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Alcohol

News from Sturgis that a woman was seen at a hospital there with a BAC of 708. Checks with local and state labs where blood-alcohol levels are tested suggest Engle’s reading may be the highest ever recorded in South Dakota.

LD 50 is the level at which 50% of people will die. LD50 for EtOH (alcohol) is 400.

My personal record is transporting a patient with a BAC of 568. He walked to the stretcher. Some of the homeless in my area habitually have a BAC near 300, and will begin to have withdrawals of they drop below 150 or so.

In 2008, 60 percent of all fatal car crashes were caused by intoxicated drivers– 26,000 of them. 85,000 people die each year due to alcohol, whether that be DUI crashes, or health problems caused by extreme intoxication.

Tomorrow is New Year’s Eve. I will be at work, and it is one of the busiest days of the year for EMS workers. Please get a designated driver. It is a rare New Year’s eve when I don’t work a fatal crash. I don’t want to have to tell anyone that there was nothing else I could do to save their loved one.

I would also point out that either guns (excluding suicide) or marijuana kill far fewer people than alcohol.

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Mr Clean vomit

If you drink a bottle of lemon scented Mr Clean at 3 in the a.m. and then wake up your parents to tell them you did it, you really aren’t trying to kill yourself, you are just being a drama Queen: but at least you have the best smelling vomit ever. Just sayin’.

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Does this mean that I won’t get my money?

I think this guy is the one who said he was going to wire $40 million to my bank account. Now that he is in jail, I guess the deal is off…

Abdulmutallab’s father, Umaru, is the former economics minister of Nigeria. He retired earlier this month as the chairman of the First Bank of Nigeria but is still on the boards of several of Nigeria’s biggest firms, including Jaiz International, a holding company for the Islamic Bank

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How Kings are selected

This has got to be one of the funniest Monty Python bits ever.

“You can’t expect to wield supreme executive power just because some watery tart threw a sword at you. If I went around proclaiming myself emperor just because some moistened bint had lobbed a scimitar at me, they’d put me away.”

“Now we see the violence inherent in the system. Come & see the violence inherent in the system. Help help I’m being repressed !”

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How to tell when you are a “gun” family

For Christmas, I got a dehumidifier and a pistol rack for my gun safe, my wife got a set of fiber optic tritium sights for her Glock 19, my Mom got a new revolver, and my Son (among other things) got a copy of Monster Hunters International.

Yesterday was a quiet day at work for the most part. The only calls we ran were for drunk bums and a not serious suicide attempt. (Superficial wrist scratches)

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Controversial, unpopular legislation and its results

A strong majority leader in the Senate manages to cut deals in the Democrat controlled body and gets unpopular legislation passed. The new law overturns 34 years of legislative precedent, and changes the face of the United States for the rest of history. That Senator goes on to win reelection against his Republican opponent, and then wins the Democrat nomination for President 6 years later. He loses the Presidential election to the same Republican opponent that he defeated in the polls just two years earlier.

Am I talking about Reid and the Healthcare reform bill? No, I am talking about the Senate Majority leader in 1854, Stephen Douglas. His Republican challenger is none other that the first REpublican President, Abraham Lincoln. The unpopular law that was passed was the The Kansas-Nebraska Act of 1854, which overturned the Missouri compromise, and set the stage for the civil war and essentially created the anti-slavery Republican party that was to oppose the pro-slavery Democratic party.

The parallels are obvious. Asking that one man spend a portion of his life carrying out labor to the benefit of another amounts to involuntary servitude, slavery, if you will. I sit here wondering if we have not set the stage for the Second American Civil War. If that is so, it is my fervent hope that the second one will be less bloody than the first, and (to borrow a phrase) that government: of the people, by the people, for the people, shall not perish from the earth.

Alas, I fear it already has.

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Albuterol is not a miracle drug

Wow, it seems that incompetence never takes a holiday, and does not care whether you are a Doctor, nurse, or paramedic. I wrote last week about a Doctor who insisted that I did my patient a disservice by going with CPAP instead of Albuterol on a patient with symptoms of CHF.

Well, not to be outdone, we arrived at one of the nursing homes in our area for a reported “heart attack” (I won’t even go into the nurse’s inability to use big boy words) to find every nurse in the facility in this lady’s room. The group included LPNs, CNAs, and even a couple of RNs, and all were trying to administer Albuterol to a woman who was sitting up in bed. The woman looked pretty sick- pale, cyanotic lips, etc.

As I got closer, I noticed to source of the problem. She was pulseless and apneic. I started chest compressions, and one of the nurses was heard calling the facility’s Doctor, and could be heard complaining that we didn’t know what we were doing, as they had just checked the patient, and she was fine. Nevermind that she was in Asystole. Even as I was doing chest compressions, one of the RNs was still trying to give the Albuterol. WTF?!?!?!?

By the time we got to the hospital, we had her intubated, had started an IO, and had given 3mg of Epi, and 2mg of Atropine. The hospital gave 2 more of Epi, and 1 of atropine, and lo and behold- we got a pulse and a BP of 80/60, but it was not to last. She passed away.

So, the lesson here for all of you incompetents- if the patient is not breathing, Albuterol will not help. Just sayin.

Note: Not all nurses are incompetent, just the ones in the nursing homes around here. We often joke that the nurses who scraped by with an 80.1% on the exam are the ones in the SNFs around here.

Note 2: SNF- now there is a joke in itself- SNF= “Skilled Nursing Facility” Haha.

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Equality

There is an article here about women in some units in the military being subject to court martial if they get pregnant.

Some complain that it infringes on a woman’s reproductive rights. My view is that women use the pregnancy thing to get out of unpleasant military assignments, and then men must be reassigned to those now vacant positions.

When I was in the Navy, my sea/shore rotation was 60/24. That means that for every 60 months I was assigned to a sea going command, it would be followed by 24 months in a shore command. Since a person on shore duty is home nearly every night, shore duty is highly prized. Since there are far more sea duty posts than shore posts, sea duty is usually the first (and only) assignment for a new sailor.

During my 6 years in the Navy, I spent the first year in school, and then the next 5 assigned to a ship. That ship spent 3 and a half of those 5 years at sea, including 3 deployments overseas for 6, 7, and 9 months, respectively.

Women, on the other hand, frequently are assigned to shore duty as soon as they complete initial training. Those who are assigned to sea duty frequently turn up pregnant as soon as the unit is scheduled to deploy overseas. They are then immediately reassigned to shore duty.

Some other unfair facts: Women who are assigned to shore duty outside the continental US (including Hawaii) are counted as being on sea duty, even though they are home every night. A man in the exact same billet is counted as shore duty. So a woman could be assigned to Hawaii for 5 years, and be eligible for 2 years of shore duty in San Diego, while a man in the exact same job would do 5 years floating on a Destroyer, followed by 2 years at San Diego.

Getting pregnant in order to go home is no different than shooting off your toe to go home. And saying it’s an “accident” is a load of crap. It’s no mystery how pregnancy occurs. It’s no magical “accident”

Women have claimed for years that they want the same chances as men to advance in the military, but frequently use their gender as an excuse to escape the real work. It is about time they were held to task.

Edited to add:

Some shore commands in the Norfolk, Va., area report that up to 34 percent of their billets are filled by pregnant sailors, and commanders are complaining about a “lack of proper manning to conduct their mission,” according to a Naval Inspector General report.

When sailors on sea duty become pregnant, they are transferred to shore-based commands that fit certain criteria, such as being close to a Navy medical center. The length of that assignment changed in June 2007, when the Navy extended the postpartum tour from four months after a child’s birth to 12 months. Combined with a nine-month pregnancy, that puts expectant mothers on limited duty for up to 21 months.

21 months? Picture this: you join the Navy, and finish two months of Boot Camp, and 4 months of A school. You get your orders, and get travel time and up to 30 days of leave, then report aboard your first ship: You have been in the Navy for 7 months, and have not contributed to the mission one bit. You get pregnant, and sit on shore duty for 21 months. You now have been in the Navy for 28 months- more than half of your enlistment is over, you have done NOTHING to earn the money you have been paid, and the taxpayer has paid for your medical care and training.

There are 54,000 women serving in the US Navy– and last year, 3,125 (5.8%) of them got pregnant. If that is an average year, then there are 9,375 women (17.4%) on shore duty due to pregnancy at any given time.

To top it off, the woman then gets another set of orders to go somewhere else, which entitles her to another 30 days of leave (because of her change in duty station). Since she is a single mother, she is now entitled to a hardship discharge. It is a waste of money, and turns the military into another government welfare/social program.

The proposed rule change? The military commander was forced to rescind the policy. We can’t infringe on a woman’s right to land on her back with her legs open, now can we? Even if everyone else gets to pay for it: The men of the military who must carry the extra load, the taxpayer who must foot the bill, and the country that is left with a weaker defense system.

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Obama sets another record

Obama has a few records under his belt:

He increased our national debt by $1,000,000,000,000.00 in only 6 months. It took GW Bush a year and a half to accomplish that feat.

He beat GW’s record in that more soldiers have been killed in Afghanistan in 2009 than during 5 years of the Bush administration COMBINED (2001-2005).

and now, his latest record: the worst ratings of any president at the end of his first year: 49% approve and 46% disapprove of his job performance in the latest USA Today/Gallup Poll.

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A difference of opinion?

We found her on the toilet. For some reason, when people become REALLY sick, they go sit on the pot. In this case, she was on the pot in a bathroom that was only accessible by passing through a hallway that was about 36 inches wide, and had stacks of junk and knick-knacks along both walls, reducing the shipping channel down to about 20 inches. This still would have only been an annoyance, except that she weighed about 310 pounds, and was 5 foot 2.

She is pale, her lips are blue, and her jugular veins are prominent. He legs are oozing fluid, and have large blisters on them. Cellulitis? Maybe. Her arms are swollen. Her complaint is shortness of breath, which she says she has had for about 4 days. She has a history of high blood pressure and hypothyroidism. She has been taking norvasc, lasix, lopressor, and synthroid for several years, and claims compliance. She has no known drug allergies.

Her vitals are as follows: HR78, SaO2 60% on room air, BP 81/50, EtCO2 is 80 with a normal appearance to the waveform. Lung sounds are clear, but diminished bilaterally. She is in a sinus rhythm, and her 12 lead is unremarkable.

My thoughts? The chief complaint in this case is supported by the cyanosis and the low O2 sats. The diminished lung sounds with the absence of wheezing, along with the JVD, the high CO2, and the hypotension lead me to believe that what we are dealing with is congestive heart failure. Since I have previously stated that CPAP is the flippity floppity floop, we went ahead and applied CPAP at 8cm and started an IV. While IV access was obtained, her O2 sats climbed to about 96%, and her EtCO2 fell to 60.

With the respiratory problem under our (temporary) control, it was time to turn our attention to the decompensating cardiogenic shock, so a Dopamine drip was hung. We hit our effect at about 800mcg/minute. I know that sounds like alot, but remember that the patient weighed in at 140kgs. Her BP climbed to 94/60, and I left it there.

When we got to the ER, the doctor on duty (same Doc from this post) wanted to know why we didn’t give albuterol/atrovent by nebulizer. I pointed out that she was not wheezing, that albuterol is only to be used with caution in CHF patients, and that she was taking beta blockers. I told him that she seemed to improve with CPAP, so I saw no point in giving the albuterol. He proceeded to tell me how wrong I was, and said that diminished lung sounds were a form of wheezing. He took her off the CPAP, and ordered the nebulizer. I left.

There is an old saying that if everyone around you seems wrong, maybe it isn’t them. I see so many cases of Doctors telling me things that contradict what I have been taught, and what I have been teaching to my own medic students, that I sometimes wonder if I am the one who is wrong. It has been known to happen. I had a junior medic with me on the call who now thinks I am an idiot, and a doctor who is trash talking me to the ER staff.

Maybe they are more current, maybe the people who taught me were wrong. What do you think?