I can just see the event that prompted THIS contraindication to be included.

"I drilled and drilled and drilled, but I just couldn't get access!"

                -or-

"I felt the pop right away, and the flow was great!  But the saline just flowed right out of the guys' foot..."

http://disqus.com/forums/ambulancedriverfiles/paraglyphics_and_ems_pidgin/trackback/

Muslim terrorists have to kill themselves if they see a naked woman. Those Canadians always find the solution!  Must be the pure water up there in the North! 

Thanks, Janae!

I mentioned that felt it would be of use in alleviating and shortening (my exact words) the symptoms of said flu.

"Oh!  Now, I don't want you to get the wrong idea.  This medicine will not get rid of the symptoms, it will only lessen them."

Uh, OK. 

From Tabors Medical Cyclopedia:  Alleviate.  - To lessen the affect of.

From Dictionary.com:  al⋅le⋅vi⋅ate  /əˈliviˌeɪt/ –verb (used with object), -at⋅ed, -at⋅ing.

to make easier to endure; lessen; mitigate: to alleviate sorrow; to alleviate pain.

Nowhere does it say anything about complete eradication.   

And at the risk of seriously pissing off the wonderful woman I live with, I will identify this person I was speaking to as a nurse.  On a nurse advise line. 

I'm not picking on nurses.  I pick on doctors and paramedics, too.   At least those who say/do stupid things.

Thanks to AD for the newest Word That Should Be In The EMS Dictionary, But Isn't

"You mean you can use the small handle on the big laryngoscope blades?  What about the other way around?"

"All you have is Succinylcholine?  Can't we use Anectine?  My last department used Anectine..."

"Who's Eric Clapton?"

"OMG!  I'veNeverSeenThisBefore!  OMG!  GetHimInTheRig!"

"Mary!  What's your name, Mary?"

Just after I asked the driver to not put on his/her exam gloves while simultaneously driving Code-3/RLS:

"Oh, it's OK.  We practice this all the time"

"Dispatch, was he on foot or was he walking?"

"I see on your paperwork that you have a congenital heart defect.  How long have you had that?"

"Dispatch, Command is dissolving..."

"We've got a 32 y.o. female with a chief complaint of cervix pain.  We've applied a collar and have the pt. immobilized."

And the response?  "Copy, but we're kinda wondering how you got a collar around that..."

"Patient is a 189 y.o. female in her 4th trimester..."

Yes, there is a grossly wandering baseline.  I couldn't get the patient to lie still.  Click on the strip for a higher-quality, larger image.

Anyway, it got me curious enough (not that it takes all that much), to get a 12-Lead tracing:

Again, sorry about the artifact & wandering baseline on the first half.  It really was the best one I was able to get.  Click on the strip for the larger version.

So my question is:  what is this rhythm?  Lets hear some answers and get some dialogue going.  I'll reveal what I called it, as well as some discussion I've had locally, when the feedback starts.

I will add that this was not a cardiac-related call, and the patient had no related complaints.

"Exit!"

"Exit!"

"Boy, there sure are a lot of exits in this place."

The elderly patient I was wheeling through the doors and down the hallways of the E.D. may have had a slight concussion.  But, strapped onto the backboard and flat on his back, he had an excellent view of the ceiling (and exit signs).

And a great view on life...

"I sure hope you take me to the right place, 'cuz I'm not ready for MY exit!"

Tired of those lame Drama System Entry patients?  Ever wish they could make it worth your while to justify the Code-3 return?  The breathless HEAR report?  Calling in the Trauma Team?

Well, now you can!

For just $19.95, you can supply your patients with the half-hearted excuses for their own pity party with the Medico Total Drama Kit!

That's right, only $19.95!

What's that you say?  What do you get in the Medico Total Drama Kit?

Well, hold on to your trauma shears, boys and girls, 'cuz we're gonna tell you!

Not only do you get the featured drama makeup, but you get gel-based, long-lasting semi-realistic tears! 

Easy-to-read cue cards with guaranteed sob stories supplied by the nations' #1 Level 1 Drama Center! 

Helpful hints on lifelike seizure activity! 

Capsicum gel-tabs for authentic story-interrupting sobs!

Genuine N95 face masks with BONUS green phlegm oozing out around the edges!

And if you act now, we'll include, AT NO EXTRA COST, a vial of Ipecac, virtually assuring you projectile vomiting, and a quick trip out of the lobby, straight through triage into YOUR OWN E.D. room!

All of this for only $19.95!

ACT NOW!

Offer good for 3 days.  Actual experiences may vary.  Shipping & handling costs additional ($73.00 U.S.).  Product shipped from our Khartoom wharehouse.  Estimated delivery time is 3 months, give or take 2 months, more if IED's encountered.  This product is not endorsed by the Hollywood Screenwriters Guild.  Always consider violent responses from the Charge Nurse.

One staff member was attaching the monitoring equipment, while the other was entering information into the computer.

The patient was attempting, rather unsuccessfully, to answer questions from the staff members.

When it came time to document the patients' level of consciousness, the staff member entering the data, looked at the patient, made an internal assessment, and glanced at the other staff member.  She said "Alert and confused?", and after the other staffer agreed, selected the appropriate drop-down boxes.  It was so.

From Dictionary.com, the definition of alert:  fully aware and attentive; wide-awake; keen: an alert mind.

And the definition of confuse:  to fail to distinguish between; associate by mistake; confound

Now I'm confused!

In my understanding, 'alert' means to be aware of your surroundings and able to communicate that.  Confused means you are perhaps unaware of your surroundings, or cannot express that understanding.

On other hand, conscious means:  aware of one's own existence, sensations, thoughts, surroundings, etc.

Now, it's been explained to me that it's the Paramedic approach (short-term, immediate fix) to things.  I would have described the level of consciousness as 'conscious but confused'.

But, as was explained to me, you can be alert (a state of consciousness), and confused.  To elaborate, we often describe a person as alert to Person, Place, Time & Event (or some variation thereof), OR, in other words Alert 1/4, or 2/4, or 3/4, or 4/4.  So, it's possible under that scenario to in fact be alert and yet still confused to some extent.

In OTHER words, being alert is not like being pregnant.  You can be a little alert, but not a little pregnant. 

That, I was informed, is the Nurse approach (global, holistic, all-encompassing), something I will apparently find out in my studies.

So, any comments, thoughts, interjections?

Alert but confused
Seems like an oxymoron
Like Fresh Frozen Fish

Oooooh....

Ahhhhh...

There are much better writers out there already a part of this, and I am honored to join them.  I can't guarantee that the quality found here will be up to par, but I'll do my best.

Oh, really?  What got you excited?

"I was gonna take a dump."

Plundered some new threads, looted a food vendor, and even managed to set a new world record!

1,623 Buccaneers (young and old) gathered for an official Guinness Book record for the most pirates gathered in one spot, beating out some foreigners.

We were entertained by some excellent story & joke telling, belly dancers, and by the premier pirate band, Captain Bogg & Salty.

See you at the Portland Pirate Festival.  I'm planning on participating in the attempt to break the Guinness World Record for the Largest Gathering Of Pirates...

Yar - Eat A Lime!

I've been battling a nagging back injury for a few weeks now, one that two chiropractors have failed to correct.

I spent an hour under the strong hands of Michael, my masseuse. 

I left there a new man.

Refreshed and rejuvenated.

I've never been spoiled like this before.  Thank you so much, Hilda!

*** I'll bet you were expecting a different post, weren't you?

Jim!  I was just thinking about you, in a purely heterosexual way..."

A State Trooper, walking up on a gathering of other State Troopers, pats another trooper on the ass in the way of a greeting.  The other troops just shook hands, but maybe this guy didn't wash his hands after using the little troopers room...

A 2-year-old, sporting his very own mullet, being fed massive quantities of cotton candy by his heavily muscled male adult figure (no mullet, but the single braid hanging from the otherwise shaved head).  At 10:30 at NIGHT...  No doubt that sugar high lasted until the very early hours.

Overheard at one of the vendor booths:  "It's portable, for better portability"

Roving bands of wanna-be gangsters, talking shit, yet waiting in line for the carnival rides, and giggling like girls when they won a stuffed animal.

Running, screaming/laughing children, with lunch remnants on their shirts/in their hair, leaving the fair, followed slowly by their weary mothers, dragging ass, toting the hard-won and expensive Dollar Store reject toys piled high on their strollers.

If you are allergic to animals, perhaps it's not a good idea to visit the rodeo/petting zoo/livestock barns...

This is why.

Also check out the Bingo.

H/T to Utterly Boring

House fills with smoke
Firefighters with contact highs
And major munchies

Stubbed her toe badly
Yesterday.  Yes, yesterday.
Now wants a free ride

Test drive under way
Way too young and way too fast
No inflight movie?

Seems the Rogue Medic took a liking to some of my comments regarding ventilations. 

Thanks for the recognition, RM, even if you think my moniker has something to do with driving.  And thanks for the recommendation for my photography!

His blog is one that is thought-provoking, VERY well researched, and takes on modern EMS in a positive way - in order to promote necessary change.

Give it a read.  You'll find it over to the left...

P.S. My buddy/former trainee Firefighter Girl came up with the nickname - it signifies that I'm an ordained minister as well as a Paramedic.

It was to update child custody and support for my two boys.

It has been a difficult time, and lots of demands had been placed on me, with manipulation abounding.

With Hilda's help, I finally stood up for myself, took a stance, held my ground, and came away in good great shape.

Today, my first ex-wife and two boys left for a Hawaiian vacation.

They're not the only visitors headed there...

This is from the Weather Underground website.  I shit you not.

What was the comment, you ask?

“Just give him some Albuterol, it won’t hurt him.”

That’s the sound of my blood pressure rising.  The sound of a vacuum in between the ears of what should be a perfused, educated brain.  The potential sound of your career circling the drain.

NO

DRUG

WE

ADMINISTER

IS

COMPLETELY

HARMLESS

In this particular case, the patient (an elderly gentleman) already had a pissed off heart.  Frequent PAC’s and PVC’s indicated to me that perhaps the patient needed a few more O’s, not a beta-agonist, with the potential for angina, AMI, arrhythmia, palpitations and tachycardia, to list just a few of the side effects (Epocrates).

Lets discuss a few of the other common drugs we administer in the back of the ambulance, and list some of the common (and not-so-common) side effects.

Aspirin – pretty common, used often, and pretty much harmless, right?

        Bronchospasm
        Bleeding
        Reye’s Syndrome
        Tinnitus
        Pregnancy complications (as in fetal death)

Narcan – the first time I ever heard the term ‘benign drug’…

        Ventricular Fibrillation
        Cardiac arrest
        Seizures
        Hypotention
        Pulmonary edema – especially in those with underlying cardiac or respiratory diseases - *BTDT
        Withdrawal symptoms (nausea/vomiting/tremor) *BTDT

Succinylcholine

        We all know that once we give it, the patient is no longer able to breathe, but what about Malignant Hyperthermia? 

        I know I never learned about it during Medic School – it was a great physician advisor that taught me about it, and allowed me to immediately recognize it.  *BTDT

Fentanyl

        Blah blah blah, respiratory depression, yadda yadda yadda
        What about the chest muscle tetany if given too rapidly?  The one where you’ll have to paralyze them just so they can breathe?

Promethazine

        That ‘harmless’ drug that is a vesicant?
        Neuroleptic Malignant Syndrome
        Angioneurotic edema
        Extrapyramidal effects

        Yes, one of the drugs that some of us carry is a BLISTER AGENT.

These side effects (and we’re not even touching on drug interactions here), are just a few that I’m aware of.  I know there’s more.

It’s the attitude of ‘it must be harmless, so let’s just give it’ that burns my butt.

Again:

It is incumbent on us, the pre-hospital providers, who so desperately want the recognition, the standing, THE PAY of our in-hospital co-health-care-workers, to learn all we can about what we are doing, what we are administering, and the benefits AND risks of those actions.

Besides, I don’t like looking like an idiot.

Rant over.

*BTDT = Been There, Done That (and not much fun)