An email alert flicked up on my screen, jumping around like a little silky terrier, begging for my attention.
I clicked on the epileptic letter icon, knowing full well it would claim down.
It was an email from my local medical school.
"Dear Andy,
Thank you for your application to study medicine at local-medical-school. We are pleased to advise that you have been selected for an interview on 5 October 2011 at 1400...."
I didn't read anymore of the letter. Instead, I was now jumping around like the previous little silky terrier, not to crave attention but in joy.
Monday, 29 August 2011
Sunday, 21 August 2011
Precordial (and Precranial) thump
A humorous look at recent guideline changes for the precordial thump and a proposed new "precranial" thump by Flobachrepublic.
Might have to try the new precranial thump on my next night shift! :)
Might have to try the new precranial thump on my next night shift! :)
Saturday, 20 August 2011
Could you come check her out, please?
It was a lovely night, getting paid double time with another experienced paramedic to provide medical coverage to a community concert. There were some great bands playing, set in a nice park, lots of police and security, and best of all, it was a dry event (aka, no drunks. Well at least that was the intent).
I was really looking forward to this event and the live music.
An hour in, a well-dressed middle aged lady comes down to the ambulance.
"Sorry to bother you, but my friend is a dialysis patient and a diabetic. I think her sugar might be low, she's fainted a little bit. Could you come check her out, please?"
Not a problem. It was our job. Sounded like a hypo (hypoglycaemic - low blood sugar level).
Just in case, we took a few things - our ALS backpack with drugs, oxygen and a response kit.
She guided us through the rather thick crowd and into the park. It was getting rather dark, it we were quite glad she was guiding us as we would have never found her.
Sitting on a rug amongst the crowd was a middle aged woman, being supported up by some friends, head flopped back against her friend's shoulder. She was clearly out of it.
As I set up to take a blood sugar, I noticed her skin was extremely diaphoretic. Very diaphoretic. It wasn't a hot night.
Plus she was very tachypnoeic.
A few second later, 22.8mmol/L read the glucometer.
Obviously not a hypo.
I looked at my partner, whom reflected a near identical quizzical look back at me.
"I'll get the stair chair..."
"I'll get some oxygen and a line in..."
Sounded like a plan.
I weaved my way back towards the ambulance. It was near impossible to get to get a stretcher in, especially though the thick crowd and the mass of people picnicking on the grass. Thankfully, we have a nifty little fold up wheel "stair" chair which was quite good to get around in.
Passing a security officer, I informed her we needed some assistance and pointed to where my partner was.
Quick as a flash (well not quite, maybe like 3 minutes later), I was back. Walter had a high concentration mask on already and a tourniquet on one of her arms already, obviously preparing to cannulate. By now, we had accumulated a few bystanders whom was willing to help, though no security turned up (or ever turned up for that matter for the entire case).
While she wasn't exactly big, her current state meant that she was very "floppy" and resulted in a dead weight. Grabbing a foot each and a giant bearhug, a few bystanders and ourselves managed to get her onto the stairchair. Securely strapped in, we enlisted some bystanders to be bag holders and again, weaved our way through the crowd and into the ambulance.
Walter climbed in while I put away some of the assembled bags before climbing in to assist.
Oxygen changed to the ambulance supply, cardiac monitor dots attached, probe on finger, NIBP cuff on, cannula out and a vein located. Ordered chaos ensured for the first minute or two.
Walter looked into her pupils as we completed a set of observations.
"Andy.... could you check the pupils for me please?" he asked, even though he had just checked them.
I got my penlight torch out and looked.
They weren't overly large, but there weren't any reaction to the light.
* Raised eyebrows *
First complete physical observations: PR 112, RR 32, BP 185/110, GCS 7, ECG Sinus Tachycardia, SpO2 100% (on 15lpm via high concentration mask), BSL 22.8, Temp 36.7C (Tympanic), Pupils were a size 4 and unreactive.
There wasn't much we could do in this environment. She needed to go to the hospital, and quickly. However, as we were providing a community event coverage, we couldn't leave, so we had to call another ambulance crew in to transport. Ironic huh?
I got on the radio as Walter attempted to put an oropharyngeal airway in, albeit unsuccessful. She had some trismus.
"We don't have anybody at the moment, but we'll get one there as soon as we can" came back the reply from Communications.
Meh.
By now, she was grunting a little bit but still no improvement in her vital signs.
Walter provided some supportive suctioning using a yankeur suction catheter while I tried to get further information from the original friend whom had got us.
Apparently, she was just sitting, watching the concert and suddenly collapsed. She had been well before, did not complain of anything, had no alcohol nor drugs today.
A secondary survey didn't reveal any other injuries or anything of significance.
Some sort of cerebral event, a CVA, we concluded.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Our backup ambulance crew arrived 20 minutes later, and rushed her Priority 1 to hospital.
I was really looking forward to this event and the live music.
An hour in, a well-dressed middle aged lady comes down to the ambulance.
"Sorry to bother you, but my friend is a dialysis patient and a diabetic. I think her sugar might be low, she's fainted a little bit. Could you come check her out, please?"
Not a problem. It was our job. Sounded like a hypo (hypoglycaemic - low blood sugar level).
Just in case, we took a few things - our ALS backpack with drugs, oxygen and a response kit.
She guided us through the rather thick crowd and into the park. It was getting rather dark, it we were quite glad she was guiding us as we would have never found her.
Sitting on a rug amongst the crowd was a middle aged woman, being supported up by some friends, head flopped back against her friend's shoulder. She was clearly out of it.
As I set up to take a blood sugar, I noticed her skin was extremely diaphoretic. Very diaphoretic. It wasn't a hot night.
Plus she was very tachypnoeic.
A few second later, 22.8mmol/L read the glucometer.
Obviously not a hypo.
I looked at my partner, whom reflected a near identical quizzical look back at me.
"I'll get the stair chair..."
"I'll get some oxygen and a line in..."
Sounded like a plan.
I weaved my way back towards the ambulance. It was near impossible to get to get a stretcher in, especially though the thick crowd and the mass of people picnicking on the grass. Thankfully, we have a nifty little fold up wheel "stair" chair which was quite good to get around in.
Passing a security officer, I informed her we needed some assistance and pointed to where my partner was.
Quick as a flash (well not quite, maybe like 3 minutes later), I was back. Walter had a high concentration mask on already and a tourniquet on one of her arms already, obviously preparing to cannulate. By now, we had accumulated a few bystanders whom was willing to help, though no security turned up (or ever turned up for that matter for the entire case).
While she wasn't exactly big, her current state meant that she was very "floppy" and resulted in a dead weight. Grabbing a foot each and a giant bearhug, a few bystanders and ourselves managed to get her onto the stairchair. Securely strapped in, we enlisted some bystanders to be bag holders and again, weaved our way through the crowd and into the ambulance.
Walter climbed in while I put away some of the assembled bags before climbing in to assist.
Oxygen changed to the ambulance supply, cardiac monitor dots attached, probe on finger, NIBP cuff on, cannula out and a vein located. Ordered chaos ensured for the first minute or two.
Walter looked into her pupils as we completed a set of observations.
"Andy.... could you check the pupils for me please?" he asked, even though he had just checked them.
I got my penlight torch out and looked.
They weren't overly large, but there weren't any reaction to the light.
* Raised eyebrows *
First complete physical observations: PR 112, RR 32, BP 185/110, GCS 7, ECG Sinus Tachycardia, SpO2 100% (on 15lpm via high concentration mask), BSL 22.8, Temp 36.7C (Tympanic), Pupils were a size 4 and unreactive.
There wasn't much we could do in this environment. She needed to go to the hospital, and quickly. However, as we were providing a community event coverage, we couldn't leave, so we had to call another ambulance crew in to transport. Ironic huh?
I got on the radio as Walter attempted to put an oropharyngeal airway in, albeit unsuccessful. She had some trismus.
"We don't have anybody at the moment, but we'll get one there as soon as we can" came back the reply from Communications.
Meh.
By now, she was grunting a little bit but still no improvement in her vital signs.
Walter provided some supportive suctioning using a yankeur suction catheter while I tried to get further information from the original friend whom had got us.
Apparently, she was just sitting, watching the concert and suddenly collapsed. She had been well before, did not complain of anything, had no alcohol nor drugs today.
A secondary survey didn't reveal any other injuries or anything of significance.
Some sort of cerebral event, a CVA, we concluded.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Our backup ambulance crew arrived 20 minutes later, and rushed her Priority 1 to hospital.
Wednesday, 17 August 2011
TST
The nurse looked at the small pinkish area on my forearm.
It wasn't raised but was, naturally, noticeable.
"It's fine", she said.
And like that, it was over.
Yay!
That was the Tuberculin Skin Test (TST), which I had done three days prior. A TST, otherwise known as a Mantoux, is used as an initial indicator of tuberculosis (TB) through the detection of Mycobacterium tuberculosis. It involves a 0.1ml intradermal injection of tuberculin on the anterior forearm, with the resulting induration (raised, hard area) measured (but not including the erythema (red swelling bit)). While the size of the induration varies depending on local health policies, a size greater than 5 or 10 mm is the normal accepted result (again depending on risk factors and the demographic).
A good fact sheet can be found on the Centres for Disease Control and Prevention (US) site.
It wasn't raised but was, naturally, noticeable.
"It's fine", she said.
And like that, it was over.
Yay!
That was the Tuberculin Skin Test (TST), which I had done three days prior. A TST, otherwise known as a Mantoux, is used as an initial indicator of tuberculosis (TB) through the detection of Mycobacterium tuberculosis. It involves a 0.1ml intradermal injection of tuberculin on the anterior forearm, with the resulting induration (raised, hard area) measured (but not including the erythema (red swelling bit)). While the size of the induration varies depending on local health policies, a size greater than 5 or 10 mm is the normal accepted result (again depending on risk factors and the demographic).
A good fact sheet can be found on the Centres for Disease Control and Prevention (US) site.
Monday, 15 August 2011
First aid course
It may seem weird, but even though I'm working as a full time paramedic, I still need a current first aid certificate.
Which is fine and I kept an open mind, especially since I'm not paying!
So off I went to the local first aid training company which, ironically, is the same company I work for.
It was a good course and I enjoyed the day. There was the usual guy whom had done and seen everything the first aid trainer talked about (poor trainer!), but I learnt a few things that had changed since the last time I did a first aid course (such as DRSABCD with the inclusion of S = Send for Help; and a constructive bandage now being referred to as a tourniquet).
Overall a good day and best part was, I passed! :)
Which is fine and I kept an open mind, especially since I'm not paying!
So off I went to the local first aid training company which, ironically, is the same company I work for.
It was a good course and I enjoyed the day. There was the usual guy whom had done and seen everything the first aid trainer talked about (poor trainer!), but I learnt a few things that had changed since the last time I did a first aid course (such as DRSABCD with the inclusion of S = Send for Help; and a constructive bandage now being referred to as a tourniquet).
Overall a good day and best part was, I passed! :)
Monday, 8 August 2011
Fistula
The indigenous population in my current area has almost endemic renal disease and many patients that we transport to hospital are on renal dialysis.
Their quality of life decreases significantly as their disability-adjusted life year increases. Many relatively young people have end-stage renal failure, not something that the community should be proud of.
We transport a young 40 year old patient with end stage renal failure due to shortness of breath and fluid overload, a fairly typical callout. A dose of oxygen via a medium concentration mask did the trick as we transported him up to hospital.
He was a really nice chap and as we talked about his past, he showed his old fistula which had failed. It was probably the worst one I've ever seen and he was nice enough to agree for me to take a photo of it for educational purposes. As he rationalised, while he wasn't proud of it, he was happy to share it to educate other people.
So, please find this attached. I have received patient permission to use it, however, if you are offended or wish me to remove it, please contact me.
Their quality of life decreases significantly as their disability-adjusted life year increases. Many relatively young people have end-stage renal failure, not something that the community should be proud of.
We transport a young 40 year old patient with end stage renal failure due to shortness of breath and fluid overload, a fairly typical callout. A dose of oxygen via a medium concentration mask did the trick as we transported him up to hospital.
He was a really nice chap and as we talked about his past, he showed his old fistula which had failed. It was probably the worst one I've ever seen and he was nice enough to agree for me to take a photo of it for educational purposes. As he rationalised, while he wasn't proud of it, he was happy to share it to educate other people.
So, please find this attached. I have received patient permission to use it, however, if you are offended or wish me to remove it, please contact me.
Friday, 5 August 2011
Blood tests and immunisations
A recent audit of my yellow card found that I had a few immunisations missing.
After a painful (aka near fainting experience from yours truly) exercise of blood collection revealed deficiencies in:
* Varicella zoster
* Measles
As well as the usual ones which I was missing anyway:
* Polio
* Cholera
* Fluvax 2011
A few painful needles and one very disgusting drink later (Cholera), I am almost up to date again (with the exception of Measles and Varicella which required another IM injection in a months' time, and Cholera with another oh-so-fantastic drink!).
After a painful (aka near fainting experience from yours truly) exercise of blood collection revealed deficiencies in:
* Varicella zoster
* Measles
As well as the usual ones which I was missing anyway:
* Polio
* Cholera
* Fluvax 2011
A few painful needles and one very disgusting drink later (Cholera), I am almost up to date again (with the exception of Measles and Varicella which required another IM injection in a months' time, and Cholera with another oh-so-fantastic drink!).
Wednesday, 3 August 2011
Pack arrives
A big fat white envelope sits patiently in the letter box.
It's exciting. It's what I've been waiting for.
Plastered on top were numerous official looking stamps.
It's what I've been waiting for.
I could hardly contain myself for the oh-so-short walk inside to the kitchen.
I rip it open, rather unceremoniously.
Out drops a huge pile of forms and a six page letter.
It goes something like this...
"Dear Mr Andy,
Congratulations! We are pleased to advise you have been successful in your application for the XYZ Polar Program 2012.
Blah blah blah..."
I wasn't absorbing much of the latter.
I'm over the moon!!!!
It's exciting. It's what I've been waiting for.
Plastered on top were numerous official looking stamps.
It's what I've been waiting for.
I could hardly contain myself for the oh-so-short walk inside to the kitchen.
I rip it open, rather unceremoniously.
Out drops a huge pile of forms and a six page letter.
It goes something like this...
"Dear Mr Andy,
Congratulations! We are pleased to advise you have been successful in your application for the XYZ Polar Program 2012.
Blah blah blah..."
I wasn't absorbing much of the latter.
I'm over the moon!!!!
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