saving skill.

The medic, who works primarily in another region of the state, told the other responders it was a new protocol in light of the COVID epidemic. Bag-valve mask ventilation can aerosolize droplets which could be dangerous to responders. (To be clear we are not taking about passive ventilation during the first eight minutes of a presumed cardiac arrest, but no BVM at all).

The recent state protocols (COVID supplement) mention the possible danger of bask-valve-mask (BVM). Here is what they say:

Aerosol generating procedures are interventions performed on patients that can generate infectious aerosols. Nebulized...

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Ambulance: New Model

Written by RSS Poster Medic Scribe

A new University of Washington model projects 4,003 people will die in Connecticut due to COVID-19 with peak deaths coming on April 22, two weeks from today.  While certainly bad news this is still down over 1,000 from their projections of just a couple days ago.  I am back in the field tomorrow, but here at the hospital, things are slow.  The number of COVID patients is steadily increasing, and there is no doubt we will start having to use our surge capacity at some point, but the social distancing seems to have slowed the peak arrival in this part of the state.  My guess is we will end up lower than 4,003, but we haven’t been hit with the full wave yet, and things seem to change every day, so the best we can do is take it a day at a time.

Daily coronavirus updates: Model now predicts 4,000 COVID-19 related deaths by June in Connecticut, down from last projection

Connecticut Model

For those interested there is a great article in the New Yorker by the great medical writer Atul Gawande about what Singapore and Hong Kong are doing to protect health care...

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Ambulance: Concoctions

Written by RSS Poster Medic Scribe

I get home from work to find my middle daughter holding a glass with a strange pinkish liquid in it.  “Drink this,” she says, “It tastes nasty, but it’s good for you!”

I’m a sport, so I toss the strange brew down my throat like I used to chug beers when I was eighteen.

It hits the back of my throat and it bubbles there like a volcano with a few red spouts flying back out of my mouth, high into the air , and then splattering on the floor.  The majority though stays in and wreaks it havoc. It’s full of cheyenne pepper and other crazy spices. I feel my throat instantly closing as I go into laryngospasm.. .

”Are you okay?”

I can barely make a sound as I walk quickly to the sink.  I try to breathe in but I get nothing. No air. I am locked up.

“Are you okay?” she says, again.  This time urgently.

My youngest daughter has sprung up from the couch and run into the kitchen to see what is up.  “Are you okay, Daddy?”

Even my masked wife comes out of her isolation room to see what’s going.

I make the horrible stridorous sound, then go...

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Ambulance: 7,781

Written by RSS Poster Medic Scribe

The newspaper is reporting that the curve may be flattening in Connecticut.  While the numbers are still shooting up, that are “linear” and not “exponential” rises.  Let’s hope so.  I am still disbelieving of the new model that says there will be over 5,000 deaths in Connecticut.  

Daily coronavirus updates: COVID-19 cases reach 7,781 and deaths jump up to 227 but hospital admission rates slow as Connecticut flattens its curve

I spend the day at the hospital, nearly every patient that came in, and there were not many patients coming in, were masked and EMS had their PPE on.  The odd thing is a fair number of the people who are testing positive are not coming in as possible COVIDs.  There are falls with broken hips, lower pains, urinary track infections, and psychiatric patients, who spike a little fever or cough a time or two.  They get tested and come up positive.  I really wish we had widespread testing to find out how many people have it and either are not aware of just don’t feel great, but are not at death’s door.  The testing process is so onerous, my...

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Ambulance: Undercount

Written by RSS Poster Medic Scribe

I responded to a cardiac arrest right out of the chute yesterday. Elderly woman recently out of a SNF had been showing signs of delirium according to the family in the last few days, who last saw her alive at midnight. A BLS crew was dispatched for an unresponsive as the only crew available. We had just punched in so we jumped in our rig when our supervisor told us the crew was calling for ALS.

On our arrival, I grabbed my house bag, heart monitor, and our new isolation bag, which holds isolation gowns, face shields, and surgical and N95 masks. After climbing three floors, I enter an apartment and made my way through a living room and a hallway into a bedroom where I could see several people doing CPR. I set the isolation bag down and started gowning up as I asked the EMT what he had. In the room with him where four firefighters all gowned up as well as his partner. “She’s got rigor in her arms and jaw, but she’s warm with no lividity.”

(For nonEMS, a patient after a patient dies, they stiffen and their blood pools through gravity. Rigor mortis...

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Ambulance: Me and Sponge Bob

Written by RSS Poster Medic Scribe

SpongeBob torments me in the night. My daughter bursts into my room . “Daddy what are you shouting? What’s wrong?”

“Nothing, I’m fine,” I say. “Go back to bed.”

With my wife on isolation is another room, only half the bed should be distrurbed, but I have torn off the covers and left them in a jumble.

It is SpongeBob’s fault, of course.

SpongeBob, aka Corona, aka Covid-19. He torments me at night.

This SpongeBob doesn’t talk like the one my daughter used to love on TV. No, he makes a high pitched, half animal, half robot sound as he waves his arms and runs after me.

In my dream, I am on the basketball courts at Wolcott Park. Two beautiful basketball courts laid out and to end. Basketball courts without rims of course, as the mayor ordered them taken down weeks ago. I stand on the court without a basketball. Instead I hold a blanket, with which I try to capture SpongeBob by leaping on him, but he always manages to escape my grasp. I think I have him, but then he is free and pouncing on me, I kick him off, but he just bounces right...

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Ambulance: Isolation

Written by RSS Poster Medic Scribe

I enter the house by myself, wearing a surgical mask, goggles and gloves. I hold a yellow full body gown in my hand, ready to put it on if need be. The daughter leads me into a bedroom where her father lays on the ground on his back in the doorway between the bedroom and the bathroom. He is a big man close to three hundred pounds and he is naked. He has soiled himself. The daughter tells me she came over to check on him and found him like this. He looks blankly up at the ceiling. His walker is still upright by his legs which are as thick as an elephants. His toe nails are also thick, uncut and ridden with fungus. From six feet away, I ask him if he knows where he is and his answer shows confusion.

“He’s had a fever,” the daughter says. “He’s been home from rehab for three days and he has been coughing.” She looks at me expectantly. Message conveyed.

I walk back outside and tell my partner, he’ll need to put his gown on. Together we bring the stretcher in, and after putting a surgical mask on him, with soap and water, we wash the man where he...

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Ambulance: Finally

Written by RSS Poster Medic Scribe

The state ordered all health care workers in the state to wear masks today.  Just a few weeks ago, my wife was getting chastised for wearing a mask at work and scaring everyone.  Then one of her coworkers got sick with COVID and ended up on a vent.  So now on self-isolation, she has left the house just twice to spent portions of  the last two days waiting in a long line of cars to get a COVID test only to be told they ran out of tests.   I am hoping her cough and fatigue are just allergy season, but it would be comforting to be able to get her tested. 

The noble lie about masks and coronavirus should never have been told

33 more deaths in Connecticut bringing the total to 167 with over 1,000 hospitalizations.

 



Ambulance: July 5

Written by RSS Poster Medic Scribe

The epidemic will largely be over in Hartford County on July 5th according to a new graph released by the state health department.  The peak will be around May 22, assuming people maintain social distancing.  This makes much more sense to me than the projected date of April 15 for the entire state.   Hartford will peak later and lower than New Haven and Fairfield counties to our south.

An article mentioned today that social distancing will last for a few week longer.  I’m okay with that.

Daily coronavirus updates: Gov. Lamont says shelter-in-place measures not necessary yet; attorney general orders some inmates in Danbury prison released



Ambulance: Waiting

Written by RSS Poster Medic Scribe

Connecticut has been named by the White House as one of the next “hot spots” for COVID. This is based on the fact that 15% or more of our COVID tests are positive. A University of Washington model says the outbreak will peak in this state on April 15 and our hospital’s capacities will be outstripped.

Connecticut’s COVID-19 peak could be two weeks away. The state won’t have enough hospital beds or ICU options when that happens, model predicts

I have been watching the numbers steadily creep up, but it still seems unbelievable that it will be as bad as it is other places. I say that not because I don’t believe it is possible or that it will not happen. It is just that it is still so quiet here in terms of volume, both with 911 calls and at the hospitals. The 911 service I work for has fewer cars on the road than typically. Nearly every ED in our area is slow compared to past norms.  Unless they have otr think they have COVID, most people are staying home.  Hospitals have large empty patient care tents sitting waiting for the patients to arrive.


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Latest Medic Scribe Stories

No BVM?
New Model
Concoctions
7,781
Undercount

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