The Life of a Student Paramedic

The life of a Student Paramedic from beginning to end. Please be aware that the opinions on this blog are mine and do not reflect the service for which I represent. Please ask questions if you so want to, but I will not disclose my location or any patient details at any point.

[emergency-nurse]

Beta-blocker Overdose

A patient came in after taking a 60 day supply of 25mg Carvedilol. He presented with a heartrate in the 50's, and a blood pressure, well, also in the 50's. 50/30 was the lowest. He was drifting in and out of consciousness, so we pushed atropine, the first line drug for bradycardia, to no effect.

You know it's gonna be fun when you call poison control, you tell them what's going on, and their first response is "ooooo that's not good." Poison control recommended Glucagon, 5-15mg IV push followed by a drip of 5-15mg every hour. This comes in 1mg vials, so we had to mix and draw up a lot of these vials. (See below)

He did respond. His pulse was now around 80, and we kept his blood pressure between 95 and 105 systollic. He was placed on a drip of 10mg/hr. I feel sorry for the pharmacist that had to mix the bag of 30mg of Glucagon. Central pharmacy also told us they only had 6 more glucagons in stock after making this bag, so if he wasn't better in 3 hours, we would have a problem.. but that was a problem for ICU to handle (I love you, ICU nurses)!

Glucagon has inotropic effects that bypass the beta blockade, this allows it to increase heartrate and blood pressure even in the presence of beta blockage. Glucagon also counteracts the negative effects of the beta blockade on a patients blood sugar.

A very interesting case with an interesting management strategy.

[paramediclife2013]

Good case but most ambulances only carry 2 to 3 vials of glucagon. Hardly enough to get started I wonder if case studies like this could prompt changes in medication quantities.

[pervocracy]

How to hack any hospital computer

-Use the password taped to the monitor

How to hack any hospital computer (L337 version for advanced security systems)

-Use the password taped to the back of the monitor

[dysgraphicprogrammer]

As a computer guy: This is what happens when you have too much security. It reaches a tipping point and then suddenly you have none. Security at the cost of convenience comes at the cost of security.  

[pervocracy]

This is true of so many things in healthcare.  Example: our software is designed to automatically alert the doctor if a patient’s vital signs are critically out of range.  If someone has a blood pressure of 200/130, the doc gets a pop-up box that they have to acknowledge before doing anything else.  It makes sense, in our setting.

But then some mega-genius upstairs realized something: the system was only alerting for critical vital signs, but not for all vital signs that could possibly be bad.  Like, yeah, 200/130 is potentially life-threatening, but 130/90 is above ideal and can have negative effects on health.  Should the doctors be allowed to just ignore something that could negatively affect a patient’s health?  Heavens no!

So now the system generates a pop-up for any vital signs that are even slightly abnormal.  A pressure of 120/80 (once considered textbook normal, now considered slightly high) will create the pop-up.  We have increased our vigilance!

Well, no, what we’ve actually done is train doctors to click through a constant bombardment of pop-ups without looking.  We’ve destroyed their vigilance and made it much easier for them to accidentally skim past life-threatening vital signs.

But you can’t tell that to management, because you’d have to confess that you are a flawed human with limited attention resources.  They’d tell you “well, all the other doctors take every abnormal vital sign seriously, it sounds like you’re being negligent.”  And if you’re smart, you back down before you start telling the big boss all about your habit of ignoring critical safety alerts.

The end result is exactly the same as if we had no alerts at all, except with more annoying clicking.

[softlyfiercely]

this here is an absolutely fascinating overview of how and why this happens

[hachama]

If everything is a priority, nothing is a priority.

This is not a bug in human behavior, it is a feature.

[sometimeswegetlonely]

Pop up 1 - note, patient is on diabetic register

Pop up 2 - note, patient is on kidney disease register

Pop up 3 - note, patient is on hypercapnia scale 2 observations

Pop up 4 - WARNING VTE assessment 72 hours overdue

Yes, computer system, the VTE assessment is overdue because I have to click through three other pop ups to know it is due and by that point I’m just clicking on autopilot

[whitepeopletwitter]

[cilein]

“How much oxygen do we really need?”

A comic introduction to the concept of ‘swimming between the flags’ which guides how medics give oxygen to critically unwell patients. It’s not about how much oxygen is given, but the concentration in the blood that this results in. Sometimes giving no additional oxygen is the right choice!

More comics: https://artibiotics.com/ Support: https://artibiotics.com/support

[sciencebelongstoallofus]

Maki Naro @ The Nib

[socialdistancing]

[extramadness]

“Humility is not thinking less of yourself, it’s thinking of yourself less.”

— C.S. Lewis (via quotemadness)

[half--agony--half--hope]

[mickfirefighter-deactivated2014]

[mr-entj]

A student once asked anthropologist Margaret Mead, “What is the earliest sign of civilization?” The student expected her to say a clay pot, a grinding stone, or maybe a weapon. Margaret Mead thought for a moment, then she said, “A healed femur.” A femur is the longest bone in the body, linking hip to knee. In societies without the benefits of modern medicine, it takes about six weeks of rest for a fractured femur to heal. A healed femur shows that someone cared for the injured person, did their hunting and gathering, stayed with them, and offered physical protection and human companionship until the injury could mend. Mead explained that where the law of the jungle—the survival of the fittest—rules, no healed femurs are found. The first sign of civilization is compassion, seen in a healed femur.

— Ira Byock, The Best Care Possible: A Physician’s Quest to Transform Care Through the End of Life (x)

[capstellium]

[stem-stims]

Physics: More pencil tricks

Source

[dexer-von-dexer]

i.e. why when you or someone else gets stabbed or impaled, you should leave the object in the wound until medical help arrives.

[wildlyannoyingdoofus]

THIS. RIGHT HERE. This is an amazing example!!

If you take the thing out, they’re going to bleed a lot more.

SO. DONT.

News Flash from the Medical Help ™ — we don’t touch it either! Unless the object they’re impaled with is literally too big to fit in the ambulance, We. Don’t. Touch. The. Thing.

The only people qualified to Take-The-Thing-Out are surgeons. End of story.

Okay, but for the love of God, please, PLEASE, if you did, if you panicked and took the thing out…. DON’T…. PUT IT BACK IN.

Or else, congratulations, you just stabbed them AGAIN. I reeeeeally shouldn’t have to say this guys, but I do.

[kimmycup]

Congratulations,

YOU JUST STABBED THEM AGAIN

[five-flats]

i feel like that last comment should be accompanied by a bill-wurtz-style jingle

[the-inspiring-quotes]

[catchymemes]

Credit: @ThinkAnneThink

[invisible-bully-40]

[ka5yth]

When my students say, "none of the other paramedics do it that way" or "none of this will change the way I treat my patient." Grrr.

[secretrn]

“You’re going to watch people die. You’re going to see them die and hear them die and everyone is going to look to you. Stay calm, take a deep breath, and remember why you’re here. To help them. And every time you do, a piece of yourself will stay with them no matter their outcome, but the key is to not let it ruin you. Don’t let it take all of you because if it does, next time you’ll have nothing to give. No one should suffer because of that.”

— - my senior paramedic after one of our calls (via blindleading-theblind)

[resuscitationist]

Is Mallampati Scoring Useless? Sep 24, 2019 01:00 am Written by Vivian Lei

Spoon Feed The Mallampati score has not been shown to be adequately sensitive for determining difficult laryngoscopy, intubation, or bag-valve-mask ventilation in ED patients. Moreover, it is unreliable and frequently unfeasible in certain patient populations.

Why does this matter? Obtaining a Mallampati score has become a routine part of airway screening in both general anesthesia as well as procedural sedation. However, there is no compelling evidence to support its test characteristics in predicting difficult airway management and may even distract from more emergent aspects of airway evaluation in the ED.

Is Mallampati scoring a waste of time? This was a literature review of the Mallampati score and its relevance in ED airway management and procedural sedation. Based on the authors’ review, they concluded:

The Mallampati score has poor sensitivity in predicting difficult laryngoscopy, intubation, or bag-valve-mask ventilation. In the largest Cochrane meta-analysis, the aggregate sensitivity for Mallampati scoring and difficult laryngoscopy was 53%; for predicting difficult intubation, aggregate sensitivity was 51%; and for predicting difficult bag-valve-mask ventilation, aggregate sensitivity was 17%.

There is not enough data regarding an association between the Mallampati score and procedural sedation-related adverse events.

Interrater reliability of the Mallampati score is poor and falls between 42% and 89% (k between 0.1 and 0.64) in studies of preoperative and dental patients.

Evaluating the Mallampati score is often not feasible in critically ill patients and children due to inadequate patient cooperation. Remember, Mallampati scoring is performed with the patient sitting upright, mouth opened wide, tongue protruding, and remaining quiet.

Overall, authors found that the Mallampati score does not add any meaningful information to a standard ED airway evaluation for procedural sedation. The upper lip bite test might be a better choice.

#airway #EMS #medic #NREMT #nclex #rn #respiratory #emergencymedicine https://www.instagram.com/p/B2yrM_lhN8u/?igshid=rm4e2zjmx8kp

[resuscitationist]

Fun facts.

#anatomyandphysiology #biology https://www.instagram.com/p/B0Y-NbjhThu/?igshid=qyzv6rmwjo7r