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Ambulance: Mother and Son

Written by RSS Poster Medic Scribe

She curls on the couch sobbing. She found her son not breathing when she came home from her midnight shift. He is on the floor now.  The fire department first responders do compressions on his bare chest.

The man is lean and muscled with jailhouse tattoos on his arms, chest, and neck. It isn’t a stretch to think heroin.

His mother’s boyfriend confirms this to us. The man on the floor was a user.  They argued about it every day, but he kept using. Two torn heroin bags are found on the floor.

We work him for twenty minutes with no response.  Asystole throughout.  His skin is cool, his pupils fixed and dilated. There is already some stiffening in his jaw. We call the hospital for permission to cease the resuscitation. It is granted.

We remove the airway,  electrodes and defib pads and place them along with our gloves in the bag the ambu-bag came in.

His mom kneels over him now, kissing his face, her tears falling on his cold skin. “Vente conmigo, vente conmigo, “ she cries.  Come with me, come with me.  “No te vaya, no te...

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Ambulance: Hunt lied and the DH continue to hide the truth......

Written by RSS Poster Garth Marenghi
Above is a response from the Department of Health (DH) to my MP, Layla Moran who very kindly sent them a question about pre-conditions to negotiation of the junior doctor contract.  The background to this is complex but this specific issue can be summarised fairly concisely.  Jeremy Hunt has repeatedly stated that there were never any 'pre-conditions' to negotiating the junior doctor


Ambulance: Dancer

Written by RSS Poster Medic Scribe

 

I first picked Veronica up on Hungerford Street one afternoon two years ago. We had been called for an unresponsive, but instead, we found a small woman with a club foot staggering along the street.  She was half on the nod and covered with leaves. I asked her if she was okay, as we walked up.  She just mumbled, and tried to keep walking. We stood in front of her and at twice her size, it became hard for her to ignore us. We were called, we have to at least see if she was okay, we explained.

“I’m fine,” she said.  “I just want to go home.”

“Why are you covered with leaves? I asked.

She wiped tears from her eyes.  “The kids robbed me and threw me in the bushes.  It happens all the time.  They like having their fun with me.”

At least she seemed to have managed to buy and use some heroin before they accosted her. Her pupils were pinpoint and she had a weakness in her knees while standing. Perhaps the kids had been warned by the block enforcer not to rob her until she had contributed her few crumpled dollars to the day’s take.

“You don’t...

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Ambulance: The NHS 'crisis'

Written by RSS Poster Garth Marenghi
There's no doubt that some of the most used cliches are so widely used for a reason, probably relating to them holding a fair bit of the truth fluid.  I think the cliche along the lines of 'you learn most about yourself when times are tough' is a pretty good one.  Where am I heading with this?  Well I think you can apply it to those within a system in positions of power during times of genuine


Ambulance: Ambulance or Nurse?

Written by RSS Poster BrianKellett.net

The Independant have an interesting story where, due to the shortage of ambulances the plan is to send community nurses first for patients over the age of 65 who have had a fall.

This is a bad idea.

But first, as a quick update on my career, I went from nursing into the ambulance service, and then returned to nursing. At the moment community nursing. So I’ve done both of the roles that the article is talking about.

The ambulance role is very much different from community nursing. When a community nurse sees a patient, it is not in an emergency situation. If you have a leg ulcer, or cancer, or a surgical wound that’s not healing as it should, then the community nurse is ideally placed to see to your needs. However if you have fallen and either can’t get up by yourself, or have broken your hip, then what you need is an ambulance.
This isn’t to say that comunity nurses don’t already keep people from going into hospital. Community Treatment Teams (CTTs as they are known in my patch, your acronym may vary) work hard to...

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Ambulance: Happy New Year

Written by RSS Poster Medic Scribe

On a private employees’ group Facebook page, an EMT posts a video of a man standing on a street corner, clearly on the nod, asleep on his feet. Another man sneaks up on the nodding man.  He reaches back and then slaps the heroin user hard across the face with an open fist. The victim grabs his head and starts running blindly down the street as if he has been attacked by aliens. The assailant meanwhile has hidden on the other side of the street. The video is captioned:



Ambulance: Post-Bingo NHS

Written by RSS Poster BrianKellett.net

I took a look at my blog the other day. ‘Last post Jan 18 2016’, so nearly a year spent noodling around on Twitter rather than actually writing anything. I’d started a new job and that needed a fair bit of my attention, then there were games to play and food to eat and things to build. Then before you know it you’ve stopped writing and replaced it with reusing other people’s writing by ‘retweeting’ it.

Urgh.

No one reads blogs anymore, or so goes the common consensus, but when I use twitter I’m often redirected to a website, a blog or a whatever you call a Tumblr thing.

I also wasn’t angry. Well, that’s a bit of a lie. I first started writing because I was angry about things and writing about it got it off my chest. I’m still angry but I came to realise that not many people cared about the things I cared about, and so my writing didn’t exactly save the NHS, fix the planet or stop tech people from doing really dumb things.

But, maybe I do have it in me to write again. There are more and more stupid things...

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Ambulance: Angry Snowman: Naloxone Refusals

Written by RSS Poster Medic Scribe

An older man with a cell phone meets us at the door to the apartment lobby. His hands shake. He motions for us to follow toward the stairs.

“What’s going on?” I ask.

“I just went out for ten minutes and I came back and found him.”

“Is he breathing?” I ask.

But he does not answer. I take the stairs two at a time, carrying my house bag over my shoulder and the monitor in my hand. I can barely keep up with him his steps are so quick. I follow him up to the second floor, and then down a long hallway to an apartment whose door opens into the living room. A large man in a sofa chair leans to the left motionless. I can only see him from behind. I come around the side and see he is blue and not breathing. I grab his arm, expecting to find rigor, but the arm is limber and the man emits an agonal gasp. He has a bounding carotid pulse. He has to be two sixty, muscle shirted with tattoos, I’m guessing late thirties. My partner gets out the ambu bag while I get my med kit from the house bag. I quickly screw...

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Ambulance: Chest Wall Rigidity

Written by RSS Poster Medic Scribe

You are called for a seizure in the men’s room at McDonald’s. You arrive to find an approximately thirty-year old man stiff and purple, gurgling.

“Versed?” Your paramedic student says as you break out an ambu-bag.

“Check his pupils.”

“Pinpoint.”

You hand him Naloxone. “Give him 1.2 IM,” you say.

He looks at you like you are testing him.

“Go ahead. “Right in the thigh.”

You normally give Naloxone IN, but when the patient is either in full respiratory arrest or in this seizure like state, you like to go IM because it works quicker.  You toss the ambu-bag to a firefighter who has just arrived. It takes him a moment to get the seal. His first breath is ineffective. You take out an oral airway and slip it in his mouth as the tension seems to go away and the man destiffens. His ETCO2 is 100, but gradually comes down to 70, then 60, then quickly drops to 35. In another moment, the man’s eyes are open, and he is looking around in panic.

“You ODed,” you say. “You are in a public restroom. We just gave...

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Ambulance: Naloxone in Cardiac Arrest

Written by RSS Poster Medic Scribe

 

Case # 1

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 overdose.

Resuscitation from cardiac arrest should follow standard BLS and ACLS algorithms

Naloxone has no role in the...

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Ambulance Blog List

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Brian Kellett (dot) Net (49)
Medic ScribeMedic Scribe (46)
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BrianKellett.net (20)
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Minimedic's Musings (11)
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Random Acts Of Reality (6)

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Emergency Shorts:
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