Wednesday, October 8, 2014

Medic School Presentations: Tetanus, Infectious disease process

  • What type of organism is involved in spreading this pathogen (bacteria, virus, etc.)?  Identify the name of the organism (if any).  If you have been provided with an organism/pathogen what disease does it cause?
    • Clostridium tetani spores
      • Anaerobic gram-positive, spore-forming bacteria
      • Spores found in soil, animal feces; may persist for months to years
      • They can survive autoclaving at 249.8°F (121°C) for 10–15 minutes.
      • The spores are also relatively resistant to phenol and other chemical agents.
      • Tetanospasmin estimated human lethal dose = 2.5 ng/kg
      • Causes Tetanus (Centers for Disease Control and Prevention, 2012, p. 291).
  • What is the common route of infection (air, blood, etc.)?  Identify what would be the most likely way a paramedic would be exposed.
    • Spores usually enters the body through a wound or breach in the skin. Toxins are produced and disseminated via bloodstream and lymphatic system (Centers for Disease Control and Prevention, 2012, p. 292).
    • Paramedic could be susceptible in any environment that could cause a minor or major penetration injury.
      • During vehicle extrication. IE: Cutting hand or arm on severed vehicle post.
      • Removal of Pt from environment to Ambulance. IE: removal via stairchair and getting cut on rusty nail or removal from woods and getting cut from the undergrowth.
  • What personal protective equipment will limit the exposure of healthcare providers to the pathogen?
    • wear full length heavy pants, ankle covering leather boots, slash resistant work/turn out gloves, full sleeve shirt/forearm guards, and most importantly, get and maintain vaccination!
  • What is the incubation time for the infection?
    • The incubation period ranges from 3 to 21 days, usually about 10 days.
      • In general, the further the injury site is from the central nervous system, the longer the incubation period.
      • A shorter incubation period is associated with more severe disease, complications, and a higher chance of death.
      • In neonatal tetanus, symptoms usually appear from 4 to 14 days after birth, averaging about 7 days (Centers for Disease Control and Prevention, 2012, p. 292).
  • What are common signs and symptoms seen in a patient with an active infection?  What will occur (signs/symptoms) if the disease is untreated?  Provide stages if applicable.
    • The first sign is trismus or lockjaw.  followed by stiffness of the neck
      • difficulty in swallowing
      • and rigidity of abdominal muscles.
      • Other symptoms include elevated temperature, sweating, elevated blood pressure, and episodic rapid heart rate.
      • Spasms may occur frequently and last for several minutes. Spasms continue for 3–4 weeks.
      • Complete recovery may take months.
      • Tetanus is often fatal if left untreated.- (Centers for Disease Control and Prevention, 2012, p. 292).
  • How is this disease treated once a host has become infected?  What medications/treatments are utilized?
    • Treatment for Tetanus consist of:
      • Antibiotics (primarily Metronidazole or Penicillin G) to eliminate the bacteria
      • Tetanus immune globulin (TIG) to neutralize the unbound Toxins.
      • This should be immediately followed by a Tetanus Toxoid containing vaccine (Hinfey, 2014).
  • Is there a vaccination for this disease?  What is the vaccination (provide the name (s) of the vaccination(s))?  How is the vaccine administered?  How long does it last?
    • Tetanus vaccination comes in a couple different forms based on the age you receive it. -(Centers for Disease Control and Prevention, 2012, p. 297-298).
      • DTaP (diphtheria and tetanus toxoids and acellular pertussis vaccine) is the vaccine of choice for children 6 weeks through 6 years of age.
      • If a child has a valid contraindication to pertussis vaccine, pediatric DT should be used to complete the vaccination series.
      • Td is the vaccine of choice for children 7 years and older and for adults.
      • A booster dose of Td should be given every 10 years.
      • Contracting the illness WILL NOT provide immunity due to the incredibly small amount of the toxin required to cause illness.


Centers for Disease Control and Prevention. (2012). Tetanus. In W. Atkinson, C.
    Wolfe, & J. Hamborsky (Eds.), Epidemiology and prevention of
    vaccine-preventable diseases (12th ed., pp. 291-300). Aurthor.

Hinfey, P. B. (2014, March 26). Tetanus medication. Retrieved October 2, 2014,
    from Medscape website:

Friday, September 26, 2014

Medic school Response: Into the water

Into the Water — The Clinical Clerkships — NEJM

Something that I have a hard time with and work equally hard at is understanding that I think, I make the world around me. I get so focused on trying to be "the best I can be" and all the silly ideas that come with that. I focus on the best I can be, which turns into just focusing on me, which turns into not thinking outside my own head. So it's good to hear I'm not alone in that thought. It's better to know that I can change it. I hope that as my education and understanding of the world around me gets better I'll remember to think more. Now I've been in EMS for 2 years, which is a small chunk of time in the scheme of things but I do understand how the clinical clerkship can affect providers. Tuesday night I had an elderly lady with chest pain. A man in his 50s who was having a STEMI.  98% occlusions of the circumflex was the cath lab report when we got back. A post arrest, vented Pt who was bucking the tube but the receiving facility denied the request for sedation. A young girl who had a concussion from a car crash and was like a record repeating the same loop of confusion, tears, and questions. I gave each of them the compassionate, empathetic voice they all needed when they were sick but I could help but think when I was going to get my next coffee. Six months ago even i would have been overwhelmed to deal with just talking to these people in a single night. Now it's much easier to just smile, answer what questions I can, and try to treat them the best I know how. Now I'm not totally heartless or disconnected ether. "Occasionally, however, there were moments that evoked a twinge of my old discomfort, some inchoate sense that what had just transpired mattered more deeply than I recognized at the time." - Neal Chatterjee. I don't think I'll ever forget the screams of anguish from the father of the 16 year old boy I did compression on for far longer than we should have. I have aspirations of being a paramedic, I have aspirations of getting to that third year. I want to be a paramedic to try and get use to the water. I'm hoping by learning what water is and how to tread in it I will be more equipped to take the dive when the time comes.

Thursday, September 18, 2014

Medic school discussions: VARK and JUNG

Vark Learning tool

Visual: 4
Aural: 12
Read/Write: 4
Kinesthetic: 14

The VARK very accurately describes my personal learning style. I have always learned best by doing. I have to actually manipulate and try things to do them to the best of my abilities. I also enjoy and do well with lecturing. I enjoy listening and talking to people. I am indifferent to visual aid and power points, I see them more as a reminder of what a good lecturer should be talking about. I also dislike just reading text. I understand it’s importance and do it willingly, but it’s a slow process for me and I often get distracted multiple times a page.

With lecturing I am going to use my visual, aural, and more than likely reading/writing. Luckily my Aural skills are better and that makes me a good student for listening to lecture.

Hands on learning happens to be my forte. I do very well working with people and practicing skills, I learn by doing very quickly and have a much higher retention rate.

Jung Typology test

  • Please post your answers to the following questions: ENFJ - Extravert(67%) iNtuitive(38%) Feeling(12%) Judging(33%)
    • Do you feel that the Jung Typology Test is an accurate description of you?  Why or Why not, please be specific.
I think this is a very good example of my personality. I've always been drawn to helping people. People find me likable, passionate, and charismatic. I feel like I could be a good leader. I always have been among friends and in social groups. I’m always a “glass half full” type of person and I think people like that about me and let me speak my mind because of it.
  • Do you think your personality type will make you a better paramedic?  Why or Why not, please be specific.
I think it will help my career as a paramedic, EMS is a team sport but at the same time every team needs a leader. The most important thing that will help me lead an EMS team would be my faith in my team. ENFJ has a strong desire to believe and expect the best out of other people. We also are excellent communicators which is essential in any good medical care, much more EMS.

  • Do you think your personality type will make you a better educator?  Why or Why not, please be specific.
I think I could be a good educator. I enjoy helping people figure out problems. At work I’m often asked questions about using the computers, mainly because I’m a geek, but also because I’m more then willing to sit down and explain things to people. I think anyone can learn anything given the time and good, quality direction.

Monday, September 15, 2014

Medic School Discussions: Roles & Responsibilities of the paramedic

**Please comment and let me know your thoughts, if I'm wrong I want to learn why and how to be better**

Roles & Responsibilities

My three good qualities are preparation, response, and return to service. The only one I would say I’m strong in is Preparation. My thought process is that every call is critical until proven otherwise. I know this isn’t entirely true, but It’s much easier to motivate myself to check every nook and cranny of the truck and house bag if I think I’m going to work a code. I always find question to ask the medics I work with about calls I’ve done or stories I’ve heard. I read and listen to people like EMCrit to try and learn more about medicine and hope I get something I can use in my daily assessments and treatments of my patients. I feel my response is good, I’m almost always in the truck first. I drive to every call as quickly as I safely can with regard to traffic, road conditions, and weather. At the end of every call I work hard to get my truck to a better condition than it was before the call. I restock a little more than I used. I clean a little more than got dirty. I always want the truck to be in better condition when I leave then when I got there.

My weaknesses I would label as Scene management, Patient assessment and care, and Patient transfer and report. I think all of my weaknesses are experience or confidence related. I’m a lot better at helping to manage the scene, I think about how to best get to the patient and how to best and safely get them to the truck. I’m constantly looking for potential hazard in homes, especially in elderly population and with fall victims. I know I still need to work on it a lot more though. I always think of and utilize gloves as PPE but I rarely even consider the need for goggles, gowns, or mask. I believe my assessments are too disorganized, I try to figure out what is going on before I’ve established a solid baseline for my patient. That leads to the issues with Patient transfer. I don’t always have some of the information the ED wants to know because I focused my exam and assessment on what I thought the issue was from talking to the patient. Then I feel like I’ve done something in error and it throws off the rest of my report because I’m desperately trying to figure out what I missed.

My plan to resolve my weak areas should be mostly resolved as I move through this course. As I learn more about scene management from the medics prospective I’ll be able to assist better as a BLS provider and know what information is pertinent to tell my partner when I’m a medic. I fully plan on utilizing everything I learn, as I learn it to my nightly work. As for my patient assessment I will have an excellent opportunity to learn and refine my technique into an orderly, concise, and accurate assessment with this class and paramedic procedures I. As I strengthen my assessment abilities I will be able to confidently give a quality, concise report to any ER nurse because I will have done a broad spectrum assessment and a focus exam of the issues.

Friday, September 12, 2014

Medic School Discussions: What Does Professional Mean to you?

**Please comment and let me know your thoughts, if I'm wrong I want to learn why and how to be better**

What Does Professional Mean to you?

professionalism: Possessing the required abilities, knowledge, and self-discipline to effectively perform a specialized action or work. As a paramedic I have to be able to quickly and accurately assess and treat a Patient. Not only do I need the knowledge and physical ability to do the work, but I need to have the self-discipline to do it appropriately, effectively, and compassionately. Because our work is so publicly available it is essential that we show ourselves in a confident, competent manner. If my patient doesn't think I’m competent because I lacked the self-discipline to tuck my shirt in and fix my hair at O’dark thirty they won’t be as receptive to my assessment or treatments.

As someone who doesn't have a lot of volunteer experience I have mixed thoughts of “professional” volunteers. On the first day of orientation at a 24/7 paramedic license service i was told never to laugh at the volunteers. No matter what they do wrong. That’s been extremely hard for me at some points. I am always extremely thankful we have volunteer EMTs that first respond in our communities. However, I think it is very hard for anyone to keep up a “professional” level of competency doing this on their off time. I have also been on scene where at O’dark thirty a volunteer jumped out of bed to meet us at a call but looks terrible. I’ve seen patients and family visibly settle when the “real” Paramedic/EMTs show up in uniform and looking semi-awake. I think a volunteer could be an EMS professional, but the majority simply can not afford the time, energy, and experience it takes to be an EMS professional.

As a full time, paid, employee of an ambulance company this is how I put food on my table. This is all I have to know how to do. I spend a minimum of 36 hours a week on a truck. During those hours I am getting paid to provide professional quality emergency medical care. I don’t have any other jobs other than being a student. Then I’m learning how to be a better, more professional EMS provider. Is every paid EMS provider a professional? I don’t believe so. Should they be? absolutely. We are the one who must take the call when a volunteer doesn’t want to. Our time is focused on keeping competent, and maintaining the abilities, knowledge, and self-discipline required to be EMS professionals.

Personally, I am always looking for means of improving myself. I am young, and still fairly inexperienced. So for me I feel my major weak spots in my professionalism are confidence, self-motivation, and time management. I am still a young provider. When I first started I was terrified to be left in the back or perform skills on a patient for fear of messing up or possibly harming a patient. Now that I’ve been doing it for a couple years I still doubt myself and my abilities at times; I know I can manage some sick and injured to my license level. Motivating myself and managing my time will be a critical skill I’m going to learn quickly from this class. I’m very motivated to do very well in this class, My only weakness is my squirrel quality attention span. my main effort will be to overcoming those and sitting down and fully completing assignments in a high quality, timely fashion.

Wednesday, August 20, 2014

Hours of boredom; Minutes of terror.

"Shut up! you don't really work! you played borderlands for eight hours!" He spat.  I had complained I was never home.  I wanted him to get off his ass and stop playing games and help me clean up after I had worked 48 hours in three days.

I had to bite my tongue.  He wouldn't get it.  He was right in a sense.  I had spent a whole 8 hours playing borderlands.  Once.  The last 24 hours hadn't been like that.  Had not been like that at all.  The area I cover is fairly quiet most days, most days being a key component in that statement.  My favorite saying at work, to the point I would call it a mantra is "No rest for the wicked".  Assuming I'm a wicked person, it's about as true as they come. Like some dispatcher somewhere was watching me, as soon as I kicked my boots off the tones dropped for another call.  I was running on fumes by the time I got home.

I wanted to tell him to go pound sand. I had worked for the last 24 hours. I had slept a full hour. That was it.  That's my job though. I personally love it, but that doesn't mean I don't get tired.  That definitely doesn't mean I spend hours on hours a day playing games at work, It can happen.  I wish I could get paid for playing games every day.

EMS is known to some as "Earn Money Sleeping." I will happily admit that I have actually earned money while sleeping at work. At some time and in some places that is normal. However, At my work it isn't. One that is normal to me is something I was told to expect in my EMT-Basic school.

Hours of Boredom; Minutes of terror.

No one really plans on having an emergency. No one jumps in a car debating how best to roll it or where to hit a pedestrian. That's my job. I sit and wait for the tones to drop. I train and read about the most current treatments of trauma, CVA/strokes, cardiac, and all other medical complaints. I could wait and read for hours. When the tones drop I have to be out that door in a minute or less. The hardest calls for me are the ones we can't do anything for but treat them with diesel. I can stop blood from getting out, but I can't do anything when it's dumping into your stomach but drive faster. We don't have the tools to see if you're having a hemorrhagic or ischemic stroke. A CT scanner doesn't fit well in the back of our truck(Some do). We can recognize a true heart attack or STEMI in the field but we don't carry the clot busting medications to hopefully stop or at least slow the damage to the heart.

So we're stuck. Watching the clock, waiting. Planning for the worst and hoping for the best. Living through hours of boredom for the sick twisted thrill of minutes of terror. EMS is a beautifully terrible place.

“Oh, you can't help that,' said the cat. 'We're all mad here.” ― Lewis Caroll,  Alice in Wonderland

Friday, August 8, 2014

Critical incidents: it's not heartless, at least I hope not.

Terrible things happen to good and/or undeserving people.  The drunk driver walks away from heaps of scrapped metal.  Parents do the exact opposite of take care of their children. One persons stupidity leads to another persons demise.  Sometimes people just die because of unintended side effects.

I had the misfortune to help with one of these cases the other day.  A young female, no medical history.  Only medication was oral contraceptives (Now I'm hoping as I write this that it doesn't turn into the catholic churches next stand against contraceptives).  Started complaining of not feeling well a few days ago and had fainted earlier on the day I met her.  When I met her she was already intubated and waiting to go to a major hospitals.  She had coded a half dozen times already. 

In EMS we have this silly notion of an "EMS code save" which means very little for people we treat.  It just means that we got them to the hospital with a chemically induced pulse.  Their heart was beating when we got to the hospital so we're now heroes in our own mind.  This is unsurprisingly a fantasy we design to make ourselves feel better about why we're here.  It doesn't matter that our patient may be nothing more then a organ donor; if that.

So this young girl had coded, and coded, and coded.  Epi, two minutes of CPR and we would be back with a pulse.  So in my foolish EMS head she was good!  Epi plus CPR equals an alive person!  we just have to get to major hospital and we'll give her the fighting chance she deserves.  We gave her the chance.  We got her where she needed to be.  In a perfect world we would call it a day and pat ourselves on the back.  I wish I could get away with being that ignorant!  Sadly she wasn't in the perfect shape the EMS brain told me she was in.

On the way back my partner got a call.  The service that brought her in wanted to know if we were going to join the CISD they were hosting.  I had my first critical incident over a month ago.  To me this felt nothing like that.  I still did CPR on a girl with her parents crying and cheering her on next to me but it worked. She came back, at that time I didn't know for how long, but she did come back.  We both politely declined our invitation. 

"Maybe I'm heartless, but we got her there. It's just another call at that point." 

I couldn't help but agree to a certain point. I'm still not sure if it's heartless or not.  I think I'm just a little more callused now.  If we everyone broke down or quit every time someone bad happened then our professional wouldn't last long.  I enjoy EMS and Emergency medicine as a whole.  I just have come to accept it takes a special kind of twisted person to do well in it.

I wish the girls family all the best.  Parents aren't meant to bury their children.  I commend them on their strength during a terrible time.