On Rope.

I am now a Level I Rope Technician. Hells Yeah!. So Below are a few photos from our Technical rescue class we had this weekend. A Three day intense as hell class which ended with the building of not one but two massive Highlines over the harbour. we made Anchor points out of nothing in mid air. We did change-overs and pick-offs. We made all kinds of cool shit that my brain can't even wrap itself around right now. But it is the coolest thing I have ever done is to ride a high lie 100 feet in the air. If any of you fire, medical people ever have a chance to take the OnRope courses (www.onrope.com) Fucking do it. It is AMAZING. and you will leave knowing things you never though you would ever understand. I had my AhHa! moments in this class.

Thumbs Up!

Thumbs Up!
Originally uploaded by artist in the ambulance 190.

The Whole Shebang

The Whole Shebang
Originally uploaded by artist in the ambulance 190.

Building the Anchor

Building the Anchor
Originally uploaded by artist in the ambulance 190.

I made a city Yall

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Kinda Cool. Not quite sure what to do now...

Holy Crap, I actually saved one.

The Angel of Death saved a life. Yep. I know hard to believe but I did. Converted them right outta SVT (SupraVentricular Tachycardia AKA really fucking fast heart rate) with a little prayin' and a little drug I like to call "this is gonna make you feel reeeeeal funny" or Adenosine. Now Adenosine basicly is a drug that stops the heart, causing it to reset and start back up at a normal rate, the patient can have anywhere from a few slow ectopic beats to a period of asystole (flatline). It causes the paramedic to have a breif period of "Oh shit don't stay in Asystole". which they normaly don't, but given my track record, I wasn't taking any chances, I had the difib pads ready, the intubation kit out and fire department on the way. None of which I needed, but like I said, wasn;t taking any chances. So this is how it started. Got called to Chest pain on a young patient. now young CPs are normally bullshit...or crack induced, so when we go the address my partner and I were taking bets on whether it was anxeity or crack. Pull up to this trailer, go inside young pt sitting on sofa, CAOx3, looks fine, complaing of chest tightness. I grab the pt wrist to get a quick pulse, but it was a kind of half-assed gesture so I didn't think much when I didn't feel anything. They was about four other people in the room and I didn;t know if [the pt] knew any of them closly so I didn;t want to go over [pt's] whold medical HX in the house. Pt looks fine so we ambulate to the truck. I sit pt on the stretcher and start with the questions as I put the monitor on [pt] and get the 12 lead cables out. Still haven't looked up at the screen yet. The blood pressure beeps that its done cooking and I then look up. and Holy fuckballs [Pt's] heart is just tachying along at 212. Pretty little narrow complexes. Well I know why your chest hurt darling and why I couldn't feel a radial you got a pressue of 80. Lets just lay back and put so oxygen on you. My Partner god love him got a line for me, the only one he could, a 22 gauge IV in the right wrist. Not the best but it was gonna have to work. Which is where the prayin came into play. So I hit her with the 6mg. Which everyone knows 6mgs of Adenosine never works. Then I hit her with the 12mgs. Which worked goddamnit. Even through a 22g in the wrist. I had never given Adenosine before. I have been there to see it work. Be never been the one to push it. And it worked. I fixed her. I saved her. I'm a pretty good medic.

Okay People...Here's a Medical Lesson

A few days ago a local news crew did a story on a local County EMS system on bad response times and high employment turnover. The story, while had some vaild points, was for the most part, and for lack of a better term, Bullshit. And while I have lots to say about all of that today I'm gonna talk about something that one woman they interveiwed said that made me want to shoot my own television. Her daughter had dislocated her shoulder, which , from what I understand, she has done many times before. While I understand this injury is very painful. It is not life threating. It blows the big one. And I am very generous with pain medication for my patients show that dislocated or broken a bone. But will you die, not likely, unless you have massive multi-system trauma like bliteral femur fractures and a broken pelvis. Then we start to worry. Anyways, Im getting off track...So Mom's being interveiwed...blah...blah...we waited three days for an ambulance to show up...blah...Then she said it...a statement all Paramedics cringe at..."She could have gone into SHOCK!" What the fuck!...Come again...So here it is a lesson on what is and isn't SHOCK.

Shock is defined in most if not all medical textbooks as: A state of inadequate tissue perfusion. Now there are several types of shock.

Hypovolemic: a reduction in cardiovasular volume AKA bleeding to death or Plasma loss such as the case with Severe burns or Fluid and electrolye loss from massive vomiting/diarrhea.

Distributive: Shock that results from mechinisms that prevent the distribution of nurtients and removal of waste products. The blood and other fluids can't get were they are going due to either poor vascular tone or other reasons such as infection
Anaphylactic: A severe...SEVERE alleric reaction that results in the bloodvessels dilating and movement of fluid in to the interstial space AKA the vessels a too big and fluids are going where they don't need to be.
Septic: Massive Infection were toxins crompromise the vascular's systems' abilty to control blood vessels and distribute blood. AKA the blood vessals are to sick to work right so blood can't get were it needs to be

Obstructive: shock resulted from interference with the blood flowing through the cardiovasular system. AKA...Something plugging up the pipes and/or the pump

Cardiogenic: shock resulting from failure to maintain blodd pressure due to inadequate cardiac output AKA they be having the BIG ONE causing the heart to fail therefore it's not able to pump blood through the body

Neurogenic: shock resulting from an interuption in the communication pathway between the central nervous system and the rest of the body resulting in decrease peripheral vascular resistance. AKA spinal cord injury...brain can't talk to the rest of the body so it can't control the blood vessels below the injury. so they dialte resulting in shock.

Okay thats the types of shock...and they are all bad. If you are in shock you are DYING. Let me repeat that IF YOU ARE IN SHOCK YOU ARE DYING. Shock does NOT happen in the following circumstances: Dislocated shoulder alone, minor MVA in the drive thru of micky d's, during a posticatal state of a ETOH induced seizure, a fall from standing height with no injury, being placed under arrest for DUI/ public drunkeness/ or beating your wife with a chair leg, being filled with the holy spirit, being assaulted by another drunk asshole and the only injury you have is a busted lip. I could go on, but I think you get the picture.

These are examples of shock...Auto-pededestrian with massive facial trauma, large avulsion across left side of chest and amputated arm with a blood pressue of shit over squat. Man with tombstoming ST elevations in fucking every lead with a blood pressure of shit over squat. Female with 8 GSWs to the chest, legs, and Abdomen who is remarkably still alive when police clear the scene for us to come in with a blood pressure of shit over squat. Old guy with a temp of 105, Respiratory rate of 40, heart rate of 140 and pnemonia with blood pressure of shit over squat. These are all shock. So for fuck sake people quit using this word to descibe...well I'm not quite sure what you are trying to descibe. But unless the person is in an ACTUAL state of shock as explained above, just fine some other word to use. And it ain't shock.