the doctors out, but i know something!

While perusing the the twitter sphere I found this tweet... Ultrasound in every service.My #ECCU2015 pick with Drew Harrell MD @tingles005 @paramedic_al https://t.co/CUAHCNagaI pic.twitter.com/mQs1Tj6eZc — Word on the Street (@wotsukrobl) December 11, 2015 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.

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 shockab...

 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 d...

"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...

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 ...

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...

** 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...

** 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 ...

"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 la...

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...

     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.

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...

     "It's simple really. You can't discuss politics like Syria in a university setting anymore; We have too many Middle Eastern students that think totally different from American students. We can't come to a clear, answer with all of these people thinking wrongly of us". - the genius state university students sitting at the next table.      I don't know what hurt worse, trying to keep with the crowd and eating my soup before it was cool, or the absolute atrocious logic from this "university student". As my tongue and ears burned from their respective assaults I watched as these two people talked of the great imperfections of the world. They were both going to be great scholars and thinkers and had to think of the global issues. I slowly chewed through my sandwich and slurped my soup as I listened, painfully, as they both debated the same small sliver of reality they lived in. I looked at them and couldn't help but be grateful of my "simp...

Finally! I have in my hands my NREMT certification and my Maine EMS license! Thank you mail man! My pretty little certification Some swag! I don't know what I'm going to put it on. I might get a spring coat and put it on that. Last but not lease my NREMT card!  I'm also signed up for my Paramedic class in September which is good. It will be interesting to try and manage work, school, and life but i'm excited for the challenge. I would be interested to hear some poor medic student stories if People have them.