Tuesday, April 23, 2013

A missing lung.

This may be an obvious one, but still, what are your guesses? MOI? Alive or dead? 


This patient presented to our services for a completely unrelated complaint to his obviously demolished L lung. The patient was a self-inflicted GSW from a shotgun to the L chest over TWENTY years prior... that is correct... the following patient is alive & well 20+ yrs after attempting to shoot himself.

A couple of you picked up pretty quickly on the discrepancy between his CXR and the lack of radiographic life support apparatus such as ET tube, chest tube, etc... if this patient presented acutely, the CXR would have contained ALL of the above & more.

So the lessons out of this:
1) Always look at your patient & not just your monitoring or diagnostic equipment... if the patient is flatline on the ECG but is talking to you... it is probably not asystole. If the patient is BLUE & not breathing, but his sats appear to be 98%, you should probably still bag him.

2) The human body is a very fragile AND a very resilient thing... I have seen ricochete 22s kill a man... and you have now seen a man missing an entire lung on a CXR with over a dozen pellets still in him be alive and fine 20yrs later. This is why we WORK some trauma patients that may still have a pulse, but yet may appear unsalvageable to us... this patient is a living testament to that. The initial scene of his shooting would have probably been quite gruesome & I can only imagine being the medic responding to that... my initial thoughts would have been that this pt will not make it... but alas.

When I post medical material... whether it be an ECG, an xray, a write up or something else... it is almost always a patient or a case that I had direct interaction with and because it caught my eye for some reason. Many of you subscribe to dozens of medical sites that recycle the same medical themes over & over... as cool as an AMI may look like on a 12-lead, it does tend to look near about the same anywhere else... I will not waste your time with the obvious.

Thanks for following & feel free to share anything I post, and as always message me with feedback or any questions!

~EMSDoc911

Monday, April 22, 2013

The importance of staging.

I'm working my last street night shift for the month tonight, when one of our crews was dispatched for an unknown problem at a local residence with no additional info. Upon arrival with PD and entering the scene, an armed assailant shoots two of our police officers. Both are ok, as is our crew... the standoff has ended with a murder & suicide... however, this ambush could have been infinitely worse. Our crew was lucky that PD beat them there... otherwise today may have had a much different ending for my fellow EMS crew... or myself.

Wherever you are working... wherever you do EMS, don't be a hero... heros get shot. Please stage until you are cleared to go in by your local PD... we never know what kind of a situation is awaiting behind those closed doors.

This has been a bad week for public service ... today could have been a lot worse... close to home as one of my own.

Stay safe, the night is young... you never know what it may bring to you or I.

~EMSDoc911

Wednesday, April 10, 2013

This is for you.

This is for all of those that have said our job is not special. This is for all of you that have said we are like everyone else. This is for all of you that have told me in person & on this page that our job as EMTs/paramedics/firefighters/police is no different from anyone else.

Today is justifiably yours... the events of today have truly shown that we in public service are no more special than anyone else.

Today, a man pulled a gun on a police officer just over a mile from my house... an officer made a life & death decision, and pulled a trigger that took a gunman's life at 330pm, today... just over a mile from me... while I was playing outside with my child in this beautiful weather... an officer was fighting for his life... I heard the incessant wail of sirens... and I wondered where they were going... knowing all too well the dangers that lurked behind every wail of the siren... only to find out a short while later that the wails were for the gunman... a desperate man that tried to take an officer's life, only to see the end of his.

Today, another man... several states away from... took several Georgia firefighter/paramedics hostage... another desperate man... in a desperate situation... yet a happy ending for us.

Today, one of my local officers went home wondering how things could have played out differently if he had hesitated... if he had been too slow.

Today, a group of our friends & public service colleagues are going home with a fresh look and perspective at life... their wife's kiss, their child's hug will be extra sweeter today... and will be extra sweeter from this day on.

So this is for you... to all of you that have said we in public service are no more special than anyone else. You are right. We are not. We are the same people... the same flesh that you are... the only difference between us and you, is that we put on a uniform and head out work on this beautiful night, knowing all too well that tonight may be our last night.

Today was a good day... we went home. Tomorrow, is a different day, and who knows what it will bring.

Stay safe.

~EMSDoc911

Monday, April 8, 2013

The other half of EMS.

A good portion of my EMS audience has been from the US... but I must say that I do also have a decent overseas following. Recently I received a message from a South African EMS provider that was... well... very heartfelt... and I thought it was prudent to share.

We have all worked in the most austere of conditions... providing the best possible care that is within our abilities... and we do it well... yet, turn to any EMS page or blog and you will find the rants about how hard our profession is & how we all have to do MORE with LESS. Unless you are a system that is EXTREMELY well funded... which is few & far between given the recent budget cut days... we all do the best we can with what we got... ironically, while we complain about our conditions here in the US, there are thousands in other countries that have to do even MORE with even LESS. This is NOT a stab at the lack of funding & the hardships that we all face here, so please do NOT post any comments about how hard we have it... I know, trust me, been there, as have many others following this blog.

I have been fortunate enough to have had the ability to create this page... and in doing so, have networked with many EMS providers overseas... a feat that even 9mo ago seemed crazy even to me.

Below is a link to a movie, just under an hour in length, about an EMS agency in South Africa. The movie takes you on a real life, 3 day journey, to the heart of Johannesburg and its surrounding areas... alongside the EMS crew... it chronicles their struggles, and challenges that they face... ones that ironically only few of us have ever experienced. I have included a 1min 30sec trailer... as a teaser to the real thing.

I watched the entire movie... and have decided to profile it for a good reason... it was not only powerful, but also opened my eyes to the herculean task that it takes to bring EMS to the farthest corners of this Earth.

Just over 400 paramedics serve the entire province of South Africa (an entire county or city department for some places in the US)... and in my opinion they are some of the BEST trained providers in the world... join them for a ride, you won't be disappointed!

Full movie:
www.tellmemovie.com or also available on Netflix

Trailer:
http://www.youtube.com/watch?v=DajZsgW3yLg

A series of black and white photographs, depicting a day in the life of a paramedic:

http://www.youtube.com/watch?v=AOsGIE56g5M&fb_source=message

~EMSDoc911