Saturday, October 28

The Spooktacular Episode

The Crossover Show - 129

In this episode, MC and HM relive their childhood memories of the spookiest of days, All Hallows Eve.


Halloween, if you like.


Here’s a brief glimpse:


MC is ambivalent and HM actually makes his front yard a graveyard.


Also, they guys go deep intho their beliefs about the most underrated holiday in existence: Arbor Day.


You read that right.


Come join the guys as they wax all reminiscent.


No BOLO this episode.


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Source: the Crossover Show

Thursday, October 19

"I'm out of ideas" Advanced Airway Seminar

Every time I try to dream up a clever title for a conference class I get stuck trying to not be too cute.  We all know the offenders who come up with something cute and clever as a class title, followed by a clinical description of the class.

Kind of like "Kids are suckers for a good joke - The Implications of Vaso Vagal Instructions using Humor on Children during Acute Asthma."  I still don't want to take the class but now I'm fascinated on how this is an hour long CE.

 

Not too long ago we had a call that could easily fill a 90 minute CE and we even accidentally named the seminar: "I'm out of ideas."

 

Called for the "possible heart attack," units are responding to a tough to reach location.  The last "possible heart attack" we were sent on was a man coughing so we're literally rolling into the unknown.  About 3 minutes into the response the first due rig asks dispatch "Can we determine if the nearby AED has been pulled (they're all alarmed) or if PD is on scene doing CPR?"

"Yes" is the only response.

Great.

 

PD, as always, is doing textbook CPR that puts the AHA video to shame.  They know our script and as we approach we hear one officer call out "15 minute down time, 1 shock delivered!"  Yes, you're jealous. No, you can't have them.

BVM, OPA and IV are almost  done in the background and an EPI is onboard as we prep for a tube.  I'm a big fan of keeping the BVM but considering the size of the patient and our trouble getting good chest rise we decide to go old school.

That would be the theme for the next 30 minutes.  Old School.

"Chords!  Passing!  End Tidal!" the medic calls out as if listing off his 3 favorite books, the blade snaps closed on the handle and is placed on the cold concrete as I begin to bag.

Nothing.

No sign of emesis, no stained clothing, evidence on mustache or chin...uh oh.  We have no sounds over the belly and zero compliance, confirmed with a big fat ZERO on the ETCO2. "Pull it and get the mask" I mention as the EMT draws the 10cc syringe out from the tube.

Mother. Of. God.

A solid 5 inches of rice, noodles and what appears to be either spinach or seaweed is clogging the tube and now filling the oropharynx.  Not in a wet, suctionable, as seen in Medic school fashion, but in an oddly dry, cakelike consistency.

"5 CALL!" is heard behind us as the local Ambulance arrives with a new hire student, ETT and camera scope in hand.

"Phew" I think.  This will be so much easier with a camera.

Wrong.  Remember our theme?  Old School.

The camera is constantly being obstructed by the food, the yank tip can't get the rice and noodle and the intern is wondering why we don't "just tube the bubbles?" Dude...that never works.

Suddenly the combined 75 years of experience begins to speak up,

"V-Vac!" Nope.

"Pull the yank tip off and just use the suction tubing!" Nope.

"Let's turn him to recovery and do some abdominal thrusts!" Oh yeah! Nope.

No matter of technology or mechanical maneuver was clearing the trachea.  19 year old me would have performed a surgical cric on him already but, alas, this is 2017 in California.  Besides, all we'd have is a new hole to clear.

"Options?" I ask the assembled crowd, CPR still in progress and a BVM standing by incase we get anything.  Before we knew what had happened 30 minutes had elapsed on the scene.  The BLS member keeping times on the Epi confirmed it.  Management of the scene was mine and time got away.  Dammit.

"We are leaving or we are done" and we began to load him up.  Quick thinking had the medic from the ambulance calling ahead to the nearby facility to warn them of this critical airway.

As we began the 5 minute walk from where he lay to as close as the ambulance could get we ran down the list of interventions attempted ending with...

"I'm out of ideas."

So was the ED.

Our preferred, dream intervention would have been an even bigger mess lying in the poorly lit garage.  We know that now from the absolute chaos the ED created.

 

It is important to remember that many of our interventions can take place enroute and others can not. Half of what we tried would have been impossible in the back of a rig and the other half just as useless but the major take away from this call was time.  Do what we can't do later now and do what we can do now, later.  While the old days of intubating with the long spine board on my knees in the back of the rig is over, we can't forget that, sometimes, that's what needs to be done.

You have a scope on your blade?  Do you know how to use it?  Do you know when it has exceeded its few limitations?

Do you know when to quit?

Do you have anymore ideas?  Because, if not, I'm calling it.

Tuesday, October 17

HM on Medic 2 Medic Podcast

Where are my manners?

Posting here has been irregular.  Sorry about that.  We've been doing this for just over 9 years now, so cut me some slack?

 

I had the honor of being a guest on the Medic2Medic Podcast not long ago and got to chat about this therapy space as well as what drives me as a caregiver. You can click over to the site HERE to have a listen and make sure you subscribe and leave a review over on itunes!

Wednesday, October 11

Respond to the Rollover - Tales from the Interwebs

In response to a recent post, a reader has requested I share a tale from their history.  I offer this service from time to time since it can help vent frustration for what it is we in the 3 disciplines do day in and day out.  You can hit me up in a DM on Twitter or FB or drop me an email.  If I like your story I make it my own and forget you ever lived.

This tale comes from a person calling themselves "Double Dispatcher."  Is it true?  I wish it wasn't.  Some details have been changed to protect the innocent, you'll see who they are in the end.  I have also made their 2 sentence story far more dramatic.  It's what I do.

 

THE EMERGENCY

"Rollover with injuries, at the Target Store, 32500 Center St.  Units due Engine 23, Truck 16, Medic 201, EMS Car 2, Rescue 3."

 

THE ACTION

We've been to a few decent wrecks at this intersection so the ears are up, the gloves are on and the beedoo beedoo is doing its thing.  Arriving at the intersection in front of the the Target we are met with frantic people in red polo shirts and khaki pants weaving between parked cars and waving us into the parking lot.

OK...

Into the lot we see no cars in odd places, on their sides, roof, in trees, or even crashed into the building.

"She's inside, cut up bad!" an employee shouts, then disappears apparently to put the Christmas Tree displays up. It is August after all.

Transmitting this new information we can think of no scenarios that led to a call for a rollover with injuries that could happen inside this large, two story Target...ohh well there you go.

At the base of the escalator, which has been shut down, is a small army of red polo shirts holding paper towel bandages to the arms and legs of an elderly woman who looks like she was attacked by a tiger.  Deep lacerations from the escalator look painful and we get to work.  Nearby is her Medicaid Scooter, shiny and new, on its side.

 

She rolled the scooter trying to ride it up the escalator.  In the apparent chaos and hearing the words "rolled over" "bleeding" and the address, radio did the only common sense thing and tapped it out as a rollover MVC.

 

The Truck was devastated they didn't have anything to cut.

 

Monday, October 9

Hazards we can most certainly remove

Code 3 for the fall!

Code 3 for the fall!

Code 3 for the...wait...you fell over what?

 

Escalator falls are serious business.  Not only do they hurt because of all the saw tooth edges, but they are designed to mash anything even slightly pliable without stopping until someone remembers where the shut down button is.

I am currently researching new ways to encourage people to remain still on escalators, more on that later.

 

First, the life or death emergency at the escalator. Well, kind of.  Well, there is one not far away.

I arrive on the scene to find a woman in her 50s on the ground near a suitcase on a tile floor.  It's a bit crowded and often folks will hurry around not realizing there are all kinds of obstacles when folks are dragging bags and such.  She is rubbing her ankle in a fashion that makes me wonder how much it can hurt if pressing it so hard.  One of the Administrative Managers has arrived and is already speaking to her.  These Managers are great.  They have the power to flex ANY resource to our needs.  In this kind of case I ask for the cameras to scroll back and see if we can figure out what happened.

Two reasons I do this:  First so that I can find out what kind of fall, if they struck their head, broke their fall etc.  Second, so that we may learn how to avoid another fall.  Was it a ridge where the tile meets the carpet?  Some other obstruction we can remove or better mark?

Most times we learn from it.  This time was only slightly different.

According to the security office, the video shows the patient place her bag on the ground, step away briefly, then walk right into it, falling to the ground.

 

No amount of signage will remove that obstacle I'm afraid.