Tuesday, September 20, 2016

CollegeLyfe: Capturing motion

CollegeLyfe: Capturing motion

closest thing I got to panning...
 It's kind of weird to be start blogging 3 weeks  into a semester, but I felt I wanted to share my college experiences and what I'm learning. So this post focuses on photography. This weeks assignments was to capture motion. I should go back and document what all the different shutter speeds were.... but that's a lot of work. Instead, just enjoy the motion captured! I tried capturing some panning, but It proved difficult, especially with a spastic kid as my subject... I finally did capture the first picture of his face mostly in focus.
I then tried to capture him in motion while keeping the rest of the scene clear. Some of the technical aspects of this photo aren't great. The sky is rather blown out, I'm still learning to work with color corrections...

 To capture a good motion blur I meant to go to an overpass and get a great shot, but that opportunity didn't come. The motion blur of this picture is the beast I could capture. It certainly didn't help that my windshield needs washing...
Circus Maine is an amateur and professional level circus school in Portland, Me. Every third Saturday they have in house performances. They bring in instructors and entertainers from all to shows off their skill. This ring acrobatics set was by far my favorite. I love how smooth her movements were and you can really get a feel with the long exposures just how smooth the arcs are. The performances are great and at $16/Person for a 2 hour show, absolutely worth it.



If you've read this far, thank you! I look forward to sharing more of my college experience. I am looking for a good way to share my Biology I and Microbiology without creating an issue... Cellphones are pretty good vectors for microbes and I don't believe my who class wants to be recorded...

Nicholas.











Wednesday, February 10, 2016

Workplace and Academia: Who Teaches You to Wear Pants?

This statement, in general, is ridiculous. No one needs to teach you to wear pants in college or the workplace. You and I learned how to put on pants as kids. Our guardians taught us cultural norms about the expectations of wearing pants... So why are we having trouble with it now?

o-WALLE-570.jpg.jpg
Let's preface this with humans are naturally lazy energy-conscious; we know and accept that. Unfortunately, humans have done more “work” than any known species, we also have to continue doing work to keep our value. Work meaning “exertion or effort directed to produce or accomplish something; labor; toil” From a scientific standpoint work is only produced IF result are produced. I can lean against the empire state building for days and have done zero work. I feel like I’ve looked at algebra problems for days… and done zero work. As an EMT I am expected to show up to work a certain way:
  • A half hour before my shift starts.
  • Wearing a clean appropriate uniform
  • Having good personal hygiene
  • Positive attitude
  • Prepared to show the attributes
    • Compassion
    • Excellence
    • Leadership
I 100% accept that I am not perfect. I can show up with mud on my boots from the last ditch I was pulling someone out of. I can have a stain on my shirt from the snack I wolfed down between calls. I can work for 24 hours and not get a shower or brush my teeth. I can have a bad day.
That doesn’t change the expectation. It means I’m slacking.

I was lucky enough to have been raised by two parents who wanted to raise adults. I’ve been reminded of this often from the time I was very young. It generally meant that I had, again, done something wrong and had to fix the issue. They did this on purpose, as much as I was sure that it was just to make me miserable. They did this because they didn't want me to end up on YouTube. I doubt I would have acted out a "greatest freakout 2" but the statement stands. Unfortunately, a lot of my generation the "Millennials" immediately get tagged as such. Every day I see people posting on social media about another "Millennial" wanting free stuff, not having to work, and just accepting their physiologic bias to laziness. 

While I would never say no to free stuff I also understand the burden of having to work full-time and go to school full-time. What does that have to do with pants? The three domains of learning basically show how we learn and think. The Domain that is becoming the problem is the affective or feeling domain. I can make you read a textbook and practice a skill a thousand times but I can't make you give a fuck about it. At work, I wear a uniform. When I put on my uniform I am expected to act a different way. I'm treated a different way. We know this and we use this. Doctor wear a white coat so you know they are important. Police officers wear uniforms so you know they are important. I wear a uniform so you know I'm important. We all wear different uniforms and we all act differently with them on. We take advantage of this internally by believing in the uniform, and externally by people believing in us.

A lot of things changed in my paramedic program to try and get people to care. To make us good students that can easily become good employees. To make the work we did in class, become the work we do as a career. Unfortunately, some people still believe in the school they went to as children. They believe that freedom of speech means they can curse and complain. They believe that self-expression means wearing their pajamas. In crisis, we sink to the level of our training. This is important if you trained like a sailor in their pajamas.
 I was always homeschooled. The only thing I knew about public school was that 99% of the kids there were dicks. I went from being homeschooled to working as an EMT. I was still a kid, so I was watched very closely. If my boots weren't clean I heard about it. So when the fact that we were going to wear uniforms in class dropped I didn't even flinch. We wore that uniform for everything we did outside the classroom, we're doing the same stuff inside the classroom, why wouldn't we? "Train how you play" right?

So pants. Does wearing pants effect the Thinking Domain? maybe? most likely not. Does it effect Kinesthetic Domain? Well... depends on what you're trying to do, but probably not. Does it effect the Affective Domain? Yes. I believe that if you show up in your pajamas you aren't truly punched in. You may sit in class, take notes, and answer questions. This isn't that kind of class. We aren't here to simply get a degree. We're here with a purpose, that purpose is to learn how to take care of the sick and injured, to live a life full of compassion, excellence, and leadership. To show up to your job as excited to be there on the first day as you are the hundredth and thousandth because you get to make a positive impact in someone's life.

The thing about the affective domain is that it follows you everywhere. Shockingly enough if you're a jerk in a classroom, you'll be a jerk in the workplace. If you're lazy in class, you'll be lazy at work. If you talk to your professors like their idiots... You'll probably get fired. You don't get to pick and choose who you work with. Being able to adapt and be in control of your affective domain is essential to being a good paramedic, good medical provider, and a good human. Anyone can train you to be good at starting IVs or remembering drugs. Only you can make yourself care.

Thanks for reading.

Sunday, December 20, 2015

"Why Ultrasound Belongs in EMS"

While perusing the the twitter sphere I found this tweet...

It really caught my eye thanks to the paper I just wrote and shared here. Point of Care Ultrasound (POCUS) has great utility in acute care and it will probably be the only imaging modality that could reasonably be put in an ambulance. Sonosite and Philips just released pocket/tablet form US devices that could easily be kept next to a cardiac monitor. If Philips is listening they will realize they make EMS cardiac monitors and US probes that could be added together... just an idea.

Tuesday, December 8, 2015

Prehospital Ultrasound in Undifferentiated shock, Cardiac Arrest, and the End of Resuscitation.

Please feel free to comment, on the topic or my grammar! This paper has already been graded. ;-)


Prehospital Ultrasound in Undifferentiated shock, Cardiac Arrest, and the End of Resuscitation.
Nicholas Jackson
Southern Maine Community College

For years ultrasound was an imaging modality for sonography technicians who acquired them and the radiologist who reviewed them. With the rapid rate technology has evolved and developed we now have point of care ultrasound. Point of care ultrasound allows physicians in the emergency department and office setting to acquire diagnostic quality imaging at the bedside. While physicians have a vast array of transducers, protocols, and views The question remains, Can paramedics perform the same feats to help our patients? In this paper we will review the “Focused echocardiographic evaluation in life support (FEEL)” protocol, the “Prehospital Evaluation of Effusion, Pneumothorax, and Standstill (PEEPS)” protocol, and assessment of non shockable rhythms under ultrasound.

Friday, July 10, 2015

Beets BLU heart rate monitor review.

I was given this Beets BLU to review by my Papi, Chris from FaithHack. He had received them as a sample to test/review for BeetsBLU.

First impression:

When I first got it i though it was decent looking, it's small and unobtrusive. Wearing it the first time was different and it took a couple tries to get it sized just right. On the inside of the chest band are the two electrodes to pick up the hearts electrical signals. I've found placing it just below the breast line in the 5th rib space sits well and gets good pickup. 

Set up:

BeetsBlu uses Bluetooth smart which means it doesn't connect through the traditional Bluetooth functions. You must connect it from one of their approved apps (I use RunKeeper and the BeetsBLU app), as soon as you figure out you have to use the app first it is easy to setup. 

Running:

Running with BLU was easy. It took maybe another 20 seconds to get it turned on and set up. While running I found it was relatively accurate. When I went full blast and was up in the 180-200bpm range it really wasn't that happy... but nether was I. When I did my normal running pace it was niceto be able to just peek and check if I was in the right range. I stopped a couple times and checked it compared to my radial pulses and they marched out with about a 5 second delay from pulse to app. My only complaint is after about 2 miles of pounding pavement the monitor had slipped down my chest a little. It was still picking up a signal and worked appropriately but I was more concerned it would fall down later. I did have to adjust it after getting my hands over my head for a little air break.

Yoga:

After my running experience I was concerned that moving in any way other than a gentle run would displace the device. So I tried a half hour yoga session with it on. It actually stayed better than I thought it would. I never had to adjust it even after major twist and turns. With the Bluetooth smart I was able to keep my phone on the table and out of my way. It is rated for a stable connection up to 10 meters (33 ft). 

Would I buy it?

If I wasn't a poor college student, yes. I found the device worked well, it's low profile and light weight make it reasonable to keep on while running. I liked being able to track how well I was doing and keeping my heart rate controlled. I could also see using it for meditation exercise to see if your getting the biologic responses you're looking for. Anyways, at $39.95 it's not a bad deal at all.

Monday, March 9, 2015

Hold your ground during the charge!


Excuse me? you said what?
"In patients with cardiac arrest presenting in a shockable rhythm during the ROC PRIMED trial, shorter pre- and peri-shock pauses were significantly associated with higher odds of survival. Future cardiopulmonary education and technology should focus on minimizing all peri-shock pauses." (Cheskes et all., 2013)

Decreasing peri-shock pauses is a good thing. 

Fig. 2. Cheskes et all., 2013
The less time we are squeezing the chest, the less time the victim is perfusing and the less their chances of survival. To maximize perfusion, the 2010 AHA Guidelines for CPR and ECC recommend minimizing pauses in chest compressions. Expert consensus is that a Chest Compression Fraction (CCF) of 80% is achievable in a variety of settings. (Meaney et all., 2013) A viable method to decrease compression pauses is to perform compressions as shocks are charged and delivered*. The purpose of CPR is to compensate for the failure of the heart to adequately pump blood throughout the body. We're trying to perfuse the heart (and brain) well enough to get the heart excitable (Ventricular fibrillation/Tachycardia) and restartable (Shock/defibrillation). 

From RebelEM
*While some evidence suggest CPR during defibrillation is safe and has benefit (Neumann et all., 2012)  the AHA does NOT recommend it. Rescuer safety is the highest priority in any scenario and should stay that way!

However, as technology evolves and research continues we may find a way to safely keep hands on during the entire incident. With the increasing frequency of CPR quality monitoring devices (or CPR pucks as I've called them so far) we may have a viable barrier to protect providers from electrical shocks, with the risk of redirecting high voltage electricity into monitors worth thousands of dollars.

Until that day, remember an 80% CCF and rate of 100-120. feel free to use this excellent reference material for a rate.


Bibliography:

Cheskes, S., Schmicker, R. H., Verbeek, P. R., Salcido, D. D., Brown, S. P., Brooks, S., … Christenson, J. (2014). The impact of peri-shock pause on survival from out-of-hospital shockable cardiac arrest during the Resuscitation Outcomes Consortium PRIMED trial. Resuscitation, 85(3), 336–42. doi:10.1016/j.resuscitation.2013.10.014

Meaney, P. A., Bobrow, B. J., Mancini, M. E., Christenson, J., de Caen, A. R., Bhanji, F., … Leary, M. (2013). Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation, 128(4), 417–35. doi:10.1161/CIR.0b013e31829d8654

Neumann, T., Gruenewald, M., Lauenstein, C., Drews, T., Iden, T., & Meybohm, P. (2012). Hands-on defibrillation has the potential to improve the quality of cardiopulmonary resuscitation and is safe for rescuers-a preclinical study. Journal of the American Heart Association, 1(5), e001313. doi:10.1161/JAHA.112.001313

Thursday, January 29, 2015

No TV week? Keep calm and read #FOAM!

 Have you just started at a service that doesn't have cable? Did your service rip the carpet out from under the feet of Abby and Gibbs? Don't know where to go without DiNozzo? Is your service trying to shield you from the Illuminati grasp on cable media? Well here's some advise for you. Keep Calm and read FOAM.

     But what is FOAM? 

Well it's Free Open Access Meducation says the amazing folks over at Life in the Fastlane. It's a fantastic tool to learn, teach, and grow as a person who providers medical care. It isn't just residents or doctors who use it. Nurses, respiratory therapist, medical assistants, paramedics, and ALL Allied health providers can benefit. FOAM has been facilitating collaboration across the world. In my little services we find it hard to talk to our neighbors, much less work with people in other countries. With social media connecting people on opposite sides of the world, it amazing to see development happening. So how do you access it? That's the fun part!

How do I join?

You're already a part of the #FOAM community if you want to be! So here are the tools used by most.
  • Twitter: Twitter is an excellent tool to share links, articles, and small comments. It's rather limiting with 140 characters and use may be frowned upon by your service while on shift.
  • Podcast: meaning Ipod broadcast is an audio feed. listening to things like FOAMcast and EMCrit is an excellent use of your time. I promise.
  • Google+: 
    • The EMCrit community is strong there! as are many other very smart people. You're service should have any problem. 1) It's Google. 2) none of your friends use it.
    •  I've also been involved with a EMS based community called Quality Box Time with a medic (he runs the Facebook version, I hope G+ is more popular!) for FOAM relevant to EMS/Prehospital providers.
    • FOAMcc is an excellent community! Moderated by Chris Nickson, John Greenwood, Minh Le Cong and Scott Weingart. It has a fairly comprehensive affiliate list. I am slowly getting into more and more of this list as time goes on.
  • Finally! Go look at EMCrits Favorites, you don't have to take it from me!

Does it need a card to be educational?

     The overwhelming answer to this is no. Unfortunately most of our educational budgets are consumed by keeping people competent. So it lands with the individual providers to learn more. Yes, that means you. The good news is you aren't alone, everyone else can use to learn more. Every day I learn something new that changes what I was taught before. I was told that we can not differentiate between a MI and a LBBB. Well we can with Sgarbossa Criteria, "A total score of  ≥ 3 has a specificity of 90% for diagnosing myocardial infarction."  (1,2), Go check out LITFL for more on that. 
     So who wants to have a four hour refresher on ACLS with information from 2010? FYI, the "Proven fact" that cooling our patients to 33°c has mortality benefit was debunked in 2013(3,4). I do not, but I must, because I need to keep a current card. I've learned the information and at this point, "refreshing" dosages and algorithms seems like something I could do more easily while sitting around base on my own or with coworkers as a full simulation. Without TV being a major barrier to get by I would hope people would be more then willing to "play". 
     As good medical professionals we are responsible for keeping ourselves up to date and well trained. With the excellent resources presented to us as FOAM it is very hard to cling to ignorance any longer! Hopefully this will spur a movement make learning a daily adventure and not an annual or monthly drag.

References:

  1. Sgarbossa Criteria. Mike Cadogan. Life in the Fastlane
  2. Sgarbossa, E. B., Pinski, S. L., Barbagelata, A., Underwood, D. A., Gates, K. B., Topol, E. J., … Wagner, G. S. (1996). Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators. The New England Journal of Medicine, 334(8), 481–7. doi:10.1056/NEJM199602223340801
  3. Kim F, Nichol G, Maynard C, et al. Effect of Prehospital Induction of Mild Hypothermia on Survival and Neurological Status Among Adults With Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2014;311(1):45-52. doi:10.1001/jama.2013.282173.
  4. Nielsen N,Wetterslev J, Cronberg T, et al. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest. N Engl J Med 2013; 369:2197-2206December 5, 2013DOI: 10.1056/NEJMoa1310519