Paramedic-Assist

I am now licensed to stab you.

In the name of medicine, of course.


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In New York State, EMT-Bs are allowed to play with glucometers if their agency has approval and provides training. Unfortunately, New York City has their own protocols, which don't allow glucometers to be used by BLS providers.

Up here in Massachusetts, glucometers are included in a separate Paramedic-Assist Certification. Which my job made me get. :) So I not only get to stab you to check your glucose levels, I also get to stick on EKG electrodes, secure ET tubes and do basic IV prep (spiking the bag, taping down the catheter). It also covers albuterol nebulizers, which are a regular EMT-B skill in New York.

The upside? More challenging calls. The downside? More cleanup.


For more reading:

How to Use a Glucometer - About.com

New York State Glucometer Protocol

Massachusetts Protocols

E4

My brand new Specialist is alive and well, and still has all her limbs attached in their proper places. She's flying back to the 'Stan tonight for another few months. We've got a last date to send care packages and everything. Cross your fingers that the brass actually sticks to their word this time.

While I was off having epic adventures, I was also contemplating the fact that I now work in a large town in a smallish state, where every department knows every other department's business. So when I go to statcounter and find that local folks have been visiting my blog, I can't really go gushing about how freaking awesome my new training is. (It's pretty awesome.)

Yes, ladies and gentlemen, I am stalking you, too.

And I have one question...


(Click to supah-size)

...Kuwait? Really?


PS: Props to Medic 999 for the linkage. :)

Getting Me Some Of This

...for 2 whole weeks of R&R. In New York City until further notice. <3

Esophageal Varices

Hey, remember this guy? That was my first real emergency, the first time I called in a note to the ER, and the first time I left a hospital knowing my patient's chances for survival were next to nil.

Well, I just learned all about what was wrong with him.

Upper GI Bleed is the vague overarching chief complaint for our paperwork. Or, as I put it at the time, Severe Bleeding from Nose and Mouth. Upper gastrointestinal bleeds usually present as coffee-ground emesis and a seriously unforgettable stench. To me, it smells like heavy metals. Like iron and something worse are so thick in the air that you can taste them.

The gentleman in question had a profuse amount of bright red blood gushing from his mouth and nose. He was so far gone in his dementia that he refused to unclench his teeth. We suctioned what we could, but anything more would've involved breaking his jaw. We couldn't drop an NPA with the amount of blood coming out of his face. For all we knew, he could've been hemorrhaging from his sinuses. We transported him left lateral recumbent with a layer of extra towels to catch the blood flow, and I held the NRB a centimeter away from his face enroute, to give me room to suction and him room to spit. The sheer terror in his eyes scared me more than anything, because he had no way of comprehending what was happening, why he couldn't talk, or where we were taking him. Trying to hold someone's hand, an NRB and a suction catheter all at the same time is not an easy accomplishment.

But back to the actual physiology, and not just Rookie Birdie peeing her pants.

Chronic liver disease (often cirrhosis caused by alcohol abuse), can obstruct normal blood flow through the liver. This makes the blood flow in your body backup, distending your finer blood vessels. In my patient's case, the ones in his esophagus. The technical name for these is Esophageal Varices. Being distended vessels, they're prone to rupture.

Ta-da! Upper GI Bleed.


For more reading:

Esophageal Varices - Mayo Clinic

Bleeding Esophageal Varices - National Institutes of Health

Bleeding Esophageal Varices - New England Journal of Medicine
*Note: REALLY COOL ENDOSCOPY VIDEO

Employment Win

Guess who has a job? Meeeeeeeeeeeeeeeeeeeee.

And I get one of these:


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And one of these:


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And some of these:


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Thank you, Commonwealth of Massachusetts. That 3-week withdrawal from emergency medicine was BRUTAL.

Please Don't Text And Drive

To the idiot in the Jeep in front of me on the highway this afternoon:

1. We were in the middle of a monsoon.

2. We were doing more than 40 mph.

3. One of your headlights was out.

4. You were texting and driving. I could see your phone.

5. You were swerving into the other north bound lane AND the oncoming south bound lane.

6. I was playing this really fun game called preemptive triage via possible mechanism of injury.

7. I realized I only have one oxygen tank in my truck. Somebody (or -bodies) would've been SOL.

8. The game got even more fun when I started keeping my foot over my brake and looking at ideal places for you to crash based on room for staging areas.

9. During that really awesome drift/swerve where you were almost entirely in the south bound lane, I concluded that I didn't want to get out of my truck in the rain.

10. Thank you very much for getting back in your lane and putting away your phone after I leaned on my horn and flashed my brights.

By the way, I really liked the 'oh shit' expression on your face when you realized you were on the wrong side of the road. And the followup expression when you looked in your rearview and saw that I was wearing a blue uniform jacket and aviators.

Because if you hadn't put away your phone, your license plate number and vehicle description were 2 seconds away from being broadcast over 9-1-1 dispatch.


PS: I hope you got home and hugged your family.