Greg Friese from EMS Educast invited me to guest cohost on episode 67. On the show was David Page from the St. Paul EMS Academy.
Make sure to go check it out.
Thanks for stopping by,
Adam Thompson, EMT-P
I am looking for help with the following projects:
- Paramedicine 101 Podcast
- Interactive Educational Software
I am also looking for software developers to assist me with the creation of something I have been working on. It would be an interactive presentation/educational program. Assistance with this would gain you commission on any income made.
Last but not least. I am looking for an artist/illustrator. Someone, preferably with experience illustrating the human anatomy.
Contact Adam Thompson at Paramedicine101@gmail.com
Back during EMS Week, EMS1.com held a writing contest. Kelly Grayson, AKA Ambulance Driver called on us EMS bloggers to make submissions. The theme was Anytime, Anywhere, We'll be there. I am not sure who one, but the top 6 can be seen here. Below is my submission. Enjoy...
I am not a cretin
Names and events have been altered to protect the patient's privacy.
Hello to all of our loyal readers. It's Adam here and I am sorry for the long periods of nothing to read. It was that time of year again, and I was preparing for the ClinCon conference. If you are unfamiliar with it, head over to their WEBSITE.
The reason this takes up so much of my time is because I am part of my agency's ALS competition team. We compete in these scenario-based competitions. It's somewhat of a game. Imagine the worst possible call you could ever run, and multiply that by five. That tends to be the types of scenarios the sadist that come up with the challenges think up.
This was my fourth year competing at ClinCon and my team had remained winless. There are two days of competitions with some of the best teams in the country competing. On the first day is the preliminary round, which every team competes in. A team is made of three crew members, and one alternate whom usually holds the video camera.
- The first five minutes was a START Triage scenario which required each team to go through a number of cards that included patient type and vital signs. Each card had a number and you had to assign a color (red, yellow, green, or black) to the corresponding numbers.
- We are then rushed in, to what is deemed the yellow treatment area. Within this area was a mother holding a baby, and a patient complaining of burning eyes.
- A good sample history and assessment uncovers the cause of the burning eyes which is chlorine. The patient also presented with wheezing.
- The baby was who was actually a green, was not suppose to be re-triaged, but kept with mom instead.
- The mother ends up having hypertension, and then postpartum eclampsia. Her seizures would persist until Magnesium was administered.
- At about the ten minute mark, another patient presents. He is nearly unresponsive, and shows signs of a cardiac contusion and cardiac tamponade.
- Rapid full-body assessments on every patient.
- Re-triage all patients red.
- Flush eyes of chlorine exposed patient
- Treat wheezing with bronchodilator
- Once wheezing subsides rales present - treat with Lasix or CPAP
- Treat Eclampsia with Magnesium Sulfate
- Recognize pericardial tamponade
- Got 100% of the assessments
- Flushed eyes of chlorine exposure
- Provided high-flow O2, then albuterol, the nebulized Sodium Bicarbonate.
- Recognized the low acuity of the baby and kept it with mom
- Treated mom with benzodiazepines then Mag.
- Recognized Beck's triad & electrical alternans (cardiac tamponade) and performed a pericardiocentesis.
- Three initial patients.
- A room filled with picket signs and full bottles labeled dihydrogen monoxide
- A single black box about the size of a shoe box was present in the middle of the room.
- First patient was in V-fib arrest, and had a dialysis shunt. CPR was being poorly performed by a distractor.
- Second is a patient with an avulsed eye from a possible explosion.
- Third patient presented with an open mandibular fracture and signs of traumatic asphyxia.
- At about 4 minutes, a fourth patient presented. He was yelling and deaf. He had signs of bilateral perforated tympanic membranes, or eardrums. He was yelling that his neck hurt.
- At about five minutes three more patients walked in with burning eyes from being maced.
- Scene control
- Assessments for every patient
- V-fib arrest patient is to be defibrillated into a PEA
- After PEA is present they expected you to determine hyperkalemic cause and administer sodium bicarbonate and/pr calcium chloride.
- The eye avulsion only required BLS care
- The traumatic asphyxia required a cricothyrotomy within five minutes.
- Obtain SAMPLE history from deaf guy by writing it down
- Flush the eyes of the maced individuals
- DON'T OPEN THE BLACK BOX
Recently I have taken part in a very interesting discussion on the NAEMSP dialog page. This discussion is based on the paper Early Cardiac Cath Lab Activation by Paramedics for Patients with STEMI on Prehospital 12 Lead ECGs. Tom B from The Prehospital 12-Lead blog, and contributing author to Paramedicine 101 is one of the active participants in the discussion.
THE POSITIVE PREDICTIVE VALUE OF PARAMEDIC VERSUS EMERGENCY PHYSICIAN INTERPRETATION OF THE PREHOSPITAL 12-LEAD ELECTROCARDIOGRAM
Background. Obtaining a prehospital 12-lead ECG may improve triage and expedite care of patients with acute myocardial infarction (AMI). Whether the ECG should undergo physician review prior to activation of a percutaneous intervention (PCI) team is unclear. Objective. To document the positive predictive value (PPV) of the prehospital 12- lead ECG when interpreted by paramedics versus emergency physicians. Methods. This was a prospective, observational study. In November 2003, our local health care and emergency medical services (EMS) systems implemented a prehospital “cardiac alert” program in which patients suspected of having ST-elevation myocardial infarction (STEMI) based on the prehospital 12-lead ECG were diverted away from receiving facilities without emergent PCI capability and the PCI team was mobilized. For the first year, a cardiac alert was activated by paramedics (Phase I). After the first year, the ECG was transmitted to the ED, with the emergency physician (EP) responsible for activation (Phase II). The PPV for cardiac alerts in Phases I and II were compared by using three different “gold standards”: cardiologist interpretation of the prehospital 12-lead ECG, disposition to emergent PCI, and coronary lesions on angiography or arrest prior to emergent PCI. Results. A total of 110 patients were enrolled (54 in Phase I, 56 in Phase II). Cardiologist confirmation of a STEMI on the prehospital 12-leadEKGwas 42/54 (78%) in Phase I and 54/56 (96%) in Phase II. Disposition to emergent PCI occurred in 38/54 (70%) Phase I patients and 51/56 (91%) Phase II patients. Lesions at catheterization or arrest prior to emergent PCI were observed in 41/54 (69%) of Phase I patients and 50/56 (89%) of Phase II patients. All of these comparisons achieved statistical significance (p less than 0.01) Conclusions. Transmission to the ED for EP interpretation improves the PPV of the prehospital 12-lead ECG for triage and therapeutic decision-making.-PREHOSPITAL EMERGENCY CARE 2007;11:399–402
Starting tomorrow, May 6th, it's nurses week. I would like to take this chance to thank all nurses. Especially that special breed, we all know as emergency nurses. We may not always see eye to eye, but we do understand each other. Thank you for quickly taking that belligerent drunk from me the other night. Thank you for treating that old lady nicely after I built such a great relationship with her. Also, thanks for the soda and cookies. We aren't so different you and I, and I would like to say Thank You. Have a great Nurses Week.
I’m a Mom to two amazing kids, an EMT, and occasionally I take some pictures. I love to write, laugh, and score swag at EMS conferences. I have a serious Diet Pepsi addiction. I have trauma shears and I’m not afraid to use them. I’m in medic school thanks to my online angels.
No, I didn't just start doing a patient assessment in the middle of this blog post. Pink, Warm, & Dry is the name of Epijunky's blog. Even though I haven't seen her post anything on here just yet, she is listed as a contributer and I bet something will eventually be posted, some day. It takes a lot to run a blog, and we have lives outside the blogosphere and outside of EMS, believe it or not. So there are a few contributers that have not yet contributed. Maybe they are awaiting inspiration. Anyhow, in her most recent post she gets nostalgic, talking about, what seems to have been a pretty busy shift, as a wide-eyed student.
Tom B pointed out to me that Paramedicine 101 has gotten a shout out on A seat at the table. I am pleased to see that Paramedicine 101 is being read by many and actually used as an educational resource.
Justin, Mike, Thaddeus, I hope it was okay I robbed your site of these videos and the EMS 2.0 logo. I invite you to contact me via email@example.com. I would love to be involved.
Paramedicine 101 was started by me about one year ago. Initially, I didn't know what would come of it, or what I wanted to come of it. As I browsed many other EMS blogs, I realized I wanted to provide something educational. Information probably not taught in most paramedic schools. Information that a brand new, and a very experienced prehospital provider would both appreciate. Most importantly, I wanted to provide evidence-based information; something funny or opinionated from time to time, as well. I soon realized that I am not the bearer of all this information. I quickly recruited well known, and respected bloggers who I thought might help carry the load, and boy have they. The blog has become a regular read by many, and even though I have been extremely busy with other projects, my cohorts have done a good job providing new posts. There are many contributers, some who post more than others, but all are very appreciated. I also continue to welcome new contributors.
All-in-all, I have to say that I am very pleased with the paramedicine 101 blog. I hope to become as productive as I once was with it shortly. Please, until then, read through the archived posts. There has been a myriad of information covered so far, and much more to come.
You have got to get your life together. A normal 33 year old woman does not get herself in these kinds of situations. This is the time, right now, that you need to get help. You are smoking crack, shooting up, hitching rides from truck drivers and taking random pills that they give you. You are dying. Your time is running out. I know you have probably heard this a million times, and it might not mean anything right now. I know this, but I am going to tell you anyways, because I do care, and I am sure someone out there cares too. You are only 33 years old, and you can live a whole different life, but only you can change that. Don't sit around waiting to be saved. Save yourself.
I have recently had my first two articles published. They can be found at EMSresponder.com, the co website for EMS magazine. I chose a couple topics that I have spoken extensively about right here on Paramedicine 101.
Go check them out and let me know what you think. Pay no attention to the description of the ECGs in the WPW article. The wrong images were uploaded. This will be fixed shortly.
Thanks for stopping by,
Adam Thompson, EMT-P