pain

Mine and theirs. Somedays I feel like I wear the pain of all those I have encountered. Weighing me down like a heavy coat in the rain. Suck it up buttercup. Yes I know. Find an outlet. Yes I have. Who cares? I still do. Over ten years of anger, pain and fear. And somedays no matter how far I run, no matter how much I write,no matter how much I laugh, I wear their pain along with mine Heavy like the rain.

PTSD Survey

I know it has been a ridiculously long time since I have blogged about anything. But I have been buried to my eyeballs in college. I am currently writing a paper on PTSD symptoms in first responders. I have created a survey to collect some data. It is completely anonymous. I would love it if any of you out in blog land would take 10 minutes and fill it out, maybe pass the word to your first responder friends? If you wish to add any information you can email me at my gmail account. Anything you send me will be kept confidential and no names will every be used in my paper.

THANK YOU ALL!

http://www.surveymonkey.com/s/Q62F3Y8

Crass Pollination

Hey I can't seem to access Nurse K's blog! anybody know whats up and how I get an invite? I miss reading her stuff

The case for critical care

I know it's been a while guys. I just wrote this for a friend who wants to go to criical care to give him some ideas. It is by no means complete, I thought you all could expand on it for me.


Critical care is not merely vent settings, balloon pumps and lab values. It is a deeper understanding of what we already do. Medicine is an ever changing field with great advances being made all the time. How often do you pick up patients with new unfamiliar medications or medical devices you have never seen? How do we know what to do with them when they are in extremis? How do we know our normal course of action will be sufficient or if it will do more harm than good? The answer is that we further our education to become more well rounded providers that have a better understanding of how the body works, how certain disease processes effect us and how medications work. Every city in this region runs mutual aid into the surrounding areas. Do we know all of the special needs patients in these other cities? When the weather is bad and the helo isn't flying there are times when we run critical ground transports to other facilities. How many street medics know how to manage multiple drips when there is no nurse to go with you on the run? How do they handle chest tubes and central venous access? How many medics can manage a propofol drip? Do they know how it works and what to watch for? EMS is diverse, we walk not only into patients homes but into doctors offices, military clinics, shipboard clinics, and a multitude of other places. They call and we go, it doesn't matter where they are. We as providers should be able to handle anything that we walk into with more than a very basic understanding. We may accept a patient who has had treatment started by a doctor and we should know what that treatment does and what else we can do for this patient. To have medics that are critical care certified is not only an asset to your department on the street it is an asset to your training division. These medics can put together classes to help the other field providers improve their knowledge base thereby improving the quality of prehospital care and patient outcome. Patient care and patient outcome are really what we are all here for, and critical care does nothing but improve on an already strong system.

SANE cases

People. We deal with people everyday. But how often do we deal with the victim of sexual assault? When we do, do we allow our perception of the world to color our views of them? These patients are a breed all their own and require a certain amount of special handling. These assaults can occur on both sides of the gender fence, though they are more reported when the victim is a woman. They can happen to anyone; Black, white, rich, poor, drug addict, prostitute, lawyer, doctor, old or young it is a crime that crosses all social barriers. Rape is a crime of violence and usually less about the sex and more about domination. So how do we deal with these patients who are in a moment of crisis, knowing that how they are handled can effect them for a very long time? I have had no formal training on this but life and quite a few psych classes have taught me a few lessons. Hopefully this can help others to deal with these psychologically complicated patients. If any of you have any thing to add I would greatly welcome any suggestions.

First I always approach my patient slowly and maintain a "safe" personal space distance. I don't want to violate their space any more than they have already had it violated.

I speak with a low even tone. I maintain an open stance and squat to their level so they can see me. I try never to stand over them or to have what appears to be an aggressive posture.

Before I do anything with them, I ask permission. I tell them up front what I would like to do and explain what is going to happen while I am doing it. I will not cross that personal space barrier until they give me permission. This is an attempt to give them back some control over what is happening to them.

I ask minimal questions, just do the basic assesment, treat any obvious inuries and I don't ask specifics regarding the assault unless they relate to the injuries I treat. ie were you struck with a fist or an object? kicked ect. I stay away from rape specific questions. I think that is more the place of the detective and the SANE nurse.

I let them talk. If they choose to talk to me I just let them say whatever they need to say. I assure them that they are safe with me and will continue to be so when they arrive at the ER.

The last thing I do is explain some of the process they will go through in the ER. This gives them an idea of what is next and also people feel more in control if they are informed.

In our area we have what are called SANE nurses. They are forensic nurses, SANE stands for Sexual Assault Nurse Examiner. They examine and collect evidence and help point victims in the right direction for further care. They are invaluable in my mind and I think all ER's should have atleast one.

I hope some of the things I have learned will help you guys deal with your patients. I am hoping to get some training with our department and a local SANE nurse. If it happens I will pass the info we get on. Remember when we are dealing with these patients that no matter what their life circumstance no one deserves to abused this way and they deserve the utmost of care and gentle handling.

Loss

Our department lost a man today. A firefighter,paramedic, brother and friend. He was my preceptor when I came to the city. He terrified me at first but we got into a comfortable rhymth and when I was done we moved out of our preceptor/preceptee relationship and onto the comfortable banter of coworkers. He was a teacher and friend. He could be a butthead but it didn't last long. He had a dry wit and a sarcastic sense of humor. He could make me laugh until I cried. The loss of him is a huge loss from our lives. He will be sorely missed.

Rest well Brother you'll be in our hearts.

Airway Class

Today we had airway training. Our numbers have not been so good even though we have multiple different airway devices on board. Our OMD came and taught our class. We got to practice using our ILMA, the King LT and the bougie. He talked about crash airway, and failed airway. We were able to ask him as many questions as we needed and practice over and over. I know I feel much more comfortable with the ILMA and the King now than I did before. This was the best class I have been to in the last 4 years and our training officer has other ideas forthe near future to get us a broader range of classes and experience. I am excited.