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ECG Question for the Day

June 14, 2013 by tooldtowork 7 Comments

Based only on the rhythm in this 12 Lead, would you cardiovert this patient? As they say in the NREMT tests, don’t read too much into the question.

Slow Flutter-sm

Here is the long awaited update. Sorry for the delay, I’ll have my wimpy excuse in a post tomorrow.

Yes, the ED decided to cardiovert the patient. Why, I don’t know unless there was something else going on that I don’t know about. I just can’t think of what that might be as the ventricular rate was certainly well in control. Anyway, here is the post cardioversion 12 Lead.

Slow Flutter - post cardioversion-sm

So now, it just looks a first degree AV block. Maybe it isn’t but other than vanquishing the ugly looking Flutter waves, was there any benefit to the patient?

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Filed Under: Paramedicine

These Are The People Who Want To Take Over Syria

June 13, 2013 by tooldtowork 1 Comment

Report: Syrian rebels executed a 14-year-old boy for insulting Islam

When a 14-year-old boy from the Syrian city of Aleppo named Mohammad Qatta was asked to bring one of his customers some coffee, he reportedly refused, saying, “Even if [Prophet] Mohammed comes back to life, I won’t.”

According to a story reported by two grassroots Syrian opposition groups, the Syrian Observatory for Human Rights and the Aleppo Media Center, Qatta’s words got him killed. A group of Islamist rebels, driving by in a black car, reportedly heard the exchange. They stopped the car, grabbed the boy and took him away.

Got that? A wise ass 14 year old kid made a wise ass 14 year old kid comment and these animals kidnapped.

The rebels waited for a crowd to gather; Qatta’s parents were among them. Speaking in classical Arabic, they announced that Qatta had committed blasphemy and that anyone else who dared insult the Prophet Mohammed would share his fate. Then, the shirt still wrapped around the boy’s head, the rebels shot him in the mouth and neck.

Got that? After taking him away and beating him, they executed him. IN FRONT OF HIS PARENTS!

Can anybody tell me why in the world we would care if these barbarians kill each other? Or why we should give them more weapons?

Like every other “liberation” movement in the Middle East since Obama took office, this one is now run by Al Qaeda or an affiliate organization. Once again the President proposes to give people who hate the West and in particular the United States, sophisticated weapons. Will he give them air support as well?

The world has gone crazy.

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Filed Under: The War Against Fundamentalist Islam

Do You Think This Is Legit?

June 13, 2013 by tooldtowork 4 Comments

I received this email today. I mean after all, what could be wrong with this? Sounds totally legit to me. I’m betting all I have to do is put up some money as a deposit to show that I am honest and the money will start rolling in.

The truly sad part is not that people pull scams like this, but that other people fall for them.

I am contacting you for a business with my company. The company I work with
is into manufacturing of pharmaceutical materials.
There is a raw material which the company used to send me to buy from
India. Right now I have being promoted to the post of manager.
The company can not send me to India anymore; they will send a more junior
staff. The director has asked for the contact of the supplier of the
pharmaceutical materials in India .
I need a person I will present to the company as the supplier in India .
You will now buy the product from the local dealer and supply to my
company. The profit would be shared between you and I.
Why I don’t want the company to have direct contact of the local dealer is
that, I don’t want the company to know the actual price I was buying the
product.
If you are interested kindly contact me for more details.
Through this email id: philipsrichard55@hotmail.com

Thanks!
Dr Philip Richard

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Filed Under: Everything Else

Politicizing Science For Everyone’s Good

June 8, 2013 by tooldtowork 4 Comments

Top Science Journal Rebukes Harvard’s Top Nutritionist

In an extraordinary editorial and feature article, Natureone of the world’s pre-eminent scientific journals, has effectively admonished the chair of the Harvard School of Public Health’s nutrition department, Walter Willett, for promoting over-simplification of scientific results in the name of public health and engaging in unseemly behavior towards those who venture conclusions that differ to his.

Willett, who is one of the most frequently quoted academic sources on nutrition in the news media, appears to have crossed a Rubicon when he denounced Katherine Flegal, an epidemiologist at the US National Center for Health Statistics, for publishing a study that showed people who were overweight (but not obese) lived longer than those deemed normal weight. “This study is really a pile of rubbish, and no one should waste their time reading it,” he told National Public Radio.

Flegal had derived this conclusion from a meta-analysis of 97 studies covering 2.88 million people, and it had been published in the prestigious Journal of the American Medical Association (JAMA). What concerned Willett – and other public health experts, who as Nature reported, later staged a symposium to criticize it – was that it seemed to counteract the general message that people should lose weight. As the journal noted:

“Studies such as Flegal’s are dangerous, Willett says, because they could confuse the public and doctors, and undermine public policies to curb rising obesity rates. ‘There is going to be some percentage of physicians who will not counsel an overweight patient because of this,’ he says. Worse, he says, these findings can be hijacked by powerful special-interest groups, such as the soft-drink and food lobbies, to influence policy-makers.”

Read the entire article for more details.What happened here is that someone with a serious reputation as a researcher and scientist, trained at Harvard no less, trashed a study that undermines his predetermined conclusions. He has been promptly, and correctly, called out for that by Nature. His complaint was NOT that the study was flawed, drew incorrect conclusions, or wasn’t backed by science. No, it was that it undermined the message he and the rest of the Nanny State pseudoscientists want us to believe.

Note also that the mention of a study that was published as confirming a link between Aspartame and cancer. It was originally hyped having dramatic conclusions, but that claim was withdrawn shortly before publication. Willett was an author of that study which some could call “a pile of rubbish” if they weren’t charitable. Apparently evidence is weak when Willett doesn’t like the conclusion, but strong when he has an interest in publishing the study.

Apparently, the general public isn’t smart enough to read the data and make their own decisions, so Willett thinks we need his help.

No wonder people are starting to question so called scientists.

 

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Filed Under: Politics of Medicine

Needless Deaths

June 6, 2013 by tooldtowork Leave a Comment

2 EMTs, patient killed in Ga. ambulance crash

I have a lot of questions to which there are likely no answers. At least no definitive answers.

The Georgia State Patrol said in a news release that the wreck happened around 5 a.m. Thursday on state Highway 32, near the small town of Ocilla in south Georgia.

Where were they going at 0500 that required lights and sirens? Not to mention speed, which is often part of that package.

Authorities said the Coffee County ambulance was heading east with its lights and siren activated when the westbound semi jack-knifed across the centerline and into the path of the ambulance. The ambulance struck the left side of the semi.

The truck jack-knifed when a car ahead of it began to pull off the road, police said.

Just for the record, in case you weren’t aware of it, but lights and siren do not cause cessation of the laws of physics. The brakes don’t better, stopping distances aren’t shorter, big objects do not magically get out of your way. That goes for tractor trailers as well, even if they don’t have lights and siren. The car ahead of the tractor trailer pulled off the road and it’s likely that the driver hit the brakes hard because he was afraid that he was going to hit it. Which tells me that the driver was also going to fast, or not paying attention. Or both.

The emergency medical technicians were identified as Teresa Ann Davis, 44, of Axson, who was driving the ambulance; and Randall Whiddon, 56, of Ashburn, who was riding in the front passenger seat.

Now I’m getting confused. Or more confused. If both EMTs were sitting up front, who was in the back with the patient? Rather, was anyone in the back with the patient? There is no mention of a third EMT who was or wasn’t injured. That makes me think that there was no third EMT, because in an accident where three people were killed, it’s unlikely that someone else would be in the back and not be injured. If they weren’t injured, then surely there would have been some mention of that. So, if there was no one in the back with the patient, what was the emergency? Was the patient already dead? In many parts of the country dead people are transported to the morgue or somewhere by ambulance. Not in my neck of the woods these days, but it’s not uncommon in some areas. Or was the patient so stable that neither EMT needed to be in the back with him? Help me out if you can think of a third option. In either case, there wouldn’t seem to be ANY REASON AT ALL for using lights and sirens. None. Again, if any readers can think of something that I’m missing, please comment.

Thunderstorms were occurring over parts of Georgia early Thursday morning, though it was not immediately clear if weather was a factor in the crash.

Were the roads wet? Was it raining? We don’t know from the story, but  if the roads are wet and it’s raining, then the best thing to do is SLOW DOWN.

It’s unlikely that this story won’t get much more play than this. It’s a small story, except for the effect on the people left behind by the deceased. Still I’d like to know what happened, because there are likely lessons to be learned from this accident. If nothing else, we’ll learn some things NOT to do when operating emergency vehicles.

There are a lot of people who will preach that we need to make ambulances more safe, and I agree. What I disagree with is how to do that. Some people want more technology to make crashes less likely or more survivable. That’s fine, but the biggest advance in ambulance safety would be if we could get every EMT and paramedic to understand that driving fast is rarely necessary and usually counterproductive and dangerous.

 

Read more here: http://www.charlotteobserver.com/2013/06/06/4089400/2-emts-patient-killed-in-ga-ambulance.html#storylink=cpy
Read more here: http://www.charlotteobserver.com/2013/06/06/4089400/2-emts-patient-killed-in-ga-ambulance.html#storylink=cpy
Read more here: http://www.charlotteobserver.com/2013/06/06/4089400/2-emts-patient-killed-in-ga-ambulance.html#storylink=cpy
Read more here: http://www.charlotteobserver.com/2013/06/06/4089400/2-emts-patient-killed-in-ga-ambulance.html#storylink=cpy
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Filed Under: Paramedicine/The Job

I Wish I Had The Talent To Do This

June 6, 2013 by tooldtowork Leave a Comment

SHAREEVERYTHING

I don’t necessarily mean the skill to add text to a picture, I can probably do that. But I wish I had the talent to come with the idea of taking a picture like this and using it to make fun of the Emporer.. I mean President. Jokes aside,  I must apologize to my liberal friends. They told me in 2008 and 2012 that voting for the Republican candidate for President would mean the continued erosion of individual rights. I scoffed, but it turned out that the were correct in their assessment. Only not quite in the way that they anticipated.

Hat tip to Instapundit.

 

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Filed Under: Civil Rights

Sixty Nine Years

June 6, 2013 by tooldtowork 2 Comments

Today marks the Sixty Ninth anniversary of the invasion of France by Allied forces. The young men who threw themselves against fortifications and men manning “Fortress Europa” are mostly gone now. They defeated the Nazis and liberated Europe, then they went back home and lead their lives. Every day there are fewer and fewer of them and every year it seems that fewer members of the following generations remember what they did and the sacrifices the entire nation made to rid the world of tyranny.

That’s a shame, because sacrifice and effort such as that should never be forgotten.

We should also remember how narrow was the margin of victory. The initial landings on Omaha beach were disastrous and for hours the issue was in doubt. A defeat on Omaha would likely have required withdrawing all of the troops and the Germans would have stopped the invasion.

The beaches were held, the Germans were defeated, and eleven months later, Europe was free. Or at least half of it was free, but that’s a story for a different day.

For today, let’s remember the courage of the young men who risked everything to free Europe.

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Filed Under: History

Miracle At Midway

June 4, 2013 by tooldtowork Leave a Comment

June 4th marks the start of what might be the decisive naval battle of World War II. Given that there were a lot of important naval battles, especially in the Pacific, that might be a pretty bold statement. I don’t think that it is.

Consider that if the Japanese had taken the small atoll of Midway, they would have been within very reasonable striking distance of Hawaii and have been able to pose a constant threat against the West Coast of the United States. The US Fleet would likely have had to retreat to San Francisco and support to Australia would have been compromised. The US would have had to launch any offensive action from the continental United States, not either Australia or Hawaii. Ships that needed repair or overhaul wouldn’t have had Hawaii to go to, they would have to go to Washington State or California.

Add to that the fact that a success by the Japanese would likely have meant the loss of the remaining US carriers in the Pacific. New ships were being built, but it would be months until they were ready. The US could muster only three carriers to fight the Japanese. One of those the USS Yorktown had been severely damaged at the Battle of the Coral Sea and was rushed back into service.

Despite the odds against the US, the Navy prevailed against the Japanese and Midway was saved. It’s likely that a United States defeat in the Pacific theater of war was saved as well.

The US suffered 307 casualties, most of the Naval or Marine Corps aviators. The Japanese suffered more than 3,000 casualties, most them Naval Aviators and crew members of the four carriers that were sunk. The loss of four fleet carriers was devastating to the Japanese in the months that followed. Even more so was the loss aircraft and aircrew. While the aircraft were replaced, the experienced airmen were irreplaceable. The cumulative effects of those losses rippled across the War in the Pacific in the months and years that followed.

At the end of the battle on June 7th, the war was far from over and the outcome was still in doubt. Midway marked the last time that the Japanese would be on the offense in the war. From there on, the momentum changed and the Allies were now the aggressors with the Japanese playing defense back across the islands that they had captured.

Sadly, we barely hear or read about Midway these days. History has moved on and most of the men who fought there have gone on to meet their comrades that died during the battle. That’s a shame, because it was one of the most decisive battles in United States history and should never be forgotten.

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Filed Under: History

Fun With Numbers

June 4, 2013 by tooldtowork 2 Comments

EMS workers union charges that shift in way response time statistics are calculated misrepresents efficiency of agency

A new policy that changes the way EMS operators input emergency calls amounts to cooking the books, union officials charge.

An internal FDNY memo obtained by the Daily News orders workers to start the clock over in the middle of emergency calls that get more serious.

If someone reports a sick relative who doesn’t present any alarming symptoms, for example, the call would likely be classified as a low priority. But if the patient’s condition gets significantly worse — like a loss of consciousness — the call would be elevated to a high priority and an ambulance immediately dispatched.

The new policy — effective May 20 — tells 911 operators to start a fresh ticket when a call that’s waiting for an ambulance gets upgraded to high-priority status. That allows the FDNY to drop any earlier wait time from its final stats — and clock a faster response to the emergency.

 

Cooking the books? Bait and switch sounds more like it. So, if the patient condition changes while they are waiting for an ambulance OR the call was mistriaged the first time, they just dump the original call and put in a new one like time has stood still or something.

That way, they can claim a fast response for high priority calls and pretend that the original call never happened.

Only high-priority calls are counted by the FDNY in the department’s average response times. Priority calls for heart attack victims, nonresponsive patients or those with difficulty breathing get the fastest ambulance response times — usually less than six minutes. Lower-priority calls wait a longer period time for ambulances to arrive.

So, they are already playing fast and loose with their response statistics by only counting higher acuity calls in their calculations. I guess those non priority calls don’t matter. I wonder what else they are lying about? Cardiac arrest saves? Transport times to cath lab equipped hospitals?

The FDNY did not respond to a request for comment.

Of course not. It’s not like they are accountable to the citizenry. They get that attitude from the Mayor, no doubt.

“Sorry your loved one died, but it wasn’t our fault. We got there within six minutes after he stopped breathing. The time that he was ill, but still breathing doesn’t really count. It’s not as if not getting to the hospital quickly contributed to his death. Besides, if he was that sick, you should have called a cab.”

Love, FDNY.

Another great stride forward for fire service EMS.

 

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Filed Under: Paramedicine/The Job

The Invisible Man

June 3, 2013 by tooldtowork Leave a Comment

Remember when Vice President Dick Cheney was moved to an undisclosed, secure location? The reason given was to protect him from assassination attempts and keep him safe in case the President was killed. Democrats scoffed at the whole thing back then and the idea became the butt of jokes by late night comedians. It’s still sort of a punch line for jokes.

Compared to current Vice President Joe Biden, Dick Cheney was hanging out on Facebook asking the world to be his friend.

Since the barrage of scandals around the Obama Administration has broken out, he’s been harder to find that Amelia Earhart.

Biden cancels annual summer beach party

Vice President Joe Biden will not be throwing his annual beach party for journalists this summer, POLITICO has learned.

Since 2010, Vice President Biden and Dr. Jill Biden have invited top journalists to their home at the Naval Observatory for a beach bash that has included Super Soaker fights, face painting, and a moon bounce.

It couldn’t possibly be that he might be asked his opinion of the scandals could it? Nah, not that.

After all, it’s not like the VP has less of an internal filter than say, Ambulance Driver.

Enough politics for today.

EMS blogging to resume when something of interest comes along.

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Filed Under: Politics
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I'm a paramedic working in a largish city in the Northeast corner of the U.S. I've been in EMS all of my so called adult life. I'm more than just a little opinionated, but that comes with having been around the block more than once. Read More…

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  • ECG Question for the Day
  • These Are The People Who Want To Take Over Syria
  • Do You Think This Is Legit?
  • Politicizing Science For Everyone’s Good
  • Needless Deaths
  • I Wish I Had The Talent To Do This
  • Sixty Nine Years
  • Miracle At Midway
  • Fun With Numbers
  • The Invisible Man

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