Nuff Said

Take the flu shot!

A myth I want to debunk today, the thimerosal in the Flu Shot does not cause autism as it is broken down into simpler products quickly while in the blood stream. Thimerosal, which is a mercury based preservative, does not exist in ANY child hood vaccines.

The flu shot has an effectiveness of 70% to 90% (FightFlu, 2012).
http://www.fightflu.ca/shot-vaccin-eng.php

Btw, the flu shot can give you negative side effects, I myself had muscle aches, felt feverish, and my lymph nodes are still mega swollen and I had my shot like 2 weeks ago!

About vaccines in general. Effectiveness.

Vaccines are an important function in today's society. They have been proven to work! The small pox vaccine, for example, was given to people world wide within EVERY country (USA + Russia united) and eradicated the disease from the face of the planet. The only live samples exist only in research laboratories today and because of vaccines the people in the world have literally one less thing to worry about, even if the virus is released from the laboratories there are actually national reserves full of small pox vaccinations ready to be distributed at the national level.

The measles vaccine is another great example of how vaccines have been extremely effective in disease control as the number of cases since the implementation of such vaccinations have resulted in numbers such as these.

"350,000 per year before 1963 to less than 2000 per year in 1995," as sourced from http://immunize.cpha.ca/en/diseases-vaccines/measles.aspx

Wordle

So here's a Wordle that basically sum up everything on my blog!

I plan to make another one in the future and post these side by side to see the changes :D

Calling EMS in General

If you read my previous post on drunk people then you will notice the relation between these two posts.

This is the official checklist you would use when assessing if the patient can make an informed decision on refusing an ambulance.

AID TO CAPACITY EVALUATION
1. Patient verbalizes/communicates understanding of clinical situation  [ ] Yes [ ] No
(ie - What is wrong with you)

2. Patient verbalizes/communicates appreciation of applicable risks    [ ] Yes [ ] No
(ie - What could happen if I don't help you)

3. Patient verbalizes/communicates ability to make alt. plans of care   [ ] Yes [ ] No
(ie - What will you do once I leave)

4. Responsible adult on scene                                                           [ ] Yes [ ] No

So if any of the above are check boxed "No," then you can't give them a refusal of service (ambulance).

Calling EMS with Drunk People

Okay, so you already got the drunk patient running on O2, took vitals, history, and now you're repeating. However, when do you call an ambulance?

Well I've been researching this and my peers tell me that it all depends on the LOA, GCS ,and LOC.

The patient must have a LOA (level of awareness) that is rated at alert.
A GCS (Glasgow Coma Scale), a neurological scale) of 15.
and a LOC (level of consciousness) that is impeccable.

They are all key deciding factors, but the most important are LOA and LOC.

If the patient has an LOA of "verbal", "pain", "unresponsiveness" then consider calling EMS.
If the patient has fails to confirm his LOC (who he is, where he is, what is he doing) then call EMS.

Both of the two points above proves the patient cannot make an informed decision and both LOA and LOC go hand-in-hand of each other usually.

How Oximeters work and measuring SP02% for Victims in Fires!

So SP02% works by placing the little clip on someones finger. It shines a beam of light and measures the intensity of the reflection and determines the O2 percentage in your blood. The intensity differs because of the amount of hemoglobin in your blood, thus giving your finger a measurable reflection.

The hemoglobin present produces the reflection in your finger as light shines on it as long as it is bonded to something. This doesn't necessarily mean Oxygen.

Carbon monoxide binds more to hemoglobin then oxygen does. Do you guys see the connection here with casualties that have come out of a FIREY building of doom with tons of smoke? Scroll down.
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It means that people with Carbon Monoxide poisoning will have 99-100% Oxygen levels! Now go ahead and treat them for Carbon Monoxide poisoning kids!

As a side note, one faulty oversight that many people have is that they forget that even thought the SP02% device on someones finger may read 97%. It doesn't mean that someone has oxygen going to all parts of the body! If they other arm was bleeding at the Brachial that means the fingers over there are definitely not getting oxygen.

Common Mistakes Among Emergency Responders

1) Performing compression's with ones foot!

Do not stomp your patients back to life....

2) Ignoring Compliance

If your breaths from either yourself or with the assistance of a BVM are not going down into the casualties lungs, do not force it down! A common mistakes is that people forget that when the client exhales, they can't inhale!

So remember to match your breaths to the patients breath, or else face the "puke-usic" (comment if you know what that means!)

3) Not giving oxygen.

There are over 200+ reasons why you shouldn't give someone oxygen, because doing so will cause death. However, your never gonna be sure if your patient has one of those 200+ out on the field. Even then, you are not likely to come across them.

The benefits of oxygen outweigh the risks in an emergency situation, so give it to them.

4) A drowning victim has an obstruction in their throat... wha-??

Only 10% of people (at least that's what I've learned) have drowned with fluid filled lungs. It is fact that most people suffer cardiac arrest before they do anyways. Most people suffer laryngospasms when a little fluid enters the lungs, thus closing the airway, causing the person to drown with no to little fluid in their lungs.

Because of laryngospasms it is impossible to force air into the lungs. The muscles however do relax anywhere from 1 second to even 10 mins after it happens, and that'll be when breaths during CPR should be finally reach the lungs. Long story short, keep trying to get those breaths, but don't panic... it's normal.

5) CPR + AED will save the casualties life

Nope, they are probably not going to make it in all honesty. Remember that the patient is probably going to stay dead with or without you, but that doesn't mean you shouldn't try and perhaps you may save that persons life. Once CPR has started you do not give up until EMS or someone else pronounces them dead.

6) EMS can't pronounce somebody dead, it is a physician sanctioned act!

Nope, not anymore. Ambulance teams have nearly similar or identical care when treating someone with cardiac arrest. It usually involves a lot of CPR; because of this, Paramedics can pronounce their patients dead. Student EMS services cannot do it still :P

*My grammar sucks.

Case Study Walk Through Part 1

Consider this...

You receive a 911 dispatch about a girl having a [severe] panic attack in a residence on campus. You arrive on the scene. What do you do?

Step 1) EMCAP-PE

Environment - You and your team enter her room carefully, using the door as cover. You see her room has text books and bottles of alcohol all over the room. You also see a bottle of aspirin on the floor.

Mechanism of injury - You see nothing apparent. You suspect an actual panic attack. You take note of the excessive alcohol and the bottle of aspirin.

Casualties - One. You see a young girl that is having excessive controlled breathing.

Additional Assistance - On standby (ambulance). Campus Police on scene. RA is on scene. Room mate is on scene.

Personal Protective Equipment - Gloves necessary for contact with patient. Keep your equipment between you and the patient. Have your eyes on the patient, be mindful of your exits.

Step 2) AVPU

Alert - Introduce yourself to the patient, check her LOA (level of awareness).

Patient responds verbally and is alert to herself and surroundings.

Step 3) Check ABCs

Airway - She talks to you fine.
Breathing - She has concentrated breathing, however she is still breathing :)
Circulation - She is still alive!

Step 4) Check vitals - You find that she has...

Pulse - 110, Full, Regular
Respiration - 28, Full, Regular
Skin - Pink, Warm, Dry
Blood Pressure - 140/88
Pupils - 3mm, Responsive, Both Eyes
%O2 - 96%
Blood Sugar - 7.8

All of the vitals are normal except for Pulse, Respiration, and Blood Pressure.

Step 5) Treat the patients vitals.

You calm and reassure the patient
You give her Oxygen via the Non-Rebreather at 15 L/min
Get the patient to simulate your breathing patterns.

Other vitals such as pulse and blood pressure requires the administration drugs which is outside of your scope of practice.

Part 2 Will be Posted Later. Still experimenting with the format for future case studies. Probably will post scenario statement as stand alone and let you readers think about it :P

Why We Don't Show Sympathy

Sympathy is never a good option for any health care professional. It is like forbidden fruit, once tasted you will never be able to let it go with the client you are caring for. Eventually you'll become attached, later you'll begin to devote unnecessary resources to their care, compromise your own judgement, and you'll start giving the client false reassurance. All of this so that you can dig yourself a hole of depression.

The habit needs to start early, never letting empathy blossom into sympathy, because it is dangerous. 

An unfortunate example of this is that during a call for UWERT (University of Windsors Emergency Response Team) there was a client who unfortunately was coughing up blood. This client was helped by several members of the team and one of the members even gave him false reassurance, the infamous "everything is going to be alright" line was used. This client died in hospital. The member that said it now has PTSD for becoming sympathetic to a client who is now deceased.

This is why sympathy should never be used, as nurses, as health care providers in general we only can have empathy.