The Unwired Medic

Teaching EMS providers & other public safety pros about using mobile tech to improve their practice, patient care, continuing education, scene safety, general entertainment, & productivity.

April 30, 2017
by The Unwired Medic
1 Comment

Modern Day Barbarism

I find it just a bit ironic that as I type this article, I have recently been in the ER for my customary Status Asthmaticus that accompanies the high pressure, windy stormfronts, was sent home on PRN and NOC home oxygen, and I am taking a DuoNeb.  The ER doc that took my case “got it”.  I think I may have even scared him a bit as I am not really a typical asthmatic.  Ultimately, because of the Pulmonologist, not the ER doc, I wasn’t admitted on what was nearly the two year anniversary of my anaphylaxis episode and the beginning of a regular occurrence of severe asthma episodes that really don’t respond well to customary treatment.  Each time I go in, I wonder, “Will I be in time for them to stop it or will I buy the tube?”

No two ways about it – It’s barbaric:

Today, yet another Facebook discussion is going on with unnamed EMS transport team arriving to an unnamed small ER to take a vent patient to unnamed big ER.  This is nothing new.  We have this discussion several times a week lately.  Frankly, in this day and age, where we are pretty damned enlightened about the effects of the medications we give our patients, what is inappropriate to give, and especially what is inappropriate to not give certain patients, it scares the $h!T out of me to think I will be the next guy getting a laryngoscope shoved down my throat after getting Succs, Etomidate, and…, and…, and nothing else.

How many times does it need to be said?

Paralytics and Pharmacologic Facilitation are NOT Analgesics and Amnestics!

Ketamine Rocuronium Patch - America Tubes On Ketamine

Ketamine Rocuronium Patch – America Tubes On Ketamine

Did you hear it that time?  It’s barbaric.  It’s cruel and unusual punishment.  Even the most hardened criminal and the most amp’ed up dope addict can be reduced to tears and have lost their ability to have any interaction to what you are doing to them.  Imagine a fragile respiratory failure patient.  Imagine a seizure patient that you paralyzed because you thought you were stopping the seizure (that’s a subject for another article) and now he’s post-ictal and starting to recover his mentation, but unable to move.

If you don’t understand the big colorful letters above, put down your laryngoscope and step away from the patient until you figure out the difference between paralytics and sedatives (any proper combination of benzodiazepines, narcotics, analgesics, and more).  You have no business touching a patient’s airway until you get it through your head how utterly and distinctly different these things are.  Attempting pharmacologically-assisted intubation without the proper combination of these medications can and will cause irreparable damage to the human psyche and maybe even irreparable physical damage too.  Even death row inmates are entitled to humane treatment at their execution.  If you aren’t treating your intubation patients with the proper pharmaceutical cocktail for their present condition, you deserve to have your licenses revoked, or at the very least, suspended pending considerable re-education.

Why is this still happening?

This is 2017, at least at the time of the writing of this article, so why, in this golden age of digital information, available at the fingertips on smorgasbord of digital devices in nearly every room and vehicle we occupy, is it that people still seem unaware that the standard of good care for pharmacologically-assisted intubation and ventilatory maintenance?  To paralyze, facilitate, intubate, restrain, and walk away is surely as cruel as you can possibly be.  Have you not bothered to read the textbooks?  Have you not seen any studies?  Surely, there are multiple studies justifying the use of sedation in RSI and DSI.

The patch I show you in the pic above is on my jacket.  They were pretty popular last year.  They get a good chuckle from medics, nurses, and ER docs.  It goes along with the ROCKETamine pic below.  The thing is, they’re great reminders of what many across the country view as the “hands down” (pun intended) best intubation cocktail out there.  Do you understand what the difference is between the two medications?  Really?  Or do you push them because they’re part of a protocol?  Or because the doc told you to?  Do you understand what could happen when you have one without the other?  And vice versa?  Do you understand what the whole pharmacology-ventilatory management standard is if you don’t have these two specific awesome drugs on your ambulance?  Why Succs and Etomidate alone aren’t a management plan?  If you are being honest, and you don’t understand, you are part of the problem, but you can fix it.  If you are being honest and you don’t care, you are the barbarian.

The Band of Brothers:ROCKETamine

I propose that it is high time we band our collective professional asses together and put an end to this nonsense.  Every professional association and board relevant to airway control, whether EMS, nursing, emergency medicine, critical care, anesthesia, trauma, surgery, pulmonology, psychiatry, and any other relevant group, should co-sign a joint position statement decrying the failure to use proper sedation in the initial and ongoing invasive airway-managed patient.  Sign the death note on the barbaric, cruel treatment of ventilatory patients being withheld or underdosed sedation.  Look upon those who do not comply with scorn and shame, limiting their licenses to practice in this area until they complete a comprehensive re-education program on the subject, and if they fail to see the light, rebuke them and strip them of their lawful ability to inflict harm upon the innocent and those unable to resist and let justice be served!

Come on all you alphabet soup groups (ACEP, NAEMT, NAEMSP, AOBEM, AAOS, BCCTPC, HEMS, SCT, CCT)!  Step up and do something about this.  How many times is too much?  I keep to a couple smaller EMS groups and I hear my colleagues complain about it regularly!  Stop complaining and act!

To my colleagues in the field, don’t just complain anymore.  Report it up.  I hear people saying they don’t necessarily know the whole story, and that may very well be true, but here’s the thing… let the review board decide.  If the caregiver was in the right, then they will and should be exonerated.  Don’t decide for the board.  Let them investigate.  If they find there were problems, then you owe it to the patients to be their advocate and the provider may not even be aware they are not properly caring for their patient.  The provider NEEDS to be re-educated, and once that happens, if they continue to mistreat patients, they MUST be removed from that role so they can never harm another patient.

April 22, 2017
by The Unwired Medic
1 Comment

Product Review: GUNNAR Emissary Premium Rx Glasses

My desk on a good day

My desk on a good day.

Blue Light Is Harmful!

I’ve minced no words about it. I have not been ambiguous about the subject. Blue light is damaging your vision, wrecking your sleep patterns, and potentially contributing to many other health issues, and you may not even be aware of it!

In the last two years, a host of assorted health issues has been experienced by me, but it started with headaches. I had been migraine-free for three years. Three glorious years. Then like driving into a brick wall at 100MPH, BLAM! A migraine. Not just any migraine, mind you, but an 18-day duration migraine, beating my record of 4-days by leaps and bounds.

I wondered if my vision might have been contributing to my headaches. I had been wearing prescription glasses for almost a year and I was due for the annual eye exam. After a significant change in my prescription, I decided I wasn’t just going for replacements. I was going to finally buy the GUNNAR glasses I had seen at a couple previous CES (Consumer Electronics Show) conferences and was pretty impressed by what I learned and saw. Not only did I plunge into the depths of spending on high-end glasses, I went for the Premium Prescription (Premium Rx) and that set me back three hundred twenty-nine bones.

GUNNAR Emissary Glasses - Amber Lenses

GUNNAR Emissary Glasses – Amber Lenses

Believe me, it was worth every penny. My full-time gig is in IT for our region’s only trauma center.  I have 2 computers with 5 monitors on my desk, plus four 42″ wall displays giving me all the critical stats for our data center and enterprise backup operations. When I’m not there, I’m going to online college at WGU, or watching a bit of TV or movies with the family, or surfing the web and social media on my phone, and occasionally playing a video game. I’m reviewing products and writing blog articles. I’m on the patient care or education end of things when I’m not doing these other things, so I’m still in front of ePCR’s and projectors with PowerPoints. All of this takes its toll on Circadian Rhythms. It dries out your eyes. It contributes to tension headaches. It can do much worse.

Why the Premium Rx?

I knew I wanted a high-quality set of glasses, so I went for the Premium Rx, which are a bit more expensive than the standard Rx glasses, because these are computer ground precision lenses, and they are set precisely for the distance of a standard computer screen with tolerances the human eye can’t even detect. This mattered to me because I had only been wearing prescription glasses for a year. I was the last holdout in the family, with all of my family having gotten their glasses by 18, and I made it to 39. Even with this, the script changed considerably from the previous set a year earlier. I had to take a couple weeks to get used to walking with them. Now I can walk with them and it barely affects me. I still prefer to not use them unless I am reading fine print or a monitor.

How bad is the color shift?

Me, My GUNNAR Emissary's, and The Home Office

Me, My GUNNAR Emissary’s, and The Home Office

In addition to my IT and EMS talents, I occasionally dabble in graphic design and semi-pro photography. I’ll say that is when I break out the old standby’s and don’t do any color intensive work in my GUNNAR Emissary glasses. Otherwise, I can honestly say that in an office or indoor environment, I don’t even notice the color shift at all. When outdoors, they make everything brighter. I also work around a lot of LED lights that are green or amber, depending on the current system state. I have no problems distinguishing them. If the thought of the color shift bothers you, then GUNNAR has a “Crystalline Lens” option, which, naturally, doesn’t block as much of the blue light as the amber lenses. New this year, GUNNAR is also offering a Progressive Lens option, which for me will be great when I get a new set, since the eye doc says that’s no more than 3 years away.

What else sets these guys apart from other computer or gaming glasses?

That’s a fair question and it isn’t hard to answer. Let’s start with the patented technology they use. It’s more than a tint, it’s a filter. How about the double-sided anti-glare coatings? Even my expensive Oakley wrap-around sunglasses and Oakley prescription glasses reflected my own eye back onto the inside of the lens. Not a problem with the GUNNAR. In my latest office area, I have large fluorescent light fixtures shining down and behind me, and every other pair of glasses that I have worn has a huge reflection problem. How about the ultra-precise, computer controlled, prescription grind that no one else is offering? They have many styles to choose from, including WoW, Razer, and other co-op branded sets, each with a unique and styled appearance that sets them apart as the leader in the computer and gaming vision industry. If you want the science to back these claims up, they offer links on their site, and I offer them here on The Unwired Medic’s blog and social media pages.

The bottom line:

These glasses are just awesome. They are stylish, custom, and every bit of what they say they are. They are even endorsed by professional gamers around the world. Check them out on social media and on their website at https://gunnar.com. Let them know that The Unwired Medic from the  #GUNNAR1337 () sent you!

Disclaimer: The GUNNAR T-Shirt was a free gift from GUNNAR for being accepted as a brand ambassador. The GUNNAR Emissary Premium Rx glasses were paid for in full by me.

April 21, 2017
by The Unwired Medic
0 comments

Product Review: Magnum Stealth Force 8.0 SZ

Magnum Stealth Force 8.0 Side ZipThe nice folks at Magnum Boots have provided me with another opportunity to review a set of their boots, and this time, they sent me a set of Magnum Stealth Force 8.0 Side Zip boots.  This has been a unique experience for me as I have never had side zip boots before, so I was excited to see what so many of my friends and colleagues have been raving about.

Magnum Stealth Force 8.0 Side ZipPreviously, I have added the lace replacement zipper modules for my Danner’s, but I never really liked them because I felt that my skinny ankles lost a lot of support by not being able to cinch them down very tight.  I honestly had no such problem with the Stealth Force boots.  I felt they provided excellent ankle support after I finally adjusted them to where I felt I got the best mix of tension versus enough looseness to allow rapid donning and doffing.  This took me almost a month to refine though.  They do untie themselves about every couple of days.  I never found a solid tie method where they would remain tied, but the knot wasn’t so bulky as to cause blisters or pressure points.  It was a give and take relationship.

Although these aren’t my favorite boots for comfort, they certainly held up well to the rain, snow, floods, mud, and daily grind.  They are a durable boot and I would consider buying a set without the side zip option.  They provided excellent traction and foot protection, and were broken-in in under a week of daily wear.  No raw spots, and with my Under Armour socks, my feet came out dry and not odoriferous.  Personally, I felt the support was better than the lace replacement for my old Danner’s, but I don’t think I gained any remarkable advantage by having the side zip.  I want to clearly note that my experience is in the minority.  I know several people with these boots and they absolutely love the side zip option.  The best I can say is to try it out for yourself.

What these boots did lack was the ability to secure a boot knife.  I tried a couple different boot knives (2.5″ blade anPrisoner In Bootsd 4″ blade) in many different positions, but they fell out every time. One, I lost walking into the IMAX debut of Rogue One when it was just a light rain and I dodged a couple awnings dripping right into my path. Fortunately for me, a group of friends attending with me were just a bit behind me and they found it and returned it to me. I find this frustrating because I like having a backup tool available that’s not too inconvenient to access, plus my boot knives tend to stay a lot sharper than my 11-year old SOG Flash II EDC folding knife, which I literally use daily.  If I were to add only one improvement, I would like to see a way to add a boot knife holder.  I saw one set of boots a few years ago that tried this, but never bought them. Maybe something that could lace through the sheath.

In summary, despite my personal preference for non-side-zip boots, they are rugged, durable, and comfortable, especially when paired with a high quality, moisture-wicking sock, and they are well worth every penny you will pay for them.  My thanks to the Magnum Boot company for allowing me to evaluate and review another pair of fine boots.

March 4, 2017
by The Unwired Medic
1 Comment

I hope your mother reads your article

So, there’s this little article from February 28th in Psychology Today being circulated about the interwebz, authored by one Peter Edelstein, M.D. and it is entitled If You Go to the Hospital, Get Ready to Yell…

It’s a story about how you can supposedly positively influence your care, or that of a loved one, by being a complete and utter asshole. Could things at the hospital have gone better? Sure, they probably could. Perhaps you considered whether to call an ambulance for your mother, whom you suspected was having another TIA, but you didn’t. I shudder to think of how you would have treated the EMS providers, had you been present in time for them to provide care and transport. Your faux pas has even inspired GomerBlog to depart from medical satire and offer critique onTwitter about how you could have handled that like a sensitive 90’s guy and been a better behaved man. Wow. That’s one for the ol’ CV.

As for me, Dr. Edelstein, I would offer you my feedback here instead as I do not subscribe to Psychology Today:

Dear D!ck… I’m sorry, Peter: That your article appears in Psychology Today is a bit of an irony as your article paints you as one with a serious personality disorder telling others how they should expect to behave overaggressively when dealing with healthcare matters.  Did you learn your professional manners at charm school? Perhaps the University of Chicago Pritzker School of Medicine taught you to be verbally abusive to people who probably make a lot less money than you and are probably consistently working a lot harder than you. You sure aren’t reflecting well on your alma mater. The only credit I’ll give you is that you didn’t start throwing $h!t around like a spoiled brat, which, sadly, I have seen more than once. I think you gravely misinterpreted the book, How To Win Friends And Influence People. It would serve you well to watch the video from The Cleveland Clinic, Empathy: The Human Connection To Patient Care. It’s easy to find on YouTube and it will take less than five minutes of your precious time.  This video highlights how you, and all of us, really, should consider patients and fellow caregivers alike.  You see, you have no idea what the hospital staff you so easily chastise have gone or are going through, or what their shift has been like. You can’t see what is happening right outside your own ER room door. I agree that some things could have been done quicker or you and your mother (God bless her) could have been better informed, but your reaction is inexcusable. Had you done that on my shift, at the very least you’d be sitting in the waiting room with your very own security guard or peace officer to keep you company. I do, most sincerely, hope that your mother reads your article.


Now, as I penned this, I looked around to learn more about the good doctor and found he wrote a follow-up article just this very day here: https://www.psychologytoday.com/blog/patient-power/201703/touching-very-raw-nerve, where the author backpedals about what he wrote after admitting to being crucified on social media by hundreds of nurses and a few doctors, and rightfully so. To this, I can admit to saying things in the heat of the moment, but I have learned that putting it in writing on the internet for all the world to see, then not bothering to update the original article to express how I shouldn’t have said what I said, and how I said it? That’s bad practice. You earned every bit of your tarnished reputation, sir. Say what you mean and mean what you say when it goes on public display.

Of note: Psychology Today has taken down the original article that brought forth the wrath of nurses scorned. When you try to access the article, you get this:

Access denied to the article that was posted six days ago.

Access denied to the article that was posted six days ago.

 

However, thanks to the internet that never forgets, if you wish to read the Google web cache version, it is here: https://webcache.googleusercontent.com/search?q=cache%3AQVgNIZzjcrYJ%3Ahttps%3A%2F%2Fwww.psychologytoday.com%2Fblog%2Fpatient-power%2F201702%2Fif-you-go-the-hospital-get-ready-yell+&cd=2&hl=en&ct=clnk&gl=us

January 13, 2017
by The Unwired Medic
0 comments

What’s (Not) Wrong With Me?

Preshospital Mental Health

Mental health issues have been given, rightly so, a LOT of attention on social media. We see it in places like the Code Green Campaign, TED talks, a Mental Health First Aid card course, and in our trade magazines. Then there is Dansun Photos and art that show a lot of what we feel. Then we reach out to the assorted forums on Facebook and we talk through it there and maybe make light of it with Gallows Humor.

anxiousI recently had a question asked in one forum where there were a couple of pediatric calls, back to back, that were what many would say are definitely emotionally taxing, except this EMS professional didn’t feel shocked in any way about what had just transpired. He treated the situation clinically. He simply moved on to the next call.

He took to the forum to ask of his trusted compatriots if something was wrong with him. This struck a chord with me because just a few weeks ago, I also asked if there was something wrong with me.  The statistical data that were available said that people with PTSD or other emotional issues, specifically related to the work we do, comprised a much smaller percentage of providers than either of us imagined.

The Social Media Paradigm

As we peak in to the information age, social media has given us a new set of realities and normalcy. Suddenly, you see issues being championed by multiple sources, whether it is LGBTQ+, racial issues, eco/environmental issues, or whatever, we as a society, are seeing much more than we would in the absence of social media. I’ve been in EMS since 1994, so I am approaching 23 years in this field. Before social media, there was only what we saw on Rescue 911 and TLC’s Paramedics. We talked it over in social cliques, or maybe at “choir practice”. We had a view of what was either within our realm of influence or what we learned about from the media.

Now, we add social media, and what we see is a growing community of people that have much in common, and we have an emotional outlet as well. In fact, social media is really giving us a myopic view of the world, so much so that my esteemed colleague and I came to ask what was wrong with us for not feeling depressed, emotionally fraught, or turning to alcohol or other substance addiction, for not being on antidepressants and anxiety meds, and for not staring down the barrel of a shotgun.

Social media is tricking us into believing that a vocal minority is the new norm. We should keep that in perspective when we peruse and partake in it. Personally, I haven’t held onto a traumatic experience for more than a couple days before I’m the same old me. That doesn’t mean I have Aspergers or am bereft of emotion, or even a sociopath. On the contrary, I am quite empathetic and emotions do hit me. I have great respect for the gravity of a situation and those it affects, like the patient, family, friends, and even bystanders. I just have a knack for leaving work at work. It’s clinical for me, not personal.

Know when to reach out

That said, never hesitate to reach out if you do have a concern about your mental health. It no longer is something we should lose our jobs and future advancement opportunities over. It isn’t a burden the family should bear with you for your choice of career. Even the “tough guys” need to find a nondestructive outlet for what they bottle up inside.  If I had it all to do over again, I assure you I would take a lot more vacation time and spend more time with the family, especially on holidays.