Who said computers don’t know how to interpret 12-lead ECGs?
12-Lead on First Contact
While studies have shown that between 15-20% of STEMIs don’t emerge until the 2nd or 3rd ECG, there are also cases where the STEMI disappears after the first ECG.
Status Quo
We can all agree that these are goals of a perfect EMS system. 1. A paramedic on every priority one emergency call2. A run form completed before leaving the hospital3. A living wage for every paramedic Ever since I have been in EMS — 24 years now — I have heard the discussions about ambulance…
The Nether Zone
On TV, the paramedics are met at the ambulance bay by at least two doctors who ride the rails as the medic gives the story. The patient is moved over to the hospital bed where a team of ED staffers are ready to go to town in a seamless continuum of care. Sometimes this mirrors…
Sickle Cell
Sickle cell anemia is a horrible, painful disease. Over the years I have gone from viewing sickle cell anemia patients as drug-seekers (here I blame the EMS culture at the time) who I did nothing more than put on the stretcher and take to the hospital to human beings suffering from a painful disease who…
Get Another Job
We were dropping off a regular patient at one of the hospitals the other day. A chronic PCP user. The “crusty” old nurse in the psych ward threw a fit complaining that she had just dealt with him two nights before. The fit was not good-natured banter, but clearly a I’m being imposed upon and…
Pain Management Podcast
These Go to 11
“I don’t think you understand,” my preceptee said. “Zero is no pain, 10 is like an alligator biting your leg off pain.”
Handsome Boy
A handsome boy plays guitar in his garage band, thick black hair down to his shoulders. Man is he in to the music. The drummer in the background is also smiling, the kid on the bass is into it too. The photo colors are faded. I’m thinking 1970. In front of the 3X5 photo in…
Where I Stand Today
I promised more columns on enhanced BLS, but I have instead been silent for the last two weeks as I have struggled to come to a clear understanding of the issue. The most successful commentators all stake out clear positions (whether they believe them or not). But I continue to struggle with this one. Just…
Gathering of the Eagles
If there was any place I could be this weekend, besides sitting here at home playing with my five-year old daughter (and working the ambulance tomorrow), it would be in Dallas for the annual “Gathering of the Eagles” conference.
Inventory (DOA)
King of the World
I work Sunday, Monday and Tuesday, 12-hour city shifts. I took the day off today (Tuesday) to go to the monthly regional EMS meetings for my clinical coordinator job that fall on the 2nd Tuesday of every month. I was excited for the meeting because we were going to be voting of our new spinal…
Homemade Soup
I am conflicted. I am having doubts about some of the benefits of medicine. Let me be more specific. In our state, we are told to advise a patient at least three times to go with us to the hospital before we can accept a refusal of care against medical advice (AMA). (For legal purposes…
Risk Assessment
This post is inspired by a book I am reading – Antifragile: Things That Gain from Disorder by Nassim Nicholas Taleb. In this fascinating book Taleb discusses risk. Take this example which I am modifying from his book: Would you get on an airplane if there was only a 5 percent chance that the plane would crash?…
First Night
Brothers and sisters, carry those lights in your heart, and spread their warmth into every house you enter, every patient you comfort, every life you touch.
Sandy Hook
In the nursing home, Mrs. Brown sits in her wheelchair, two feet from the television in her darkened room. The blue hues illuminate her face. Our stretcher rolls past in the hallway. Each door is open. The story on every channel. In stillness, they watch. We are still young, the children call to them. Craddle…
Pink Sneakers
She has become a regular. She calls early Sunday morning. “923, respond for the abdominal pain.” The dispatcher gives the street and apartment number. It’s always her. We have stopped bringing the gear in. We just wheel the stretcher in and leave it in the hallway, and then walk up the three flights of the…
NTG and the Hero medic
My favorite stories are when medics talk about great medics from their past. The stories can be made up, exaggerated or true, but with telling they achieve the status of folklore and the medics in them are our Paul Bunyans and Davy Crockets, our Supermen and our Columbos (the great TV detective played by Peter…
It Depends
Here is a question that I recently considered. If you have a critical patient who you are worried may crash, when do you do the IV? At the patient’s side, on scene in the ambulance, or en route to the hospital? The key is that you need to have the IV when you need it….