Field Guide to ParaMagic

This is Timber Fenris, my Siberian Husky Puppy His favorite toy...

Thu, 16 May 2013 19:51:26 -0400

This is Timber Fenris, my Siberian Husky Puppy

His favorite toy is a stuffed armadillo which I have started calling Dillan.

Just a quick note to my followers. I have added a second...

Thu, 16 May 2013 19:45:52 -0400

Just a quick note to my followers. I have added a second blog,
The life of Siberian Huskys

http://snowdoglife.tumblr.com/

emtgin: We need to talk

Wed, 15 May 2013 20:42:16 -0400

emtgin:

We need to talk

Photo

Thu, 09 May 2013 20:01:12 -0400

The Time Warp!

Thu, 02 May 2013 09:03:23 -0400

The Time Warp!

Red Bull can. Don’t think that is how it works

Wed, 01 May 2013 10:10:37 -0400

Red Bull can. Don’t think that is how it works

Photo

Tue, 30 Apr 2013 13:01:41 -0400

Photo

Tue, 30 Apr 2013 13:00:34 -0400

greentextmedic: Trauma Time with Greenie - Flail Chest, Part...

Tue, 30 Apr 2013 09:57:23 -0400

greentextmedic:

Trauma Time with Greenie - Flail Chest, Part III

Stabilizing a flail chest is tricky —you must depress the segment to the anatomically correct alignment and reduce instability, all without interfering with respirations. However, there are two quick fixes for this —the first, is obviously hold pressure manually. The second, is to stack linen sheets over the segment and let gravity hold it in place. You will be wasting valuable time trying to intricately dress this sort of wound with gauze and 2” tape or wrapping an Ace wrap around the entire chest.

Always complete your trauma assessment —do not stop after stabilizing or performing interventions on the flail chest. If the mechanism of injury was powerful enough to cause a flail chest, there is a good chance that there will be other injuries. It is easy to get sucked into this type of major trauma —it’s big and it’s obvious, but it’s always the little things that you miss that will endanger the patient. Even if your assessment reveals no other injuries, maintain C-spine —the flail chest qualifies as a distracting injury and can mask the presentation of other injuries.

Other major trauma protocols like intravenous access and fluid resuscitation still apply if they are within your scope of practice. Preferably, two large-bore INTs in the bilateral ACs are the best route for rapid intervention. Consider intraosseous access if you have a decreased LOC, rapidly deteriorating respiratory drive and are unable to establish a patent IV. Be guarded with your fluid bolus and do not attempt to raise the pressure higher than 90 systolic or until you return peripheral pulses.

A patient with this injury warrants immediate transport to the nearest appropriate trauma-receiving hospital. Do not be concerned about missing a few steps along the way so long as you cover the basics. It is nearly impossible to perform all the interventions I’ve listed here in the time it takes from initial-patient-contact to transfer-of-care at the hospital —even with the help of multiple pre-hospital providers. Do what you can to keep the patient alive long enough to make it to the operating room.

That’s all any of us can hope for with a patient like this.

greentextmedic: Trauma Time with Greenie - Flail Chest, Part...

Tue, 30 Apr 2013 09:56:37 -0400

greentextmedic:

Trauma Time with Greenie - Flail Chest, Part II

A flail chest is way up there on the list of life-threatening injuries. In the pre-hospital setting, it should be the first injury you address during your initial trauma assessment after stabilizing C-spine, assessing LOC and performing your ABC’s.

Your first hands-on assessment of the flail chest should be bilateral lung sounds and heart tones. Labored breathing, but clear lung sounds is to be expected early on in the disease process. Heart tones should be clear and crisp. Having a good baseline will help you determine the extent of internal damage and the rate of bleeding or air leakage inside the chest. Should the lung sounds be diminished or absent, look for evidence of tracheal deviation or tugging. This would suggest a tension pneumothorax —be prepared to decompress a flail chest if it is within your scope of practice.

Patients with flail chests fatigue very quickly. The work of breathing they must do has been doubled with the loss of effective chest wall movement on one side. They should be given supplemental high-flow O2 regardless of presenting blood O2 saturation. Be prepared for the patient’s respiratory rate to plummet as they decompensate —you will have to ventilate the patient with a BVM if they become agonal or apneic. Should the patient go unconscious and unresponsive, consider advanced airways or intubation if it is within your scope of practice.

Any three symptoms of Beck’s Triad could suggest cardiac tamponade. Assess for distended jugular veins, muffled heart tones and hypotension. If it is within your scope of practice, place the patient on the cardiac monitor. Obtain a 3-lead to determine sinus rhythm and accurate pulse should peripheral pulses be absent. Cardiac alternans and low-voltage readings on the EKG could also indicate cardiac tamponade, but do not delay on scene with obtaining a 12-lead to confirm cardiac effusion. Additionally, there is no longer a pre-hospital protocol for pericardiocentesis.

greentextmedic: Trauma Time with Greenie - Flail Chest, Part...

Tue, 30 Apr 2013 09:55:19 -0400

greentextmedic:

Trauma Time with Greenie - Flail Chest, Part I

If you’ve never seen a flail chest before, it is easy to take a patient with a broken floating rib and call it a flail chest. After all, it’s a rare injury and few ever see it. When all you know about flail chests is one or two pages in a textbook you read a couple of years ago, you never really understand what it is they were talking about.

But when you do see it in the field years later —you’re going to think the patient has an alien bursting out of their chest.

The flail chest is defined as 3 or more ribs with segmental fractures. The majority of flail chests are traumatic in nature and require a huge blunt force mechanism like pedestrian vs auto or rapid deceleration. It’s a beast of an injury that compromises multiple critical organ systems. The blunt force required to create a flail chest is strong enough that the kinetic energy will transfer into the organs inside. Flail chests rarely occur without pulmonary or cardiac contusions. Roughly half of patients with severe flail chests will die from respiratory failure associated with pulmonary injuries.

The mechanism of the flail chest is rooted in the damage to the pressurized chest cavity. Internal pressure is directly dependent on the stability of the thoracic cage. Upon inspiration, the chest wall will expand and cause negative pressure in the chest cavity to inflate the lungs. However, the unstable flail segment will retract into the chest because it cannot resist the negative pressure pulling on it. This is what causes the paradoxical chest movement seen in these videos —it is the hallmark of the flail chest.

In addition to observable paradoxical chest movement, there is an unobservable lateral shift of all internal structures away from the flail chest on each inspiration. That includes the entire lower respiratory tract, the mediastinum, the major blood vessels in the chest and the heart. This shift can cause a multitude of respiratory problems ranging from erratic or shallow breathing, hypoxia, and pneumo- and hemothoraces. Additionally, aortic tugging can cause significant hypotension if the patient does not already show signs of shock from other injuries.

emtgin: Fly the bird

Sat, 27 Apr 2013 19:14:35 -0400

emtgin:

Fly the bird

fire-ems: paramedicine: A little weekend humour! For everyone...

Sat, 27 Apr 2013 19:14:05 -0400

fire-ems:

paramedicine:

A little weekend humour!

For everyone working this weekend, be safe!

lol thats pretty funny

9gag: The difference between a Boss and a Leader A lesson for...

Fri, 26 Apr 2013 19:09:05 -0400

9gag:

The difference between a Boss and a Leader

A lesson for every medic who wants to be a supervisor

3niccy3: indeed it is

Fri, 26 Apr 2013 19:08:37 -0400

3niccy3:

indeed it is

“That’s what happened last Wednesday, when a fire alarm...

Fri, 26 Apr 2013 09:47:03 -0400

“That’s what happened last Wednesday, when a fire alarm sounded across a quiet Texas evening. As we’ve heard, the call went out to volunteers — not professionals — people who just love to serve. People who want to help their neighbors. A call went out to farmers and car salesmen; and welders and funeral home directors; the city secretary and the mayor. It went out to folks who are tough enough and selfless enough to put in a full day’s work and then be ready for more.

And together, you answered the call. You dropped your schoolwork, left your families, jumped in fire trucks, and rushed to the flames. And when you got to the scene, you forgot fear and you fought that blaze as hard as you could, knowing the danger, buying time so others could escape. And then, about 20 minutes after the first alarm, the earth shook, and the sky went dark — and West changed forever.”
-President Obama
Memorial for West Texas Firefighters

Air NorCal Serving Northern California

Wed, 24 Apr 2013 18:43:39 -0400

Air NorCal

Serving Northern California

Based in the mountains of North Carolina

Wed, 24 Apr 2013 18:17:38 -0400

Based in the mountains of North Carolina

Pediatric Ground AmbulanceHermann Memorial in Houston, Texas

Wed, 24 Apr 2013 18:11:09 -0400

Pediatric Ground Ambulance
Hermann Memorial in Houston, Texas

Differential Diagnosis for Abdominal Pain

Wed, 24 Apr 2013 18:09:58 -0400

Differential Diagnosis for Abdominal Pain