Right here! Right now!

I am grouchy tonight and I will probably be grouchy tomorrow, the next day, and the day after that too. If anyone reading this does not like attitude, foul language or complaining then I suggest you go elsewhere because I am venting. Right here! Right now! This is one reason I have this blog so that I can put my thoughts in writing instead of in someone's face. I am not little miss perfect personality and I have bad days and weeks just like everyone else does. I can no longer hold back my bitching for the sake of all goody goodness and am coming out of the closet with my temper tonight. Take me or leave me.

I have not gotten used to our new shift change yet and after doing 24/48's now for two weeks now I still think it sucks. I don't like it. Never will like it and no one can make me like it. Yeah, I am a spoiled brat. So what! Everybody has to be good at something and I think I have found my calling this week.

I found a little blurb of sorts today that fits my mood right now perfectly. Actually, it is the mother of all insults. I must memorize this and put it to good use if the occasion occurs. Take a gander if your virgin eyes can stand it.

It's amazing how much better I feel after typing this entry so humor me PA-LEEZE!!

I have two more 24-hour shifts this week and then I will have five days off. Until then you can expect minimal entries from this old gal. I am just not up to it.

Rambling About An Ordinary Day

I am sleepy and will probably ramble with this entry a bit but I am posting it anyway.

Yesterday at work wasn't too busy. We had seven calls. Three of them non-transports. All of our patients were elderly and three of the calls were blood pressure related. I was beginning to wonder if someone had put something in the water to make all those blood pressures go hay wire.

One call was an out of town transfer for a hip fracture. The patient was very friendly and despite her pain wanted to talk. Turned out that she knew my grandpa when he was younger. It has been my experience that many elderly patients will ask who my family is and when they learn who my grandpa is their faces light up. My grandpa, when he was alive, was a well known and much loved person in our town. Being one of his "chickens" has helped me gain the trust and respect from many people that I come in contact with. Due to his good standing in the community, they automatically assume that they can trust me too. This trust can make a huge difference in medic/patient relationship.

Another was a 911 call for an unresponsive person. When we arrived at that residence the family said, "Oh, there is really nothing wrong. We just want you to take dads blood pressure." The elderly gentleman was bedridden from numerous strokes and didn't speak (so we thought). We checked him good, made a big fuss over him and complimented the family on how well they took care of their loved one. This made them feel good and they were very appreciative of us coming out. Despite the fact that they misused 911 there really was no need to make a scene because they were sincerely worried about him. As we were getting ready to leave, I patted the old man’s arm and told him that we were going to leave him alone now. He turned his head slowly, smiled at me with his twisted mouth and although his speech was slurred he said, "thank you" in a whisper. The family made a big to-do about him speaking to me. They said that he rarely talked. I asked him if he had been playing possum and he grinned and shook his head yes. We all got a laugh out of that one. I never did figure out if he was thankful for us checking on him or if he was just glad to see us go. HEH!!

I had been in bed for about an hour and a half this morning when the last call came in at 0540. I hate those last minute calls when you are just about to get off shift but that goes with the territory. We got on scene about 0550 and when we got to the patients room one of the nurses stopped us and said, "Wait, she is not ready yet." ARG!! I know they didn't call at shift change on purpose but the thought did cross my mind.

Burning Down The House

My mom and I got up early this morning and went to the fire fighter training facility so that we could meet up with the fire fighter class and follow them to their practice burn. This is the same class that I taught first responder to earlier in the year.

Mom and I both took our cameras and snapped photos all morning of fire, smoke and exhausted students. The photo below is of the house just after part of the roof fell in. I have more but I am saving them for the next 26 Things Photographic Scavenger Hunt.



Mom will more than likely have some good shots up on her blog later. We were both exhausted and smelled of smoke when we got home this afternoon. I crashed across the bed and slept for several hours and I would imagine that mom did the same.

Photo Friday: Neglect

The Photo Friday challenge for this week is "Neglect".



"Neglected" house numbers with vines growing over them.

Sneezure

Snee"zure, n. 1. Sudden and violent reflexes caused by a state of uncontrollable paroxysms of sneezing. (otherwise known as the Achoo syndrome)

I came up with this out of the blue at work yesterday while watching a co-worker go "Achoo...achoo...achoo....achoo...achooo...achooooooo" in rapid succession.

I think I will have to submit this one to Words That Should Be in the EMS Dictionary But Aren't.

I submitted one several weeks ago but they haven't listed it. It was Xanaxemia, n. The toxic bodily condition associated with having too much Xanax in the blood. Often seen in nursing home patients or patients who attempt suicide but really don't mean it.

It Wasn't Me

Our day was quiet but as usual, the calls started coming in pretty much back to back around dark. First, we had an MVA with five patients. Luckily, none of them was seriously injured nor did they require transport. Then we had a "possible stroke" and shortly after that, an "ear hemorrhage". As we are on our way to the ear, I am thinking, "Yeah right, this is an unlikely story". Sure enough, an elderly lady had a bleeder that was coming from a tumor in her ear and it was spurting blood several feet. We put a big wad of 4X4's on her ear, bandaged her head up tight and transported her to the ER.

After that call, we transported the stroke to another facility out of town. By the time we got back, it was getting close to midnight. I didn't think I was going to be able to finish my paperwork without nodding off but I managed to get it all done without drooling on the keyboard.

My partner had crashed on the couch and soon started snoring his little heart out. He had worked several shifts in a row so I didn't bother him with helping me restock the truck. He needed the rest more than I did.

I couldn't help but laugh at him when he got cranked up with those sounds that were a mix between a snore and a gasp for air. I actually considered getting a bag of IV fluid, hanging it just above his head and let it slow drip into his gaping mouth. HEHEHE!! He would have deserved it because he accused me of farting in the ambulance when we were on our way back from our last call of the night.

I hate it when a smell comes from out of nowhere and creeps into your unit. You know that you didn't do it and you would like to believe that your partner wouldn't be so rude as to fart in such close quarters but that smell had to come from somewhere. He blamed it on me and swore that he did not do it. I blamed it on the catalytic converter of the car in front of us but I really think that he did it. ;)

To-Go Is The Way To Go

We had a quiet morning at work yesterday. Zero calls before noon. Several of us went to a local restaurant for lunch and had been there for about 5 minutes when we were toned out to a respiratory distress. First call of the day -- right in the middle of grub time. It never fails.

I don't usually like to eat out when I am at work because of this very reason. I would rather get a to-go plate and go back to the station. That way, if we do get a call in the middle of a meal I can at least put it in the fridge and finish it when we get back. I was being polite though. Following the crowd. I am not complaining mind you. I enjoy hanging out with my co-workers but I have wasted too many meals because of interruptions and yesterday just proved to me once again ...... Don't eat out when you are on duty!

Without My Wings

This is a poem written by my daughter. They are learning how to write poetry in school. She asked me tonight if I would put it on my website and of course I said, "yes". My baby girl has such a tender heart.

EMS Pay Is An Embarrassment

I followed a link that I found at Far From Perfect and came across and excellent read by Bryan Bledsoe, DO, FACEP, EMT-P. The link, along with an excerpt from the article is below. It points out a little known statistic about EMS worker fatalities.

The article has some good info about the pay, working conditions and the educational requirements of EMS personnel around the U.S as compared to Canada, Africa, United Kingdom, Australia and the Netherlands. According to the article, other countries seem to put a greater value on EMS than does the United States. I wonder why that is?

Dr. Bledsoe sums up his article by saying, "Consider this: My $3.45 an hour salary as a paramedic in Fort Worth in 1977 is equivalent to $11.48 in 2003 dollars. Sadly, EMS pay in my hometown is not much better nearly 30 years later. And that, my friends, is an embarrassment and a shame."

EmergiBlogs News

I haven't mentioned Emergiblogs in a while but that little project has taken off and has become quiet popular as a point of interest for the EMS/medical blogging community. It now has 19 members.

Doc has been working the site today and has added a Latest News page to keep the "community" informed about announcements and important items. I am sure that if you find something of interest to the community as a whole he would be glad to post it there.

Emergiblogs has been third on my list of top referrers for the past three months now so I know that it has been useful for many.

Home Defibrillator

I had heard about the home defibrillators but hadn't seen them advertised. I saw a comercial last night about the Philips HeartStart and for about $2000.00 you can purchase one for your home if a doctor deems that it is a medical necessity and perscribes one to you or a family member. Medicare may pay for it if the patient meets the criteria.

Some of the medical conditions that may meet the criteria for medical necessity for a home defibrillator are:

• If the patient is at risk for sudden cardiac death but an implantable cardioverter defibrillator is contraindicated
• Pre-heart transplant
• Patients for whom an ICD would be indicated were it not for other co-morbidities (e.g., infection, trauma and breast removal)
• Family members who have yet to manifest disease, but whose family is at risk for SCA
• Other psychological or physical contraindication for ICD
• General cardiac risk profile that would indicate an elevated risk

Read more about the defibrillator coverage policy which was effective January 1, 2004.

gadgetguys.com also gives a review of the product.

Tricks Of The Trade

I found a huge list of "Tricks of the Trade" the other night. It was fun reading though all of them all because I am such a "know buff". Although most are for physicians there were a few that would be useful to EMS personnel. I have listed some of them below.

HANDY RULER
Don't have a ruler? Dr. John Wipfler in Peoria, Illinois, always keeps his handy, so to speak. Every doctor should make a mental note of three measurements from his or her index finger: metacarpal-phalangeal (MP) joint to tip (usually 8 cm), MP joint to proximal interphalangeal (IP) joint (usually 2.5 to 3 cm), and MP to distal IP (usually 6 cm). This "ruler" stays with you wherever you go to facilitate physical assessments involving measurement, such as the extent of a rash or laceration. Knowing the distance from your thumb tip to your fifth digit tip with fingers abducted is also useful for larger measurements.

SOUND CHECK
To detect a femoral fracture in the field, Gary Keel, PA-C, in Granbury, Texas, enlists the ability of hard tissue to conduct sound better than soft tissue. He places his stethoscope on the symphysis pubis, then taps on each patella. The percussion note on the side of the intact femur sounds like a click, while that on the side of a broken femur could be described as a thud. This added bit of diagnostic information may help to identify the leg in need of radiologic evaluation and at least warrants a splint for the side with the thud. Practice on a healthy, uninjured leg to become familiar with the normal sound, suggests Mr. Keel.

SHEATH THAT STETHOSCOPE
Recent data support the idea that the head of a stethoscope can serve as a transmitter of disease. To reduce that risk, and especially to avoid contaminating the stethoscope with blood, pus, vomitus, or other infectious substances, Dr. Chris Dutra of Berkeley, California, covers his stethoscope head with a nonsterile examination glove. This tightly fitting cover rarely interferes with auscultation and is easily discarded after the exam. Dr. Dutra also uses an isopropyl alcohol pad to wipe off the diaphragm and bell after all is complete.

DO THE MATH
Tube sizes for pediatric patients are difficult to remember. Accordingly, Dr. Fred Leonard of Tucson, Arizona, offers these useful mnemonics--generally confirmed in the Harriet Lane Handbook. If you know the size of the endotracheal tube (ETT)--which is equivalent to the size of a patient's little finger or to (16 + age in years)/4-you know the rest:

• ETT X 2 = nasogastric or Foley (French) size
• ETT X 3 = depth to insert the ETT
• ETT X 4 = chest tube size

In a pinch, use anything that you think will fit while you calculate the correct size.

MELLOW YELLOW
Can't remember the desired color for end tidal CO2 indicators? Here is a handy mnemonic provided by Dr. Steve Jarrard of Lander, Wyoming. He says the phrase "yellow is mellow" helps him keep the patient the right color and maintain a proper pH.

(I remember the colors by saying "purple problems, yellow yes")

Although EMS wouldn't have a use for the next one, I thought it was funny.

STOICAL STANCE
When collecting a urethral swab from a man, Dr. Jaeger directs the patient to hold his own penis with both hands. He finds that if the swab hurts, the patient holds the penis tighter but doesn't pull away.

Photo Friday: Morning

This weeks Photo Friday challenge is "Morning".



I was on my way to work one morning last week and the closer that I got to town the foggier it got. Our EMS office sits close to the banks of the river and I could tell as I approached work that there was a huge fog bank hovering over the water.

After I clocked in I went back outside to fetch my camera. As I walked around the building, the two trees in the photo caught my eye. Their blackness against the white fog made them seem alone and cold. The river is in the background but it is hidden because the fog was so thick.

The scenery over the river every morning is beautiful sight. I find myself in a trance sometimes when looking at it. The picture that Mother Nature paints is never the same.

Little Miss Suzy Homemaker

I finally got around to getting the material to finish my quilt yesterday evening. I am a little confused as to exactly where I need to start with the quilting part so I am going to have to call my grandma and maybe do a little research via the Internet on quilt making procedures. It's not as easy as it looks.

Earlier this week I cut some small blocks, sewed them together and made a pot holder or hot pad (which ever you want to call it). It isn't square and the corners are rough but I think it is sorta cute. Hubby said he thought that it looked like a tiny pillow instead of a pot holder. I wonder if I could sell it on Ebay?



Speaking of Ebay, I made my first buy there the other night. I found some neat looking material that I really didn't need but wanted at the moment. I was also curious as to how a transaction worked on Ebay so I decided to give it a shot. I made a bid and won. Hubby came in just as I was paying and asked me what I was doing. I looked up at him and said, "I just bought something off of Ebay baby". He looked at me with that "oh crap" look and said, "How much?" In a sheepish tone of voice, I said, "Four dollars and seventy six cents."

The butt munch laughed at me.

After I made my purchace I noticed that there are tons of folks selling those little squares for quiltmaking. They have got to be making some money doing that because some of that stuff was being sold at some redicilous prices. I just might have to give that a try.

Have any of you ever sold things on Ebay before? Is it worth the trouble?

Weblog Author Personality Quiz

Want to know what kind of weblog author you are? Take the Weblog Author Personality Quiz to find out what weblog archetype personalities you most closely resemble.

I answered 60 percent of the questions in a manner that closely resembles those of a normal person.