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Showing posts from 2014

Cranial nerves and hard ons, oh my...

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"Ooh, Ooh, Ooh, to touch a female vagina, gives Victor a hardon." Patrick J. Lynch, medical illustrator See, I said it. Vagina, hard on, and I'll just go ahead and add penis to this sentence. However, It worked for it's purpose. Remembering the 12 Cranial nerves. I – Olfactory II – Optic III – Oculomotor IV – Trochlear V (1,2,3) – Trigeminal VI – Abducens VII – Facial VIII – Vestibulocochlear IX – Glossopharyngeal X – Vagus XI – Accessory XII – Hypoglossal  - ( Via Wikipedia ) (Yes, I'm using Wikipedia as a source. No this isn't a scholarly or even very intelligent post, it's okay.) Sooo, I was suppose to memorize the 12 cranial nerves and their function (sensory, motor, or both) for a test this semester. I didn't, the test didn't go well. this is the point of test (or is how I use them at least). They are to show you what you need to learn! Within hours of that class ending, the tale of Victors sexual adv

Medic school paper - Appropriate Utilization of Helicopter EMS - Draft

(Please comment! If you want to comment on the paper in Google docs then I will happily share the link! Thank you!) Helicopter based emergency medical services (HEMS) are an essential part to any EMS system.  The first benefit noted with HEMS is that it gives prehospital providers access to rapid transport without the difficulties of traffic or terrain. HEMS utilizes staff ranging from a critical care paramedic to a physician led team. Working under an expanded scope of practice compared to the traditional ground ambulance. However, HEMS can be misused and abused like the rest of the EMS and emergency response system. According to Taylor, C. B. (2010) annual cost range from $115,777 to $5,571,578.  The LifeFlight Foundation annual report states that in 2013 alone Maine’s very own “Green Angels” had expenses equalling $9,109,732 (2013, p. 22). That cost can be placed with the patients and insurance or absorbed by the government and citizens. No matter where the funding comes from,

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.

Medic school Response: Into the water

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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

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 ra

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 t

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

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 fu

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.  The

Critical Incident Stress Debriefing: Rule 1, It's confidential, respect the other attendees.

The first thing I have to say about a Critical Incident Stress Debriefing(CISD) is that they are like civil fight clubs. They have a very sensitive, confidential nature about them, so like fight club it has 2 rules. You don't talk about the CISD.  You DO NOT talk about the CISD. Jk...

THAT unknown medical.

     You're called to residence for an unknown medical.  Short response time to scene.      Once you arrive you gain access by unlocked door and find patient slumped to the right in a kitchen chair and moaning "oh my head, it hurts" over and over.  Patient responds to speech by only continued moans.  Patients medications suggest significant cardiac history.  Patient rapidly moved to stair chair and moved to ambulance.  While moving patient from the house he stops moaning and is no longer responding to voice, only painful stimulus.

Host of new features coming everywhere!

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It never fails! April always showers us with new technology and useful things to spend out time on! Why just checking my tumblr this morning I found that they had finally  released the new and improved tumblr pro... Look at that daperness! I know. It's a major overhaul of a previously amateur look and feel! I honestly can't thin of anything that say sophisticated professional like a top hat! I mean look at that profile picture. I've been waiting for that hat for ages... I just wish I could be as fancy in my hat as some of the new Google improvements! First off. Google has made it even easier to be the best employable geek you can be! Thanks to new innovations with Google+ AutoAwesome!  As If you needed another  reason to ditch facebook for the new and wonderful Google+!(  Hit me up when you get there!) Anyways! I don't need to explain when this wonderful tutorial can walk you through making your resume (auto)awesome. *sniff sniff, sigh* Google really can

Anime Boston 2014 recap!

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Wow. Just Wow! This was my first ever Con so I had no idea what to expect. In many aspects it was great and terrible. Having lived in Maine my whole life I've never really ran into the problem of literally thousands of people trying to fit into a much smaller space. Trying to get into the first showing of Attack on Titan  was comparable to going to a Best buy on black Friday. The line almost circled the hynes convention center... The line went from outside exsibit hall D down the small hallway, all the way down and back Boylston hallway and half way to pre function hall C! That's when I got in a half hour before. we didn't make it into the showing on Saturday. Luckily they added one one Sunday. It was amazing and worth the wait. From what I've learned a large part of the issue was the fact that Anime  Boston is trying to slim down and focus on just anime. Panels were cut and sadly panels had to turn many people away because thy couldn't fill slots like in year

Norepinephrine(Levophed) usage in ME EMS protocol

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From the ME EMS Protocols : A. Preperation - Mix NOREPINephrine 8 mg in 250 ml NS.  B. Dosing - Starting Dose is NOREPINephrine 0.03    μg(mcg)/kg/min. Titrate by 0.03  μg(mcg)/kg/min every 3-5 minutes. Usual dose is 0.03-0.25  μg(mcg)/kg/min. Usual max dose is 0.6  μg(mcg)/kg/min. Absolute max dose is 3  μg(mcg)/kg/min C. Titrate to maintain SBP greater than 90 mm Hg. For 2013 the  Medical Direction and Practice Board decided to move away from Dopamine to  Norepinephrine. I am no doctor (yet) but I'm guessing it has to do with some of these studies  ( 2 , 3 ).   A subgroup analysis showed that dopamine, as compared with norepinephrine, was associated with an increased rate of death at 28 days among the 280 patients with cardiogenic shock but not among the 1044 patients with septic shock or the 263 with hypovolemic shock -   Daniel De Backer, M.D., Ph.D., Patrick Biston, M.D., Jacques Devriendt, M.D....  for  the SOAP II Investigators  Medicine is called a practice for a

Americans need metric!

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Forget the NSA. Forget the CIA, FBI, and DEA. Forget LMNO and P! Today we have to address the true monster of America! the USCU. The United states Customary Unit , Also known as the Imperial system. Bah, Imperialism. The very name is oppressive! It’s very nature is to alienate us from the rest of the world! How can you ask your Canadian neighbor for a cup of sugar if we’re the only ones that use ‘A cup’ as a measurement! They’ll give you a full tea cup of sugar! They would be not only stereotyping but ridiculous! Now I know here on the internet we only have content that is clear cut, well thought out, and mostly peer reviewed. I can’t just walk out and start shouting madness and expect you to listen! No! I’m going to give you a very simple reason every american will want to switch to a metric system.   It’s easier! Done, no argument left! What? that’s not enough? What is this the science channel? Discovery? Scishow ? Fine. Rocket science 101- Why we should switch. 1 mi