Future Ditch Doctor

Just in case you’ve been under a rock for the last couple of days (or, like me, busy with school and other things), I wanted to pass along that the new American Heart Association CPR/ECC guidelines have arrived!  I will be completely honest:  I have not had the time to digest everything just yet but I’m hoping to complete my review of the new guidelines very soon.  When I do, I’ll be able to better give you my take on the new guidelines.

In the meantime, if you would like a good rundown of what the new guidelines are and what they mean for EMS, I invite you to check out the latest edition of Medic Cast.  Host Jamie Davis, along with Tom Bouthillet of the Prehospital 12 Lead EKG blog (a great resource for anyone in EMS especially students) speak with Dr. Monica Kleinman, incoming Chair of the Emergency Cardiovascular Care committee at the AHA about the new guidelines.

Enjoy!  I will provide my thoughts on the new guidelines as soon as possible.

First, I want to brag a little.  Today we had our intubation check off in lab and I passed on my first attempt!  The only thing I lost a point on was that I didn’t verbalize the depth of the tube at the teeth but otherwise I did well.  I don’t mind telling you that I was nervous because I figured I would do something silly like rocking the teeth or forgetting BSI but thankfully I remembered my steps (except for the aforementioned depth issue).  I’m happy that I passed!  I didn’t do as well on my test as I had hoped, though.  It’s just something to work on improving.

It’s a good thing that I don’t mind a challenge.

I had a clinical rotation at an ICU on Friday and I really enjoyed it.  I only had two patients (and one of those went to the floor) but I still got to practice several medication administrations and work on assessments.  Ah, assessments:  The bane of medic students’ existence.  I’ll be the first to admit that when I first started doing them for school, it sucked.  Yes, I said it:  My assessments sucked.  I feel that I’ve come a long way and I want to continue to improve so that I accurately and thoroughly examine my patients to determine a proper course of treatment.  The only patient I had who was able to speak (the other was on a vent – more on that one in a bit) was a bit of a challenge but, as I said above, I sure don’t mind one.  He put me to the test and I’m glad that he did because it helped that much in making me a better EMT already and a good medic later on.

As for the other patient… she wasn’t so well off unfortunately and I was around when the family got some not so good news about her prognosis.  I kept my distance, of course, while the doctor was giving them the dreaded news but I still saw their grief from across the room.  I’ll be honest:  Seeing the family go through a loss (or immanent loss) is something that is hard to get used to.  I think everyone in EMS (or in any other field for that matter) knows how too well what they’re going through.  It stinks knowing that, whether I’m a basic or a medic – or even a doctor – there’s nothing I can do to bring back their loved one (last time I checked, there was only one God and I’m certainly not Him).  In those situations a family loses their aunt, uncle, granny or whomever they’re grieving for and I don’t think anyone would disagree that it’s tough to witness.  We also have to remember that at that point we’re not treating one patient anymore, rather we’re treating that patient’s entire family and friends who may be there to witness you calling the code.  I hope that empathy is a skill that I never lose sight of as I learn all of the new ALS interventions I’ll be able to do as a paramedic.  May this is true of anyone in EMS now and those who are going to enter the field after basic and/or medic school.

Anyway, sorry to get off on that tangent.

Later on when I went into the room to reassess her and give her the meds she had due, I could tell how much the family loves her.  They were telling me about how healthy she had been up to that point and how she hated hospitals.  I got to hear them share special memories of her and how much they will miss her.   I couldn’t help but think of my loved ones who have passed and even of my mother who was on a vent for 15 days back in 1999.  It was a scary time; I know how they felt because I felt that way too.

All in all I had a great experience and I look forward to going back.  It wouldn’t hurt my feelings to have the same preceptor because he was really cool and showed me a lot of things in addition to helping me with my assessments and skills.

Next stop: A rural ER!  My clinicals up to this point have been in urban facilities but this week I get to go to a rural ER. It’s also in my hometown!  Thursday I will spend the night with my mom and step dad and visit with them as I prepare for my day.  As always, I’m eager to get in there and get my medic student hands dirty!

Hopefully I’ll be calling it an early night tonight.  One thing I’ve neglected on my quest is sleep.  Tomorrow we’ll dive into more airway lecture and begin some new skills in the lab so I want to be well rested.  With that… goodnight!

Muay Thai is considered one of the toughest martial arts. His technique can equally well to fight at long, medium and short range. But the most dangerous muay thai camp thailand fighters in the middle distance and in close combat. “Elbow wins fist and knee leg wins” – says one of the basic principles of Thai boxing. It is in close combat knees and elbows are the most dangerous for the opponent.

Another “brand” reception Muay Thai – low kick (roundhouse shin on the thighs). Generally used as a striking surface did not lift the foot (as in most other martial arts), and the tibia is one of the characteristic features of Muay Thai. For the “padding” shin developed special exercises: the impacts on the trunks of palm trees, the sand bags, “rolling” faceted wand – followed by treatment with calf special ointments. After such a “stuffing” Muay Thai fighter can kick to break a baseball bat. With the leg lock and low kicks the opponent. Much attention is paid in Thai boxing as “stuffing” the body, stretching, development of endurance.

Hand technique in Muay Thai technique resembles a “European” of boxing, but very diverse.

Unlike other martial arts, Thai boxing there are no formal systems (such as kata in karate), but there are so-called “three-step movement” (yang Lapp khum) – short bundles, consisting of basic movements that are in the process of training brought to automatism. Most are used in Thai boxing combinations and techniques known from the days when it was known as the art of “pahuyut.” All combinations of these basic fundamental 30:15 (mae May) and an additional 15 (onion May).

In Muay Thai, there are two styles. Muay nail (literally “hard battle”) is now rare. Earlier this style was common in the villages. Muay varnish – is a solid, stable stance fighter, a powerful protection, the slow movement. Action is based on the counter, the battle is mainly conducted at close range. Muay Kieu (literally, “a nifty battle”) is built on a feint, goes away, dodge, fighter constantly moves. Thus on the specifics of combat stiffness Muay Kieu has no effect.

The art of working with weapons in Muay Thai is called “crab krabong” (swords and sticks) and was formed in the first place, on the basis of Indian, Chinese and Japanese methods of combat. The first school of crab krabong, opened in the 14th century., – Buddhau Saba – operates to this day. Thai traditional weapons – daab – is a heavy two-handed sword of medium length and is used as a single and dual weapons. Also in the arsenal of military Muay Thai includes: Halberd “ngou” spear “Thuan” many sticks and daggers and throwing knives, bow “Thane” and crossbow “naa May”.

Fight in Muay Thai dance precedes the frame-muay. This is not only a tribute to an ancient tradition, but also a kind of physical workout, as well as psychological training fighter before the fight. (The performance of the frame-muay can determine which school he belongs to what technique of preference). Before the fight rivals meditate. The fight takes place at the traditional music of the Wye Kru, a rhythm of battle. It is believed that the instrument sounds are endowed with magical powers.

In Europe and America Wye Kru Muay and frames are not necessary. Evrotayboks (or taykikboksing) differs from the classical Muay Thai and rules: it banned elbow strikes to the head, long jaws, and in some cases, and knee strikes. This adapted version of Muay Thai was eventually one of the seven areas of kickboxing (see kickboxing). In addition, in Europe and America virtually no attention to weapons.

Uniform Thai boxer – athletic shorts, ritual headband (at the time it is given to fight the trainer) and boxing gloves. Previously used to protect the shells of mollusks, now – the standard inguinal sink

Political cartoonist Marshall Ramsey of the Clarion-Ledger (Jackson, MS) has drawn a cartoon regarding the idiotic comments made by Jackson city councilman regarding EMS waiting waiting for police to secure a shooting scene.  I’m a fan of Mr. Ramsey’s work so I may be biased but I believe this cartoon is hilarious.

Also, JEMS has provided a link to a video interview with WAPT Jackson, MS with Stokes. He has not changed his mind.  Evidently he thinks that EMS is public safety. Not so much. If you’re reading this and reside within the city of Jackson I encourage you to get involved with a recall petition and get this nut out of office as soon as possible.

The biggest enemies of novice exercisers are training for their ignorance and their own ego. The second thing is dangerous even for experienced bodybuilders.

No product in the world will not produce a beautiful body and muscles. There must be honest and hard work, good nutrition, good diet and knowledge of human anatomy. You must have a plan and system. Do not expect miracles. If you know the risks, you’re ready to start bodybuilding. The procedure can be corrected by a few quality products to help your efforts. Pay attention to the different products. Do not believe everything. Investigate, ask. Finally, you can find what you are looking for.

For example, you can try Muscle Maximizer. On trymusclemaximizer.com you can review details here about the product and decide whether to fit you. Remember that even Arnold Schwarzenegger didn’t become famous in one day. He remembered his six basic rules. The first was: Trust yourself.

African mango (Irvingite gabonensis) is a breakthrough in food supplements intended for weight loss. It is a powerful antioxidant, 100% pure extract packaged in capsules that are easy to swallow. The product is manufactured under license in the United Kingdom, in strict Good Manufacturing Practices.

It is always better to prefer a natural product. African mango fruit with a healthy side effect of weight loss. Africans in the State of Cameroon eat it for hundreds of years and when you visit their beautiful country, you will find that these people are not fat but nice and healthy. African mango is different from other types of mango. The natives use the seeds from the mango for ages as a medicine.

The natural solution is safe and does not harm the human organism. And if it can not hurt, it can only help. If you do not trust the extract in tablets, you can always consult your physician or other experts on weight loss.

Before I get too deeply into what the title of this post is about, the #questforthediscopatch for Fall 2010 is coming to a close.  I see a light at the end of this tunnel and I’m really hoping it’s not a train.  Tomorrow I have my final for lecture and Tuesday my classmates and I will have one last pharmacology test and a critical on dosage calculations.  All of this will, of course, determine whether or not I move on to next semester.  I’m really hoping for few problems.  I’ll be spending a lot of time studying and in my final clinicals for the semester too.  I’m hoping the next time I post about school, I’ll be celebrating a break and getting ready for Spring.

Now, on to some non-school fun!

Thaddeus Setla is not only the genius producer of Chronicles of EMS and an appreciator of wines, he’s also a huge fan of the University of Michigan Wolverines.  I am a huge Mississippi State University Bulldogs fan and our two teams are set to square off in the Gator Bowl on 1-1-11.  Naturally, I saw the opportunity for a friendly wager.  When I suggested to Ted that we come up with something, I was expecting something along the lines of “loser has to display the winner’s logo on their Twitter and Facebook profiles” but I was pleasantly surprised when he suggested a wager involving wine.  So, here we are!  I’ve warned Ted that I know very little about wine but he didn’t seem worried about that.  Essentially:  If Mississippi State (likely) wins, Ted’s going to send me some wine that he’s been holding on to for a little bit.  If Michigan (unlikely) wins, I will send him a Zinfandel of my choice.

I wonder if he’ll accept a fine vintage from Mad Dog 20/20?

In all seriousness, I’m looking forward to this.  The smack talk has already begun and I invite you to follow our banter on Twitter and Facebook as gameday approaches.  I just hope Ted and the rest of his Wolverines are ready.  A pissed off wolverine is a dangerous thing but a pissed off bulldog with 40K + ringing cowbells is going to be a big challenge.  Plus, Michiganders are used to cold and snow this time of the year and Florida doesn’t normally have any snow.  Seeing as MSU is a cow college, we’re used to grass and won’t question what the field is made out of and its intentions.

Let the games begin!  Oh, and on behalf of the Bulldog Nation, I present this as a warning of what the Michigan faithful have to look forward to!

I just got home from my last clinical of the Fall and I’m grateful that I’m not but some pathophysiology and drug information away from officially being on break.  Mentally, I’m tired.  Physically, I’m tired.  Tomorrow will be the first time I’ve slept past 0500 since August.  You have no idea how much I’m looking forward to that.

Unfortunately, I also got some bad news when I turned on my laptop.

I logged onto Facebook and noticed several local EMS friends had changed their profile pictures to the Star of Life with a black bar.  Before I had a chance to ask any of them why, I found a story on EMS 1 about an EMT in Montgomery, Alabama who was struck and killed while she was working a MVC on I-65.  This hit close to home for a few reasons.  One, she was my age (29).  Plus, it’s literally close to home.  Montgomery is about three hours from my house.  My thoughts and prayers go out to EMT Laura Elizabeth Pullam’s family, friends and co-workers at Care Ambulance in Montgomery.  More »

I hope that everyone who may read this had a very merry Christmas or whichever holiday you may have celebrated.  I got a great Christmas gift from school when I got my final grades:  All Bs!  I’m not complaining one bit.  We report back January 11 so the quest will begin again at that point.  In the meantime, I’m trying to relax as much as possible.  So far, so good on that one (just ask my wife).

I also spent Christmas on the truck and we were actually pretty busy.  The two biggest things we seem to be picking up right now are flu symptoms and stomach virus symptoms.  I took a flu vaccine a couple of months ago and so far it seems to have worked.  However, I really wish we had a vaccine for the stomach virus as I came down with a pretty good one on Sunday.

Merry Christmas to me!

We were finally able to find someone to come in for me (in fact, it was my director who had to come in – and I appreciate it very much) and I’m thankful that it finally happened because I was miserable.  I had been talking to my wife throughout the afternoon and I let her know that I was finally about to head home.  By the time I arrived she even had PJs laid out for me, Sprite and crackers by the bed (for when I felt like eating or drinking something) and bed itself was even ready.  I went to sleep but woke up every so often to… well, to do what those with stomach viruses do.  It wasn’t fun and I’m thankful that I’m almost over it.

I don’t wish this on anyone.

So after now two days of basically doing nothing, I’m reminded of what  a patient must feel like and my wife has gotten a taste of what it’s like to be a healthcare worker.  I’ve been at some weak moments and my wife has had to help me in ways she normally wouldn’t have to.  I’m grateful for her willingness to assist me just as I’m sure our patients are grateful for us helping them.  It’s a sobering reminder that anything we can do for a patient to make them more comfortable matters.  Being a patient for the first time in a long time has given me a renewed sense of what we do.  On my next call – and hopefully on many more to come – I’ll remember what I’ve felt the last couple of days.

During this time I’ve also discovered first hand what many other EMSers have told me…

EMTs make the worst patients. I believe it wholeheartedly.

The project started out innocently enough in August.  On my first day as a paramedic student, all bright eyed and bushy tailed, I was handed a list.  The list was about four pages long and included information about the drug cards we would be making, what information was required and a list of drugs that stretched from acetaminophen to warfarin and everything in between.  The information gathering was done at various points along the way and slowly but surely I made my way through the list.  Then, last night, victory!  The drug cards were finished and this morning I handed in my stack of alphabetized cards with information about the medications.  However, the victorious feeling would be short lived as I was hit with another realization.

Dosage formulas. They are now the bane of my existence.

We began studying and practicing the formulas yesterday.  Today we had more practice and I found out that the critical skill check off on dosage calculation would be right before we start Christmas break.  Pass or fail.  All right or all wrong.  Three chances max.  I’ve never been the best at math.  I’m sure my high school math teachers still laugh when they think about my feeble attempts to master what they were trying to teach me and I had the grades that showed I had no idea what they were talking about.  I was scared then.

Now is no different.

My problem really isn’t the math itself.  Once I see a formula and learn how it works, I generally don’t have much of an issue.  My issue is remembering all of that when I’m handed a test.  The plan is to practice, practice, practice, practice and do the absolute best I can.  The best effort will be put forth and I plan to do my absolute best.  That and hope for the best is really all I can do.  Somehow or another it will work out and I’m thankful that I have a great support system in place.  I have some practice problems to do over the weekend so I’m optimistic that this will help me with my confidence. More »