Just a brief post. (Internet access is $7.50 for 15 minutes.) Interesting conference. I just got out of the Capnography class and it was great. I made some notes and will be posting when I return. I was on the EXPO floor yesterday and it was mind-numbing. EMS is such a huge business. So many gadgets and training programs and consultants. I felkt like I was in a Tijuana market and I was trying to walk through without making eye contact with any of the vendors.
I should post next with a recap of my trip on Sunday.
Thursday, September 28, 2006
Tuesday, September 26, 2006
I'm headed out to Las Vegas for the 2006 EMS EXPO.
I'm planning on attending two of the three conference days, and then spending the third day playing poker and attending the Jeff Beck concert at the House of Blues that night. I also want to get in some baking in the desert sun pool time.
The highlight of the trip for me will be the capnography class by Baruch Krauss.
Session 702: Full-Spectrum Capnography in EMS
Baruch Krauss, MD, EdM, FAAP, FACEP
ALS Track
"This class provides in-depth training in the use of capnography for: rapid assessment and triage of critically ill patients, verification of ETT placement, continuous monitoring of tube position, cardiac arrest, head trauma, chemical terrorism, asthma, COPD, seizures, alcohol and drug intoxication, diabetes and shock states."
I'm planning on attending two of the three conference days, and then spending the third day playing poker and attending the Jeff Beck concert at the House of Blues that night. I also want to get in some baking in the desert sun pool time.
The highlight of the trip for me will be the capnography class by Baruch Krauss.
Session 702: Full-Spectrum Capnography in EMS
Baruch Krauss, MD, EdM, FAAP, FACEP
ALS Track
"This class provides in-depth training in the use of capnography for: rapid assessment and triage of critically ill patients, verification of ETT placement, continuous monitoring of tube position, cardiac arrest, head trauma, chemical terrorism, asthma, COPD, seizures, alcohol and drug intoxication, diabetes and shock states."
Sunday, September 24, 2006
Mortal Men (Chapters 16-20)
Five new chapters added to Mortal Men. It will probably be a couple weeks before I add anymore because in the next section I have to insert two new chapters which are as yet unwritten.
Saturday, September 23, 2006
A Life
I recently did a presumption. A sixty-eight year old man found cold and stiff in bed in his one bedroom apartment in an elderly housing complex in town. He died sometime during the night, curled on his side, his head pressed against the pillow, a quilt pulled up to his neck. I couldn’t imagine a more comfortable position to enter the big sleep in.
The officer on scene can only find the man’s name on an envelope. After I put the leads on the body and run my six second strip of asystole, and then announce the time, we help the officer search the apartment for a date of birth and a doctor’s name. The apartment is clean and ordered – it looks like he hasn’t lived there long. On the wall are pictures of a little girl from birth to maybe four, big framed portrait type pictures. There is even a picture of her sitting on Santa Claus’s knee. At first I think it might be pictures of all his grandchildren, but after looking closer, it is the same girl. “Check this out,” the officer says, looking in the man’s bureau. The top drawer is piled high in three neat rows with folded white briefs. The second drawer is the same. The third drawer contains neatly folded stacked long underwear; the fourth drawer, white tee-shirts. To the side of the bureau is a plastic garbage bag with more white undergarments.
In the bathroom closet, there are stacks of Ivory soap, piled ten bars high. In the kitchen cabinets, cans of Chef Boyardee ravioli are neatly stacked in three rows three tall, three deep. There are three identical bottles of Aunt Jemima maple syrup. Three boxes of pancake mix.
On top of the refrigerator are three pairs of worn baby shoes, each size slightly bigger than the preceding.
In the refrigerator is sausage, three sticks of butter, orange juice and milk.
Still no vial of life, no meds, no paper with a doctor’s name.
In the bedroom we find a plastic filing bin. We open it on the kitchen table. More photos -- all of the same little girl who never appears more than four or five years old. There are lab results from the doctor’s office – pediatric clinic. The girl’s HIV tests are negative. There is a copy of her birth certificate – dated 1995. There are copies of police reports. Domestic violence. Restraining orders. All from 1997-1999. We get the man's date of birth from one of the police documents. We crosscheck the mother’s name and the child’s name with a few names scrawled on pieces of paper by the phone, but there is no match.
The officer finds some medication – but it is just a physician’s sample – Viagra – in a cabinet by the easy chair which faces the TV. Next to the sample are five aged Polaroid’s – A tall thin woman in her late thirties or maybe younger with hard years accounting for the lines in her face and the darkened eyes. In the first photo she is lifting up her tank top to reveal large oval shaped breasts. In the next, she has one of the breasts lifted up to her mouth as she licks it with her tongue. The next shows her on the bed with her legs open. The fourth is a close-up shot.
We finally find some medication wrapped in a CVS bag shoved in the back of a drawer. Zoloft and Aricept. Zoloft, of course, is an antidepressant. Aricept is for Alzheimer’s.
The officer writes down the prescribing physician’s name, and then calls the Medical examiner’s office. We walk out passing some of the deseased's neighbors in the lobby who are speaking in hushed tones about the goings on in the man’s apartment this morning. He just moved in recently, I can hear them say, they really don’t know much about him.
The officer on scene can only find the man’s name on an envelope. After I put the leads on the body and run my six second strip of asystole, and then announce the time, we help the officer search the apartment for a date of birth and a doctor’s name. The apartment is clean and ordered – it looks like he hasn’t lived there long. On the wall are pictures of a little girl from birth to maybe four, big framed portrait type pictures. There is even a picture of her sitting on Santa Claus’s knee. At first I think it might be pictures of all his grandchildren, but after looking closer, it is the same girl. “Check this out,” the officer says, looking in the man’s bureau. The top drawer is piled high in three neat rows with folded white briefs. The second drawer is the same. The third drawer contains neatly folded stacked long underwear; the fourth drawer, white tee-shirts. To the side of the bureau is a plastic garbage bag with more white undergarments.
In the bathroom closet, there are stacks of Ivory soap, piled ten bars high. In the kitchen cabinets, cans of Chef Boyardee ravioli are neatly stacked in three rows three tall, three deep. There are three identical bottles of Aunt Jemima maple syrup. Three boxes of pancake mix.
On top of the refrigerator are three pairs of worn baby shoes, each size slightly bigger than the preceding.
In the refrigerator is sausage, three sticks of butter, orange juice and milk.
Still no vial of life, no meds, no paper with a doctor’s name.
In the bedroom we find a plastic filing bin. We open it on the kitchen table. More photos -- all of the same little girl who never appears more than four or five years old. There are lab results from the doctor’s office – pediatric clinic. The girl’s HIV tests are negative. There is a copy of her birth certificate – dated 1995. There are copies of police reports. Domestic violence. Restraining orders. All from 1997-1999. We get the man's date of birth from one of the police documents. We crosscheck the mother’s name and the child’s name with a few names scrawled on pieces of paper by the phone, but there is no match.
The officer finds some medication – but it is just a physician’s sample – Viagra – in a cabinet by the easy chair which faces the TV. Next to the sample are five aged Polaroid’s – A tall thin woman in her late thirties or maybe younger with hard years accounting for the lines in her face and the darkened eyes. In the first photo she is lifting up her tank top to reveal large oval shaped breasts. In the next, she has one of the breasts lifted up to her mouth as she licks it with her tongue. The next shows her on the bed with her legs open. The fourth is a close-up shot.
We finally find some medication wrapped in a CVS bag shoved in the back of a drawer. Zoloft and Aricept. Zoloft, of course, is an antidepressant. Aricept is for Alzheimer’s.
The officer writes down the prescribing physician’s name, and then calls the Medical examiner’s office. We walk out passing some of the deseased's neighbors in the lobby who are speaking in hushed tones about the goings on in the man’s apartment this morning. He just moved in recently, I can hear them say, they really don’t know much about him.
Friday, September 22, 2006
Hacking
We spent the first three hours of the shift covering a suburban town while their ambulance was on a call. There were reports of gunshots in the city, but when the ambulance got there the supposed victim had fled. Nothing else was going on anywhere, so it wasn’t like we missed a lot.
My preceptee and I went over various drugs and situations. I was really hoping we would get him a bad trauma to put him over the top. Don’t worry about the IV, I said, get the patient on the board, on the stretcher, on the way to the hospital, protect the airway, and get the patient stripped. I told him about how I always preach the IV only comes when everything else is done. I told him how one of my preceptees we had gone over that time and time again and then on our first big trauma, the first thing she did, the very first thing, was to put a sixteen in the man’s arm. No BP, no survey, no oxygen, nothing. She just jabbed him with a sixteen. She hadn’t even spiked a bag. She realized what she’d done and she’d looked at me for help, and I was just shaking my head. The large bore on the trauma is a powerful urge.
But there was no trauma call coming for us. We were sent back to the city and were given a GI bleed at the nursing home. Then it was back to posting, waiting.
Twenty two minutes before our crew change and two minutes before we normally are sent in, they gave us a colds and flu call. A healthy four year old who vomited an hour earlier. His mother wanted him checked even though he was playing with his toys when we got there. We transported to the children’s hospital on the other side of town. I’d been keeping my cough pretty well under control, but then a couple blocks from the hospital, I just started hacking away in the driver’s seat. I was hacking so hard, my brain hurt from all its rattling around inside my skull. When we got to the hospital, I got out and opened up the back door, and helped the mother waddle down.
She looked at me and said, “Maybe you ought to be the one seeing a doctor.”
I was tempted to say, “Yeah, maybe I ought to call an ambulance to take me to the hospital.” But I try not to be a wise guy. I just gave her a tired nod.
I didn’t punch out till quarter to one this morning.
They wanted me to come in to work today, but I said, no. I need the day off. I’m still run down.
My preceptee and I went over various drugs and situations. I was really hoping we would get him a bad trauma to put him over the top. Don’t worry about the IV, I said, get the patient on the board, on the stretcher, on the way to the hospital, protect the airway, and get the patient stripped. I told him about how I always preach the IV only comes when everything else is done. I told him how one of my preceptees we had gone over that time and time again and then on our first big trauma, the first thing she did, the very first thing, was to put a sixteen in the man’s arm. No BP, no survey, no oxygen, nothing. She just jabbed him with a sixteen. She hadn’t even spiked a bag. She realized what she’d done and she’d looked at me for help, and I was just shaking my head. The large bore on the trauma is a powerful urge.
But there was no trauma call coming for us. We were sent back to the city and were given a GI bleed at the nursing home. Then it was back to posting, waiting.
Twenty two minutes before our crew change and two minutes before we normally are sent in, they gave us a colds and flu call. A healthy four year old who vomited an hour earlier. His mother wanted him checked even though he was playing with his toys when we got there. We transported to the children’s hospital on the other side of town. I’d been keeping my cough pretty well under control, but then a couple blocks from the hospital, I just started hacking away in the driver’s seat. I was hacking so hard, my brain hurt from all its rattling around inside my skull. When we got to the hospital, I got out and opened up the back door, and helped the mother waddle down.
She looked at me and said, “Maybe you ought to be the one seeing a doctor.”
I was tempted to say, “Yeah, maybe I ought to call an ambulance to take me to the hospital.” But I try not to be a wise guy. I just gave her a tired nod.
I didn’t punch out till quarter to one this morning.
They wanted me to come in to work today, but I said, no. I need the day off. I’m still run down.
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