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… and it ain’t pretty.
I just went to pick up cold medicine, Coke Zero, and chicken soup at Wal Mart.
While wearing pajama bottoms with leaping deer on them, Mossy Oak Breakup house slippers, and an Advantage Timber shirt with a big hole in the back. I expect my picture to appear on People of Wal Mart presently.
Hey, don’t judge me. I’m sick!
… there’s a new column up at EMS1.
read my Top Ten EMS events of 2010, and while you’re at it, visit the 2010 Year in Review page to read all the other columnists’ wrap-up of the EMS news of 2010.
Enjoy.
… Episode 30 is up at Confessions of an EMS Newbie.
Listen to the greatest hits of Ron’s first semester of paramedic school. We talk about excited delirium, why you can’t always accept dispatch at face value when they say the scene is safe, why intraosseous insertion doesn’t hurt, excerpts of the Mark Glencorse and Bryan Bledsoe interviews, why the key to memorization is relating everything to food or sex, and other EMS esoterica.
And if you listen closely, eventually you can hear Mixmaster AD doing his best Fat Boyz impression. What can I say, kids, I’m a child of the 80′s.
It’s Confessions of an EMS Newbie, the only podcast that incorporates the missing minutes of the Nixon tapes. Listen close, they’re in there.
Sore throat, eyes packed with hot sand, and body aches.
Since my immune system is known to attack squirrels in the back yard, I can only conclude that I’ve caught something serious, like ebola.
Check back this afternoon, when I’m not feeling like death warmed over.
Drinking Protip: If you’re at the keg party, and the instructions you’re given for getting really, really drunk, really, really fast, begin with the phrase, “Take your pants off and lay down on your stomach…”
… just say no.
You kids these days with your hula hoops and your Davy Crockett hats and your rock and roll music and your red wine enemas…
In my day, we used to lay on our backs, and put the beer funnel in our mouths.
And by God, we were drunk grateful.
There was a time when Christmas wasn’t a very happy time for me; there was too much family strife and bickering, enough to make me avoid any and all social engagements during the holidays. My Christmas mornings were usually spent in the woods or the duck blind, and that was fine with me.
All that changed when I got married to a woman who started her Christmas shopping in January and planned her entire year around the month of December. She was so relentlessly cheery, and looked forward to Christmas with childlike wonder, that it was impossible to be much of a Scrooge.
And when KatyBeth was born, her mother and I made a vow that we’d never let her get caught up in the commercialism of the holiday season, and we’d remind her of the true meaning of Christmas.
And thus a tradition was born. From her very first Christmas Eve in the NICU, we read her the appropriate Bible verses of the story of Christ’s birth. Tonight I’m working, and so The Ex will be fulfilling those duties:
Luke 2: 8-14
And there were in the same country shepherds abiding in the field, keeping watch over their flock by night. And lo, the angel of the Lord came upon them, and the glory of the Lord shone round about them: and they were sore afraid. And the angel said unto them, Fear not: for, behold, I bring you good tidings of great joy, which shall be to all people. For unto you is born this day in the city of David a Saviour, which is Christ the Lord. And this shall be a sign unto you; Ye shall find the babe wrapped in swaddling clothes, lying in a manger. And suddenly there was with the angel a multitude of the heavenly host praising God, and saying, Glory to God in the highest, and on earth peace, good will toward men.
Pay particular attention to that last line: Peace on earth, good will toward men.
That’s one that can be embraced by all belief systems.
Merry Christmas, everybody.
Your favorite EMS bloggers wish you a Happy Hair Metal Christmas.
Courtesy of Sean Eddy at Medic Madness.
Four years ago, I only had a vague idea of what blogs were. I had never read one.
And then, a friend forwarded me this story from LawDog, with the subject line, “If Kelly were a Texas peace officer…”
I was hooked. I had just published a book, and it struck me that this blog business might be an effective means of publicizing it, and help me polish my writing craft at the same time. And so, on this day in 2006, I put up my first post.
That was four years, 1261 posts, almost 42,000 comments, and over 1.5 million hits ago. Well over 1,000 people visit this blog every day, and I am profoundly grateful for each and every one of you.
It’s been a heckuva ride, people.
**********
It seems fitting that, here on my 4th Blogiversary, I can announce a special deal for my readers, courtesy of the good folks at Kaplan Publishing.
From January 4-10, 2011, Kaplan will offer electronic versions of En Route for free download.
That’s right, FREE electronic versions of my book, downloaded directly to your laptop, netbook, Kindle, Nook, iPad or Sony eReader.
Kaplan is using the promotion to encourage customers to try eBooks and increase awareness of their print titles, so by all means, browse the other available titles while you’re there, and download to your heart’s content.
And please, do me the favor of promoting this on your own blogs, Twitter and Facebook as well. My goal is 4,000 downloads between January 4-10. If we could meet or exceed that, it’d be the berries.
… Episode 29 is up on Confessions of An EMS Newbie.
Ron waxes ecstatic over the completion of his first semester of paramedic school, I profess my love for Fentanyl - the bestest prehospital analgesic evar! – and we answer a couple of listener questions.
Find out why being short and female is sometimes a handicap in EMS, and what you can do to overcome it, and how rare – and valuable – it is to have a medical director that actually interacts with the EMTs under his supervision.
It’s Confessions of An EMS Newbie, the only podcast too hardcore for even Keith Richards. Snort us at your peril.
Overheard in the ED: “Do you think it’s time we put Grandma in a home?”
Well, seeing as how Grandma was living at home alone, and brought in with raging sepsis and dehydration, yeah, I’d say you’re well beyond that decision point.
Was it the unholy stench of decaying flesh, or the maggots crawling in her leg ulcers that clued you in?
KatyBeth asked Santa for an iPod for Christmas, so she can get a head start on being a sullen, isolated teenager listen to her favorite music. Over the past few weeks, I’ve been gently pumping her for information, presuming that Santa did grant her wish, what sort of music would she like on her iPod?
Because, you know, I might be able to drop the jolly old elf a message through the special Parental Santa Hotline.
Of course, she has the normal 8-year-old’s taste in music, including a distressing fondness for Miley Cyrus and Justin Bieberlake or whatever the hell his name is…
… but she also requested Norah Jones, Natalie Merchant, Zac Brown, Sara Bareilles, Bonnie Raitt, Dobie Gray and the like from my iPod playlist. And the number one song she had to have was this one:
Not many 8-year-old girls have even heard of Marshall Tucker Band.
Mine can quote the lyrics to Can’t You See.
Verbatim conversation from last shift:
Patient: “My arm was kind of numb and aching from where I was sleeping on it, and it scared me.”
Ambulance Driver: “Okay. So why all the jerking and flopping around, and the catatonic act?”
Patient: “I have conversion disorder. That’s how I deal with fear, pain and stress.”
Translation: “There is nothing physically wrong with me, but I have such poor coping skills that I react to the slightest emotional distress or physical discomfort by flopping around on the ground like a Tazered fish and making a spectacle of myself. Once I have garnered a sufficient audience of concerned friends and onlookers, I will fake a catatonic state until the ambulance arrives, whereupon I will react to the skepticism of the paramedics by suddenly awakening and declaring my symptoms resolved.”
Nowadays, they have official diagnoses for such conditions; convenient pseudo-scientific nomenclature that absolves people of responsibility for their actions. “I can’t help it, it’s a medical condition!”
Back in my day, we just called it “Being a pussy.”
I think the U.S. would be a better place if our next President would appoint Chopper as Surgeon General. He’s got the cure for what ails us:
… whether you’re a believer or unbeliever, Christian or Jew.
Simply magnificent.
Found via Bob Agard.
In case you haven’t read them, the EKG Yoda, Tom Bouthillet, has a series on narrow complex tachycardias on his Prehospital 12-Lead ECG blog. If you’re interested in cardiology, you should definitely give them a read. Go ahead, I’ll wait.
Narrow Complex Tachycardias: Part 1
Other than the rare zebra, there’s a reason I don’t post many cardiology case studies here on my blog, and that’s because I see no point in the exercise if there is already someone who does it better. Tom is that guy.
In his first installment in the series, Tom offers his opinion on the terminology we so blithely throw around regarding tachycardias:
I’ve come to dislike the term “SVT” (supraventricular tachycardia).
In the first place, it’s not an arrhythmia. It’s an umbrella term that covers a group of arrhythmias which require the AV node for their maintenance.
Most importantly, it includes sinus tachycardia!
For some reason, this is a difficult concept for many clinicians to grasp, partly because of myths passed on from generation to generation.
For example, my least favorite of all.
“If the rate is 150 or greater, it’s SVT.”
Forgive me, but what in the Wide World of Sports is that supposed to mean?
Does it mean that junctional tachycardia at a rate of 149 is not SVT?
I think the term “SVT” is less helpful than the term “narrow complex tachycardia” for figuring out a differential diagnosis.
Word to ya mutha, Tom.
Using a blanket term like “SVT” is akin to using the word “car,” when you actually mean “red Ferrari 308 GTS.”
That red Ferrari is akin to a Yugo only in the fact that they both have four wheels and seats, and WPW is akin to atrial tachycardia only in the fact that they’re both faster than 100 beats per minute.
Otherwise, they’re very different critters. You’re not going to use the same tools to treat them, no more than you’d use the guy at Jiffy Lube to do the warranty work on your Ferrari.
The EMS gods are fickle beings, quick to anger and hard to appease. They rarely give you what you pray for.
If you want good calls, they send you transfers. If you want rest, they send you on back-to-back cardiac arrests. If you bitch about taking a BLS transfer, they’ll send you a ventilator-dependent patient with intracranial pressure monitoring, an arterial line, and seven medication infusions, going to a hospital 200 miles away.
And none of your friggin’ pump batteries will be charged.
Case in point, my current partner. He’s currently doing his paramedic clearance time, a minimum of 12 shifts with a designated preceptor before he’s cut loose on his own. Right now, he’s itching for the busload of hemophiliac Jehovah’s Witnesses in a head-on collision with a truck from the glass factory.
What he gets instead are refusals, public assist calls, little old ladies with minor complaints, and trustees of modern chemistry.
At this rate, he’ll get his first cardiac arrest somewhere in his second year as a medic.*
I have, however, discovered his EMS Kryptonite. On his first call in the right-hand seat, we got dispatched to a woman in labor. While reviewing emergency childbirth, the inverted resuscitation pyramid and the elements of a resuscitation-oriented history en route to the call, I noticed he looked a little pale.
I didn’t think much of it, as we were canceled before we arrived on scene.
On the very next call, we were dispatched to a 14-month-old who had overdosed on Grandma’s blood pressure medication. En route, while reviewing pediatric bradycardia and hypotension, fluid boluses, and using Glucagon for Beta-blocker overdoses, I noticed the same look, along with a peculiar sucking noise.
It wasn’t until after the call that I noticed the puckered naugahyde where he had been sitting.
Unless I miss my guess, I’d say my partner is a wee bit skeerd of vaginas and anyone under two feet tall and wearing a diaper.
Oh, and I’ve saddled him with a new, permanent nickname. Since he looks exactly like this guy:
… henceforth, he shall be referred to as Peter Griffin.
*And hopefully, by making such a blog prediction, I can anger the EMS gods into sending him one sooner. Only, being vengeful EMS gods, they’ll probably send him a pregnant woman who arrests during active labor.
… but I think this business of crowning the Phillies pitching staff as the best! starting! rotation! evar! comes a bit premature.
I think Tamara would agree with me that there are at least three good reasons that ain’t so:
Glavine, Maddux and Smoltz, bitches.
… Episode 28 is up at Confessions of an EMS Newbie.
Ron and I talk about acid/base balance, what vital signs are really vital, why mean arterial pressure is often more important information than a simple blood pressure reading, and we answer a few listener questions along the way.
It’s Confessions of An EMS Newbie, the only podcast that comes wrapped in bacon. Give us a tasty, tasty listen, and feel your arteries harden.
A friend with London Ambulance Service recently fielded an emergency call from resident who was video-chatting with a young lady from California, who apparently overdosed and passed out, right there on camera.
Thanks to Google, perseverance, a few phone calls and a helpful guy at LAPD, they were able to dispatch the fire department to the girl’s home.
From London frickin’ England.
Yet, we have some -not all, but some – drones in the Borg’s Dispatch Hive that cannot reliably dispatch the closest available ambulance to an emergency scene across town.
I wonder if we can work a dispatcher foreign exchange program?
… is streaming live, right now.
Still taking donations until midnight, and top donation gets an EMS Monopoly game and some Blogorado schwag from Farmgirl.
… Episode 27 is up on Confessions of An EMS Newbie.
Ron and I talk about the various specialty alphabet soup courses such as tactical EMT, wilderness EMT, critical care paramedic, etc., and we get the definitive answer on what hurts worse – Taser or getting shot in the thigh with a .357 Magnum.
We also talk about the historical background of intraosseous infusion, various IO devices and how little it actually hurts to get a needle drilled into your bone, and how to tell when the guy working on you is a student (hint: it requires lots of Bandaids).
It’s Confessions of An EMS Newbie, the only podcast outlawed by the Hague Accords as being too brutal for civilized warfare. You should give it a listen!
I jokingly call my employer The Borg, because we inexorably creep outward from our central Hive, assimilating smaller EMS systems as we go, and I make light of the fact that my penchant for doing first and asking for forgiveness later often runs contrary to The Borg’s idea of what a good little drone should be. Try as they may, I refuse to be fully assimilated into the Hive Mind.
I simply don’t believe that private, for-profit EMS is the ideal EMS system, despite – or perhaps because of – the fact that I have spent my career working in such systems.
I’ve known some of my fellow drones for 15 years, and I’ve spurned more than a few recruitment offers over the years, because of that fact. A few of my supervisors are people I taught to be EMT’s, way back in the day.
But having been a semi-assimilated drone for close to three years now, I have to say that, as private, for-profit EMS goes, The Borg is head-and-shoulders above any company I’ve ever worked for in the past. Indeed, they do it better than just about any that I’ve even heard of, and my contacts and friends in EMS stretch from coast to coast.
They take education seriously, they pay you a decent salary, and they give you nice equipment to work with. Moreover, they do try to treat their Drones well.
I was reminded of that fact today by a phone call from my supervisor, informing me that a Christmas bonus would be awating me in his office on Friday.
A very nice Christmas bonus, one independent of the annual pay raises we’ll get again this year. In fact, in the 30+ year history of this company, there have only been a couple of years when its employees didn’t get an annual raise, and never has their pay been cut.
In this economy, that’s saying something.
So, AD of Borg thanks you for your generosity. I feel rejuvenated, my faith restored in the Hive. Heck, I may even try to go the rest of the month without getting another refusal.
But don’t count on it. I’m only half-assimilated, after all.
Day Medic (chugging a liter bottle of water): “God, I’m thirsty! Still dehydrated from the weekend, I guess.”
Ambulance Driver: “Have a bit too much of the demon rum this weekend, did you?”
DM: “Dude… epic party. Epic.”
AD: “How epic?”
DM (extends iPhone with pictures): “…”
AD: “Um, wow. Is that a – ”
DM: ” – midget stripper dressed like a naughty Santa’s elf? Why yes, yes it is.”
AD: “I hate you.”
I’ve read quite a few EMS books in my day, and most of them are of the “Look at me, I’m a hero!” variety.
Two notable exceptions to that rule are the books of Peter Canning, and Rescuing Providence, by Lt. Michael Morse.
If you’ve read the blog of the same name, you realize that Michael Morse is one of those rare EMS authors that writes with humor, wit, and heart. He’s an excellent wordsmith, and his portrayal of EMS is as real as it gets.
Now, Michael has found a publisher for the Rescuing Providence sequel, Night and Day, provided he can get 1500 pre-orders.
There’s no order link as of yet, but you can simply go by his blog and leave a comment that you’d be willing to buy one. Stop by occasionally for updates, and pre-order yourself one when a link becomes available.
Read Michael’s blog (or heck, his first book), for a taste of what’s in store.
Only 48 hours left to get your donations in to aid Pensacola paramedic Jimmy Powell’s fight against colon cancer!
Reader Brent Caryl is going to willingly sacrifice his own colon by eating 357,000 Scoville unit hot sauce, in an effort to rally supporters to Jimmy’s cause.
Drop a little something in the kitty, won’t you? Just click on the DONATE button on my left sidebar. Top donation gets a free EMS Monopoly game. Right now, the top donation is $25.
Surely, somebody can beat that!
Y’all welcome Cheyne Stokes Inspirations to the EMS blogsophere.
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