tag:blogger.com,1999:blog-108116162024-03-14T03:04:03.894-07:00New Orleans EMT's Sound Off!This blog was created by a New Orleans paramedic for other EMT's in the New Orleans area to post their comments, compliments, complaints, bitches, whines and assorted other editorials. Anonymous postings or fake names are acceptable, but discouraged.Unknownnoreply@blogger.comBlogger166125tag:blogger.com,1999:blog-10811616.post-37614995826194540382013-04-23T01:01:00.001-07:002013-04-23T01:01:55.544-07:00Quiet
<br />
Maybe it’s because no one know about this blog or hasn’t looked at it in a
while, but man it’s quiet around here!! What use to be a place to express your
opinions or distain about things is no longer? Trust me this should be filled
with crap being said. Well if you would listen to the daily ranting’s around
the ems business, yet no one has posted or comments in a long time. Besides our
oh so wise and great leader that is!!!<o:p></o:p><br />
<br />
Shhhhhhh if we speak we will get in trouble and labeled as such, ohhhhh
screw that , damn it we still are in America.......or as close to it as the 3rd
World Country New Orleans will allow it to be.<o:p></o:p><br />
<br />
So speak up people, sure someone may get offended but who cares, truly not
you I see and heard the way you speak and treat people daily!!!<o:p></o:p><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 10pt;">
<o:p> </o:p></div>
T-MANhttp://www.blogger.com/profile/01169041555780007024noreply@blogger.com1tag:blogger.com,1999:blog-10811616.post-89737034083976164802012-12-01T07:08:00.002-08:002012-12-01T07:08:43.468-08:00<div dir="ltr" style="text-align: left;" trbidi="on">
Yep, this is completely true. One of New Orleans' EMS units got booted WHILE ON A SCENE by the fools that run this convenience store. Discuss.<br />
<br />
<a href="http://www.wwltv.com/news/eyewitness/brendanmccarthy/Ambulance-gets-booted-while-tending-to-emergency-181631351.html">http://www.wwltv.com/news/eyewitness/brendanmccarthy/Ambulance-gets-booted-while-tending-to-emergency-181631351.html</a><br />
<br />
<script src="http://www.wwltv.com/templates/belo_embedWrapper.js?storyid=181631351&pos=top&swfw=470"></script><object classid="clsid:D27CDB6E-AE6D-11cf-96B8-444553540000" height="264" id="bimvidplayer0" width="470"> <param value="true" name="allowfullscreen"/> <param value="always" name="allowscriptaccess"/> <param value="high" name="quality"/> <param value="true" name="cachebusting"/> <param value="#000000" name="bgcolor"/> <param name="movie" value="http://swfs.bimvid.com/bimvid_player-3_2_7.swf?x-bim-callletters=WWLTV" /> <param value="config=http://www.wwltv.com/?j=181631351&ref=http://www.wwltv.com/news/eyewitness/brendanmccarthy/Ambulance-gets-booted-while-tending-to-emergency-181631351.html" name="flashvars"/> <embed src="http://swfs.bimvid.com/bimvid_player-3_2_7.swf?x-bim-callletters=WWLTV" type="application/x-shockwave-flash" width="470" height="264" allowfullscreen="true" allowscriptaccess="always" cachebusting="true" flashvars="config=http://www.wwltv.com/?j=181631351&ref=http://www.wwltv.com/news/eyewitness/brendanmccarthy/Ambulance-gets-booted-while-tending-to-emergency-181631351.html" bgcolor="#000000" quality="true"> </embed><br></object><script src="http://www.wwltv.com/templates/belo_embedWrapper.js?storyid=181631351&pos=bottom"></script></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-10811616.post-23739761729078765612012-11-12T14:35:00.003-08:002012-11-12T15:12:47.228-08:00"Ya wanna hear about dumb?"<div dir="ltr" style="text-align: left;" trbidi="on">
<a href="http://4.bp.blogspot.com/-ekoHnHG5-u4/UKF7UdJQlyI/AAAAAAAACyE/HeZVby8ezDQ/s1600/paramedic.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="215" src="http://4.bp.blogspot.com/-ekoHnHG5-u4/UKF7UdJQlyI/AAAAAAAACyE/HeZVby8ezDQ/s320/paramedic.jpg" width="320" /></a>Recently I called out a local ambulance service for reporting a “blood pressure” that was obtained during chest compressions while performing CPR (obviously a pressure generated by CPR itself). It’s generated a lot of laughter as well as some angry responses from EMTs - but not anger at the EMT; they were angry with me. So please, allow me to elaborate.<br />
<br />
I have no doubt that in every EMS service there are many excellent medics. Additionally, it has been demonstrated that every ambulance service has some goofballs working there too. Excellent medics know who they are. The goofballs do not. And the problem is not with the ambulance services, but rather that no one ever tells the individual(s) that they are a goofball. <br />
<br />
Now certainly, even the best EMS professionals make mistakes. I’m not referring to that. I am talking about the ones who should never have been allowed to continue in the EMS profession. We EMTs are quick to call ourselves heroes and give ourselves little awards for whatever and declare how generally awesome we are as a group. But as soon as the awards ceremony is over and we’re back in the ambulance with our partner or hanging out on the ER ramp with others, out come the stories that start with “You wanna hear about dumb? Lemme tell ya about this one person I was working with…” <br />
<br />
So let’s just clear the air here - yes, even <i>you</i> know that there are some incompetent folks at your service, at my service, and at that other service. So what have <b>YOU</b> done about it? As a group, we have struggled for years to get others to view EMS as a “real” profession. Then we hear about a story like this, and it sets all of us back to square one in the eyes of others. Suddenly all the learning, training, refreshers, ACLS, BTLS, in-services and accomplishments fly out the window and we’re back to being “ambulance drivers.” And the worst part is <i>no one says anything</i>. We allow an incompetent coworker to destroy the reputation that we’ve worked so hard at trying to achieve. At best, the offending EMT might be sent to remediation. No one learns from remediation. If they don’t get it by now, more of the same won’t help. <br />
<br />
So what to do? More awards? Hardly. Does anyone remember as a kid when there were “winners” and “losers”? What did that teach you? That you either strove for excellence as a winner or got out of the game when you consistently went home in shame as a loser. Now, however, all the little kids get an award just for showing up. I won’t go into how that does kids a disservice, because I’m talking about EMTs. But the “award for showing up” is something that EMS cannot afford to allow. It has no place in the real world, and <b>YOU,</b> dear EMT, have the power to make it stop. <br />
<br />
If you see or hear someone doing something like reporting a “blood pressure” on a patient in full cardiac arrest, don’t get angry at the person who calls them out on it. Instead, get angry at the person who just knocked out your years of hard work from under you. You need to call them out on it too, else such incompetence is viewed as the standard by which all EMTs practice. Tell them that they are acting like an idiot when they demonstrate it. Yes, I’m talking about good ol’ fashioned shaming. It delivers more results than any hero’s banquet. Ask any of the EMTs that I have personally trained if I was afraid of shaming them for idiotic behavior. I guarantee you they’ll say no, and I’m proud to say that most of them turned out to be not just good medics, but excellent medics. And if anyone is wondering, I’ve had my own share of shame and embarrassment from others. It works. <br />
<br />
So yes, please hang out with your coworkers for a drink; demonstrate the camaraderie that makes EMS a great group of people. But when it comes down to incompetence or idiocy professionally, don’t let <i>that</i> guy turn you back into an ambulance driver. I want you to be an excellent EMT. So be one.</div>
Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-10811616.post-85680884489582097432011-11-04T20:34:00.000-07:002011-11-05T03:15:35.704-07:00Where To Find the Real Corruption<div dir="ltr" style="text-align: left;" trbidi="on">Well, well, well…<br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-BC0u9UGl160/TrSrkq3h3CI/AAAAAAAABQY/wuNt8sPprjw/s1600/Saussy.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://3.bp.blogspot.com/-BC0u9UGl160/TrSrkq3h3CI/AAAAAAAABQY/wuNt8sPprjw/s1600/Saussy.png" /></a></div>NOLA.com decided (late last night, at 10:30 pm) to publish <a href="http://www.nola.com/politics/index.ssf/2011/11/former_new_orleans_ems_directo.html" target="_blank">an article</a> following up on the Times-Picayune’s indictment last year about Dr. Jullette Saussy’s supposed wrongdoing and corruption by holding a second job with the Vidacare Corporation while working full-time as the director of EMS for the city of New Orleans. The follow-up article covers the state ethics board’s decision that Dr. Saussy was cleared of any wrongdoing by holding the second job. <br />
<br />
In the article, Vidacare’s relationship with the city is described. It details that their products are purchased “through a third-party company that distributes them” and that the city has “no direct business relationship with Vidacare.” Therefore, the ethics board cleared Dr. Saussy of wrongdoing on her part. This decision comes thirteen months after Dr. Saussy was asked to resign by the Landrieu administration. <br />
<br />
All this talk about ethics gets one to wondering about some things. Obviously, Mayor Landrieu did not wait for a decision by the ethics board before requiring her resignation. WWL television in New Orleans <a href="http://www.wwltv.com/news/local/Ethics-opinion-clears-former-NO-EMS-director-132835093.html" target="_blank">covered Dr. Saussy’s clearance</a> five days prior to the Times-Picayune’s article and put it on prime-time news instead of burying it deep in the archives of their website. So, speaking of ethics, I’d like to submit the question of the ethics of both Mayor Landrieu and the Times-Picayune. <br />
<br />
Mayor Landrieu had at his perusal the documents and testimony by Dr. Saussy and City Hall’s legal department of her official permission to work for Vidacare. Granted, all this documentation occurred before his shift at the helm, during the Nagin administration. But so did Dr. Saussy’s employment with Vidacare. By the time Landrieu took office in 2010, Dr. Saussy had been gone from Vidacare for nearly two years. The whole thing should have been a non-issue - a thing of the past. Dr. Saussy was serving the city admirably, and in fact had been doing so even while she worked for Vidacare and fought cancer at the same time. Mayor Landrieu even thought her service was excellent enough to retain Dr. Saussy as head of EMS when he took office. <br />
<br />
So what happened? Did some terrible secret come to light? Was there some awful scandal involving Dr. Saussy that screamed for her banishment from public service? Well, no. There wasn’t. There was a story in the newspaper that said Dr. Saussy worked for Vidacare in addition to her primary employment with the city. But wait, didn’t we all know that already? We sure did. Was it a violation of ethics? Basically Landrieu said, “I don’t know; maybe we should ask the state ethics board.” Which Dr. Saussy did. But instead of waiting for their opinion, Mayor Landrieu took as gospel truth the hearsay and imprecise accusations that the Times-Picayune and its commenters had to opine about. Apparently taking into consideration only the dubious journalism of the Times-Picayune and NOLA.com commenters, and not the opinion of any professionals actually versed in medical ethics, he asked for her resignation long before the state ethics board had anything to say on the matter. How much expertise does Mayor Landrieu have on the subject of medical ethics? Well, none, clearly, since those who do said there was no wrongdoing. But that didn’t stop him from firing one of the most valuable assets the city had. <br />
<br />
So why is no one calling into question the ethics of Mitch Landrieu? As it turns out, Dr. Saussy was fired for… nothing, really. As someone who assumed a position in which moral integrity is so badly needed, it is deplorable that no one has called into question Mayor Landrieu’s ethics for kowtowing to what could at best be described as yellow journalism instead of getting the facts straight before making such a crucial decision on city leadership. Of note also is the quote in the article by Landrieu’s spokesperson, Ryan Berni, in which he says “we are extraordinarily pleased by Dr. Jeff Elder’s leadership of the department since he became EMS director.” Wow! Way to avoid the question, Berni (and Landrieu)! Spoken like a true politician. And I don’t mean that in a good way.<br />
<br />
…Which brings me to the Times-Picayune itself. Last year, the newspaper bent over backwards to accuse Dr. Saussy of wrongdoing when there was none. All the supposed infractions they "uncovered" were already a matter of public record. Dr. Saussy’s employment was approved by City Hall. Donations of sick time to her by fellow employees while she fought cancer was according to established city policies. At no time was she unavailable for her duties as EMS director, despite what the Metropolitan Crime Commission alleges. <a href="http://nolaemt.blogspot.com/2010/10/as-if-new-orleans-hasnt-lost-enough.html" target="_blank">As I said last year</a> when I wrote about Dr. Saussy’s resignation, the Times-Picayune created a scandal where none existed. This is borne out even further by the decision by the state ethics board that there was no wrongdoing by Dr. Saussy. Yet during that time last year, the newspaper was all atwitter over their latest attempt to bring someone down. It published articles such as “<a href="http://www.nola.com/politics/index.ssf/2010/09/post_363.html" target="_blank">New Orleans’ EMS Director’s Second Job Raises Questions at City Hall</a>” and “<a href="http://www.nola.com/politics/index.ssf/2010/09/new_orleans_ems_director_was_g.html" target="_blank">New Orleans’ EMS Director Was Given $53,000 In Sick Leave By Paramedics</a>” and “<a href="http://www.nola.com/opinions/index.ssf/2010/09/the_moonlighting_by_new_orlean.html" target="_blank">The Moonlighting by New Orleans EMS Director Doesn’t Feel Right: An Editorial</a>.” <br />
<br />
I beg your pardon? It doesn’t <i>feel </i>right? Instead of reporting some vague, unquantifiable feeling as the way everyone else should also feel, perhaps as journalists you might stick to objective facts rather than whatever emotional upheaval crosses your fancy at the time.<br />
<br />
Here’s a title the Times-Picayune should write an article for: “Times-Picayune Makes False Accusations Of Wrongdoing By EMS Director.” Or perhaps this one: “Times-Picayune Remains Unapologetic For Intentional Libel.” Yes, you bastion of journalistic integrity, I said it: Libel. As alleged journalists, I would expect you know the meaning of the word, but judging by your past attempts at reporting perhaps you should allow me to refresh your memory. Libel: noun. a: Defamation by written or printed words, pictures, or in any form other than by spoken words or gestures. b: The act or crime of publishing it. c: A formal written declaration or statement, as one containing the allegations of a plaintiff or the grounds of a charge. The stories by the Times-Picayune certainly all fit the bill for libel. They falsely defamed Jullette Saussy in print, published it, and insinuated corruption on her part, as did the commenters on NOLA.com who called for her head on a platter.<br />
<br />
So tell us, Times-Picayune, what were your motives in reporting this non-story about Dr. Saussy? It doesn’t seem to be uncovering corruption, since those with far greater knowledge of ethics than you about such issues have cleared Dr. Saussy of wrongdoing. Was it about a problem with the city's policy of sick time donation? It doesn’t seem so, since the policy is still in place and you haven’t said a word about it since. Perhaps you were trying to garner sympathy for the anonymous “demoralized” EMT’s and paramedics who were so upset over Dr. Saussy’s absence while she received cancer treatments? No follow-up stories on that either, huh? <br />
<br />
Well, then one can only observe that either someone(s) at the the Times-Picayune had a personal vendetta to execute against Dr. Saussy and abused the newspaper and web media to carry it out, or that the staff of the Times-Picayune were caught up in a frenzy of bringing down public officials and pointed their inky cannon at Dr. Saussy and fired away with no regard to facts, other than to put their own peculiar slant on them. Go on, click the links to the articles above. Other than a few repeated quotes by Dr. Saussy, the majority of the articles join together the otherwise unrelated topics of her salary, her employment with Vidacare and the donations of sick time, so that it appears that there was some malicious scheme afoot. There wasn’t. But in their most recent article, instead of apologizing outright for this defamation of character or even <i>seeming</i> sort of apologetic, the Times-Picayune lumps together the now-exonerated Saussy with the likes of those with legitimate, concrete evidence of corruption, such as Joia Crear-Perry (public health director with a suspended license), Kenneth Ferdinand (public credit card used for personal expenses) and Greg St. Etienne (diverting federal grant money intended for non-profits to his brother’s company). <br />
<br />
Ethics? Really? Mitch Landrieu has revealed that ethics and facts have nothing to do with his decisions as mayor by dismissing Dr. Saussy based on nothing but false accusations by the TP (abbreviation intentional). The Times-Picayune, in their clearly desperate attempt to legitimize themselves as paragons of journalistic virtue in our corrupt world, has offered no recantation, reparations or even so much as a “woops, our bad” after they single-handedly brought down someone who <i>actually</i> displayed moral integrity and an exemplary ethical paradigm. Jullette Saussy, congratulations on your victory. Mayor Landrieu and the Times-Picayune, you’ve shown us where to look for the real corruption. </div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-10811616.post-24068316025731823032011-04-16T15:42:00.000-07:002011-04-16T15:43:17.265-07:0020-A at West End & Harrison (Plane Crash)Despite the reporter guy's enthusiasm trying to make a Hindenburg-esque "Oh the humanity!" moment out of this, the resounding phrase is "We're fine."<br />
"WHAT HAPPENED?"<br />
"A plane hit my car."<br />
Duh.<br />
<br />
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p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 13.0px Times New Roman}
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<div class="p1">...It’s Carnival Time And Everybody’s Drinking Wine!</div><div class="p2"><br />
</div><div class="p1"><a href="https://lh6.googleusercontent.com/-_vSqfvwJWWs/TW6r3vCJ_mI/AAAAAAAAA9Y/UTWA_HgTMK4/s1600/gator.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="213" src="https://lh6.googleusercontent.com/-_vSqfvwJWWs/TW6r3vCJ_mI/AAAAAAAAA9Y/UTWA_HgTMK4/s320/gator.jpg" width="320" /></a>We find ourselves once again in that special time unique to our city, our much-loved and much-hated Mardi Gras season. There is much to hate about Carnival - the hundreds of thousands of tourists who all come from dry counties and immediately proceed to down “only” five or six Hurricanes or Hand Grenades; the ubiquitous smell; the “can you tell me where such-and-such is?” (two blocks, make a right); the overloaded emergency rooms, the ungodly traffic. There is also much to love about Carnival - EMS gets the absolute best spots on the parade routes (especially if you can back your truck right up to the route), being pelted with throws, Polish sausage & pizza, parade-goers offering you food from their grills, the big parties after the season is done, and of course, the “entertainment” that comes with French Quarter details. One of my favorite feelings is going 10-8 early Mardi Gras day and driving down St. Charles while everyone is setting up for parades; there’s hardly any other traffic and everyone is in a great mood. Good or bad, it’s uniquely New Orleans and the challenges it poses to EMS (and all the emergency services) make it a source of pride when we’ve handled it bravely every year. </div><div class="p2"><br />
</div><div class="p1">If you’re new to NOEMS, or if you’re a veteran, here’s a few pointers (and yes, I’ve seen EMTs with years of Carnival experience who still need every one of these tips. So pay attention.):</div><div class="p2"><br />
</div><div class="p1">Number ONE, first and foremost, superseding all other pointers: LISTEN TO YOUR RADIO! If you’re unfamiliar with directions in the city, let your more experienced partner listen to the SPEC channel and NOPD. There is nothing worse than being one block from an emergency and not responding because you weren’t listening! </div><div class="p2"><br />
</div><div class="p1"><div class="separator" style="clear: both; text-align: center;"><a href="https://lh3.googleusercontent.com/-l_IrGccxEYk/TW6stP34Y1I/AAAAAAAAA9g/hvs9LAE073o/s1600/image2497035g.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="https://lh3.googleusercontent.com/-l_IrGccxEYk/TW6stP34Y1I/AAAAAAAAA9g/hvs9LAE073o/s200/image2497035g.jpg" width="200" /></a></div>Know what to say on the radio, especially when communicating with the police. Base 9 (NOPD parade dispatch) doesn’t care or need to know when you’re at the hospital, or that you’re waiting for a bed or whatever. This is what you need to tell them: 1. You’re leaving your assigned location. 2. You’re on scene at a parade item (but not when you get pulled for a regular 911 street call). 3. You’re back at your assigned location. By all means, ask for specifics about a call they sent you to, like if you’re having trouble finding a scene. But do not crowd up the air with “en route to whatever hospital,” or “bathroom break” or “Code 77.” Base 9 doesn’t care and the cops have actual parade-related traffic to air on the SPEC channel. </div><div class="p2"><br />
</div><div class="p1">Know where your partner is at all times! Since you’re on two different channels, he won’t know if there’s a call on your channel and you won’t know if there’s a call on his channel. Delaying response because you didn’t follow the long-established rules is unprofessional, dangerous and downright wrong. Don’t be that guy.</div><div class="p2"><br />
</div><div class="p1">Do not expect free anything (except parade throws). Expect to pay full price for any snacks or drinks you buy at concession stands, even if you know for a fact that they’re offering free stuff to EMTs. Pull out your wallet to show your good intentions. If you do get anything for free, tip nicely and do not be greedy, going back for more. Otherwise, you’ll ruin it for everybody. Don’t be that guy.</div><div class="p2"><br />
</div><div class="p1">If you’re on the parade route, do not scramble to get parade throws. If you catch something mid-air, great. Otherwise let the tourist or little kid have that cheap Chinese plastic thing.</div><div class="p2"><br />
</div><div class="p1"><div class="separator" style="clear: both; text-align: center;"><a href="https://lh4.googleusercontent.com/-7sT6gVBGJUw/TW6rlO_x6YI/AAAAAAAAA9U/yBwEBCbB9W4/s1600/asap.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="213" src="https://lh4.googleusercontent.com/-7sT6gVBGJUw/TW6rlO_x6YI/AAAAAAAAA9U/yBwEBCbB9W4/s320/asap.jpg" width="320" /></a></div>Act right. Of all times of the year, stressful though it is, be nice. You never know who you’re picking up out of the gutter. I once picked up a very influential travel writer at his worst moment during Carnival. That one story from that one patient can seriously impact our city’s tourist economy for years. Let’s hope it’s a good impact. And if you can’t be nice to the patient (e.g. they’re unconscious or a real asshole), be nice to the friends. When the patient comes around, the friends will tell the patient how great the EMS crew was. Or how awful they were. This goes double, no... triple, for the crew stationed at Gallier Hall. Remember, your bosses (the city council and the mayor) are there watching you. </div><div class="p2"><br />
</div><div class="p1"><div class="separator" style="clear: both; text-align: center;"><a href="https://lh5.googleusercontent.com/--9PGBlsU534/TW6sYmaw-0I/AAAAAAAAA9c/ox-kQmPRNkw/s1600/mardi-gras-shooting.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="192" src="https://lh5.googleusercontent.com/--9PGBlsU534/TW6sYmaw-0I/AAAAAAAAA9c/ox-kQmPRNkw/s320/mardi-gras-shooting.jpg" width="320" /></a></div>Related: Act right. You know perfectly well that someone is drunkenly filming the EMTs picking up the drunk pukey guy in bad drag face down in the gutter on Bourbon Street. That video is gonna be on YouTube, HIPAA be damned. It will go viral and millions of people will see you performing EMT work. Do everything National Registry-style. Swab your IV sites. Don’t walk trauma patients who need a spineboard. Do not let patients turn blue because you didn’t feel like lugging the oxygen around. Do not stop chest compressions till there’s a pulse. I guarantee you there’s <i>someone</i> who will write EMS to complain after seeing that video, and then they’ll put up some huge news story about the poor patient care in NOLA. It would be far better if they wrote in to say what a perfect job was done. </div><div class="p2"><br />
</div><div class="p1">When responding in elbow-to-elbow crowds, try to get a mounted officer to lead you. People won’t get out of the way for a siren, stretcher, ambulance or ASAP unit, but they will damn sure get out of the way for a horse.</div><div class="p2"><br />
</div><div class="p1"><div class="separator" style="clear: both; text-align: center;"><a href="https://lh4.googleusercontent.com/-Djl_lEiQAyU/TW6rB5qaRuI/AAAAAAAAA9Q/QhMOxBnzSfU/s1600/mardi-gras-beads.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="198" src="https://lh4.googleusercontent.com/-Djl_lEiQAyU/TW6rB5qaRuI/AAAAAAAAA9Q/QhMOxBnzSfU/s200/mardi-gras-beads.jpg" width="200" /></a></div>Make sure your boots are snug and protect your ankles. You WILL be walking across seas of grounded beads and you WILL slip. Do not sprain your ankle or break your leg in the process. </div><div class="p2"><br />
</div><div class="p1">Do not assume that everyone you pick up is drunk, and do not assume that the drunks you do pick up are only drunk. There are some hellacious occult injuries and medical conditions that have been missed because the crews assumed “they’re just drunk.”</div><div class="p2"><br />
</div><div class="p1">And lastly, LISTEN TO YOUR RADIO!</div><div class="p2"><br />
</div><div class="p1">Good luck with this year, guys. I miss you! </div></div>Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-10811616.post-13386578861954801342011-02-24T06:49:00.000-08:002011-02-24T06:49:01.093-08:00EMS Myth #7: System Status Management lowers response times and enhances patient care<div dir="ltr" style="text-align: left;" trbidi="on">Here's an excellent article about the science (actually, the lack thereof) behind System Status Management:<br />
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<a href="http://www.emsworld.com/article/article.jsp?id=2030&siteSection=14">http://www.emsworld.com/article/article.jsp?id=2030&siteSection=14</a><br />
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Feel free to read it while en route to your next posting location (and racking up a whopping 46% increase in ambulance maintenance costs).<br />
<br />
Don't kill the messenger.</div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-10811616.post-47606426098396531772011-02-15T08:36:00.001-08:002011-02-15T15:32:01.372-08:00From Both Ends: Food Poisoning In All Its Glory<div dir="ltr" style="text-align: left;" trbidi="on"><title></title> <style type="text/css">
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<div class="p1">Lately I’ve seen a few references to “food poisoning.” Most recently is <a href="http://search.japantimes.co.jp/cgi-bin/nn20110215a6.html">an outbreak in Japan</a> where 840 students were out sick. No doubt that you, dear EMS practitioner, have encountered this same malady, either in your patients or yourself. Perhaps your patient asked you if you thought their symptoms could be food poisoning from that restaurant they patronized. You probably recognized the telltale sign of dollar symbols in their eyes ($_$) as the thought of a lawsuit against the establishment occurred to them. Perhaps your experience came after consuming whatever passed for food at the local convenience store at 3a.m., which had been sitting under the heat lamps since the previous morning (which you consumed on the way to the dollar sign patient). By its very name, it sounds like “someone” poisoned your food. I’ve seen people begin plotting their revenge on this unknown individual, perhaps some busboy or salad chef. Even more hilarious have been the times when the “victim” thought he or she knew exactly who had “poisoned” him, and started to hatch their plan for dark vengeance. </div><div class="p2"><br />
</div><div class="p1">Food poisoning is not the horrendous plague or crime that is commonly imagined. It occurs when food has been improperly prepared. It’s not caused by someone pouring a foul elixir from a vial marked with a skull & crossbones (that would be actual poisoning; or perhaps voodoo). Food poisoning is caused by bacteria, plain and simple. If you’ve ever had diarrhea, and I know you have, you’ve had some form of food poisoning. </div><div class="p2"><br />
</div><div class="p1">Very commonly, it’s caused by bacteria that we normally lug around with us every day. The problem comes when it gets somewhere it isn’t supposed to be. For example, escheria coli and staphylococcus aureus (e. coli & staph) are two species living in abundance on your body right now. E. coli lives in colonies weighing kilograms within your lower GI tract. When you poop, about a third of its mass is pure e. coli. Staph lives on every inch of your skin. The problem comes when these little critters set up shop in our upper GI tract, between the mouth and duodenum. It’s not supposed to be there and the anatomical structures in your stomach don’t have the mechanisms to accommodate them, so you get sick. </div><div class="p2"><br />
</div><div class="p1">Generally food poisoning is facilitated from the way food is prepared. In the case of meat, remember that meat comes from animals that have to be killed and chopped up. It is not grown in those little plastic packages in the supermarket (sorry to shatter your illusion). Animals also have an abundance of bacteria in their GI tract. Food inspectors have to check that the bacteria and germs in the guts don’t contaminate the meat in the slaughtering process. But as you can imagine, when there are a thousand tiny, wooly, innocent lambs cowering in fear or little calves mooing out of sheer terror as they witnessed their brothers and sisters being disemboweled and dismembered, things can probably get a little hectic as your lamb chops and veal begin their way to your table. With lots of creatures you grew to love in Mother Goose fairy tales dying and being drawn & quartered, it’s reasonable to picture that some of the bacteria in Little Bo Peep's sheeps' guts might get into the actual chops that make it to the plastic packages in the store. </div><div class="p2"><br />
</div><div class="p1">Now, with that image firmly in your head, keep in mind that bacteria are living things. They consume, metabolize and excrete, just like us. While that meat is waiting for you to purchase it and not think about where it came from, all the e. coli, salmonella, clostridium, staph, listeria and enterococcus is happily consuming the meat and excreting the bacteria version of poop into your lamb chop. Later, if the heat of the cooking process isn’t enough to kill all the bacteria and break down all the bacteria poop, it ends up in your tummy. Even if your body can handle the bacteria, it probably can’t handle the bacterial poop, which is made up of all kinds of fun toxins & chemicals. What doesn’t end up in your tummy winds up in tupperware containers so you can eat it later. The bacteria process starts all over again in the leftovers, so even if the first batch didn’t sicken you, the leftovers might, particularly since microwaves don’t heat evenly. So relatively vast colonies of bacteria and their poop can make it into your belly from the cooked leftovers too.</div><div class="p2"><br />
And for all you vegetarians out there, sitting at your laptop all smug and self-righteous, the same thing can happen with your bean sprouts and tofu. Who's picking and packaging your food? Probably not a bunch of other vegetarians. It's a bunch of undocumented workers trying to hustle a buck or euro by picking your lettuce, arugula, swiss chard and soybeans. They're out in the fields picking and packaging with some foreman yelling at them to hurry up before Immigration catches up with them. So when Juan or Abdullah or Cho needs to go to the bathroom, he'll be hitting the outhouse, or maybe he'll just go right there in the field. With no time or facilities to wash his hands, your broccoli arrives to you with a little staphylococcus souvenir.<br />
<br />
</div><div class="p1">How to prevent and treat food poisoning? First, proper handling and cooking is paramount. Unless you work in a slaughterhouse, that part is kind of out of your hands. Wash your food, because God only knows what illegal immigrants with questionable bathroom hygiene handled it between the farm and your table. Cook it thoroughly to kill bacteria and denature the poop chemicals. Store it refrigerated to retard bacterial growth, and reheat it thoroughly. Basically do everything they taught you in grammar school. One other thing - those heat lamps over prepared food or the tiny burners under the chafing dish at a buffet do NOT prevent bacterial growth. In fact, the slightly elevated temperature provides a bacterial paradise for the little guys to be fruitful and multiply. When treating food poisoning, diarrhea and vomiting can cause severe dehydration. If PO fluids can be tolerated, rehydrate that way. Most likely, IV fluids will be necessary. On the streets, there’s not much you can do for the electrolyte imbalances that occur, but expect an abnormal EKG from hypokalemia. Some patients may have burned up all their glycogen reserves since they can't eat without vomiting, and their cells try to consume glucose, so some may experience hypoglycemia. Urine output will be decreased, so be sure to ask your patient about that, as acute renal failure can occur. Be especially suspicious of dehydration in the elderly and the very young. Expect a few rounds of antibiotics to deal with the invading bacteria. </div><div class="p2"><br />
</div><div class="p1">So no, food poisoning is not fun, but it’s not an insidious crime and it probably should be renamed. It can happen to anyone, anywhere. And if someone in the house gets sick with food poisoning, throw out the offending culprit. Don’t do as I saw, when two people were obviously sick from bad crawfish. When I told them to throw it out, old Grandpa decided to start eating them right there in front of us. New crawfish is cheaper than a hospital visit and no, you won’t win your stupid lawsuit.</div><div class="p2"><br />
</div><div class="p1">Onward and upward...</div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-10811616.post-21469347975626241752010-10-01T21:53:00.000-07:002010-10-01T22:03:38.604-07:00As If New Orleans Hasn't Lost Enough...<div class="p1"><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/_GGtAe8hrTlw/TKa9CMg5hcI/AAAAAAAAA3E/RXLRf193Iog/s1600/33869_1592872218296_1130619824_2794677_7002927_n.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://1.bp.blogspot.com/_GGtAe8hrTlw/TKa9CMg5hcI/AAAAAAAAA3E/RXLRf193Iog/s1600/33869_1592872218296_1130619824_2794677_7002927_n.jpg" /></a></div>The City of New Orleans has lost something today. With the resignation of Dr. Jullette Saussy, now former Director of the city’s Emergency Medical Services, our community has lost one of the few people in city administration who upholds the highest standards of integrity and ethics; a quality that few need to be reminded is often sorely lacking in our leadership.</div><div class="p2"><br />
</div><div class="p1">Many, especially the Times-Picayune, are quick to attribute scandal where none exists. Several weeks ago, the T-P “broke” a story regarding Dr. Saussy. In it she was accused of holding a second job while working as Medical Director of EMS. The second job was with Vidacare, supplier of the EZ-IO device, now widely used in many ambulance services. She was also accused of taking donated sick leave from other employees while she was having cancer treatments. To top it all off, she was the highest-paid city employee at around $187,000 per year. All of these “accusations” are true.</div><div class="p2"><br />
</div><div class="p1">So, why do I say that Dr. Saussy upholds the highest standards of integrity and ethics in view of these facts? Because there was no scandal. Nothing Dr. Saussy did was in any way subterfuge or “under-the-table.” Her second job with Vidacare was cleared and blessed by none other than the city attorney and the Nagin administration. Anyone who wanted to could see that Dr. Saussy was holding another job. Nor is it anything unusual for physicians to hold second jobs. In fact, I cannot think of a single physician I know who does not have another job. Virtually every emergency room doctor I know has a second job; one owns a vineyard, one is a contractor and a lawyer, one has a holistic alternative medicine practice. Even the new acting Medical Director of New Orleans EMS, Dr. Jeff Elder, holds a job at University Hospital. </div><div class="p2"><br />
</div><div class="p1">Dr. Saussy’s second job did not take time away from her primary function as the city’s EMS Director. I know, because I was there. I witnessed firsthand that never did an issue come up that Dr. Saussy was not available to handle promptly. Therefore, despite the Times-Picayune’s insistence that Dr. Saussy’s second job was some sort of a scandal, it clearly was not.</div><div class="p2"><br />
</div><div class="p1">Vidacare is the supplier of the EZ-IO device, a type of specialized needle that injects fluids and medications into bones rather than into veins. It is particularly useful in emergency situations where vascular access is difficult or impossible to obtain. New Orleans EMS uses the EZ-IO on all of its ambulances and sprint vehicles. Is it scandalous that Dr. Saussy worked for a company that supplies devices that her other job uses? As anyone who is familiar with the purchasing procedure regarding supplies among city services, which I will not describe in its arcane detail, it becomes quickly apparent that no matter whom the products’ representative is, they have no influence on whether the city purchases the product. As far as I know, there is not another device similar to the EZ-IO, and I have personally used it to save the lives of many of the citizens of New Orleans, perhaps even some of those who are so quick to declare “scandal.”</div><div class="p2"><br />
</div><div class="p1">While receiving treatment for cancer, Dr. Saussy was donated hundreds of hours of sick leave by fellow employees. This was done under a policy approved by City Hall for city employees. If anyone has a problem with the donation of sick leave hours, I suggest they take it up with City Hall, the masterminds behind the policy. Many city employees are donated sick leave when they are out for an extended time. Does the Times-Picayune (or anyone else) have a problem with a firefighter being donated sick leave because of broken leg, or a paramedic who is out for an extended time because he contracted a disease from a patient? No? Then why is this practice a problem when Dr. Saussy utilized it? Never were any employees “coerced” or “forced” to donate sick leave, each one of us who donated did so voluntarily. Feel free to investigate the city’s email system (again) in a fruitless search for coercive correspondence. It isn’t there.</div><div class="p2"><br />
</div><div class="p1">The Times-Picayune asserts that city employees complained that Dr. Saussy “quit showing up for work,” according to the Metropolitan Crime Commission. Have they taken into consideration that the offices at “work” consist of two trailers, the same two trailers that EMS has been relegated to since Katrina, one devoted to supplies and the other occupied by the shift supervisors? Where, exactly, was Dr. Saussy supposed to report to work, given the tiny trailers at 300 Calliope, and seeing that her office is actually within City Hall? Further, must we reiterate the fact Dr. Saussy was receiving treatment for cancer? If anyone is fighting for their life, isn’t it vaguely possible that answering phone calls and emails might temporarily take a backseat to survival? If any city employees did, in fact, complain, then shame on them. I hope others show as much mercy to them when they are fighting for their lives.</div><div class="p2"><br />
</div><div class="p1">So you see, the media, specifically the Times-Picayune, has tried to create a scandal where none exists. Dr. Saussy’s salary is a matter of public record. Her outside employment got the thumbs-up from City Hall. It is impossible for her to have influenced anyone in city services to purchase the device she helped to market. And her sick leave donations were part of a policy that City Hall has had in place for years. So where is the scandal? Further, why has Mayor Landrieu and the rest of City Hall asked for her resignation for following the procedures that they, themselves, approve? </div><div class="p2"><br />
</div><div class="p1">It seems that some of the writers at the Times Picayune have a personal vendetta against Dr. Saussy. Why? We likely will never know. In addition, it is shameful that WDSU grouped Dr. Saussy in with their list of officials who have resigned since Mayor Landrieu took office, including Greg St. Etienne, Joia Perry, and the executives of the Public Belt Railway - all of whom are followed by legitimate, concrete evidence and accusations of wrongdoing.</div><div class="p2"><br />
</div><div class="p1">As you’ve no doubt gathered, I know Dr. Saussy personally. I worked for the city’s EMS system for eighteen years, from 1991 until 2009. Dr. Saussy and I have not always seen eye-to-eye, but in our occasional differences, it was nearly always me that was in the wrong. Dr. Saussy’s mission has always been straightforward: deliver the best care possible to the people of New Orleans, and never do anything to tarnish EMS’ reputation. She not only preached this, she lived it every day. </div><div class="p2"><br />
</div><div class="p1">The paramedics and EMT’s of New Orleans EMS will continue to serve the public. Under Dr. Saussy’s leadership, and by that I mean genuine leadership, she has transformed our city’s EMS into a world-class example of prehospital care. I hope you remember that when the paramedics show up for you or your family’s crisis. We will care for you in the most professional, technologically advanced way this country has to offer. But for those who rejoice at Dr. Saussy’s departure, we will be ashamed of you.</div><div class="p2"><br />
</div><div class="p1">-Sean H. Fitzmorris, EMT-Paramedic; RN</div>Unknownnoreply@blogger.com4tag:blogger.com,1999:blog-10811616.post-20853363191854001052010-09-30T06:13:00.000-07:002010-09-30T06:39:41.770-07:00Councilman Stokes Is an Explosion In An Idiot FactorySomeone on Twitter, <a href="http://twitter.com/RobRiscoe">@RobRiscoe</a>, asked my opinion on <a href="http://www.wlbt.com/Global/story.asp?S=13191657">this fiasco:</a><br />
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The incident occurred in Jackson, Mississippi and there's been considerable hullabaloo in the EMS community regarding it. Normally I don't voice my opinion on things where the answer is as clear as this situation. But since I was asked...<br />
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As you can tell by the title of this article, Councilman Stokes has proved to the world that he knows absolutely nothing about the subject on which he has chosen to pontificate in hilarious ignorance.<br />
"You got to take risks; you can't let citizens die!" In a backwards way, he is correct. The shooter and victim took their risks in whatever behavior preceded the shooting. The EMT's try not to let citizens die. But Councilman Stokes, I must ask you, had the EMT's arrived on an unsafe scene and gotten themselves shot and killed, then wouldn't there be two more citizens dead besides the first victim? We can continue this formula - then two more EMT's show up and get shot, and so on - until all the EMT's in the city are dead. You see, going into that scene and 'taking risks' might not be the best policy. As every EMT is aware, even scenes that are declared "safe" often remain very unstable and can go downhill to "extremely unsafe" in a heartbeat.<br />
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(Should we tell Councilman Stokes about what we do when <i>that</i> happens? Actually <i>leave</i> the scene?)<br />
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One of the solutions for this "problem" that Stokes has proposed is having the city go into the ambulance business themselves, rather than contracting with AMR. That's fine. No offense to AMR, but certainly few would have a problem with there actually being more ambulances in the city. Tell us, Mr. Stokes, where will you find the EMT's to staff your city ambulances? No doubt you wouldn't want those wimps from AMR to come over and work for you, with all their insistence on "scene safety" or whatever they call it.<br />
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Councilman, I have news for you. Your "problem" isn't with AMR. Every EMT in this country, to be certified as an EMT, has to go through an EMT course approved by the nation's Department of Transportation. And in <i><u>every single one</u></i> of those classes, the first lesson on day 1 is "Scene Safety." During that class, it is ingrained into the brains of every prospective EMT that <b>you do NOT go into scenes that are not safe! If the scene becomes unsafe, leave!</b> Every practical exercise that the EMT's will perform during class must include the question "Is my scene safe?" If they do not ask that question and determine scene safety, then no matter how magnificently they perform the practical exercise, they will fail. Every day from day one, scene safety will be burned into their brain.<br />
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That, Councilman Stokes, is the culture of the pool of EMT's from which you have to staff your nascent city ambulance service.<br />
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Perhaps Councilman Stokes would prefer if the class would go something like this: "Hello and welcome to EMT class. The first thing you should know is if you are called to a scene where gunshots are still going off or cars are still colliding with each other or gangs are stabbing each other all over the place, don't worry, just go right ahead in. Everything will be fine and unicorns and rainbows will sprout from your footsteps."<br />
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Really, Councilman Stokes? Would you actually <i>want</i> EMT's who were schooled to take such risks? If they are willing to "take risks" with their own personal safety, then what kind of risks will they take with the care they deliver to their patients? When you're in the back of that ambulance one day, maybe when the medic pulls out some big scary tube or needle to put into your body, will you want the EMT's to say "I've never done this procedure before, but I'm willing to take the risk!" Or maybe "You don't have to sterilize the site where you're going to stick in that needle/tube/scary device. It's a risk that he may die from a horrible infection, but we're willing to take it!"<br />
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As a casual aside, according to the news video, which I trust more than the "facts" of either Councilman Stokes' or the outraged mother-in-law of the victim, I notice that AMR is accused of taking 21 minutes to arrive at the patient. But then later in the video, the dispatch, en route, arrival and at-patient times add up to only 7 minutes and 25 seconds. This is well under the national average of 9 minutes. Did Stokes even bother to actually investigate the details of the call? Or is he just taking the word of some emotional, angry woman off the street?<br />
Councilman Stokes, you are a fucking idiot.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-10811616.post-62379957090501345012010-09-25T16:33:00.000-07:002010-09-25T16:33:52.437-07:00"Found Wanting" now available for everyone!Just wanted to announce the release of my book, "Found Wanting." If you've seen my Facebook profile, you know I've been yammering about various problems with its release. Well, finally, it's out now! It hasn't yet hit retailers like Amazon and the iPad app store, but it's available already! You can get it from the wholesale publishers (for a LOT cheaper than my original publisher!).<br />
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If you'd like the print version, a real, actual book, then click this link: <a href="http://www.lulu.com/product/paperback/found-wanting/12812792">http://www.lulu.com/product/paperback/found-wanting/12812792</a><br />
Just click Add to Cart and checkout like any purchase!<br />
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If you'd like to download "Found Wanting" to your mobile device like iPhone, iPad, Kindle, Nook, Kobo, Stanza or other device, then click this link from your mobile device: <a href="http://www.smashwords.com/books/view/25111">http://www.smashwords.com/books/view/25111</a><br />
You have to register (it's free) and select which format you want. Don't panic! Pretty much any device will read the .Epub format. If you have a Kindle, you can download the .Mobi file. You can also read a free preview of the book! Just remember to go back and purchase the full copy!<br />
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"Found Wanting" will be available via retail outlets like Amazon and the iPhone app store in 4 - 8 weeks, so get your copy now! Why wait?<br />
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Thanks to everyone, and enjoy "Found Wanting"! All the best!<br />
-SeanUnknownnoreply@blogger.com0tag:blogger.com,1999:blog-10811616.post-83193449354004549162010-07-29T07:57:00.000-07:002010-07-29T08:00:53.611-07:00ScaryI don't know what's more frightening - that "frank petta ems" was used as a search term or that "frank petta ems" was a search term for TWO different people?!<br />
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From the traffic report on this webpage via Google Analytics:<br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/_GGtAe8hrTlw/TFGW2bggb3I/AAAAAAAAAxE/MevYrJqBf40/s1600/Picture+19.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/_GGtAe8hrTlw/TFGW2bggb3I/AAAAAAAAAxE/MevYrJqBf40/s320/Picture+19.png" /></a></div>Unknownnoreply@blogger.com5tag:blogger.com,1999:blog-10811616.post-32994255683055909972010-07-21T06:33:00.000-07:002010-07-21T06:33:00.645-07:00Five years later...<br class="Apple-interchange-newline" /><br />
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><a href="http://blog.nola.com/editorials/2008/10/a_911_for_ems.html">This article</a> was written two years ago: <a href="http://blog.nola.com/editorials/2008/10/a_911_for_ems.html">http://blog.nola.com/editorials/2008/10/a_911_for_ems.html</a>. In it, EMS' plight in securing a new home following Hurricane Katrina was addressed. Back then, EMS was responding to "700 calls" a week. That number has increased greatly, yet New Orleans EMS is still operating from two trailers in a parking lot under a bridge. Employees are still dodging trash thrown from the bridge, there's nowhere near enough space for parking, supply storage or even washing the ambulances.</div><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">Now, call volume has required the purchase of additional ambulances and sprint vehicles, taking up more already scarce space, yet EMS is still relegated to their position of "trolls hiding under the bridge." There is talk of new headquarters on City Park Avenue, but little or no progress has been made toward moving there. How long will one of the city's most vital components be ignored and have to "make do," especially in view of the scads of unoccupied territory everywhere in the city? Everyone understands that New Orleans' city budget is tight, yet every firehouse and police station has been rebuilt, renovated or relocated, but the red-headed stepchild of emergency services remains barely an afterthought in the grand scheme of things.</div><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">Repost this, tweet it on Twitter, write an email or letter to your city councilperson, spread it on Facebook... whatever. Help to spread the word and get those that will help you and your loved ones in a crisis a decent headquarters.</div><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">It's a damn shame.</div>Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-10811616.post-24547860174019832912010-07-05T07:46:00.000-07:002010-07-05T07:48:00.281-07:00EMS Gets a Little Recognition - Especially "portly, balding Chris Martinez"<span class="Apple-style-span" style="color: #444e5c; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 13px;"></span><br />
<h1 style="color: #293546; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;"><i><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-weight: normal;">This makes me proud to have spent the last twenty years working with Martinez, Schlumbrecht, Frezel, Petta and ALL the medics of New Orleans EMS! It's not for just anybody...</span></span></span></i></h1><div><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"><i><br />
</i></span></div><div><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"><i>Original Article: <a href="http://www.nola.com/crime/index.ssf/2010/07/citys_ems_teams_handle_life_an.html">http://www.nola.com/crime/index.ssf/2010/07/citys_ems_teams_handle_life_an.html</a></i></span></div><h1 style="color: #293546; font-size: 17pt; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 10px; padding-left: 0px; padding-right: 0px; padding-top: 10px;">City's EMS teams handle life and death on the streets of New Orleans</h1><h5 style="color: #293546; font-size: 11px; font-weight: normal; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 5px; padding-left: 0px; padding-right: 0px; padding-top: 0px;">Published: Monday, July 05, 2010, 5:59 AM Updated: Monday, July 05, 2010, 9:19 AM</h5><div class="author_info" style="float: left; height: 40px; margin-bottom: 8px; margin-left: 0px; margin-right: 0px; margin-top: 8px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><a href="http://connect.nola.com/user/rvargas/index.html" style="color: #305cb6; cursor: pointer; font-weight: bold; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-decoration: none;"><img alt="Ramon Antonio Vargas, The Times-Picayune" height="40" original="http://media.nola.com//avatars/userpic-3597-100x100.png" src="http://media.nola.com//avatars/userpic-3597-100x100.png" style="border-bottom-width: 0px; border-color: initial; border-left-width: 0px; border-right-width: 0px; border-style: initial; border-top-width: 0px; display: inline-block; height: 40px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: middle; width: 40px;" width="40" /> </a><span style="display: inline-block; 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padding-top: 0px; vertical-align: bottom;" /><span class="photo-data" style="border-bottom-color: rgb(213, 213, 213); border-bottom-style: solid; border-bottom-width: 1px; border-left-color: rgb(213, 213, 213); border-left-style: solid; border-left-width: 1px; border-right-color: rgb(213, 213, 213); border-right-style: solid; border-right-width: 1px; border-top-color: initial; border-top-style: none; border-top-width: initial; display: block; font-size: 10px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 10px; padding-left: 5px; padding-right: 5px; padding-top: 5px;"><span class="byline" style="display: block; float: right; line-height: 1.35em; margin-bottom: 0.75em; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-align: right; width: 220px;">Michael DeMocker / The Times-Picayune</span><span class="caption" style="clear: both; display: block; line-height: 1.25em; margin-bottom: 0px; margin-left: 3px; margin-right: 3px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-align: left;">Paramedics prepare to transport Chester Reeder after he was shot in the head in Algiers on May 24, 2009.</span></span><span class="photo-bottom-left" style="background-attachment: initial; background-clip: initial; background-color: #f1f1f1; background-image: url(http://media.nola.com/design/baseline/img/corners.png); background-origin: initial; background-position: -28px -7px; background-repeat: no-repeat no-repeat; display: block; float: left; height: 7px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: -7px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; width: 7px;"></span><span class="photo-bottom-right" style="background-attachment: initial; background-clip: initial; background-color: #f1f1f1; background-image: url(http://media.nola.com/design/baseline/img/corners.png); background-origin: initial; background-position: -35px -7px; background-repeat: no-repeat no-repeat; display: block; float: right; height: 7px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: -7px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; width: 7px;"></span></span></span></div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Chris Martinez and Scott Schlumbrecht were cruising the streets in an ambulance near the Crescent City Connection.</div><div class="box_gray_gray_ol clear" id="EntryStats" style="clear: both; float: left; margin-bottom: 5px; margin-left: 0px; margin-right: 10px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; width: 380px;"><div class="box_top_left" style="background-attachment: initial; background-clip: initial; background-color: #f1f1f1; 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background-origin: initial; border-bottom-color: rgb(26, 53, 110); border-bottom-style: solid; border-bottom-width: 1px; border-top-color: rgb(135, 154, 192); border-top-style: solid; border-top-width: 1px; color: white; display: block; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-weight: bold; margin-bottom: 0px; margin-left: 17px; margin-right: 1px; margin-top: 1px; padding-bottom: 3px; padding-left: 6px; padding-right: 6px; padding-top: 2px; text-shadow: none;">Share</span></span></span></a></div><div class="clear0" style="clear: both; height: 0px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"></div></div><div class="box_bottom_left" style="background-attachment: initial; background-clip: initial; background-color: #f1f1f1; background-image: url(http://media.nola.com/design/baseline/img/corners.png); background-origin: initial; background-position: -28px -7px; background-repeat: no-repeat no-repeat; float: left; height: 7px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: -7px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; width: 7px;"></div><div class="box_bottom_right" style="background-attachment: initial; background-clip: initial; background-color: #f1f1f1; background-image: url(http://media.nola.com/design/baseline/img/corners.png); background-origin: initial; background-position: -35px -7px; background-repeat: no-repeat no-repeat; float: right; height: 7px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: -7px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; width: 7px;"></div></div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Dave Frezell and Frank Petta were standing on the porch at <a href="http://www.cityofno.com/pg-126-1-ems.aspx" style="color: #305cb6; cursor: pointer; font-weight: bold; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-decoration: none;">EMS headquarters</a> -- two trailers in a parking lot under the bridge -- when the radio emergency line crackled to life.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">"Male down, 34S." It was a shooting near the corner of Ptolemy Street and L.B. Landry Avenue in Algiers. Next came "Code 3," a life-threatening emergency. Then, the orders: Wait for police to secure the scene, but get in position.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">"Crap," Petta said. "We gotta go."<br />
<br />
Petta and Frezell hopped into separate sport utility vehicles, blared their sirens, turned right on Calliope Street and barreled toward the bridge's on-ramp. Petta quickly hit 70 mph. Some cars deftly shifted out of his path. Others were perilously slow to do so.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Schlumbrecht and Martinez, slightly ahead, drove the ambulance.<br />
<br />
Six minutes later, the rescuers approached the intersection, not knowing exactly what they might see.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Working as an emergency medical responder in New Orleans, the country's most murderous city, is not for the faint of heart. The city's paramedics are like MASH doctors in wartime. Sometimes their patients suffer a heart attack or a stroke. But far too often, paramedics are rolling out on a shooting or stabbing, where the victim's chances of making it depend on how well the EMS team does its job. It's a hugely stressful line of work, and one that brings with it constant reminders of man's capacity for cruelty.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;"><b style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;">'Save him, y'all'</b></div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">The four medics sailed through a mob of people drawn from a nearby second-line parade to the crime scene by the gunshots, flashing lights, and yellow crime scene tape put up by police officers.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Frezell and Petta put on latex gloves and fetched equipment from their trunks. Martinez and Schlumbrecht grabbed a stretcher and spine board from the ambulance.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">The victim, in a white T-shirt and blue jeans, lay unconscious, face-up atop a rusty storm drain. He had been shot once in the head. Blood covered his face. It mixed and clumped in with dry grass in his dreadlocks.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">The paramedics rushed out with the spine board, the stretcher and an electric heart monitor. A crowd of spectators in quiet conversation watched them. Police officers implored them to back up. One woman, her voice shaky, called out, "Save him, y'all."</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Martinez jogged to the man's feet. He pulled a pair of scissors from a belt holster and snipped off the victim's jeans and T-shirt. Martinez spared the man's boxers because hundreds of strangers surrounded him. He ran his eyes down the man's legs, torso and arms but saw no wounds apart from the gunshot wound to his head.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">The man's toned stomach rose and fell slowly. Frezell pressed his fingertips on the man's wrists. "He has a pulse," he said.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">The man was alive, but he had lost a lot of blood. His breathing was slowing. They had to hurry. If he was to live through the next hour or two, the four paramedics needed to carry out a frantic but crucial process in less than 10 minutes to stabilize him. Then, they had to whisk him to an emergency room six miles away.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">"Let's load him and go," Martinez said.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Petta ran to the ambulance to prepare a thin breathing tube. Frezell strapped on a dark blue brace that immobilized the man's spine. Schlumbrecht grabbed the man's side and gingerly rolled him to the left. Frezell and Martinez checked his back for bullet holes but found none.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">All three slid the spine board under the man and gently rested him on it. They snapped the yellow board onto the stretcher and wheeled it under the tape, past the growing crowd.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">A bright red bubble suddenly emerged from the man's mouth and popped. Blood sprayed onto his closed eyelids.<br />
<br />
A woman watching gasped. She said, "Oh Lord, he's dead."</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">The man's arms dangled. His head lolled to the left. Blood pooled in his right ear.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">A trembling voice called out to the rescuers once more: "Save him, y'all."</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;"><b style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;">Frantic, yet controlled, activity</b></div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Martinez -- portly, his dark head of hair balding -- placed a plastic shield over his own face when he boarded the ambulance bay, occupied already by his three colleagues and the stretcher.</div><div class="entry_widget_large entry_widget_right" style="float: right; margin-bottom: 0px; margin-left: 20px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; width: 380px !important;"><span class="mt-enclosure mt-enclosure-photo" style="display: inline; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="adv-photo-large" style="background-attachment: initial; background-clip: initial; background-color: #f1f1f1; background-image: initial; background-origin: initial; display: block; height: 564px; margin-bottom: 15px; margin-left: 0px; margin-right: 0px; margin-top: 5px; max-width: 380px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><img alt="ems-chester-reeder.JPG" class="adv-photo" original="http://media.nola.com/crime_impact/photo/ems-chester-reederjpg-b1f923bfb3cfd8e5_large.jpg" src="http://media.nola.com/crime_impact/photo/ems-chester-reederjpg-b1f923bfb3cfd8e5_large.jpg" style="border-bottom-style: none; border-bottom-width: 0px; border-color: initial; border-color: initial; border-left-style: none; border-left-width: 0px; border-right-style: none; border-right-width: 0px; border-style: initial; border-top-style: none; border-top-width: 0px; border-width: initial; display: block; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; max-width: 380px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; vertical-align: bottom;" /><span class="photo-data" style="border-bottom-color: rgb(213, 213, 213); border-bottom-style: solid; border-bottom-width: 1px; border-left-color: rgb(213, 213, 213); border-left-style: solid; border-left-width: 1px; border-right-color: rgb(213, 213, 213); border-right-style: solid; border-right-width: 1px; border-top-color: initial; border-top-style: none; border-top-width: initial; display: block; font-size: 10px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 10px; padding-left: 5px; padding-right: 5px; padding-top: 5px;"><span class="caption" style="clear: both; display: block; line-height: 1.25em; margin-bottom: 0px; margin-left: 3px; margin-right: 3px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-align: left;">Paramedics work on Chester Reeder, who was shot in the head after a second line in Algiers on May 24, 2009. They stabilized Reeder and rushed him to a hospital, but he died two days later.</span></span><span class="photo-bottom-left" style="background-attachment: initial; background-clip: initial; background-color: #f1f1f1; background-image: url(http://media.nola.com/design/baseline/img/corners.png); background-origin: initial; background-position: -28px -7px; background-repeat: no-repeat no-repeat; display: block; float: left; height: 7px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: -7px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; width: 7px;"></span><span class="photo-bottom-right" style="background-attachment: initial; background-clip: initial; background-color: #f1f1f1; background-image: url(http://media.nola.com/design/baseline/img/corners.png); background-origin: initial; background-position: -35px -7px; background-repeat: no-repeat no-repeat; display: block; float: right; height: 7px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: -7px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; width: 7px;"></span></span></span></div><div class="entry_widget_right" style="float: right; margin-bottom: 0px; margin-left: 20px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; width: 380px;"><div class="box_gray_gray_ol" style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><div class="box_top_left" style="background-attachment: initial; background-clip: initial; background-color: #f1f1f1; background-image: url(http://media.nola.com/design/baseline/img/corners.png); background-origin: initial; background-position: -28px 0px; background-repeat: no-repeat no-repeat; float: left; height: 7px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; width: 7px;"></div><div class="box_top_right" style="background-attachment: initial; background-clip: initial; background-color: #f1f1f1; background-image: url(http://media.nola.com/design/baseline/img/corners.png); background-origin: initial; background-position: -35px 0px; background-repeat: no-repeat no-repeat; float: right; height: 7px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; width: 7px;"></div><div class="box_content linkbox" style="background-color: #f1f1f1; border-bottom-color: rgb(213, 213, 213); border-bottom-style: solid; border-bottom-width: 1px; border-left-color: rgb(213, 213, 213); border-left-style: solid; border-left-width: 1px; border-right-color: rgb(213, 213, 213); border-right-style: solid; border-right-width: 1px; border-top-color: rgb(213, 213, 213); border-top-style: solid; border-top-width: 1px; font-size: 11px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 10px; padding-left: 10px; padding-right: 10px; padding-top: 10px;"><h4 style="color: #293546; font-size: 10pt; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 5px; padding-left: 0px; padding-right: 0px; padding-top: 0px;">Related stories</h4><ul style="line-height: 1.5em; list-style-position: inside; list-style-type: disc; margin-bottom: 15px; margin-left: 15px; margin-right: 0px; margin-top: 15px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><li style="line-height: 1.3em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 3px; padding-left: 0px; padding-right: 0px; padding-top: 3px;"><a href="http://www.nola.com/crime/index.ssf/2010/07/familys_hospital_vigil_gave_th.html" style="color: #305cb6; cursor: pointer; font-weight: bold; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-decoration: none;">Work of EMS team gives one family time to say goodbye</a></li>
</ul></div><div class="box_bottom_left" style="background-attachment: initial; background-clip: initial; background-color: #f1f1f1; background-image: url(http://media.nola.com/design/baseline/img/corners.png); background-origin: initial; background-position: -28px -7px; background-repeat: no-repeat no-repeat; float: left; height: 7px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: -7px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; width: 7px;"></div><div class="box_bottom_right" style="background-attachment: initial; background-clip: initial; background-color: #f1f1f1; background-image: url(http://media.nola.com/design/baseline/img/corners.png); background-origin: initial; background-position: -35px -7px; background-repeat: no-repeat no-repeat; float: right; height: 7px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: -7px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; width: 7px;"></div></div></div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">He shut the door behind him. The murmur of the crowd disappeared. It was replaced with the ripping of plastic and paper equipment wrappers.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">The smells outside -- barbecue, beer and grass -- gave way to the smells of sweat, rubbing alcohol and latex.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Martinez kneeled at the wounded man's head and prepared to slide the breathing tube into his trachea. But blood in the man's mouth choked him and blocked Martinez's view.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Martinez reached for a catheter and suctioned out some blood. He tried sliding the breathing tube in again but the man gagged, nearly vomiting into Martinez's mask.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">"He's still choking on his blood," Schlumbrecht offered.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Martinez pressed a stethoscope against the man's chest. "I know. It's all up in there," he said. He reached for the catheter and suctioned out more blood.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Schlumbrecht placed the heart monitor's leads on the victim's left bicep and right pectoral muscle. They registered a beat. As the monitor emitted an unnerving beep every three seconds, the man's stomach rose and fell, rose and fell.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Frezell sat on a bench seat to the right of the stretcher. Martinez's suction hose, wine red, wrapped around his right arm and across his chest like a bandolier.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Not bothered, Frezell wound a band tightly around the man's right upper bicep. A vein bulged. He slid a needle and catheter in and removed the needle. He then started an intravenous saline drip -- to compensate for the blood the victim had spilled on the street -- and secured it with adhesive tape.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Petta mirrored Frezell's actions across the stretcher. When they were done, they peeled off their bloodstained gloves and ducked under the bevy of tubes to the side door and out of the cramped quarters.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Back in the bay, Martinez slid the breathing tube in. The patient's stomach jutted out abruptly, and he gagged. But Martinez didn't remove the tube. He slowly slid it further down. The patient didn't resist, and Martinez announced, "Good. We're good."</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Schlumbrecht jumped out of the back doors and hopped into the driver's seat. Martinez attached the breathing tube's tip to a bag connected to a pump. He handed it to a New Orleans firefighter who had climbed aboard to provide help.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">"Hold on to this. Just squeeze the pump for me every few seconds," Martinez instructed. He flipped a wall switch. Air whooshed through the tube.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">"Scotty, we can go! Let's go!" Martinez shouted.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Schlumbrecht backed out. Martinez radioed doctors at Interim LSU Public Hospital to brief them about the new patient.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Seven minutes after the ambulance arrived at the scene, it was headed to the emergency room.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;"><b style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;">'Damn. That's the guy I worked on'</b></div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Five days later, Martinez, 44, threw a copy of the newspaper onto his kitchen table. After pouring himself his morning cup of coffee, he sat down and perused the headlines.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">"Man dies two days after being shot" grabbed his attention. A paragraph detailing the location of the shooting then jumped out: the corner of L.B. Landry and Ptolemy, near a second-line parade on May 24, 2009.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">"Damn," Martinez muttered. "That's the guy I worked on."</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Unless paramedics specifically ask emergency room staff about patients they care for, they rarely learn their fate. They often don't even catch the name of the victim or his exact age during the frantic race to the emergency room, unless they handle the paperwork.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Martinez and Petta had worked to save three shooting victims, two of them 15 and one 18, the night before they worked on the 25-year-old on Ptolemy Street. Martinez didn't know any of their names.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">The weekend before that, Martinez tried to help two shooting victims: Devin Goines, 23, at the corner of North Broad and Duels streets, and Qian R. Sabatier, 26, at a bar in the 8500 block of Hickory Street. Both died.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Typically, if patients' names and ages don't make the news, it means they survived. The New Orleans Police Department doesn't release the names of shooting survivors, and the coroner's office can identify only homicide victims.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Martinez read on. The young man he tried to save was Chester Reeder III, who made a living in Houston but was in town briefly to visit his mom and kid sister for the Memorial Day holiday. He died at 6:29 p.m. two days after the shooting.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">"Two days," Martinez thought. "At least his friends and family had two days."</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">He folded the newspaper and set it aside. He wished he hadn't read it.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;"><b style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;">A nightmarish scene</b></div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Longtime paramedics say those who can shake the images of shattered skulls and bloody bodies -- and suppress their revulsion at the culture of violence that feeds the carnage -- have the best chance at a career in New Orleans EMS.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Those who are haunted by what they see, or who turn to alcohol or drugs to dull the pain, don't last.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Martinez doesn't talk much about his job. At family gatherings, his relatives can't stomach the few stories he does share.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">"I don't want to hear no more," they often say, almost immediately after he begins one.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Generally, he just tries not to think about work during his free time. If he did, he'd go crazy.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">He was called out in March, for instance, to one of the most gruesome crime scenes in memory -- an Upper 9th Ward home where a 25-year-old mother and her 7-year-old daughter, 4-year-old son and 17-year-old sister had been fatally shot, allegedly by a relative.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">There was little for Martinez to do but connect the leads of a heart monitor to their corpses and watch as a doctor pronounced them dead.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">As he drove away from the nightmarish scene, he was troubled. "Even animals don't do s--t like this," he thought.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">But he said he was able to "let it go" by the end of his shift.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">"Seeing those kids shot was horrendous," said Martinez, a paramedic for 18 years. "But I can't spend time trying to make sense of it. ... I couldn't do this job otherwise. No one could."</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">In a career where he routinely works on the victims of suicide, shootings and car accidents, he has never seen a trauma counselor.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">"It must be something that's built into you," Martinez shrugs. He knows some may be confounded by his seeming ability to erase human tragedies from his thoughts. It puzzles even him.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">When his grandparents died in 2008 and 2009, Martinez could not cry. He was sad, even depressed. But he simply could not cry.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Several weeks later, Martinez's husky, Sheba, died from a seizure.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">The hardened paramedic sobbed for days. He couldn't explain it, even to himself.</div><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">"I guess animals, especially dogs, have unconditional love," Martinez said. "That's hard to find in human beings."</div><em style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"></em><br />
<em style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"></em><br />
<em style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><div style="line-height: 1.55em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 17px; padding-left: 0px; padding-right: 0px; padding-top: 3px;">Ramon Antonio Vargas can be reached at <a href="mailto:rvargas@timespicayune.com" style="color: #305cb6; cursor: pointer; font-weight: bold; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-decoration: none;">rvargas@timespicayune.com</a> or 504.826.3371.</div></em>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-10811616.post-82263270819128081972010-06-18T14:29:00.000-07:002010-06-18T14:29:24.254-07:00Muddying The Waters of C-Spine Stabilization Even MoreFrom EMS1: <br />
<br />
Link to the <a href="http://www.ems1.com/medical-clinical/articles/831555-Prove-it-Extrication-collars-create-internal-decapitation/">original article</a>.<br />
<br />
<b>Prove It: Extrication Collars Cause Internal Decapitation</b><br />
<br />
By Kenny Navarro<br />
<br />
Highlights:<br />
The Scenario<br />
The Review<br />
What It Means for You<br />
<br />
The Scenario <br />
Medic 3 responds with the fire department to a reported motor-vehicle collision at a busy intersection. Two patients are present on the scene; both were front seat passengers in a car versus telephone pole collision. The seat-belted driver is walking around, has no complaints, and no evidence of traumatic injury. The second patient was not wearing his seat belt at the time of the impact and is sitting in the vehicle.<br />
<br />
Inspection of the vehicle reveals a broken area in the windshield that approximates the shape and size of the patient’s head. The patient is a male, age 42, who is conscious and alert with multiple lacerations on the forehead. Bleeding appears controlled. The patient denies loss of consciousness, complains of mild neck pain, but is able to move all extremities. The remainder of the physical exam is unremarkable.<br />
<br />
One of the firefighters enters the back seat of the vehicle and maintains the patient’s head in a neutral position with manual in-line stabilization. The paramedic measures and selects an appropriately sized extrication collar and applies it to the patient’s neck. The rescue team successfully removes the patient from the vehicle, secures him to a long backboard, and places him in the ambulance.<br />
<br />
The patient remains conscious and alert with a Glasgow Coma Score of 15. The patient’s blood pressure is 130/86 mmHg, the pulse is 90 bpm, and the respiratory rate is 14 bpm. The head-to-toe exam is unremarkable for trauma except for the lacerations to the forehead. En route to the hospital, the patient begins complaining of a tingling sensation in the arms and legs and increased discomfort in the neck.<br />
<br />
Emergency department X-rays do not discover evidence of cervical fractures, although the patient continues to have worsening paresthesia. Magnetic resonance imaging (MRI) reveals significant disruption of the upper cervical ligaments and an atlanto-occipital distraction.<br />
<br />
Back at the station, the medics wonder if application of the extrication collar may have made the situation worse, since the tingling only began after spinal motion restrictions occurred. The shift duty officer assures them that they performed exactly as protocol dictated and that without the collar, the injury could have been much worse.<br />
<br />
The Review<br />
Article: Ben-Galim, P., Dreiangel, N., Mattox, K. L., Reitman, C. A., Kalantar, S. B., & Hipp, J. A. (2010). Extrication collars can result in abnormal separation between vertebrae in the presence of a dissociative injury. The Journal of Trauma Injury, Infection, and Critical Care, [Epub ahead of print].<br />
<br />
Using fresh whole human cadavers, investigators from the Spine Research Laboratory at the Baylor College of Medicine in Houston examined the effects that spinal motion restriction devices have on a destabilized cervical spine (Ben-Galim, Dreiangel, Mattox, Reitman, Kalantar, & Hipp, 2010).<br />
<br />
None of the cadavers had previous cervical spine injuries or abnormalities. The research team placed the cadavers in a refrigerated state until the effects of rigor mortis subsided and then warmed the specimens to room temperature. Previous investigations demonstrated a high correlation in vertebral movement between room temperature whole cadavers and asymptomatic live humans (Brown, Reitman, Nguyen, & Hipp, 2005; Subramanian, Reitman, Nguyen, & Hipp, 2007).<br />
<br />
In this study, researchers focused on the first and second cervical vertebrae. The first cervical vertebra (C1, otherwise known as the atlas) forms a ring of bone upon which the skull (more specifically, the occiput) rests (Marieb, 1989).<br />
<br />
The atlas rests on the axis, which is the second cervical vertebra (C2). A small bony protuberance called the odontoid extends from the body of the axis into the opening of the atlas alongside the spinal cord. Under normal conditions, connecting ligaments and other tissues limit movement of these vertebrae.<br />
<br />
However, damage to those ligaments, as might occur during traumatic injury, permits abnormal movement or allows the skull to separate from the spinal column, a condition known as internal decapitation (Brown, Reitman, Nguyen, & Hipp, 2005). Most patients who suffer this type of dissociative injury die almost instantaneously (Bucholz & Burkhead, 1979), although the literature describes dozens of survivors (Anderson, Towns, & Chiverton, 2006).<br />
<br />
Two previous investigations of fatal atlanto-occipital injuries describe complete disruptions of the supporting ligaments, with and without associated fractures (Bucholz & Burkhead, 1979) (Ben-Galim, Sibai, Hipp, Heggeness, & Reitman, 2008).<br />
<br />
For this investigation, the researchers replicated this type of upper cervical spine injury by leaving the muscles intact but surgically transecting the supporting ligaments. In addition, the team fractured the odontoid at its base.<br />
<br />
Using a standard EMS spinal immobilization protocol that included manual stabilization, the team applied a commercially available and properly sized extrication collar. Researchers obtained before-collar and after-collar fluoroscopic images in the first four cadavers. The five remaining cadavers received before and after computed tomography (CT) scans. Researchers then measured the degree of distraction or separation between C1 and C2.<br />
<br />
In every cadaver, proper application of an extrication collar resulted in abnormal separation between these two vertebrae. The mean of the average distance was 7.3 mm with a standard deviation of 4.0 mm. In effect, application of an extrication collar in these cadavers resulted in separation of the head from the spinal column.<br />
<br />
What It Means for You <br />
There are approximately 12,000 new cases of spinal cord injury in the United States every year (National Spinal Cord Injury Statistical Center, 2010). The most common cause is motor-vehicle collisions, which account for almost half of the injuries. Patients who survive often face devastating physical immobility and a lifetime of related health issues.<br />
<br />
Since the birth of the modern emergency medical service system, training programs stressed the need for proper application of cervical collars to safeguard against the possibility of further damage during movement to the hospital.<br />
<br />
This direction is in spite of the absence of proven benefit from spinal immobilization (Domeier, Frederiksen, & Welch, K. 2005). Quite to the contrary, researchers have demonstrated that rigid spinal immobilization procedures can result in tissue necrosis (Cordel, Hollinsworth, Olinger, Stroman, & Nelson, 1995), increased intracranial pressure (Dunham, Brocker, Collier, & Gemme, 2008), reduced pulmonary function (Bauer & Kowalski, 1988), and even death (Papadopoulos, Chakraborty, Waldron, & Bell, 1999).<br />
<br />
Although the results of this study add to the collective knowledge about the harm that cervical collars can create, one must be careful about making false assumptions about the results.<br />
<br />
Extrapolating the results from an investigation involving specific research conditions to a much larger population involves a concept known as generalizability. Some conclusions are easily generalizable across a broad spectrum of conditions while others are not.<br />
<br />
For example, suppose an observer (or researcher) watched cars travelling on a road for a period of a month. At the end of the study period, the observer saw 5000 people driving on the right-hand side of the road. The observer might conclude drivers operate their vehicles in that right hand lane.<br />
<br />
However, those results are not generalizable to all drivers everywhere. We are all aware that drivers in some other countries operate their vehicles on the left side of the roadway.<br />
<br />
The cervical collar study examined only one specific type of injury, namely atlanto-occipital dissociative injuries. In the general population, these injuries are rare and almost uniformly fatal at the moment of impact (Cooper, Gross, Lacey, Traven, Mirza, & Arbabi, 2010).<br />
<br />
Motor vehicle collisions and falls can produce many other types of cervical injuries. No convincing data demonstrates similar degrees of distraction in other cervical injuries as the result of rigid extrication collar application.<br />
<br />
Therefore, one cannot reliably conclude that application of cervical collars will produce dangerous spinal cord stretching in ALL patients with cervical injuries.<br />
<br />
Another limitation that also addresses the issue of generalizability is in this study’s use of cadavers. Cadavers lack muscle tone. Normal muscle tone provides a considerable degree of stabilization in upper cervical spine injuries (Ben-Galim, Sibai, Hipp, Heggeness, & Reitman, 2008).<br />
<br />
It is possible that this inherent stabilization limits the separation between C1 and C2 in conscious patients with this type of dissociation injury including those with extrication collars applied. However, it is reasonable to assume that the lack of muscle tone in cadavers mimics the reduced tone found in patients rendered unconscious from the trauma or from subsequent rapid sequence induction procedures.<br />
<br />
Although the International Trauma Life Support guidelines warn against the prehospital application of in-line traction during stabilization procedures (Augustine, 2008), field application of cervical collars appears to produce distraction or stretching of the spinal column in some patients.<br />
<br />
While this study does not mean that EMS should abandon the use of cervical collars, it does suggest the need for a reevaluation of the risks and benefits of the currently accepted practices for cervical spinal immobilization.<br />
<br />
Medical directors must ensure that field providers utilize proper restraining techniques, including choosing appropriately sized collars. In addition to the dangerous distraction for some patients with normal use, cervical collars that are too large for the patient or those strapped too tightly around the neck may worsen distraction by pushing the head even farther away from the trunk (Ben-Galim, Sibai, Hipp, Heggeness, & Reitman, 2008).<br />
<br />
Perhaps future research will lead to an evidence-based redesign of cervical collars or the realization that collars are no more effective than rolled-up blankets used decades ago. <br />
<br />
References<br />
Anderson, A. J., Towns, G. M., & Chiverton, N. (2006). Traumatic occipitocervical disruption: a new technique for stabilisation. Case report and literature review. Journal of Bone and Joint Surgery British Volume, 88, 1464-1468.<br />
<br />
Augustine, J. J. (2008). Spinal trauma. In J. E. Campbell (Ed.), International trauma life support for prehospital care providers (6th ed., pp. 161-182). Upper Saddle River, NJ: Pearson Education.<br />
<br />
Bauer, D. & Kowalski, R. (1988). Effect of spine immobilization devices on pulmonary function in the healthy nonsmoking man. Annals of Emergency Medicine, 17, 915-918.<br />
<br />
Ben-Galim, P., Dreiangel, N., Mattox, K. L., Reitman, C. A., Kalantar, S. B., & Hipp, J. A. (2010). Extrication collars can result in abnormal separation between vertebrae in the presence of a dissociative injury. The Journal of Trauma Injury, Infection, and Critical Care, [Epub ahead of print]. <br />
Ben-Galim, P. J., Sibai, T. A., Hipp, J. A., Heggeness, M. H., & Reitman, C. A. (2008). Internal decapitation: survival after head to neck dissociation injuries. Spine, 33, 1744-1749.<br />
<br />
Brown, T., Reitman, C. A., Nguyen, L., & Hipp, J. A. (2005). Intervertebral motion after incremental damage to the posterior structures of the cervical spine. Spine, 30, E503–E508.<br />
<br />
Bucholz, R. W. & Burkhead, W. Z. (1979). The pathological anatomy of fatal atlantooccipital dislocations. Journal of Bone and Joint Surgery, 61, 248-250.<br />
<br />
Cooper, Z., Gross, J. A., Lacey, M., Traven, N., Mirza, S. K., & Arbabi, S. (2010). Identifying survivors with traumatic craniocervical dissociation: A retrospective study. Journal of Surgical Research, 160, 3-8.<br />
<br />
Cordel, W. H., Hollinsworth, J. C., Olinger, M. L., Stroman, S. J., & Nelson, D. R. (1995). Pain and tissue-interface pressures during spine-board immobilization. Annals of Emergency Medicine, 26, 31-36.<br />
<br />
Domeier, R. M., Frederiksen, S. M., & Welch, K. (2005). Prospective performance assessment of an out-of-hospital protocol for selective spine immobilization using clinical spine clearance criteria. Annals of Emergency Medicine, 46, 123-131.<br />
<br />
Dunham, C. M., Brocker, B. P., Collier, B. D., & Gemme, D. J. (2008). Risks associated with magnetic resonance imaging and cervical collar in comatose, blunt trauma patients with negative comprehensive cervical spine computed tomography and no apparent spinal deficit, Critical Care, 12. Retrieved May 17, 2010, from, http://ccforum.com/content/12/4/R89<br />
<br />
Marieb, E. N. (1989). Human Anatomy and Physiology. Redwood City, CA: Benjamin/Cummings.<br />
<br />
National Spinal Cord Injury Statistical Center. (2010). Spinal cord injury facts and figures at a glance. Retrieved May 16, 2010, from www.nscisc.uab.edu/public_content/pdf/Facts%20and%20Figures%20at%20a%20Glance%202010.pdf.<br />
<br />
Papadopoulos, M. C., Chakraborty, A., Waldron, G., & Bell, B. A. (1999). Exacerbating cervical spine injury by applying a hard collar. British Medical Journal, 319, 171-172.<br />
<br />
Subramanian, N., Reitman, C. A., Nguyen, L., & Hipp, J. A. (2007). Radiographic assessment and quantitative motion analysis of the cervical spine after serial sectioning of the anterior ligamentous structures. Spine, 32, 518-526.<br />
<br />
The author has no financial interest, arrangement, or direct affiliation with any corporation that has a direct interest in the subject matter of this presentation, including manufacturer(s) of any products or provider(s) of services mentioned.<br />
<br />
Link to the original post.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-10811616.post-61858618228982099942010-06-11T09:57:00.000-07:002010-06-11T19:19:35.309-07:00PartnersPartners<br /><br />In an ambulance, you spent a good portion of your life with your partner. In my service, I would spend 12 hours a day in the ambulance with the same person, for 7 out of 14 days. That’s 25% of my life. Being a partner in an ambulance is, in some ways, a closer relationship than marriage. My wife would work days and I usually worked nights. We would see each other for a few minutes in the morning, when I was getting home and she was leaving for work, and then a few more minutes at night, when the reverse was happening. But at work, I’d say hello to my partner and then spend 12 continuous, unbroken hours with him or her, talking with them, listening to each other’s music, smelling their food and seeing their face. With my partner, we would respond to crises throughout our entire shift. Our exasperation with stupidity would peak simultaneously, our adrenaline would flow together during life-or-death emergencies, our boredom at times would cascade into a common pool of ennui. You eventually get to know your partner’s quirks and pet peeves; you not only know, but understand what drives them; you even become personally acquainted with details you’d never imagine you’d know of another person, like what their farts smell like. The old saying goes “an experience shared is twice as sweet.” When you’re sharing those experiences in an ambulance responding to medical emergencies day in and day out, it has an effect more powerful as a shared experience than any sunset, dessert, wedding or vacation spot could ever hope to have. And unless your spouse, family or significant other is also in EMS (God help you if they are) EMS partners may well rank as of the most unintentionally intimate relationships human society has ever created.<br /><br />Therefore, it behooves me to describe your partner. If you have been in EMS for years, no doubt you will recognize some of, if not all, the partners you have had. If you are new to the field, here’s an idea of what to expect in your nascent career.<br /><br /><span style="font-weight:bold;">"The Great Partner”</span><br /><br />This is the person whom you should never expect to be paired with. In the extremely unlikely circumstance that you are, you will quickly come to appreciate this individual. He or she will have far more than a passing knowledge of EMS. You will be impressed with their knowledge of the profession and the care they deliver to your patients. You will be able to handle a complicated scene with them and know exactly what you and they need you to do and barely speak a word about it to each other. He or she will drive the ambulance carefully, not throwing you around the back of the truck. Alternately, he or she will thank you for a good ride when it was your turn to drive. You will both happily agree on the same place to get lunch. Your relationship will make it a pleasure to come to work, you’ll look forward to your time together and take mental notes of each others’ medical techniques. If something needs to be done and you can’t handle it all yourself, like triaging a multiple-casualty scene or calling in a report to the ER while you’re busy doing CPR, you will confidently delegate that task to your partner and you will not have to worry about them fucking it up. You will enjoy each others’ company even outside of work and be friends with their family. Once administration gets wind of how well you get along with your partner, you will immediately be split up... at which point you will find yourself with one of the following.<br /><br /><b>"The Talker”</b><br /><br />This person will never stop talking. When you come to work and hope for an easy shift, the patients may be compliant with your wishes, but your Talker partner will continue to prattle on about their latest argument with their spouse, their patient they had last week who had a hangnail, their credit card bill, their kids, their trip to Cleveland, their mother, their child, their burger on a soggy bun from the drive-thru last week, their hairdo, their review of some movie you’ve never heard of and what they saw on TV last night. You will fall asleep at some point during your shift and when you wake up, your partner will still be yammering on uninterrupted, oblivious to your absence during your nap. You will be delayed from taking the next call because you had to go find your partner who was busy telling the emergency room doctor about the condition of someone’s clothes on an emergency run they handled last year.<br /><br />If you’re not partnered with the Talker, you may find yourself with...<br /><br /><b>“The Chick That Thinks They’re Hot”</b><br /><br />This will be a female, obviously. She is at best a mediocre EMT. She might be able to adequately apply a cervical collar and long spineboard, maybe even a bandage. But when you ask her why she thought it was necessary to spineboard the atraumatic grandfather with chest pains, she will thrust out her boobs at you, then make a quick turn on her heels so you can get a view of her glorious ass as she goes to make up the stretcher, or herself. Any coherent answer when asked about her erratic actions on the scene will not be forthcoming. Years after being at your EMS service, she will still not be able to adequately explain the mechanics behind CPR, she will still interpret a 12-lead EKG exactly as the EKG machine interprets it, and will she be not able start an IV under the best of circumstances. But... she will... um.... uh.... Dude! Check out those tits!<br /><br /><b>"The Paragod"</b><br /><br />A close relative of the Chick That Thinks She’s Hot, the Paragod can be a male or female and has been everywhere, seen everything and knows everything there is to know about EMS. Even though he or she is known for jumping in the driver’s seat despite it being their turn to take the patient, the Paragod will insist that whatever their actions were on scene were the best possible actions to take, even if they deliberately stabbed the patient in the eyeball with an IV needle. This partner has responded to every possible permutation of anything that could ever go wrong with a human body, and the Paragod will fabricate a story to back up their claims. The Paragod responded to the World Trade Center on 9/11 and saved every survivor; they personally, physically carried the President of the United States to their ambulance when he was injured or unconscious; they wrote the medical protocols that some country with nuclear weapons uses in their EMS services. If you question the Paragod on why he licks sterile equipment prior to inserting it into a patient’s body, he will sneer down his nose at you, point to his advanced-level patch on his uniform, and say, “When you get one of these, then you can ask about why I do something.” The Paragod will be recognized when you find yourself daydreaming of actual plans to assassinate your partner.<br /><br /><b>“The Eternal Newbie”</b><br /><br />This poor soul will have been at your service for twenty years, but every day will be their first day on the job. You will marvel that in twenty years, he or she will still not have picked up on the proper way to apply a nasal cannula, or splint a fracture, or read a map, or figure out the best way to get to the hospital. You can play dumb and offer your partner helpful advice, even though he or she far outranks you in seniority, to which he will reply “Oh yeah, I knew that! I must’ve had a brain fart.” This will be the same response he offers even if you call him out twenty times a day. Alternately, you can become insanely angry at their idiocy, jump and scream and insult them, to which your partner will give you a doe-eyed look that says ‘I have no idea what you’re talking about.’ Defeated, you will curl up into a metaphorical fetal-position (if not a literal fetal-position) and wonder how your partner ever passed his EMT exams, let alone made it through twenty years at the same EMS service.<br /><br /><b>“The Actual Newbie” (AKA “Ricky Rescue”)</b><br /><br />Sooner of later, you will be partnered with the “new guy.” He or she will be fresh-faced and eager to save the world. Your partner will shout with joy when he turns on the lights and sirens. This eager beaver will lie on the radio, saying that your crew is miles closer to a “good call” than the crew that was actually dispatched. Ricky Rescue will shout driving instruction over the PA system to cars in front of your ambulance. He will become sullen and morose during slow periods between calls. He will become sullen, morose and angry when your emergency call is not some horrible trauma scene, such as when the gunshot call you were dispatched to actually turns out to be a little old lady with arthritis in her feet. He will drive 120 miles per hour to get to a motor vehicle accident, probably causing a few more accidents along the way. He will want to perform every procedure that an EMT can possibly perform, but will balk when you ask him to write the report. If it is Ricky’s turn to make up the stretcher and clean the back of the truck after a call, it will not be done. You will recognize the Actual Newbie/Ricky Rescue because he will show up to work on his first day wearing every possible accoutrement ever made with the label “Tactical,” including tactical flashlight, tactical knife, tactical boots, tactical window punch, tactical trauma shears, tactical baseball cap and tactical underwear.<br /><br /><b>“Crispy”</b><br /><br />The Crispy partner will most likely be your first partner, a paramedic that was burnt-out since before you could spell “EMS.”. He or she will find no joy in his job and will do his or her best to bring you down into his or her bitterness. Every call will be a horrible waste of time to your partner, no matter how dire the circumstances were that caused EMS to be summoned, and no matter how significant a difference you make in the patient’s life and existence. Any call, no matter how serious or trivial, will be met with an angry “harrumph.” Be prepared for objects to be thrown around the cab of the ambulance when dispatch assigns you a call. Be prepared to slink away silently when the Emergency Department staff questions your partner about any of his actions or non-actions while transporting a patient, because your Crispy partner will launch into a frustrated diatribe describing the need or lack of need for whatever it was the staff was asking about. You will recognize Crispy as you approach his ambulance; there will be cracks in the windshield on his side of the ambulance from clipboards or computers hurled viciously onto the dashboard during his bouts of anger over getting assigned a call. One point to remember (to your advantage or disadvantage): in his eyes, YOU are the Newbie/Rickie Rescue, no matter how long you’ve been at your service.<br /><br /><b>“The Family Guy”</b><br /><br />This person will wear out the battery of their cell phone several times a day. They will be on the phone all throughout your shift together as they talk about “family issues.” You will hear your partner’s side of the conversation all day as they argue with their spouse, discipline their children, fight with the cable guy doing work at the house, chat with various contractors regarding the lowest bid for work to be done on the house, whine to their lawyer about paying child support and during slow times at work, you partner will describe in nauseating detail all the goings-on in his or her family dynamic. After a week or two with the Family Guy, you will know all about their spouse and children in ways you don’t know your own spouse and children.<br /><br /><b>“The Walking Crisis”</b><br /><br />The Walking Crisis never has a good day. Every day, no matter how benign the calls are, will be “the worst day ever.” The patients might have a minimum of problems, be extraordinarily cooperative with your partner and yourself, and thank you profusely for your service, maybe even offer you some food or drink, yet your partner will find something wrong with the call. “Oh my God, that was awful!” you partner will exclaim after every EMS run. If you enquire why they found the call so stressful, they will respond by elucidating some vague, unlikely, unobservable possibility, the repercussion of which invariably result in their suspension, firing, revocation of their certification and possibly jail time. Often the Walking Crisis will overlap with the Family Guy, as their “horrendous” job description spills over into their home life. Your partner will spend their time between EMS calls talking on the phone with family members about worst-case outcomes in whatever circumstances their family is in. “Junior got an A in math? Jesus Christ, I thought he wanted to be an artist! This will never work out!” your partner will say.<br /><br /><b>“The Slut”</b><br /><br />The Slut will be recognized the first week of orientation. The Slut can be male or female. By the end of the first week, the Slut will have had sex with at least one fellow employee, often that employee will be his or her field training officer. If the Slut is a female, after six months of her employment, most of the male employees will obliquely refer to her skills at sexual prowess. There will be whispered references to her as “The Suction Device,” “The Bottomless Pit,” “The Sperm Bank,” “The Freak,” and other crass but recognizable names. If the Slut is a male, a meaningful fraction of the female employees will be taking maternity leave within a year of his hiring. The Slut may or may not be a good EMT, but to many of the people who make that determination, their professional skills will likely not matter much.<br /><br /><b>“The Gay”</b><br /><br />You will find an extraordinary percentage of your EMS co-workers are gay. This can have both advantages and disadvantages. If you are a gay male and your partner is a gay male, your chances of getting laid just went up, as is also the case if you are both gay females. If you are a straight male partnered with a gay female, you can both have a good time ogling the attractive females that you encounter during your shift, and the crew with the gay male/straight female can have the same fun pointing out attractive males to each other. The disadvantages can be a problem, though. The Gay, if they are too horny, promiscuous, or opportunistic at work, can acquire the gay version of the label “The Slut” among that portion of the work community. If two gay males or females from EMS become an item, they run the risk of the dreadful “Family Guy” problems (and label) as a result of the shrieking drama that can be so endemic to gay relationships. Further, your straight co-workers will get endless fun pointing out the ongoing spectacle between you and your co-worker boyfriend or girlfriend.<br /><br /><b>“The Social Butterfly” (AKA "The Silent Treatment")</b><br /><br />The Social Butterfly will usually be on his or her cell phone, texting updates to Facebook, Twitter, MySpace and various other social networking sites. Actually responding to EMS calls will be a chore, as actual EMS work tends to distract them from texting their boyfriend, girlfriend, or 3rd-grade classmates. Expect little in the way of conversation from the Social Butterfly; somehow actually interacting with another human being (you) is far too cumbersome an activity compared with the instant gratification and massive life-affirmation they receive when someone “likes” thier Facebook status (“OMG, my partner is so lame! He actually wants to TALK to me WTF?!!”).<br /><br /><b>“The Fighter”</b><br /><br />The Fighter will be related to the Walking Crisis. Paranoid at every turn, your Fighter partner will call for police backup for every 2-month-old with a fever. The Fighter will manage to get into a difficult situation on a call with a patient who is completely alone and unresponsive. Be prepared to apply restraints to every patient because “They’re combative!” according to your partner. Even if you are not partnered with the Fighter, you will hear them on radio asking for another crew to help with the the “uncooperative” patient. The patient could be an arthritic little Grandma who offers you some of the chocolate chip cookies she baked earlier; somehow the Fighter will press assault charges on her when she reaches to give your partner a hug.<br /><br /><b>“Driving Miss Daisy”</b><br /><br />Miss Daisy has an infinite number of personal errands to run. Don’t be fooled by the nomenclature “Miss” Daisy; this partner can just as easily be a “Mister.” It is unthinkable to Mister or Miss Daisy to run personal errands on their day off, while they’re off the clock. Be prepared to visit their mother, shop for groceries, stop off at the electric and water company so Miss Daisy can pay their bill, purchase their hardware at the Home Depot, pick up their kids from school in the ambulance, give friends a ride home from the bar in the ambulance and attend some school class in between calls. Miss Daisy will never make and/or bring her own lunch, so you will be meeting her boyfriend, girlfriend, spouse or other family member so lunch can be delivered to Miss Daisy while on duty. Note that the closest location that the friend can meet you and Miss Daisy is clear on the other side of town, as far away from your dispatch-assigned location as you can possibly be. Do not be surprised when Miss Daisy asks YOU to inform dispatch why you are forty miles from where you were expected to be when dispatch assigns you a call.<br /><br /><b>“Sleeper Cell”</b><br /><br />Not unlike Miss Daisy, the Sleeper Cell will have personal duties to perform that probably should have been done on their time off. However, the duties will fall under only one category - sleep. This partner will do their best to sleep during their entire shift. You will wonder what activities could possibly be so exhausting that your partner actually falls asleep while attempting to intubate a non-breathing patient. The moment your stretcher is made up and secured back in the ambulance after a call, you partner will be stretched out on it, with “Zzzz’s” almost visible on their snoring breath.With some partners, the cause of their sleep deprivation isn’t too hard to find - the narcolepsy may be secondary to his off-duty antics being “The Slut.” Possibly, the partner schedules too much abuse during her time off as she cooks, cleans, sends the kids to school, and runs her errands on her days off (the Family Guy?) then looks forward to napping in the ambulance. You can recognize the Sleeper Cell easily - you will be responding to a call, lights and sirens blaring, potholes jostling the ambulance to the point that your heads are actually making contact with the ceiling but your partner is snoozing away, undisturbed, oblivious to the fact that your ambulance overturned upside-down just now.<br /><br /><b>“The Soldier of Fortune”</b><br /><br />This die-hard ex-military person will sneer in the face of danger, insult you for calling for backup when six big guys attempt to shoot you with pneumatic spearguns and steal your ambulance, and will be packing a firearm somewhere on his person. Every conversation will start with “When I was in the military...” This partner will regale you with war stories (literal stories of genuine war). The Soldier of Fortune will actually purchase “Soldier of Fortune” magazine and point out articles, insisting you read the review of the latest X-10 Kill-o-Matic weaponry. No situation in your experience is as awful a crisis as “This one time, in the military...” The Soldier of Fortune will spend his time off engaging in re-enactments of the Civil War or collecting unlikely weaponry, like a catapult or a guillotine. Do not engage such a person in conversation, it can only end badly.<br /><br /><b>“The Partner of Questionable Hygiene”</b><br /><br />This partner will be recognized the moment you climb into the ambulance. You will imagine that the previous crew, while cleaning, had missed some foul turd that a patient had left behind. You will inspect the ambulance for the cause of the aroma. Unsuccessful, you will fall into a deep depth of depression as you slowly begin to realize that the stench emanates from you partner - the partner who you will not only have for the rest of your shift, but have just been assigned to work with permanently. Bring extra tissue paper to wipe your eyes and blow your nose as the irritants of his personal gasses fill your ambulance. If you lower the window in the ambulance, they will raise it again, claiming he or she is “too hot” or “too cold,” as your partner seals you into your personal corner of stink-hell. There are advantages to the Partner of Questionable Hygiene. When you have a patient on your stretcher, if you fart, it will be easily attributed to your partner. Conversely, your patient may have an episode of uncontrollable, explosive, stinky, diarrhea incontinence on your stretcher, in which case the smell will be unnoticeable, obscured as it is by your partner’s personal odor. Recognize this partner when fellow employees anonymously present him or her with a basket of personal hygiene products, including, but not limited to deodorant, soap, shampoo, laxatives, tampons, Gas-X, Febreeze, laundry detergent and cologne.<br /><br /><b>“The Princess and the Pee”</b><br /><br />Not necessarily a female, the Princess cannot, under any circumstances, get their hands dirty. Should a stray drop of blood, urine, vomit or bodily fluids mar their perfect uniform, the Princess must go home immediately and will most likely file a personal injury report. The Princess will arrive at work with her makeup perfectly applied, his hair immaculately coiffed. Any object or patient heavier than a newborn baby will require backup for lifting assistance. If the patient is actually a newborn baby, your partner will be unable to touch it, “in case it throws up or poops.” The Princess is a delicate winter blossom, unaccustomed to the hysteria that frequently accompanies emergency medical calls. Such hysteria paralyzes the Princess and they cannot possibly be expected to function when there is “drama” going on. Starting an IV or bandaging a wound is outside their scope of fragility. The Princess cannot ever be expected to get so physically close to an actual patient so as to assess vital signs or use a stethoscope.<br /><br /><b>"Mister Clean"</b><br /><br />Mister Clean has an extraordinary need to keep the ambulance sterile. Probably diagnosable with obsessive-compulsive disorder , he or she will spend a large portion of their paycheck on cleaning items for the ambulance. Whatever cleaning equipment your company provides will be far inadequate for their needs. Mister Clean will have a large bin chock full of bleach, Windex, scrubber pads, Armor-All, sponges, brushes, brooms, mops, a vacuum cleaner and anti-bacterial soap. They may keep their own pressure washer machine to scrub the outside of the ambulance. At least once a shift or more often, this partner will launch into a cleaning frenzy to scrub, polish and straighten every item in the ambulance. When you look under the hood at the engine, the caps for brake fluid, radiator coolant, windshield washer fluid and oil will have colorful hand-made labels identifying each. Your eyes will frequently burn as the ammonia and bleach mixes during their cleaning fits. You dare not leave lunch leftovers anywhere as they will be thrown away the moment your partner finds them idle. Mister Clean will stare at the drop of the patient's blood that fell on the floor, transfixed, mesmerized at the fantasy of cleaning it up. Should you offer to help clean the ambulance, your hand will be slapped away when you reach for Mister Clean's stash of supplies, in the fear that you might disrupt the meticulous organization of their precious paper towels.<br /><br />Thanks for reading! Hopefully you’ve found a little light to brighten your day. As you climb into your ambulance for another shift with your partner, I want you to ask yourself not only “Which one are they?” but also “Which one am I?” (And if I missed any partners out there, please describe them in the comments!)<br /><br />Onward and upward.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-10811616.post-70044304381149722010-06-08T12:46:00.000-07:002010-06-08T12:51:55.131-07:00IV Tips From the IV King<span style="font-weight:bold;">IV Tips From the IV King</span><br /><br />Lots of times at work, others call me to start IV’s on patients who are “hard sticks.” I’m usually successful. Many doctors and nurses acknowledge that if I can’t get an IV on a patient, they need to put in a central line. I’m not boasting about my prowess with the needle, Lord knows there are days when I can’t hit the broadside of a barn with a 22 gauge. But I want to share some tips to help you, dear IV-sticker, to make your job easier and become your own IV king or queen.<br /><br />I won’t go into the basics of IV-sticking. If you’ve read this far, you already know the basics of how to stick an IV into a patient. Let’s work on getting better at it. There’s lots of different “hard sticks” out there: diabetics, IV drug abusers, frail little old people, children, babies, cardiac arrest patients, CHF-ers and so on. Their veins may blow, they may be very deep and invisible, or very tiny. These tips will help on all those.<br /><br />One of the first and most helpful things you can do to be a better sticker is to brush up on your knowledge of the vascular system, particularly the veins. “But everybody’s veins are different!” I hear you screech. True, everyone’s different, but we all have two arms, two legs, a stomach, a heart and a brain and they’re generally located in the same place between individuals, right? Our veins are no different. We all have a radial vein, an ulnar vein, a brachial vein, a cephalic, basilar, saphenous and external jugular and they all are placed in more or less the same location in our bodies. Sometimes you have to do a “blind stick.” If you know where a particular vein should be located, it will help in hitting that vein, rather than just sticking the needle into any old patch of skin and hoping. You may have to dig around a bit to get the flashback. Move the needle slowly so you don’t pierce through the vein. Remember that veins follow the bone, and everywhere in the body, the NAV rule applies- Nerve, Artery, Vein. Aim the tip of your needle a little lateral to a pulse point and you should find the vein. I also find that while the initial needle stick is painful, after a minute or two of digging around, the pain almost disappears, thanks to our amazing sympathetic nervous system. So don’t feel that you are torturing your patient if it takes a while to find the vein.<br /><br />Some patients are severely edematous. The swelling makes it impossible to distinguish the feeling of a palpated vein from edematous tissue. With these patients, remember the veins will be deeper under the swollen tissues. Don’t be afraid to stick your needle in at a steeper angle than usual. Your flash chamber may fill up with interstitial fluid rather than blood, so if you feel like your in the vein but there’s no blood in the chamber, pull your needle out and see if the catheter bleeds. If you keep everything aseptic, you can reinsert your needle into the catheter and keep trying if you didn’t get it. Just be cautious of tearing the catheter with the needle. If you feel <i>any</i> resistance reinserting the needle, pull the whole thing out & start again.<br /><br />People with tiny veins are another challenge. Yes, everyone likes to use big ol’ honking 16 and 18 gauge catheters. But Grandma with the tiny spider veins won’t be able to take that. I know you learned that big, long catheters can infuse more fluid and could show me the math to prove it. But in real life, a well-placed 22 gauge can infuse just as fast as a 16. So to hit Grandma’s tiny little veins, use a small needle. Feel free to poke one of the varicose veins just under the skin. Make sure you’re very gentle as you pierce. Often the vein will form a hematoma at the insertion site. If it does, don’t give up yet; keep advancing the catheter and infuse a little fluid. If it doesn’t expand the hematoma when you push the fluid, you can use the IV. Another tip is to insert the needle bevel-down when poking a small or fragile vein.<br /><br />Some IV-stickers freak out when they have to stick kids. People - it’s not that hard! Kids whine less than adults do. And kids have young, strong veins. Please don’t use a crappy little 24 gauge catheter just because the patient is a child. 24 gauge catheters are too small to support their own weight. I’ve stuck 16 gauges in 2 year-olds with no problem. Kids generally have a fair amount of adipose tissue that can hide the veins, but use the same principles of anatomically finding a vein and you’ll be fine. Scalp veins are commonly used on kids and kids often have great foot veins. Remember, you can use any vein in the body for an IV. Don’t get stuck in the thinking of using <i>only</i> arms for IV’s.<br /><br />Speaking of which, if you can’t use an arm for an IV for whatever reason, look up the arm towards the shoulder. Frequently patients with terrible arm veins will have terrific veins on their shoulders and upper chest. True, you can’t use a tourniquet, so the lack of pressure in the vein may not give you a flashback. But if the catheter bleeds when you pull out the needle, you’re golden. On those crazy-looking sideways veins, just make sure you stick in the direction that’s most towards the heart and you’ll get it in the right direction.<br /><br />Lots of folks have valve-y veins. When the valve senses the foreign body of the catheter, they tend to clamp shut and you won’t be able to advance your catheter. If the vein is relatively straight and strong, use the needle to pierce through the valve, making sure to keep the tip within the lumen of the vein. It may take a surprising amount of force, but remember, it the valves are that strong, so is the vein. Don’t be chicken.<br /><br />Lots of EMS services use the EZ-IO (intraosseous needle) on cardiac arrest patients as their first line of access. Call me old-fashioned, but you can’t beat a good IV, especially on a code. Folks, at least <i>try</i> to get an IV on a code. You’ll be surprised at how easy it is. The lack of vascular tone usually makes the veins engorge with blood so they stand out yelling “stick me, stick me!” The whole purpose of ACLS and IV access is to get the patient back, and if they regain a pulse, they’ll be in the hospital for a while. Your IV will remain in use for days, helping the patient recuperate. If you stuck an IO in, it’ll get pulled before the patients gets to the ICU. Please try to get an IV.<br /><br />One last tip - EMS people, your IV’s fall into two extremes by the time the patient gets to the floor in the hospital. Either they A) last forever and are great for infusing fluids and drawing blood or they B) need to be pulled prematurely because they get infected. Please start your IV’s as aseptically as possible. Yes, I know the thinking “you can always give them antibiotics.” However, antibiotics don’t always work. Antibiotics also contribute to resistant infectious organisms. Also, insurance companies don’t pay for treatment of iatrogenic infections, you and I do. If you’re going to start an IV, do it right.<br /><br />Thanks for reading, and good luck!Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-10811616.post-66247627898672446572010-05-12T05:56:00.000-07:002010-05-12T06:10:14.058-07:00EKG's You Can Text!<meta charset="utf-8"><span class="Apple-style-span" style="font-family: 'Lucida Grande', sans-serif; font-size: 10px; "><ol id="timeline" class="statuses" style="margin-top: 6px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; font-size: 14px; "><li class="hentry u-seanhfitz mine status" id="status_13815458815" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">So I texted a bunch of EKG rhythms on Twitter. Feel free to peruse my work, repost it on Twitter or on your blogs. I got like a dozen new followers from it! The basic ones are at the bottom; work your way up the page to the more advanced rhythms. Or do it the other way; I don't care. This is the best way I could find to write EKG's via keyboard. Enjoy. (Sorry, but I doubt you can get continuing education hours.)</span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">
<br /></span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">Torsades des pointes (French accent mandatory): VVVvvvVVVVvvvvVVVVvvvmmmMMMmmmMMMvvvVVVvvvVVVmmmMMMmmmvvvVVVvvv</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
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margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; 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margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">V~V~~VV~V~V~~V~VV~~V~V~V~~V~V~~~~V~~~~V~~V~~~V~V~~~V~~~~V~~V~~~V~~~~V~~~V~~~~V</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13815257822" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13815257822" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">A-fib with RVR: ~~V~~V~V~~V~VV~V~V~~V~V~~V~VV~V~V~~V~V~V~~V~~~V~V</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; "><span class="Apple-style-span" style="color: rgb(0, 0, 0); font-size: 14px; ">
<br />
<br /></span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; "><span class="Apple-style-span" style="color: rgb(0, 0, 0); font-size: 14px; ">SInus pause: </span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; "><span class="Apple-style-span" style="color: rgb(0, 0, 0); font-size: 14px; ">--~-V~--~-V~--~-V~----------~-V~--~-V~--~-V~--~-V~-----------~-V~--~-V~--~-V~--~-V~--~-V~</span></span></span></li><li class="hentry u-seanhfitz mine status" id="status_13815127442" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13815127442" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13815088166" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13815088166" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">Epinephrine: </span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">-----------------------------------------------~-V~--~-V~--~-V~--~-V~--~-V~--~-V~--~-V~--~-V~--~-V~</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13815067977" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13815067977" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">Asystole: </span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">--------------------------------------------------------------------------</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13815051274" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13815051274" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">Atropine: </span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">----------~-V~----------~-V~----------~-V~--~-V~--~-V~--~-V~--~-V~--~-V~--~-V~--~-V~</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13814976264" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13814976264" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">Synchronized cardioversion: `V`V`V`V`V`V`V`V`V`V`V`V`V`VCLEAR<>BLAM<>--~V~--~V~--~V~--~V~--~V~--~V~--~V~--~V~</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13814908649" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13814908649" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">Defibrillation w/ conversion: MmwVwMmwwvvVWMCLEAR!<>BLAM<>------~V~--~V~--~V~--~V~--~V~--~V~--~V~</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13814824858" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13814824858" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">Ventricular fibrillation: wWwWWWwwWwWvVVvwMMwMMmmmvvvMM</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13814769804" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13814769804" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">Pacer rhythm w/ capture: </span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">--|W~--|W~--|W~--|W~--|W~--|W~--|W~--|W~--|W~--|W~--|W~--|W~--|W~--|W~--|W~</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13814714885" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13814714885" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">3rd degree heart block: </span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">~V---V-~-V--~V---V~--V-~-V--V---V~--V-~-V--~V</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13814542874" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13814542874" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">2nd degree heart block, Type 2: </span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">--~-V~--~-V~--~-V~--~--------~-V~--~-V~--~-V~---~---------~-V~</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13814454898" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; background-color: rgb(247, 247, 247); "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13814454898" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: visible; background-position: -32px 0px; "> </a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">2nd degree heart block, type 1 (Wenkebach): </span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">---~V~--~-V~-~--V~~---V~~-----------~V ---~V~--~-V~-~--V~~---V~~-----------~V</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: visible; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); ">Delete</a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13814359359" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13814359359" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">1st degree heart block: </span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">-~---V~-~---V~-~---V~-~---V~-~---V~-~---V~-~---V~-~---V~-~---V~-~---V~-~---V~</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13814306932" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13814306932" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">Atrial Flutter (3:1 conduction): :vvvVvvvVvvvVvvvvVvvvvVvvvVvvvVvvvVvvvVvvvVvvvV</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13814251873" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13814251873" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">Atrial Fibrilation: ~~~V~V~~~~~~V~V~~~V~~~V~~~~~~V~~V~V~VVV~~~~V~V~</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; "><span style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">
<br /></span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; "><span style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><span class="Apple-style-span" style="color: rgb(0, 0, 0); line-height: normal; font-size: 10px; "><ol id="timeline" class="statuses" style="margin-top: 6px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; font-size: 14px; "><li class="hentry u-seanhfitz mine status" id="status_13814222388" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">Premature Atrial Complexes: </span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">--~-V~~V~--~-V~--~-V~--~-V~~V~-~-V~--~-V~-~V~-~-V~</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13814164565" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13814164565" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">Ventricular Bigeminy:</span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">--~-V~M--~-V~M--~-V~M--~-V~M--~-V~M--~-V~M--~-V~M--~-V~</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13814135532" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13814135532" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">Unifocal Premature Ventricular Comlplexes: </span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">--~-V~--~-V~M--~-V~M--~-V~--~-V~--~-V~M--~-V~</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13814087691" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13814087691" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">Multifocal Premature Ventricular Complexes: </span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">--~-V~--~-V~--~-V~W--~-V~M--~-V~W--~-V~M--~-V~</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13814003948" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13814003948" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">Adenocard:</span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "> ~V~V~V~V~V~V~V~V~V~-------------ohshit---------~V~--~V~--~V~--whew</span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13813940843" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13813940843" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">Paroxysmal Supraventricular Tachycardia:</span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "></span></span> --~-V~--~-V~--~-V~V~V~V~V~V~V~V~V~V~V~</span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; ">
<br /></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; "><span style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">
<br /></span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; "><span style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><span class="Apple-style-span" style="color: rgb(0, 0, 0); font-size: 14px; ">Supraventricular Tachycardia ~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V~V</span></span></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13813855762" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13813855762" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">
<br />Ventricular tachycardia: VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV</span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">
<br /></span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; ">
<br /></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "></span></span>Sinus tachycardia: </span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; ">~-V~~-V~~-V~~-V~~-V~~-V~~-V~~-V~~-V~~-V~~-V~~-V~~-V~</span></li><li class="hentry u-seanhfitz mine status" id="status_13813789041" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "></span></span>
<br /><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; "><span class="Apple-style-span" style="color: rgb(0, 0, 0); font-size: 14px; ">
<br />Sinus bradycardia: </span></span><span class="meta entry-meta" data="{}" style="margin-top: 2px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; font-size: 11px; color: rgb(153, 153, 153); height: auto; "><span class="Apple-style-span" style="color: rgb(0, 0, 0); font-size: 14px; ">--~-V-~--------~-V-~--------~-V-~-------~-V-~--------~-V-~-------~-V-~-----</span></span></span></li><li class="hentry u-seanhfitz mine status" id="status_13813682060" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13813682060" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: hidden; background-position: -32px 0px; "></a></div></span></span><ul class="actions-hover" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 10px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; position: absolute; bottom: 8px; font-size: 11px; right: 0px; overflow-x: visible; overflow-y: visible; color: rgb(153, 153, 153); float: right; visibility: hidden; height: auto; "><li style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; float: left; position: relative; "><span class="del" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; background-image: none; display: block; float: left; line-height: 16px; "><span class="delete-icon icon" style="margin-top: 0px; margin-right: 1px; margin-bottom: 0px; margin-left: 8px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; width: 15px; height: 15px; cursor: pointer; display: block; float: left; background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); background-position: -112px 0px; background-repeat: no-repeat no-repeat; "></span><a href="#" title="delete this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); "></a></span></li></ul><ul class="meta-data clearfix" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; list-style-type: none; list-style-position: initial; list-style-image: initial; zoom: 1; display: block; font-size: 10px; "></ul></span></li><li class="hentry u-seanhfitz mine status" id="status_13813627581" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 0px; padding-bottom: 8px; padding-left: 0.5em; position: relative; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(238, 238, 238); line-height: 16px; zoom: 1; background-color: rgb(247, 247, 247); "><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="actions" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; position: absolute; right: 10px; top: 8px; line-height: 1.25em; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "><a id="status_star_13813627581" class="fav-action non-fav" title="favorite this tweet" style="margin-top: 0px; margin-right: 0px; margin-bottom: 3px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; text-decoration: none; color: rgb(0, 0, 255); background-image: url(http://s.twimg.com/a/1273620457/images/sprite-icons.png); width: 15px; height: 15px; display: block; cursor: pointer; visibility: visible; background-position: -32px 0px; "> </a></div></span><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">Sinus rhythm: </span></span></span><span class="status-body" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; display: block; min-height: 0px; width: 425px; overflow-x: visible; overflow-y: visible; "><span class="status-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; overflow-x: hidden; overflow-y: hidden; "><span class="entry-content" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; ">--~-V-~--~-V-~--~-V-~--~-V-~--~-V-~--~-V-~--~-V-~--~-V-~--~-V-~</span></span>
<br /></span></li></ol></span></span></span></span></li></ol></span>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-10811616.post-39580244287631394262010-04-17T05:10:00.000-07:002010-04-17T05:14:25.888-07:00Hospital Clinicals - A Million Hours of Misery Or A Million Chances to Become an Excellent EMT?<div style="text-align: center;">Hospital Clinicals - A Million Hours of Misery Or A Million Chances to Become an Excellent EMT?</div><br />You remember your hospital clinical hours, right? Maybe you're doing them now. They never seem to end. Back in the dinosaur days of EMS when I was in paramedic class, the only place we did clinicals was in the ER, because the emergency room is the most like EMS, right? And back then, EMS wasn’t exactly taken very seriously. Appreciated, yes, maybe even commended, but seldom taken seriously. Most of our clinical time (two hundred forty hours!) was spent watching the nurses start IV’s and push drugs, watching the doctors intubate patients and helping fetch and carry things thither and yon. Few of the nurses trusted us enough to actually stick a patient with an IV. We only practiced intubation after the patient was pronounced dead. 12-lead EKG’s took the same place as Egyptian hieroglyphics in our curriculum. At best, we might inspire enough confidence in the staff to allow us to give a pill or rub some ointment on a rash.<br /><br />Nowadays, the curriculum includes over four hundred hours of hospital clinicals spanning not just the emergency department, but the ICU, med-surg floors, labor & delivery and surgery. On the surface it seems like the ways to be bored have increased exponentially. And if you’re looking for something to do, you may find yourself in the same predicament we did back in my class, when the Tyrannosaur was the king of the earth, and go look for an empty patient room to nap in.<br /><br />One thing is for certain, when you take your hospital clinicals you’ll be a newbie. A “lowly” EMT (actually, you’ll be worse- an EMT <i>student</i>!), so judged by the nurses and doctors on the floors who don’t know you from Adam. You may be able to run circles around any other EMT, but there’s no way you’re going to prove that to crotchety old Nurse Ratchet. And she won’t care if you did.<br /><br />So is there any benefit to the spectrum of torture your instructors are putting you through? If you want to be an excellent EMT, there most certainly is!<br /><br />Maybe, just maybe, you’ll get to stick an IV. The CRNA or anesthesiologist might let you intubate a real, live person. Good, you need that. But it’s no big deal. Why? Because you can teach a monkey to intubate or start IV’s. All that takes is training. As an excellent EMT, you need to seek out <i>education</i>. And the hospital environment provides you with multiple opportunities to do so. Training teaches you how do do stuff: “Is my scene safe? I put on universal precautions. How many patients do I have?" Blah blah blah. What to do on every scene you’ll ever have. What education does is teach you how to think critically about your scene, especially when your scene is one of those “what if...” situations that EMT class can’t prepare you for. A great deal of education can be gleaned in the hospital.<br /><br />Let’s look at some examples. One thing you’ll have to do on every call is write a run report. “Nobody’s gonna read this thing besides a lawyer,” you say to yourself. On the contrary! Many, many times the very first thing a physician or nurse will do when initially encountering your patient is read your run report. Your run report stays in the patient’s chart until he or she is discharged. It is referred to nearly every time a new doctor or nurse has any interaction with your patient. Even if they’ve been in the hospital for months and you’ve long forgotten about the call, your words are still being read and taken into consideration. If you are doing clinicals, try to take note of how often EMS reports are read. Now imagine those are your words being read. Is the report clear? Is the mechanism of injury and pertinent history accurate? What did you do for the patient? Why or why not? And be assured, your spelling, grammar and penmanship are under keen scrutiny. It is those words that will make the difference as to whether we EMT's are to be taken seriously by the medical community!<br /><br />Speaking of what you did or didn’t do for the patient, another valuable lesson you can learn from hospital clinicals is the concept of continuity of care. Though your responsibilities may end when you hand over the patient to the emergency department staff, the patient’s care does not. More importantly, what you did while the patient was in your care has repercussions long after you’ve gone home and forgotten about the call.<br /><br />Did you intubate the patient? Once your patient is intubated, you’ve assumed responsibility for the airway & breathing - two of the cardinal aspects of the ABC's. By intubating them, you’ve effectively made them vent-dependent. Once the body realizes it doesn’t have to breathe, many times it doesn’t start again. In your hospital clinicals, take a look at the patients who are intubated, particularly by EMS. A week or two after you’ve patted yourself on the back for “getting that tube” while hanging upside down in an overturned car in a ditch at night, that patient may well be getting a tracheostomy. That sweet grandma with CHF might not ever be able to speak the words to thank you for “saving her life” because she’s dying of ventilator-acquired pneumonia. Are you SURE you absolutely NEED to intubate that patient? Is there anything you can try to prevent an intubation and subsequent vent-dependency? The chest decompression you performed, the perhaps-less-than-aseptic IV and the hypotension you induced by walking your patient to the ambulance also all create a huge change in the continuing course of care for the patient.<br /><br />The drugs you push have effects beyond the ER doors, too. Educating yourself about them can make the difference between an EMT who can pass his test and an excellent EMT. If you’re in clinicals, take a look at how the course of care is altered by drugs the EMT’s gave. Did EMS max out the patient on Atropine? The care changes. When EMS pushed labetalol on the hypertensive crisis, did the patient’s asthma kick in and now they have to be intubated? Another detour in the path of care. That patient with eclampsia - why is the ER giving them levophed after EMS pushed the magnesium sulfate? All those drugs have side effects, some of them deleterious. What may make you seem like a hero at the moment may cause an unnecessarily extensive hospital stay for the patient, added expense for insurers or taxpayers and a negative outcome in general.<br /><br />In the hospital, you’ll encounter equipment that you’ll believe you will never have to think about again. Wrong! Many patients are discharged to home care with a variety of medical devices. As was stated earlier, the emergency room is the most like EMS right? Well, that’s no longer the case. A huge part of EMS calls nowadays have to do with ongoing care. That’s right- home health. People call EMS when their home oxygen machine breaks or their premature infant’s feeding tube is clogged. Imagine going to the home of a chronically ill patient who’s receiving tube feedings. The feedings are still running to the PEG tube and you have to disconnect it to package them for transport. How do you disconnect it? How do you flush it? Use your hospital clinical time to find out. Some patients go home with a Wound-Vac device to remove exudate from a surgical wound or pressure ulcer. When and how should you disconnect it? How long can it safely remain off? What should you do if it is accidentally dislodged? Again, pay attention and ask questions in the hospital. Some patients have a PICC line (Peripherally Inserted Central Catheter). Can you use that for IV’s? How should you access it? If it starts coming out, what should you do? There is a cornucopia of devices that you may not feel you need to know about, but in reality you will have to deal with frequently. Quinton cathers, Foley catheters, suprapubic catheters, colostomies, home ventilators, home CPAP and BiPAP machines and tracheostomies are only a few of the things you have a golden opportunity to learn about while doing your hospital clinicals, and you will be glad you did when you encounter them on scenes.<br /><br />You can take note of other things too. True, cleaning a patient isn't a priority in EMS. But try to assist the nurses to turn and bathe that 600-pounder in the ICU. Help them keep the combative head bleed still for a minute during the CAT scan. Feel the soreness in your muscles the next day. The nurses will acquire a newfound respect for you and you will appreciate what they do when they have to do it without your help.<br /><br />Use your hospital time to really learn about <span style="font-style:italic;">patient</span> care, not just the bare minimum of EMS training. Understanding that what we do in the back of the ambulance has a lasting effect on our patients’ outcomes will make the difference between you being an adequate EMT and an excellent EMT. Remember, any trained monkey can start an IV and memorize ACLS algorithms. Being an excellent, <i>educated</i> EMT is not only what makes you stand out, but is also what truly makes a difference. And making a difference is one of the reasons we all started in this field, isn’t it?Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-10811616.post-82157179360483370782010-03-28T14:50:00.000-07:002010-03-28T19:31:48.750-07:00Chronicles of EMS - An EMS Reality Series That Tells The Truth!<div>I know you tell war stories. I certainly do. And the questions that your non-EMS audience ask sometimes make you laugh. "How do you deal with death all day, every day?" "Do you have to cut cars up all the time?" "What's the worst call you've ever been on?" If you've spent more than twenty minutes in the back of an ambulance, you know all too well that such calls, while memorable, are the exception rather than the rule. Instead, on a typical shift we wonder about which frequent-fliers we'll be transporting, how many drunks we'll be scraping up, if it's nursing home Dump Day and where we're going to try to eat lunch. And we try <i>not</i> to think about who's footing the bill for our services. Sometimes we long for someone to tell our story- our <i>real</i> story, not some overly dramatized spectacle.</div><div><br /></div><div>Your wish has been granted.</div><div><br /></div>With Chronicles of EMS, Thaddeus Setla and Chris Montera have created an EMS reality series on the web that tell the REAL story in EMS. You can follow along with San Francisco paramedic/firefighter Justin Schorr and Mark Glencorse from North East Ambulance Service in the United Kingdom and see American EMS as it really is. No explosions, no Code 3 club, and every patient isn't dying from some unlikely scenario. Mark & Justin run <i>actual</i> EMS calls in San Francisco and show what it's really like to be an EMT - dealing with the chronic bullshit, the homeless, the drunks and occasionally even a real patient ("Trauma" on NBC, are you listening?). Also of note is Justin's warning to Mark - no meal breaks! <div><br /></div><div>It's interesting to see Mark's reaction to the way EMS is run here; he's a paramedic in England. Compare his comments about U.K. EMS with the way it goes in the States. It was a long time in the making, as Justin explains in the first part of the video. Facebook, Twitter and blogs played a key part in CoEMS' creation, and I'm happy to have had a miniscule influence in it. The guys have done an outstanding job illustrating what we really do.</div><div><br /></div><div>Watch <a href="http://chroniclesofems.com/entertainment/chronicles-of-ems/">episode one</a> of Chronicles of EMS <a href="http://chroniclesofems.com/entertainment/chronicles-of-ems/">here</a>.</div><div><br /></div><div>And if you'd like to follow everyone on Twitter-</div><div>Follow Justin Schorr <a href="http://twitter.com/theHappyMedic">here</a>.</div><div>You can follow Thaddeus Setla on Twitter <a href="http://twitter.com/setla">here</a>.</div><div>Follow Mark Glencorse on Twitter <a href="http://twitter.com/UKMedic999">here</a>. </div><div>And follow Chris Montera <a href="http://twitter.com/geekymedic">here</a>. </div><div>And don't forget to join the <a href="http://www.facebook.com/COEMS">Facebook page of Chronicles of EMS</a>!</div><div>CoEMS is sponsored by <a href="http://www.zoll.com/coemssupport/">Zoll</a> (still my favorite monitors).</div><div><br /></div><div>Looking forward to Episode 2 and more!</div>Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-10811616.post-74140697787479080662010-03-09T18:40:00.000-08:002010-03-09T18:53:17.011-08:00Sticky Situation<p>OK here's an interesting scenario and I'd like to hear from you. According to this story <a href="http://bit.ly/bzSYxz">http://bit.ly/bzSYxz</a> a Jefferson Parish deputy recorded on his cell phone the dying testimony of a gunshot victim while in the back of the ambulance. </p><p>My question: Is this OK or not OK? We all know HIPPA law prevents any of us medical people from recording images, voice or any specifics about patients, particularly if they will be made public (as this recording surely would be). Even our conversations must be tailored so as not to divulge such information. Does HIPPA include such informal legal testimony? If you were the paramedic, would you prevent the deputy from recording your patient? If there were no police around, would YOU record the patient's testimony?</p><p>The legal implications seem frought with peril. A video is far more convincing evidence in court than the debatable memory of a paramedic who was distracted with patient care. On the other hand, remember the trial of the shooters at the Louisiana Avenue car wash? They were acquitted despite there being a video of them shooting. How much of a risk would it be to your job if you knowingly allowed a police officer to video record your patient?</p><p>Oh, and if you are the paramedic who was on this scene, I'd love to hear from you about any backlash or issues that may have come up with this.</p><p>Write your comments using the link below. Thanks!</p>Unknownnoreply@blogger.com8tag:blogger.com,1999:blog-10811616.post-89267265972732811982010-02-27T23:26:00.000-08:002010-02-27T23:29:09.659-08:00Military Allows Facebook, Twitter, Other Social MediaApparently the benefits of social media outweigh the security risks. Hmmm... Where have I heard that before?<br /><br /><a href="http://www.reuters.com/article/idUSTRE61Q07G20100227?type=technologyNews">http://www.reuters.com/article/idUSTRE61Q07G20100227?type=technologyNews</a>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-10811616.post-92231544777567303832010-02-19T15:57:00.000-08:002010-02-19T20:26:09.795-08:00At the risk of sounding bitchy...Many of us loved the shooting game on Facebook. It was a bit of diversion that only a small group of Facebook friends could see. Guess the time of the next shooting. Closest guess won. No private information was given, no one got hurt, there was no national media attention. The game died because I was ordered to cease & desist for, at best, unclear reasons.<br /><br />This very blog has been a bane to the EMS hierarchy. Apparently it has the reputation of "stirring the pot," a pot which apparently needs to remain unstirred. In reviewing the past dozens of articles written on here and the comments in the tag-box, I can't find any stories that might be considered "pot-stirring" (this current article notwithstanding). It's been a place to encourage others for professional improvement, point out a job well done, post photos from the Times-Picayune of us in silly poses, and cite links to other helpful EMS-related websites. How any of this is "pot-stirring" eludes me.<br /><br />Therefore I find it fascinating that social media websites such <a href="http://www.facebook.com/ProjectNOLA/posts/341940306666#%21/ProjectNOLA">this one</a> exist unmolested: <a href="http://www.facebook.com/ProjectNOLA/posts/341940306666#%21/ProjectNOLA">http://www.facebook.com/ProjectNOLA/posts/341940306666#!/ProjectNOLA</a>. It is not my Facebook page and I have no idea who is involved with is creation or maintenance. It details crimes in the city as they happen, by someone who obviously has a radio scanner, with very specific information on who, what, where & when, etc. It also clearly has a large base of followers from the general public. Nowhere in the many comments and updates on it do I see a cease & desist request from any city entity. Further, it is just one of a myriad of similar online sources for the gory emergency responder details of the city in which we live and work. Here's another <a href="http://www.scanware-fccfrs.net/sw_audios.html">one</a>, and <a href="http://www.radioreference.com/apps/audio/?ctid=1144">another</a>, and <a href="http://itunes.apple.com/us/app/emergency-radio-ultimate-police/id312949947?mt=8">another</a>, and <a href="http://www.projectnola.com/forum?func=showcat&catid=16">another</a>.<br /><span style="font-weight: bold;"><br /></span>I was informed in one of my many cease & desist meetings that the internet is not the proper medium for letting out frustrations. It was recommended to go to a bar and bitch about work with my co-workers over a drink. Alternatives to such "therapy" were not explored. I must ask, is drinking & complaining the only approved method of stress reduction? After Hurricane Katrina I explained my own methods of decompressing to the CISD psychiatrists. One doctor called two other doctors so I could repeat my coping methods to them, namely writing about my experiences and channeling my frustration, sadness or joy into a productive medium. They were fascinated and encouraged me to continue doing so, saying "You obviously have a very effective way of coping with stress."<br /><br />So, sorry for stirring the pot once more. Since websites such as the Facebook page above continue unbridled in their haste to inform the public with raw, unfiltered information for anyone to read and comment on, I will continue to feel justified for posting my own take on my EMS experiences. Until such public websites and social media are stopped from their own "violations," please do not single ME out as a troublemaker for my methods of dealing with stress and creativity by simply telling war stories.<br /><br />There. I've said it.<br /><br />-FitzUnknownnoreply@blogger.com6tag:blogger.com,1999:blog-10811616.post-67311548928819865992010-02-14T02:56:00.001-08:002010-02-14T02:57:22.572-08:00Mid-City Shooting<a href="http://2.bp.blogspot.com/_GGtAe8hrTlw/S3fXBDy81VI/AAAAAAAAAb8/pXbdkmit3Yc/s1600-h/-011c1740e8c7d21f_large.jpg"><img id="BLOGGER_PHOTO_ID_5438051488272012626" style="WIDTH: 320px; CURSOR: hand; HEIGHT: 214px" alt="" src="http://2.bp.blogspot.com/_GGtAe8hrTlw/S3fXBDy81VI/AAAAAAAAAb8/pXbdkmit3Yc/s320/-011c1740e8c7d21f_large.jpg" border="0" /></a><br /><div></div><br /><div></div><br /><div>Night of Endymion, Palmyra & S. Gayoso.</div><br /><div>(Via NOLA.com)</div><br /><div></div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-10811616.post-4515927073352269932010-01-15T07:17:00.000-08:002010-01-15T07:22:19.819-08:00Don't Kill the Messenger...<div>Below is an excellent article why the rampant paranoia surrounding social media, blogging and the Internet is unfounded, particularly in the EMS field. There is nothing wrong with using the internet or social media to decompress or let the world know that we are indeed plain ol' human beings after all. I didn't write it, so don't get all out of sorts because I agree with it.</div><div><br /></div><a href="http://michaelhyatt.com/2010/01/five-reasons-why-your-company-doesn’t-need-a-social-media-policy.html">http://michaelhyatt.com/2010/01/five-reasons-why-your-company-doesn’t-need-a-social-media-policy.html</a>Unknownnoreply@blogger.com0