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My Biggest Blogging Fears and Heart Attacks

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Want to know what my biggest fear as a blogger is? It’s that one day you may find out that I’m an idiot. You’ll find out that there are things that I don’t know, and those things that I don’t know will be something that “any idiot should know” and if I don’t know them you’ll think that I’m not as smart as “any idiot”.

Take this issue for an example. Say you have a 48yo M Pt with substernal chest pain. He indicates with his hand that it’s radiating towards the lower left part of his chest from the manubrium. He stresses that he doesn’t perceive it as “pain” per se, but that he feels it more as a “pressure” and he rates it at a 4 out of 10. He denies that it exacerbates to movement or palpation, and it doesn’t change with respiration. His skin is slightly flushed and moist and he complains of some shortness of breath. He states that he’s been experiencing it for an hour or so, and that it’s getting worse despite antacid tablets and an aspirin he took. The patient has no medical history and takes no meds. He does have a family history of heart disease but has never experienced any problems.

What would we do here? Easy: a 12-lead, IV, o2, and EKG Monitoring is in order. You do that and get…

A normal 12-lead EKG. Nothing is wrong with it. Not a darn thing.

Doesn’t that suck? I mean, no, not for the patient of course… but for you. Now what are you going to do? Are you sure that this patient’s chest pain isn’t caused by cardiac ischemia? You’ve seen the 12-lead… but you also see the patient’s presentation. They seem to contradict each other, don’t they? If this patient had three boxes of ST segment elevation in three leads, you’d know right what to do and the treatment would be pretty straight-forward, right? Now it’s not so clear.

I’ve vacillated in my career between giving nitroglycerine to these types of patients to make sure that there isn’t something I’m missing with them. My usual decision is to prophylacticly give one NTG tablet (0.4mg SL) after the IV is in place under the doctrine of treating the patient and not the monitor; but I don’t call the cavalry, activate cath lab, or give them the bigger drugs we have to give them (Our STEMI protocol includes: o2, Asprin, Nitroglycerine tablets and paste, Morphine, Metoprolol, and Heparin while bypassing the closest ER by a minimum of 45min to go direct to a hospital with interventional cardiology capabilities)

You tell me that I should contact medical control for these cases and I do if I have something vital to ask that I’m unsure of. I do know that I can’t possibly know everything about everything there is to know about. I also, like probably a good number of providers out there am sometimes afraid to be found out as an idiot by asking a question that “any idiot should know”.

So there you have it. Like most people, I’m afraid to be found out as an idiot and it’s keeping me from asking questions that may give me the appearance of being stupid and ignorant.

Unfortunately for my urge to go hide underneath a rock, I have a blog about EMS that I feel compelled to write something on every day. This means that eventually, I’m going to write something that is so stupid and ignorant about something that you are going to find me out for being an idiot. I may even ask a question about something that I should know by now and you may laugh at me for not knowing the answer to the question I ask.

So I’ve made up my mind. From now on, with you as my witness, I am going to be unafraid to ask dumb questions about things I should already know about. If I don’t know something, I’m going to assume that there’s someone out there that doesn’t know it either… and I’m going to write those answers down here on this blog just for that person… and for you.

I hope that maybe you might start being unafraid to ask those types of questions too. You never know what you might learn. The only cure for this affliction is to buck up and ask the questions, knowing full well that every single person out there feels the same way that you do… and is scared of being found out themselves.

Or you can come here and find out the answers that I’ve found out for you. I’m already a known idiot… no sense in you risking your own neck.

See you tomorrow, Folks.

Changing the EMS World – The Chronicles of EMS

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Man, my arm hurts. I think I pulled something over the weekend… which is funny because it was Medic 999 who was the one handing me my hindquarters in an arm-wrestling match. In my defense, the sun was in my eyes, the gravity was especially strong on his side of the table, and um… the… (There’s gotta be another plausible excuse for losing to a limey… There’s not? Oh well)

The weekend I spent with my lovely wife Gkemtp(it) in San Francisco to go visit my buddies The Happy Medic and Medic999 could be summed up in one word: “Awesome”. I could say it was profound, I could say it was “Bitchin”, and I could also say that meeting the two biggest EMS bloggers and the other fantastic people I met changed my world view and reenergized me on this profession. The word “Awesome” just seems to fit though.

Seriously, between the time I got to spend with Justin and Mark, The Angry Captain and Justin’s wonderful family, the time I spent talking to some wonderfully dynamic people at the Tweetup, and the time I got to spend meeting Thaddeus Setla and The ‘Dridge something changed in my world view.

It’s hard to say that someone like me can become cynical to something that I love so much. I don’t know if you can tell it in my writing, but I really do love EMS as much as I say that I do here on the blog. It’s just that someone like me who really and truly wants the profession to change for the best can become disillusioned when it feels like they’re constantly and consistently hitting their head against brick walls. I had recently asked one of my coworkers if anyone actually cared about EMS anymore. Sure, I get a decent bit of traffic here from people who obviously are caring and concerned about the profession and their patients, but sometimes a guy just needs a face-to-face meeting with people who are just as committed and share the same goals.

And well, folks, I got that.

Today’s headline on the blog could read: “Ckemtp heads off to San Francisco for Chronicles of EMS: Becomes reenergized. Finds no Rice-a-Roni and no limits either. Thinks he can change the world and knows we can do it.”

I haven’t felt this energized, this positive, or this good about EMS since I was a brand new paramedic with a brand new paramedic card. I tweeted that if I could make every paramedic, EMT, and other EMS person feel the way I feel about EMS after the Tweetup, that our profession and whole society would change for the better overnight.

So hold on to your hats folks, because that’s just what I intend to do.

Justin and Mark, The Happy Medic and Medic999 respectively, are two stand-up guys who really are just who you expect them to be. Their blogs really are what the medium truly should be, a place where they communicate to their readers their true thoughts, feelings, and emotions so much so that you feel like you really know them. Meeting them face-to-face, I felt like we were friends who’d known each other for years already. Even though Mark has a nearly incomprehensible accent. (Wait, wait… no, we settled that. Per the arm-wrestling outcome I am obligated to say that his accent is perfectly fine)

Thanks guys, you’re an inspiration. Thanks to everyone who came out to see us at the tweetup and to everyone who watched live over the interwebz. All of you showed me that there really are people out there who care about EMS just as much as I do. This is fantastic. I intend to help leverage this collaboration and cooperation between us to help us change the profession together. I know we can.

So hold on to your hats folks, from here on out it’s going to get interesting. From where I sit there just aren’t any walls out there anymore that we can’t smash through. I’m truly excited and I intend to change the world. With your help, there’s no stopping us.

It’s just plain awesome.

Justin, have fun over there in England with Mark playing in their funny looking sickly lime green ambulances professional and sharp looking equipment with Mark’s ­limey coworkers. I’m figuring it’ll be a hoot! Mark, take good care of him like I know you will. I can’t wait to see what you guys turn this in to. You’ve got my full support! For what it’s worth… now that I can’t really move my right arm.

EMS 2.0, Bernoulli, Fluid Dynamics, and Changing the World

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Today the Boy was playing with one of the junk mail “newspapers” that we get involuntarily delivered to our home when I thought of a way to actually make it useful. I tore off a long, narrow piece of it and made him a Bernoulli strip to play with. For those of you who don’t know, a “Bernoulli Strip” is a long, narrow piece of paper that you hold just below your bottom lip and use your mouth to blow straight out. The strip then floats up and lays perpendicular from your mouth in response to the faster moving stream of air above the strip.

It works because of the “Bernoulli Principle” which was devised by the 18th century physician and physicist Daniel Bernoulli and published in his text, “Hydrodynamica”. It states that with velocity of an inviscid flow, as velocity increases, pressure decreases. So, the Bernoulli strip shows that as you blow outward and increase the velocity of the air above the strip, the static air below the strip of paper is of higher pressure and pushes the strip upward towards the faster, lower pressure airflow.

Bernoulli’s principle of fluid dynamics also made possible a method for physicians to measure the blood pressure of patients by sticking a glass tube directly into an artery and measuring how high the blood rose inside the tube. This method was the preferred method of measuring blood pressure for 170 years!

In this simple experiment, where he found out, basically that higher velocity fluid was of lower pressure than lower velocity or static fluid, he ended up changing the freaking world. Why? Because airplanes fly because of the Bernoulli principle. Wings, or “Airfoils” are shaped according to Bernoulli’s principle, with a longer humped surface area on the top and a straight edge on the bottom.

(Yes, there is the Radial Velocity theorem and the whole battle between Newtonian flight that is raging in the physics community. I’m not smart enough to get into it. They both seem plausible to me.)

So why, you ask, am I putting the above on THIS BLOG, where I usually write about kneeling in poo?

Think about this: Bernoulli published “Hydrodynamica” in 1738. Powered flight became possible by the Wright Brothers in 1903. Yes, a lot of others contributed… but the basic principle that made it all possible had been around for 165 years.

What if Daniel Bernoulli had had a blog?

I imagine that the post would have detailed the experiment that he conducted. His twitter feed would have said “Whoa! Check out the experiment I just did. I made a piece of paper float… It’s on my blog”. His readers and peers would have read it, commented on it, linked to it, and participated in the discussion. The wider community would have devoted a lot of brain power to it. My guess is that flight would have been made possible inside of 6 months.

Ok, maybe that’s a stretch… but you see what I mean. The community participation, shared brain power, the collective engagement of an interested wider audience: That’s the power of this medium. With each post by every blogger, we invite you to participate. We all think of comments as gold. I do. I love when I spark a conversation on my blog and I like participating in the ideas brought forth by my fellow bloggers and commenters. Each idea, like Bernoulli’s simple strip of paper, has the power to change the world.

EMS is an industry sorely neglected by the people actively practicing it. Our profession has been controlled by outside influences and groups for too long. There’s a lot of players trying to dictate the profession, and most of them have an interest in keeping our educational standards low and our pay dismal.

But that time is coming to an end. You have the power, right here in your keyboard, to change everything. I don’t want to sound pretentious or even naive, and maybe I am… but I look at the EMS blogosphere as the end of the status quo in EMS. The times they are a changing, and I have an important role to play in it just because I say that I do. You have just as much of a role as I do because you’re here reading this. Reading articles in a magazine transmits information to you, and that’s important. However, reading blogs transmits information to you and invites you to transmit information back to them. The next reader intakes both opinions, and calculates their own response. Bad ideas are found out, good ideas round out and float to the top of the collective consciousness. Everything can be analyzed, absorbed, participated in, and reworked rapidly. Ideas are shared immediately.

Change happens. A single EMS professional, or even a group of them, often feels powerless to make changes they feel are positive. EMS politics keep a great many good ideas and new ways of improving care down for various reasons. Most of those politics are swept under the rug and kept from the light of day. Just like in Chicago, corruption only exists in the dark. While I’m not calling day-to-day EMS politics “corruption” per se, shining the light of scrutiny on both of them tend to bring positive change.

Welcome to the EMS blogosphere. It is the single most powerful force for positive change in the profession I’ve ever seen. We are the future. The bloggers, the readers, and anyone whose ever punched “EMS” into a search engine are poised to usher in the change in the industry we’ve all been yearning for.

Here’s the call to action: Bring a friend. The more eyeballs we have reading the ideas put forth in the EMS blogosphere, the more participants we’ll have in the marketplace of ideas. Together, we’re strong and are growing stronger with every post, comment, and thought put forth about our profession. We’ll change everything… but we need you to do it.

“Bring a friend to the Blogoshere” I like the sound of that.

The Handover is coming! The Handover is coming!

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Coming soon to Life Under the Lights, The Handover Blog Carnival!

Yes, Medic999 has convinced me to put my money where my mouth is and host an edition of the Famous EMS Blog Carnival. Hopefully I can live up to the heavy expectations of the readers and fill the big shoes of the bloggers who have hosted before me. The Handover is the biggest and best blog carnival featuring awesome bloggers from the world of the Emergency Medical Services and The Emergency Room (US) and Accident and Emergency Room (UK).

Yep, it’s an international EMS blog carnival featuring the best in Emergency Medical content from around the world. It is published monthly. There are Paramedics, EMTs, firefighters, Nurses, and Doctors that participate. If you haven’t read it before, you should. In fact, head on over to Medic999′s place – http://medicblog999.wordpress.com/ and check out this month’s edition. The theme for his edition is “My First Call” which promises to pull out the emotional, the macabre, and the flat out hilarious stories that we all share as members of this crazy profession we call EMS and Emergency Medicine.

Oh, and you’ve all been waiting for the announcement, so here it is…. The theme for my edition will be:

“Funniest. Call. Ever.”  The deadline for submissions is Monday, Sept 21st and it goes live on Friday 9/25.

Yes, that’s right. Pull out the best call you’ve ever had, the one that you tell in the coffee shop to other medics that still makes them wet themselves laughing or scratch their head wondering how we could ever make this stuff up. We can’t, and that’s what makes it so funny.

Can’t wait to see this month’s edition and I can’t wait to get started on the submissions for my edition next month. Stay Safe, everyone.

Oh, and in case you haven’t seen (and I hid it when I posted it) Here’s the story of my first that I submitted for this Month’s Handover:

http://proems.blogspot.com/2009/06/my-first.html

A warning to the EMS Blogosphere

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http://www.iemta.com/KEMSA%20Chronicle%20Article.pdf

The above link is to an essay written by a Paramedic from the State of Kansas who got into a very large amount of trouble by being less than flattering in a blog post that he wrote about a specific patient. There is no link to the actual blog that I know of, but in the above letter he stated that he broke patient confidentiality.

The hit he took was huge. He lost two jobs, lost his license for 90 days, and was almost barred from practice indefinitely. Two of his coworkers were suspended for writing comments as well.

Just a note for us EMS bloggers. Do not do not do not violate patient confidentiality, ever. Change any and all details. Not only is it good for your patients, it’s good for your career. I like the EMS blogosphere, and I do not wish for it to disappear because of any like incidents.