Welcome to Episode 55

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.

Fill out our Survey!

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Contact Me!
Call the Voice Mail Line — (941) 306-3342

send me a note at podmedic@mac.com

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Link of the Week: Mitigation Journal Podcast

Acid/Base Balance In-Service Episode

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News:

Event Honors EMS Crews

Gathering for Training

Crew Falls With Pregnant Patient

Software Gives 3-D View of Territory

Bio Clock and Heart Attacks

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Tip/Trick of the Week — BLS NREMT Skills

Airway/O2/Ventilation pdf

Bag Valve Mask Apneic pdf

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Med of the Week — Verapamil

Medicine Net on Verapamil

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Visit the MedicCast Forums

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Thanks for Supporting the MedicCast!

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

Visit the MedicCast Store!

Get the New MedicCast Newsletter — Sign up now — it’s free!

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.

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Podsafe music from the PMN — Jim’s Big Ego with — “Stress” at iTunes

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

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Until next time, Scene safety, BSI!

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

I found an article today that describes a man’s journey from his father’s heart attack to his becoming a paramedic. It describes what inspired him to join the rest of us in the world of EMS.

Check out the article here.

It’s interesting to think about why I do what I do. I came to EMS because of several events in my life.

I was a patient in an MVA when I was 18 (far too long ago). I came from a small town with a strong local volunteer fire/EMS company in Maryland. I knew many of the responders to my accident. I knew the providers who loaded me onto the helicopter.

I remember the nurses at University of Maryland’s Shock Trauma Center in Baltimore. I was scared, wondered what was happening to me. I had head and facial trauma so I couldn’t see, but I can still hear their voices reassuring me. Telling me that I was going to be alright. Explaining the procedures to me.

My childhood was also prepping me for this field. My father and Mother instilled in me a drive to be active in my community and help others as best I could. And, like many in my generation of EMS providers, I was shaped by the TV show EMERGENCY! Johnny and Roy — running the routine calls, the funny calls, and sometimes saving a life.

So here’s your chance, MedicCast listeners. What brings you to EMS? Comment below, email me, or call the voicemail line (941-306-3342).

blubrry.com

West Virginia legislators have voted and passed a bill that will extend a death benefit to the families of volunteer EMS and fire personnel who die in the line of duty. This is a reaction to the deaths of two volunteer firefighters in the Ghent, WV convenience store propane gas explosion I talked about back in Episode 52 of the MedicCast. The death benefit proposed will offer $50,000 to the families of the deceased vounteers.

Read about it here.

What kind of benefits are offered to you if you run with a volunteer service, as up to 75% of us do? If the answer is nothing, perhaps it’s time to forward the story from West Virginia to your elected representatives.

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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

With more and more information coming out of studies pointing to a rapid increase in the number of women presenting with heart disease, the American Heart Association has come out with some strong advice for them to avoid developing the disease.

Read the article here

The new focus is on reducing “Life Risk.” Some of the advice seems to be common sense:

• Regular Exercise
• Eat Vegetables and less saturated fats
• Stop smoking
• Maintain healthy body weight goals

The study also recommends an increased daily aspirin dose (325 mg) for those at highest risk. Check out the article and see all of the new guidelines for female heart health.

Jamie

the Podmedic

Why do our patients and colleagues smoke when we continue to see the effects of smoking on long term health all around us?

Harvard University researchers have confirmed findings from the state of Massachusetts that cigarette companies have increased nicotine levels in cigarettes by about 10-11% since 1997.Dr. Michael Rabinoff, a board certified psychiatrist on the faculty of the Department of Psychiatry at UCLA, expert on tobacco issues and author of Ending the Tobacco Holocaust: How Big Tobacco Affects Our Health, Pocketbook, and Political Freedom, and What We Can Do About It, also points out that “besides using increased nicotine levels to make cigarettes more addictive, tobacco companies use product engineering and many other chemical tricks to increase the addictive properties of cigarettes”.

Some of those chemical tricks used by tobacco companies include:

Ammonia technology. Ammonia generating formulas, such as the combination of diammonium hydroxide, pectin, and ammonium hydroxide increase nicotine transfer from tobacco into smoke. Ammonia technology, reconstituted tobacco, and tobacco essence are utilized to increase freebase nicotine, and to have front-end lift (where cigarettes are engineered to have the highest level of nicotine in the first puffs). Increased free base nicotine may lead to increased distribution, faster distribution of nicotine in lungs, faster crossing of membranes, faster central nervous system penetration, and greater concentration crossing membranes at lungs and central nervous system. All of this can lead to increased impact and addictive effect.

Anesthetics such as menthol, benzaldehyde, benzoic acid, benzyl alcohol, carvacrol, cinnamaldehyde, cinnamic acid, guaiacol, linalnyl acetate, and thymol have a numbing effect on the respiratory tract, masking irritation from cigarette smoke. According to a report in the medical journal Chest, 76% of black smokers choose menthol brands compared to 23% of white smokers. The menthol brands are associated with higher levels of nicotine and carbon monoxide, and appear to be associated with increased health risks as compared to nonmenthol brands.

Bronchodilators such as cocoa, glycyrrhizin (a component of licorice), and caffeine open the airways and allow the smoke to be drawn more deeply into the lungs.

Levulinic acid binds to nicotine receptors in the brain, and increases the brain’s response to nicotine.

Sugars are extensively added to cigarettes, especially “reducing sugars” used for the ammonia technology processes that increase vapor freebase nicotine. In fact, a 1990 Brown & William study found that 11.2-12.9% of Marlboro cigarettes were sugars. (Some of the sugars in tobacco are natural, but tobacco companies also add significant amounts of sugars).

You can read more about the many chemical tricks the tobacco companies use to addict and keep smokers addicted in Chapter 4 of Ending The Tobacco Holocaust.

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Educate yourselves as to the reason that our patients (and too many of our colleagues) continue to smoke. What we see as a weakness is really a legally addictive drug. Understanding the nature and causes of the diseases we see in the field can help us to prevent the onset in others. Learn about smoking cessation programs in your community. Start one in your company or community. Partner with local hospitals to bring their educators to your facility.

Welcome to Episode 54

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.

Fill out our Survey!

—————————-

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

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

MedicCast Listener Deals at GoDaddy.com –

Code BLU27 gets you 10% off your order at checkout
Code POD27 gets you 10% off any web hosting order at checkout
Try them out and get your piece of the internet at GoDaddy.com!

———————————

Contact Me!
Call the Voice Mail Line — (941) 306-3342

send me a note at podmedic@mac.com

Sign up for the Newsletter!

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Link of the Week: 12-Lead Link

Gustavo’s Comments Link

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News:

Salt Lake City Victims

Play Doctor for a Day

Baghdad Ambulances

Amputation Saving Shunt

Child Flu Deaths

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Tip/Trick of the Week — Influenza

CDC on Flu Signs/Symptoms

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Med of the Week — Flu Vaccine

CDC Flu Vaccine Fact Sheet

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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!

Get the New MedicCast Newsletter — Sign up now — it’s free!

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.

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Podsafe music from the PMN — bluesman Billy Jones with “da Love Doctor”

Click here to get other 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

Long time listener and contributor Gustavo wanted to correct some things I talked about in Episode 52 of the MedicCast. I was talking about diagnosing acute myocardial infarction (AMI) when presented with a left bundle branch block (LBBB). I was talking about making a definative diagnosis using a 12-lead ECG but some of you may have misunderstood. Gustavo makes several good points and gives a reference link as well. I’ve quoted his comments below. As always — I appreciate any comments, corrections, and clarifications from the MedicCast listeners.

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“Now, my real issue comes with a statement you said about not being able to diagnose an AMI in an EKG with LBBB. BBBs alter the baseline and therefore create ST-elevation mimics which render the diagnosis not as straightforward as we are usually taught. However, Sgarbossa and colleagues in 1996 published a VERY interesting article in the New England Journal of Medicine (NEJM abstract below . . . ) which described some criteria to describe whether an ECG with LBBB is also showing an AMI. As you know, the T wave is usually discordant with the QRS in BBB settings. If the QRS is positive, the T wave is negative, and viceversa due to repolarization abnormalities. So, when it is CONCORDANT in two or more contiguous leads, that rings a bell. Also, way too much of an ST elevation is also significant. More than 5mm is significant even with a discordant T wave. In summary, these criteria are:

1. ST elevation > or = 1mm and concordant with QRS.
2. ST depression > or = 1mm in v1,v2 or v3.
3. ST elevation > or = 5mm and discordant with QRS.

NEJM reference article

You made a tangential comment on this regarding the issue of the different diagnostic tests not yielding the same positive results on patients with coronary artery disease patients. In fact, I find it very interesting the fact that an angiogram may show clear lumen of vessels… but the problem may lie OUTSIDE the vessel. The vessel walls grow thicker and do not allow for distention in times of increased oxygen demand, leading to ischemia. Coronary artery ultrasound can detect this external thickening. Thus, erring on the side of caution and “going the extra mile” for somebody who does not look good despite all odds may prove beneficial until unequivocally proven otherwise.”

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Thanks again, Gustavo, for the excellent comments and your research! I think the biggest point here is to maintain an index of suspicion and treat the patient and not the monitor.

Remember that I always want the MedicCast listeners to correct any mistakes in the information I make available on the podcast. You can email me at podmedic@mac.com , you can leave a comment on the episode shownotes page, or call in to the voicemail line (941-306-3342).

It is February and that means it Heart Health Month.  I found a great resource over at the Mayo Clinic web site.  They have a lot of information on all kinds of health issues there.  Whether you need a healthy heart wake up call or you want information to pass on to patients, this is something to check out.

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It’s never too late to take steps to prevent a heart attack, even if you’ve already had one. The new heart disease risk calculator on MayoClinic.com helps you become better informed about your heart health and learn how to reduce your risk for having a heart attack in the next 10 years.

After you answer several questions about your lifestyle and health, the calculator determines your 10-year risk of a heart attack. Risk scores are based on a number of factors, including age, gender, tobacco use, cholesterol levels and blood pressure. Approximately one out of 10 people with a risk level of 12 percent will have a heart attack or die of heart disease within the next 10 years.

MayoClinic.com’s Heart Disease Center offers articles, tools, recipes and advice to help keep your heart healthy. Here are five heart disease prevention tips to get you started:

1. Don’t smoke or use tobacco products. “If you smoke, quit,” advises Sharonne Hayes, M.D., a cardiologist and director of the Women’s Heart Clinic at Mayo Clinic Rochester. “That’s the most powerful, preventable risk factor for heart disease.” For heart disease prevention, no amount of smoking is safe. Smokeless tobacco and low-tar and low-nicotine cigarettes also are risky, as is exposure to secondhand smoke.
2. Get active! You already know that physical activity is good for you. But you may not realize just how good it is. Regular participation in moderately vigorous physical activity can reduce your risk of fatal heart disease by nearly 25 percent. And combining physical activity with other lifestyle measures, such as maintaining a healthy weight, results in even greater benefits.
3. Eat a heart-healthy diet. Consistently eating a diet rich in fruits, vegetables, whole grains and low-fat dairy products can help protect your heart. Legumes, low-fat sources of protein and certain types of fish also can reduce your risk of heart disease. Limiting your intake of certain fats also is important. Saturated fat and trans fat increase the risk of coronary artery disease by raising blood cholesterol levels. Heart-healthy eating isn’t all about cutting back, though. Most people, for instance, need to eat more fruits and vegetables, with a goal of five to 10 servings a day.
4. Maintain a healthy weight. As you gain weight in adulthood, the increase is mostly fatty tissue. This excess weight can lead to conditions that increase your chances of heart disease — high blood pressure, high cholesterol and diabetes. Even small weight reductions can be beneficial. Reducing your weight by just 10 percent can decrease your blood pressure, lower your blood cholesterol level and reduce your risk of diabetes.
5. Get regular health screenings. High blood pressure and high cholesterol can damage your cardiovascular system, including your heart. But without testing, you probably won’t know whether you have these conditions. Regular screening can determine your risk factors and whether you need to take action.

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About MayoClinic.com–

Launched in 1995 and now visited by more than 7 million users a month, this award-winning consumer Web site offers health information, self-improvement and disease management tools to empower people to manage their health. Produced by a team of Web professionals and medical experts working side by side, MayoClinic.com gives users access to the experience and knowledge of the more than 2,000 physicians and scientists of Mayo Clinic.

MayoClinic.com offers users intuitive, easy access tools such as “Symptom Checker” and “First-Aid Guide” for fast answers about health conditions ranging from common to complex; as well as more in-depth sections on over 25 common diseases and conditions, a wealth of healthy living articles, videos, animations and features such as “Ask a Specialist” and “Drug Watch.” Users can sign up for a free weekly e-newsletter, “Housecall,” which provides the latest health information from Mayo Clinic.

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The Mayo Clinic site is a great resource on medical information for everyone, including EMS personnel. I get a lot of great info from them. You can use this site to get yourself more healthy or to find information you can use in the field. It’s also a great place to follow up on a call that left you scratching your head.

Stay safe!

Jamie

the Podmedic

blubrry.com

This week I found a story about a lawsuit that alleges an EMT disrobed a woman inappropriately after he administered an undocumented third dose of a narcotic analgesic. Clearly there are many issues to look at here. However, while I think there were some unusual circumstances in play here, I’d like to focus on the wording of the lawsuit itself. The article lays out the substance of the suit in the text and there is some good reading that might encourage you to be more diligent in your documentation. Check it out!

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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

Tips On Home Care From the National Association for Home Care and HospiceWhen your patients become ill or need home care, it can be a very difficult and confusing time for their family. In order to help people make the difficult decision regarding who will care for their loved ones in their final days, NAHC has compiled advice to help family members decide on the right time to consider home care and how to ensure their loved ones are being well provided for. “Signs it is Time to Consider Home Care” and “Questions to Ask When Choosing a Home Care Provider” are vital for those people who must make this vital decision.

As EMS providers, we often see people in states of gradual deterioration and in need of more care than the family’s resources can provide for. It can be a very difficult and confusing time for a family. In order to help people make the difficult decision regarding who will care for their loved ones in their final days, NAHC has compiled advice to help family members decide on the right time to consider home care and how to ensure their loved ones are being well provided for. “Signs it is Time to Consider Home Care” and “Questions to Ask When Choosing a Home Care Provider” are vital for those people who must make this vital decision.

We can offer information like this to our patients and their families. Compile a list of helpful weblinks to give to families of terminal patients. Contact your local hospice center and have them come in and give training on what services they provide and how EMS can best interact with them. Talk with them about your concerns with DNR patients.

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Here’s some of the information and questions available at the NAHC familycare page.

Signs it is Time to Consider Home Care:

1. The patient is consistently short of breath, unable to eat, sleeping excessively, and experiencing increasing pain.
2. The patient has started to withdraw from life and/or family and friends.
3. The doctor has stated that the patient’s condition is not curable and that there are no more medical options.
4. The patient has expressed they are ready to die but the family is not ready to let go.
5. The treatment the patient is receiving seems no longer to be helping or working but prolonging the inevitable.
6. Financial issues are becoming more challenging.
7. The patient is unable to do everyday chores such as dressing themselves, going to the toilet or bathing without assistance.
8. It is becoming harder for the caregiver to take care of the patient.

Questions to Ask When Choosing a Home Care Provider:

1. Can you please share your company’s performance standards for their employees?
2. How long has your company been in business?
3. What qualifications, certifications, experience and training do you require of your workers?
4. Are your employees insured and bonded?
5. How do you supervise your workers to make sure the proper care is given?
6. Will the same caregiver oversee my case consistently?
7. Do you conduct a home visit before starting the home care service?
8. Do you work with my doctor in developing a plan of care?
9. Can you provide me some references from doctors, hospital personnel and social workers?
10. Has your company been involved in any lawsuits involving customer satisfaction?

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You might wonder why I push for us to be educated on the additional resources available for different patient populations in our areas. Part of it is to make us more aware of the big picture of caring for our patients. We don’t just pick them up and drop them off — often we pick the same ones up again and again.

By making ourselves aware of other avenues of treatment for the patients we have, we save EMS resources and time for other more pressing emergencies.

Stay Safe!

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