A rainy day at work. I’m sitting at the computer and trying to get caught up on email, bills, scheduling, and maybe even this blog.
Here’s a couple of recent tidbits.
This morning a first occurred. I occasionally hit my head at work — most often on the overhanging bright lights above ER beds, and sometimes on a door when I turn suddenly. Today while walking into a house hallway, I ducked to avoid hitting my head and when I raised my head back up, I hit a light-fixture, knocking it from the ceiling, into the arms of a cop, who fumbled it. The glass fixture hit the floor smashing into a 100 pieces. Fortunately, I was working with the boss of our service who was cool about it and the family was very cool about it as well. So no big deal. We gave the unresponsive diabetic some D50, got some slippers on her bare feet, and walked the now awake patient to our stretcher and took them in to the hospital.
The last two weeks were big meeting weeks for me, and some of the issues I found were very frustrating. The roadblocks ranged from obstinate obstructionists to people who criticize, but never read the material beforehand, to numbing bureaucracy, to problems too complex for our little committees to be able to solve to the inevitable personal and political agendas (we all have them) behind every best effort to improve patient care. My back was getting a little stiff so I stood for a moment, and then feeling better standing, began to pace a few strides back and forth from my chair. I suddenly felt quite happy and empowered. Could I perhaps attend all meeting and instead of having to sit in a chair, could I just pace while I talked? I had a vision of Robert DeNiro in The Untouchables. I pictured myself carrying a baseball bat…
A number of years ago when I full time city medic working nights, I turned down a chanced to be a suburban medic like I am now. I loved the street and wanted to be right in the middle of all the lights and sirens glory, the shootings and stabbings, etc now to mention the sheer craziness of the city at night. I eventually accepted the suburban position when it was offered againa couple years later — I took it due to changes I saw coming in the way things were happening. While I continued to work quite a bit in the city (on what was then unlimited overtime), I was glad for the change. Now years later, I am equally glad.
I was talking with one of the city medics and the issue became intubations, and while it has been quite awhile since I have done a traumatic arrest, my intubation numbers are much higher than most of the city medics (due to the proliferation of city medics now along with the fact that medics do transfers much more than they used to, which when I started was never unless it was an ALS transfer. We have a number of nursing homes in the town. Two of them, it seems all the patients are DNRs. The other three, it seems most of the patients are full codes. And they keep us busy. I do enjoy intubating.
I know there is a lot of literature out there about how intubations may not in fact benefit the patients and the ET tube may be completely replaced by the LMA, Combitube or other airway device, but I read an interesting presentation (see below) that pointed out most of the literature studying intubation was done before capnography. There is reason to believe that prior to continuous wave form capnography there was quite a high rate of unrecognized misplaced intubations (mainly tubes that had become dislodged)(possibly as high as 1-4) and that this may account for the poor science backing intubation. With wave form capnography, the misplaced tube should be nonexistent, and outcomes should improve.
Check out this powerpoint:
Making Waves Continuously in the Big Apple
The above powerpoint comes from the annual Gathering of Eagles Conference. The Eagles are a group of big city EMS Medical Directors, who are pretty cutting edge. Check out their site. There are many more powerpoints available there on many, many interesting EMS topics.
So anyway, back to my suburban job. I am the contact paramedic on a busy suburban volunteer ambulance. But not so busy that I didn’t have the opportunity to ride my bike around our industrial circle (0.7 miles)for 12 miles on Sunday and another 12 today. Yesterday, I watched the Boston Marathon on the big screen HD TV, but unfortunately I only got to see miles 1-22. Duty calls. I was back in time to watch the end of the Red Sox 12-1 win. 4 in a row!
Tonight I am hoping to be able to watch all of American Idol. This year on the Tuesdays I have worked (I work till 10:00 P.M.) we have seemed to get a call every time at the stroke of 8 just when the show is starting. I do have it taped for me at home, but I like watching it live. For those idol heads out there, I am rooting for Allison, but am also a big fan of Adam (I likely won’t buy his records, but he is entertaining and has a voice from outer space).
Anyway, the best part of being out here in the suburbs in our new stretcher. Now, when I started in EMS we had the two man stretcher. You basically deadlifted your patient (one EMT on each side) into the ambulance. I resisted the one man stretcher when it debuted for about a week. So with the past, all I had to do was watch the video for the new power stretcher to be sold. There are some drawbacks — it is heavier and harder to maneuver by yourself, lugging it into a house, but you just push a button and it raises and lowers itself. It adjusts to just the right level for sliding patients on and off the bed. It is a levitation machine. I love it!