Uncategorized

A lesson in cardiology

This post arises from a call I ran yesterday with a relatively new medic. Those of you in EMS know that new medics are pretty timid, and tend to have problems with calls that require them to think outside of the box we call protocol. This was one of those times that it is obvious that we need to do so. I hope any new medics that read this will learn an important lesson.

Our patient was a 58 year old man who was working at some light gardening when he began having pain between his shoulder blades, and began loudly burping, which relieved the pain. He went inside and took some gas medicine. His obviously intelligent wife called 911 and got him to take 2 baby aspirin.

When we arrived, we found him seated on his couch, he was cool and covered in sweat. He states he has a history of hypertension, for which he takes no medicine. He states that his doctor feels like his blood sugar is too high, and wanted him tested for diabetes, but that was 6 months ago, and he hasn’t been back since. When we stand him up to plpace him on the stretcher, his pulse becomes irregular. His vitals are: P- 88, BP 138/86, RR 20. In the truck, we start an IV, and find him to be in a normal sinus rhythm, his SaO2 is 99% on room air, blood sugar is 170. His 12 lead EKG is as follows:

(Click for a larger picture)

There are a few things that jump out at you here.

  1. The 12mm height of the QRS in lead aVL indicates “voltage criteria” for left ventricular hypertrophy. This is likely caused by his history of uncontrolled high blood pressure.
  2. The length of his QRS (0.122 sec) could be considered a left bundle branch block, but I think this is probably due to the QRS widening caused by the LVH, since the EKG doesn’t have that “LBBB look” to it.
  3. The poor R wave progression in leads V1 through V6
  4. The ST segment depression in Leads V3 and V4

I pointed out to New Medic Partner (NMP) that nitroglycerin was probably a good idea here. NMP didn’t want to give it because the patient “didn’t have chest pain.”

Sigh. This is one of my pet peeves. This man has risk factors- possible untreated diabetes AND high blood pressure. He is complaining of anginal equivalents- indigestion, and back pain. His irregular pulse on standing MAY be PVC’s, and his 12 lead confirms a cardiac event.

I finally prevailed, and we alerted the hospital. The doctor sent him to the cath lab, and it turns out that he had a complete blockage of the distal end of the left anterior descending coronary artery. He was having a hearta ttack, but we caught it early, and he is now recovering.

Please, medics. Learn how to read the signs your patient is giving you, and learn to read and interpret the 12 lead EKG. Cardiology, diabetes, and drug overdoses are the three areas where medics save the most lives. Be the best you can be at this, lives depend on it.

By Divemedic, ago

Billing errors and documentation

I recently moved. When I moved, I shut off all services at the old house, and opened them at the new one. I had my mail forwarded, and I gave my new address to all of the people who needed it. All of my final bills came to me and were paid. Except one.

Bell South sent my bill to the new street address, but the old city, like so:

123 New House Street
Old Town, Florida

So as a result, I never got the bill. Three months later, I am contacted by a collection agency. I call Bell South and ask them why I was sent to collections, and the problem is quickly identified. I point out that since the error was theirs and not mine, that I will pay what I owe, but that I will not pay late fees, nor will I pay this unless I get a letter that states that the collection will not be placed on my credit.

The lady tells me that they don’t do that, and that I should just pay. She goes on to say that since the letter was not returned, the fact that I did not get the letter is not their problem.

The problem is that I will not pay a late fee that was not my fault, and if I pay at all without such a letter, nothing prevents them from placing a black mark upon my credit record.

I send a dispute letter to the collector AND to Bell South. Bell South sends me a copy of my last three bills, and these copies clearly show that they had the address wrong.

Funny thing is that the collection agency manages to get the address right. Since my dispute, they have both ignored my letters, and continue to call. They call me, they call my girlfriend. They send letters. Soon, I am sure they will place this on my credit record. When they do, they are going to force me into suing them for violating the law.

Why can’t businesses just do business in an ethical manner? I want to pay this, but I also am not going to ruin my credit for the next seven years because of an error on their part.

By Divemedic, ago

More vote buying

This election is going force me to choose between a douche and a turd. There is no other way to put it.

What brings on this latest diatribe? Now Hillary has decided that giving $5,000 to each parent won’t work to buy enough votes, so she plans to tax every person worth over $7 million to pay $1,000 to each person who makes less than $60K.

Read on:

Her campaign said that for every $7 million estate that gets taxed, at least 5,000 families would receive the matching funds.

That means that each person worth more than $7 million is gonna pay an average of $5 million in new taxes. How is she going to pay for this in year two, when all of those people are now worth only $2 million?

If you were worth $7 million, would you and your money stay in the country?

If you win $10million in the lottery, by the time taxes are paid, you might be able to buy another lottery ticket with what is left.

Socialist crap. Between the frontrunners and a turd sandwich, I would rather have the turd sandwich.

By Divemedic, ago

aaaaannnnnnd we’re back, and Rudy sucks

I thought I was gonna die, or at least it felt like it.

on with the posting:

Rudy Giuliani, the RINO. He will not be getting my vote, due mostly to the following quotes, from his speech on crime:

What we don’t see is that freedom is not a concept in which people can do anything they want, be anything they can be. Freedom is about authority. Freedom is about the willingness of every single human being to cede to lawful authority a great deal of discretion about what you do.

Or even that he favors handgun registration, and that a person needs to demonstrate a NEED to own a gun. He wants to make owning a gun like owning a car. I say GREAT!! Let’s do it. He overlooks the fact that one does not need to pass a test to OWN a car, or even to drive one. One must pass a test to operate that car on public roads. I can get behind that. I can have a gun, and the only permit I need is to operate it in public. We already have that, it is called a concealed weapons permit.

A person can own any car he or she wants and can afford. From a military truck to a corvette. Let’s do that with guns. I can have anything I want, from a machine gun to a cannon.

Of course we know what he REALLY wants. Why is that? Do you think that the gangbangers will suddenly stop buying and selling drugs and lay down their guns? Or could you be trying to say that it is easier to get people to cede authority if they are unarmed?

Watch the video:
http://www.youtube.com/watch?v=emeu2KRt2Vg

As for me, I will spend the election year buying guns and ammo. Lots and lots of guns and ammo.

By Divemedic, ago

I beat the big dogs to it!!!

When I made this post two weeks ago, I didn’t realize that I was gonna beat the big dogs to a story. SayUncle, Tam, and practically the entire Blogosphere are now onto the lies spewing from CBS. It seems like there is an overwhelming effort by the MSM to get ready for the upcoming elections.

If a Dem wins the White House, be ready for more asinine and useless gun laws that will do little to effect crime, but much to reduce liberty.

By Divemedic, ago

Can you believe this shit?

Read this story.

Lets sum up the story.
Man sneaks into country illegally.
Man works illegally for 11 years, living in Florida, using the social infrastructure for 11 years, all the while earning over $100,000.
Man fails to file or pay taxes for 11 years.
Man saves money- $59,000 over 11 years.
Man tries to illegally smuggle the money out of the US.
He gets caught, and the money is confiscated. Between the immigration violations, smuggling, and tax fraud, he will get none of his money back.
He has the nerve to say. “They are treating me like a criminal when all I am is a working man.”

Uh, you ARE a criminal. The Government offers him a deal:

Robert Gershman, one of Zapeta’s attorneys, said federal prosecutors later offered his client a deal: He could take $10,000 of the original cash seized, plus $9,000 in donations as long as he didn’t talk publicly and left the country immediately.

He turned it down, saying he wanted ALL of the money. I got news for ya dude- I was born here, and I don’t get to keep all of my money. Welcome to America- now go home.

By Divemedic, ago

Half Assed Medic

WARNING: Medical terminology to follow, but I will try and keep it to a minimum.

I was the first medic on scene to a 54 year old male, whose chief complaint was that he nearly passed out while he was lifting a heavy object from the back of his minivan. He had a History of insulin dependent diabetes, a heart bypass, high cholesterol, and high blood pressure. His vitals were as follows: HR 72, RR 20, BP 136/72. He takes lopressor, insulin, lipitor, and aspirin. His 12 lead showed nothing acute, except LVH. I was in the middle of finishing my assessment when the transport unit arrived.

The medic on that truck told the patient that the near syncope was probably due to stimulation of the vagus nerve that lifting the box caused. I pointed out to the patient that while the other medic was probably correct, due to his extensive history, it would probably be best to take him in, just to be sure. You see, diabetics frequently do not have the classic symptoms of a heart attack, and often the first sign that a diabetic has of a serious heart attack is fainting, nausea, or shortness of breath, and not chest pain. The patient agreed with me, and decided to go to the hospital.

Apparently, that angered the other medic, who had been hoping to talk the patient out of going to the hospital. After he dropped the patient off at the hospital, he decided to come talk to me about “taking over his patient.” I pointed out to him that he is a new medic (less than a year on the street) and that patient refusals are not there for his personal comfort- paramedic inconvenience is not a reason to avoid transport.

If there is any piece of advice I can give you new medics out there, it is this:

If you are ever undecided as to the proper course of action, whichever option it is that causes you the most work is usually the correct one. Don’t ever forget that we are the patient’s advocate, and all of our decisions need to be in the best interests of the patient, not ourselves.

By Divemedic, ago

Musings on self defense

I ask one question: What do you do if this guy attacks you by pulling you out of your car at the next stoplight?

If you are against gun ownership, what is going to happen when you try to call the cops? Will this guy let you? Or will you have to hope a good Samaritan in a nearby car will call for you? Then, I ask what happens during the 10 to 30 minutes it takes the police to arrive?

To those who are FOR gun ownership, do you carry a weapon with you at all times, or do you refer to the previous paragraph? Does your local government recognize your right to self defense, or must you attempt to retreat? Does this meet the threshold for deadly force? Are you willing and ready to take a life to defend your own?

Think about that. I know I am, and I will, if I must.

By Divemedic, ago