Most people don’t like needles but some people don’t like wrinkles more. Unfortunately, when you aren’t careful about how you select your botox clinic, you could end up dead.

In Florida recently, an unlicensed Botox clinic used a batch of the bacterial toxin that was highly concentrated and not intended for use on humans. The clinic doctor injected himself and 3 others with the toxin and all soon suffered side effects and had to be rushed to the hospital. The four of them survived after lengthy hospital stays.

Read the story here.

Botulism toxin is produced by a bacteria and can cause paralysis and death. When used in controlled, diluted amounts and injected subcutaneously, it can relax and smooth out facial wrinkles. This is an increasingly popular treatment and is regulated by the FDA which requires the providers be licensed to administer the injections. However, unlicensed clinics are popping up and you may be called to administer treatment to individuals like the one’s I mentioned above.

Watch for these signs and symptoms:

1. progressive weakness and cranial neuropathies (abnormality of certain nerves in the face and neck that control functions including sensation, facial muscle movement, and swallowing).
2. Also general paralysis may begin with respiratory distress and arrest a possibility. Airway management until a hospital ventilator will be key in these more extreme cases.

I report on this and other EMS news in the most recent episode of the MedicCast News at the Podcaster News Network.

Jamie

the Podmedic

A new breakthrough in rapid lab testing has been published out of the University of Illinois. Imagine a rapid test like a home pregnancy test that can test for cocaine, heroine, cardiac enzymes, liver and kidney function, anything. We could rapidly identify and treat the underlying causes of unresponsiveness or cardiac arrest.

Here a link to the article at Medical News Today.

Need to administer bicarb? Check for acidosis. Suspect Hyperkalemia is the cause of the arrhythmia? Check potassium levels. We could now have one of the last pieces of the field diagnosis puzzle.

Combine this with increased use of capnography readings, 12 and 15 lead ECG, and focused assessment and we can be a whole lot more effective in the field.

Jamie

the Podmedic

The National Heart Lung Institute and the Centers for Medicare and Medicaid Services is launching a study on the effectiveness of home oxygen on the treatment of moderate COPD. The study will look at 3500 patients and focus on whether Medicare rules should be extended to cover home oxygen for moderate disease.

Currently, Medicare covers use of home oxygen only for patients with severe COPD. This could mean that we’ll see a lot more patients on O2 in the field. My concern would be whether we’ll see more people on home O2 who are still smoking and will not be safe with their oxygen. My reasoning is that moderate COPD patients haven’t reached the make or break moment in deciding to quit and are more likely to still be smoking.

If this comes about, we might want to team up with the local hospitals, visiting nurses, and health departments to start an education campaign in our communities. Fewer burn injuries and structure fires alone would justify the cost and time spent.

Welcome to Episode 42

The MedicCast is a proud member of the Blubrry Podcast Network.

Right click to download this episode or click the little arrow to listen here.

A podcast for EMT’s, Paramedics, and other medical providers of all kinds.

Rate the podcast at iTunes or at EMS Village

Visit the MedicCast Store! Click here to get Songs from the MedicCast

Listener Link to Armor Piercing Bullets

Photodog Link (pics of my fire company)

—————————-
Contact Me!
send me a note!
—- or —-
Leave up to a 2 minute message with your onboard microphone right through your browser by clicking the link below.

MobaTalk Online Voicemail
———————————

Link of the Week: EMS Live Podcast

Dr. Fran Interview

———————————

News:

EMT Saves at the Airport

New Hampshire School AED Save

ER Docs and Naps

Click here to go to pzizz.com

Ambulance Contract Ethics

School Bus Accident

Bus Seat Belts

———————————

Interview with Chief Billy Goldfeder of EMS Close Calls Site

———————————–

Visit the MedicCast Forums

———————————–

Thanks for Supporting the MedicCast!

Rate the podcast at iTunes or at EMS Village or Vote at Podcast Alley

Visit the MedicCast Store!

Check out the MedicCast News at the Podcaster News Network for EMS news updates during the week and check back here next week for the next Episode of the MedicCast.

————————————————

Podsafe Music this week by Matthew Ebel

“Walk a Thousand Miles (to get home this Christmas)”

Click below to get more of Matthew’s music on iTunes

————————————-

Click here to get Songs from the MedicCast at the iTunes Store.

Until next time, Scene safety, BSI!

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 2.5 License

Here’s an update I received from the Maryland Poison Control Center. You can subscribe to receive their ToxTidbits email newsletter here. You can download this month’s entry in pdf format.

———————————

Hydrofluoric (HF) acid has been used for centuries in industry for glass etching and brick and metal cleaning. More recently it has been used for electroplating and etching microchips. This strong inorganic acid is even found in household products for rust removal and porcelain cleaning. In 2005 there were 920 exposures reported to U.S. poison centers, with 893 being unintentional. Many are related to occupational accidents with the majority of patients 19 years of age and older. Most cases involve exposure to the hands, usually on the fingers.

HF acid penetrates deeply into tissues where it dissociates into a hydrogen ion and a highly electronegative fluoride ion. The reactive fluoride ion binds to calcium and magnesium stores causing a precipitous drop in both electrolytes. In addition, the free hydrogen ions can cause corrosive burns. Dilute solutions penetrate deeply before dissociating, leading to delayed injury and symptoms, whereas concentrated solutions cause immediate injury. One characteristic unique to HF acid burns is that the pain and symptoms may be severe in relation to a perceived lack of skin abnormalities.

Symptoms are related to the concentration of the HF acid and the body surface area affected. Local effects can include pain, erythema, blisters, and necrosis. HF acid can cause profound systemic effects, especially with higher concentration solutions of ≥ 50%. Hypomagnesemia and hypocalcemia are most prominent. Tetany, QT prolongation, and cardiac arrest quickly ensue if not treated immediately. Inhalation exposure from dermal burns can cause respiratory distress.

———————————-

General management should include thorough decontamination including removal of all clothes and showering with copious amounts of water. Airway assessment, cardiac monitoring, and electrolyte measurement are critical. Minor dermal burns can be treated with 2.5% calcium gluconate gel. To treat a finger burn, add the gel to a latex or nitrile glove in the affected digit and have the patient wear the glove. This should help alleviate some of the pain and prevent further fluoride toxicity. Subcutaneous or intraarterial calcium gluconate can be used to treat more serious exposures. Systemic toxicity should be treated with IV calcium gluconate and magnesium sulfate.

To all of my listeners and visitors to this site –

I want to wish all of you a safe and Happy Thanksgiving Holiday. In the United States, this is a time when we give thanks for all that we have to be thankful for:

• Family
• Friends
• Colleagues
• Mutual Aide Backup
• Trainers
• Skills

All of the things we take for granted the rest of the year. Take a moment today where ever you are in the world and think about the blessings around you. We know how quickly lives can change, we see it everyday. Remember that and make sure you thank your partners, dispatchers, medical control docs, everybody we work with to help others.

Stay safe!

Jamie

the Podmedic

Don Roper, EMT, does his job with a smile on his face almost all of the time. Ask his coworkers and they’ll tell you that that is just who he is. But what some patients have come to love even more than his smile is his singing voice. Known around his area as the “Singing EMT”, Roper serenades his patients with songs like Shenandoah and songs from his past performances in musicals like “Cinderella.”

Here’s the article

His partner says that his patient’s love it. The old ladies just hold his hand and smile while he sings. Roper loves his work and says that someday he sees himself on that stretcher. He hopes that someone sings to him as well. Here’s a sample of his work.

This just reminds all of us that healing doesn’t just come out of a syringe or a bandage. Healing really comes from caring. If you can’t sing then take the time to talk with your patients. Caring is what really helps healing along, and heck, it helps to pass the time as well.

I report on this and other EMS news in the most recent episode of the MedicCast News at the Podcaster News Network.

Jamie

the Podmedic

Medical News Today has a story about a study on the effectiveness of cardiac catheterization when performed later after a heart attack. One third of heart attack patients don’t get angioplasty until more than 12 hours after their cardiac events. The study comes out of The National Heart Lung Institute, a branch of the NIH. Previously, it was believed that even late angioplasty had substantial benefits. However, when compared to drug therapy, the study found no significant benefit for cardiac catheterization after 12 hours have elapsed.

This is important to the EMS field. If we take our cardiac patients to the wrong hospital, we can delay effective treatment of their heart attack. This study doesn’t say that catheterization is not effective — it just says that it needs to be diagnosed as a necessary treatment early during a heart attack.  It then needs to be performed rapidly. For us this means making sure we:

1. are proficient in our 12-lead interpretation skills
2. know the capabilities of our local facilities
3. are aggressive in our treatment to maintain heart muscle viability

If we do these things we can not just save a life but save the quality of a person’s life as well.

Sometimes I wonder why the docs want us to work so hard on some of the codes we get that are seemingly hopeless. Yeah, we’re sure the patient isn’t viable but we work them anyway, diligently pushing our drugs, focusing on good CPR, managing airways, and watching our waveforms. Sometimes we’ll cavalierly offer that the patient was a skills session.

It seems harsh but even when the patient offers no hope of full survival, their organs may still be saved. Hundreds die every day because they’re waiting for a donor organ — a few pounds of viable flesh and muscle. Hearts, kidneys, livers, and lungs — all vital to life if we can keep them perfused.

This week, Johns Hopkins performed the first five way kidney transplant. Five families willing to donate a kidney but not compatible with their own loved one. Matches were made for four of them and an anonymous donor gave one of their own for the fifth. Every code we bring in with good organ perfusion from excellent CPR and code management is potential fifth kidney for these kinds of really hopeless situations.

To paraphrase the song by the Police, “Every breathe you take, every move you make . . . ” They’ll be watching you!

EMS trivia questions:

I got a chance to be a guest trivia guy on the My Trivia Podcast. This is a show that Will Jones does with his two daughters and it features 10 trivia questions each week with the answers at the end of the show. It is only about 8 to 10 minutes long and is a lot of fun for family podcast listening.

I did 5 questions on EMS for a bonus round. Will also offered to put me in touch with a pediatric anesthesiologist. Hopefully this works out. I have a lot of questions to ask and share with you guys. In the meantime, check out Will’s show.

� Previous Entries