Young Mom

I grew up having a "young mom." At all the school functions, she was always the parent that seemed so much younger than those other parents. It's never been an issue for me. I've always felt I have a young mom.

This week I had a patient who had that same birthday as my mom...down to the day.

I was transporting her home after she was in the hospital from being in an MVA. This woman had bad knees and just had a hip replaced (because of the MVA). But, she did seem drastically older than my mother. She even had a mole with gray hair on her cheek. Now, the patient was almost 300 pounds, and a long-term smoker. I suspect this had a lot to do with the apparent age of the patient compared to my mother.

I suspect my mother has aged some..she is a certain age in my mind, no matter how old she becomes. I suspect it is the same phenomenon that makes me appear still as her little boy in her mind.

Having the young mom was ok then, but now that I am grown, I feel lucky having the young mom.

working holiday weekend

Well, I worked 4pm on 12/24 to 4am on 12/25. It was a slow night. But, of course, we get a call at 0330, causing me to get out of work a bit late. Luckily the kids were still asleep when I got home. The hard part was that I had to work again at 6pm that night.

Legos were the thing of the year for my boys. They both got Lego Ambulances...very cool. It's neat the details they put into these things. It was an O2 tank, strecher, carry-in bag, and monitor. The little Lego Medic is wearing some cool shades too.

The neat thing is that my sons (5 & 6yo) were able to follow the directions on their own and build many different things. It even beat out the Hot Wheels this year...never thought I'd see that so soon.

My wife and I also broke down and got something for us that we have been wanting to get for years. A new 32" TV. Our old 27" tv was 16 years old and the tuner would not go to all the channels anymore. It's so cool...buying something nice for us for once.

from the same womb...

My boys are 14 months apart in age. They, obviously, have been raised in the same home. That's when I really think about how different they are. Though I could go on about many examples, we experienced a good one this past week.

On 12/22/05, I finally used the gift certificate that I was given on Father's Day. Good thing, the gift certificate was to expire on 12/31. What was it for? A free 30 minute joy-ride flight above our town in a small plane.

The day was slightly hazy, the views were ok, but not great. There was *slight* bumps on the way up but otherwise a smooth flight.

The things is, my oldest was very firmly grasping my had the whole flight...he could turn on his picture smile when requested but otherwise looked scared-sick. My youngest, on the other hand, had his nose smashed flat against the glass of the window exclaiming all the things he was seeing the 1,500 ft below us.

After landing, my youngest ran out on the grass of the landing area, his arms out-streached making plane noises stating he wanted to fly again. My oldest, stated he was "air-sick" and proceeded to vomit on himself.

Both my boys fell alseep on the way home, but I suspect for different reasons.

Personally, I loved the sights but I did get a little motion sick too.


On 12/21/05, I was working a different shift than normal. Nicely, I was still working with another Paramedic.

We are dispatched to an MVA, pickup truck vs. pickup truck. There was an expected amount of preholiday traffic and the fire department was already on scene and had the pt on a backboard & c-collared when we arrived. This was our only patient from this scene and I begin care in the back of our truck. This patient was not wearing a seatbelt and hit the side of another truck at about 35-40 miles per hour. There was steering wheel deformity and a small spider web like fracture on the windshield right where the pt's head hit.

The pt's a 44yo male, alert & oriented, denies any loss of consciousness. We take vital signs, all within "normal" ranges. The pt has abrasions to both shins and round bruise on his abdomen that's the same size as the steering wheel. The pt's abdomen is distended but the pt states this is normal for him.

I start an 18 gauge IV in the pt's left arm while my partner places the pt on O2 and on the monitor.

All was going well until...

I was pulling the needle back out of the catheter. The design of the catheters we use has us back the needle out into the handle while still attached to the catheter. Once the needle is all the way out, it locks into place and reduces the chance of an accidental needle stick. The thing is, I had about 1cm of needle left to draw back when my partner placed the monitor lead on the pt's abdomen. The pt jerked his arm back, removing the catheter from the needle I was holding. The pt then immediately jerked back. The remaining needle then went through my glove and entered the tip of my right index finger.


I hooked the line I had started to the pt so that he would stop bleeding out the now open catheter. I then removed my glove, cleaned my finger with an alcohol wipe and put on a new glove. I explained the the pt what had happened and apologized for my momentary outburst of expletives. I then called my supervisor to report the exposure.


All the pt's tests came back negative as well as mine. There was one interesting result. My resistance to HepB was not as high as expected for someone who has gone though the series of vaccination shots. So, I am being offered a booster shot to hopefully remedy that. At least I know and will get the booster. At least one good thing came out of this.


I was pissed at myself the whole night. The amount of paperwork was amazing. But, mostly I was pissed and worried out the "what if's". Definitely have to enjoy this job and be as careful as possible at all times. Next time, the monitor can wait until the needle is gone...



I learned a new word today that I like. Reminds me of the women in my life.



Thank you for teaching us to brush our teeth

OMG, I had a patient recently whose mouth seemed to be rotting away. It was a gash of brown and stench with the occasional narrow tooth remnant jutting through. The worse part, I almost had to intubate him. I ended up placing a NPA (nasal airway) and bagging him though that. There were some questions about his code status, his jaw was clench tight and I couldn't get an IV. So, I voted for fast BLS treatment and let the hospital work out how far they wanted to go with him. (Less than 10 minutes to the ER.) His pulse oximetry was 79% with a respiratory rate of 40 and unresponsive. I was able to get him up to 96% just by bagging. I've been off the last few days, so I do not know what happend to him. But, he had a bad history and seemed to be an almost-hospice patient with contractures in all 4 extremities, cancer, etc. I'll look into it tomorrow if I remember.

The point of this post was not that run...got a little off track there. But rather, I seem to have a habit of looking at patient's teeth. I guess that's from being raised by a mother who makes false teeth for a living.

I don't like the color of my teeth and my few fillings, but I do know there are some mouths out there that seem to have never felt a tooth brush. Why are they always the mouths that we need to get so close to?

Maps as Lifesavers

The following post is from http://ccablog.blogspot.com/. I thought it interesting and relevant to those who read this blog.

WFAA.com (also in the Denton Record-Chronicle and a few other sites; free subscription required for each site) has a story about the work of the GIS Corps in the wake of Hurricane Katrina and the role that maps and GIS have played in the locating and resuce of trapped people in need of help. For those of us who work in the field of mapping and GIS, all of this comes as no surprise. But for many others, this is new technology and for some, it is even a source of wonder.From the article: “We're using mapping for distribution sites, shelters, hospital locations, helipads, search and rescue and debris fields,” said Brian Adam, director of the Hancock County Emergency Operations Center. “There is no way we could have made it without our maps.”


My interest in Geography shows up every now and then. My town/county does have a GIS (Geographic Information Systems) Department but I have not seen them do any work for any emergency agencies. It would definately be nice to see. Have any of you worked with a GIS team on making sure you have spacial data when needed?


Another great free piece of software is Google Earth. I originally used this when it was owned by a company called keyhole (before Google bought them). It's getting better with each update. I just wish they had better images of my area. Luckily, the local GIS department has their informaion on the web that I can access with 2000 aerial photos as one of the map layers.


Now I just want to get GIS maps on the trucks to give me directions to the scene from wherever I happen to be. I know some services are lucky enough to have that. Maybe someday I'll buy the software and receiver for my personal laptop and just bring it in to try out...yeah, when I have the money for that...(eyeroll)

She was beautiful.

December 10, 2005

I gained a son-in-law and worse, I became a father-in-law.
Heck, now I'm married to a mother-in-law.
How's that happen? It just sneaks up on us dangit!

She was beautiful. My wife cried. The wedding was nice. Everyone, for the most part, behaved at the reception.

I have to say, it was a lot easier being the groom than the (step)father-of-the-bride.

My wife wrote a nice blog entry before the wedding. Here it is:


I Hope She Dances...
Current mood: nostalgic

Well, today's the big day. Amber's getting married. Yesterday was very long and very hectic, but today should be wonderful! I only teared up once during the rehearsal - when my Dad was walking her down the aisle. Today WILL be a different story!!

As I was trying the help her get things ready for today, I was blessed with flashbacks for the past 21 years...

I remembered how beautiful I thought she was when I first saw her. I didn't realize that all babies do NOT look alike when they are born!

I remembered that from the start, she was not content to sit still. She had to be on the go at all times. Who ever heard of a baby walking at 7 months?? But she did...

I remembered that she had this precious little personality...a tad sassy toward life (which is cute when you're 3) and definitely an independent kid.

I remembered realizing that she was not a singer!!! Having a 4 year old sing Red Red Wine...Makes you Feel so Fine...way off key is cute though!

I remembered that first day of Kindergarten. I take her to school. Stop the car at the sidewalk. She gets out, as do I. With a look of disgust, she says "Mom! Where are you going?" "I'm walking you into school," I replied. With her little hands on her hips she says, "Mom! I'm 5 years old! I can do this by myself, you know!" Although she let me walk her in just that first day...she was sure to let me know it would not be the norm!!

I remembered watching her hour after hour, day-in day-out, dancing. Tap...jazz...but no ballet! She is not a ballerina!! Give her some funk and she's awesome...Grace. She has none!
I remembered that she can follow instructions. At her first National dance competition in Orlando...coach said, "Never pull on your costume." After this performance she said, "Never pull on your costume unless your top is falling down and you're exposing yourself to the entire world!"

I remembered when her 5th grade 'boyfriend' broke up for her. No, she didn't want the baseball hat back that she bought him for Christmas. She told him to shred it... just to make sure he was still wearing it when he did. (some of that sassy little attitude again)

I remembered when the dance practices turned to cheer practices. I remember traveling, sometimes with Lacee, sometimes just the two of us, all over the country. Made me so happy to have these memories with her!

I remembered the "I Love You" signals that we'd sign to each other EVERY time she took that cheer floor. I remember that being the most important part of the competitions to me.

I remembered the call, "Mom, I got a ticket today" (first week after she got her license) Then 2 days later came, "I'm never driving again!" Wreck 1... then the subsequent 3 calls about wrecking her cars. I was always relieved that she was ok. Although going by ambulance to the ER kinda freaks a mom out!!

I remembered some of the arguments we had...but for the life of me can't remember all the details. That's a huge plus! :)

I remembered her high school graduation and how proud I was of my little girl...not so little anymore.

I remembered how she's grown into such a beautiful young lady. Independent, strong, and able to take care of herself...unless she's sad/hurting. Then she still wants her Mommy.

As I watched her walk down that aisle with my Dad...it was a happy moment, indeed. And I realize that it now comes down to what she has ahead of her. I wish her happiness...and love...and to become one with Regan, yet to maintain her indviduality. But most of all, Amber... I hope you dance!

I love you Bean!


I Hope You Dance by Lee Ann Womack is the song I chose to dance with her. Good song.


Obviously, this is the main reason I was not driving the 9 hours to see my sister in the hospital.


What is normal?

When I meet a patient with some form of altered mental status, I always ask if this is normal for this patient. Sometimes the answer comes from a family member, sometimes from paperwork given to me by a nurse. Sometimes a bystander tells me the patient was not like this only moments before.

But, what happens when the patient's normal mental status is not "normal"? Would you notice an elderly dementia patient with a UTI? A autistic patient with a stroke? A mentally retarded patient with a blood sugar of 40? Or, what recently happened to someone I care for, a patient with a history of Cerebral Palsy, severe kidney infection and now suffering from Guillain-Barre Syndrome?

My sister has Cerebral Palsy. My sister has improved greatly during the 29 years of her life. If you met her, you may notice something, but may not know quite what. Her speech pattern is something similar to many people who've had a couple beers. Slightly slow, but still very understandable. Also, she walks at one speed. She doesn't run very well and don't ask her to jump up and down on one foot. But, she walks just fine and wouldn't notice anything unless she was on a large slippery surface where she had to worry about loosing her balance. And to be totally clear, she has no mental deficits. She was a B/C student in school like many people I have known. She did well in areas she enjoyed and not as well in those subjects she did not.

On November 22, my sister gave birth to her first child...a lovely baby boy. No complications that I heard of. They were sent home as normal.

Last week Wednesday/Thursday, my sister was running a fever and feeling pretty poorly. She likely had some abdominal pain, but chalked it up to recovering from her first delivery. She called her doctor's office and they recommended taking some Tylenol and calling them if she does not get better in a day or so. Saturday, the doctor's office is closed and my sister takes a turn for the worse. Her husband takes her into the hospital's emergency room in the early hours of Sunday. My sister cannot walk. She's barely conscious. Her words a slurred. She is responsive to Verbal stimuli, no longer fully Alert & Oriented. My sister's home thermometer read 102F. The hospital's read 104F.

The hospital begins to treat her for an infection they eventually determine to be a extremely bad kidney infection. Describing the infection as severe would not be over-stating the situation. She would need to be evaluated for permanent kidney damage. As the infection is beaten back, her mental status improves. Yet, she is still not talking. Her legs are described as being "like noodles." She also has very slurred speech and hard to understand. Occasionally, she has phrases that are clear as normal, like "I love my baby." She appears to be suffering from depression and is barely eating the chicken-broth-like soup the hospital is giving her.

The hospital is considering discharging her with some antibiotics for the infection, a done deal. She is still not walking or talking. The family is telling everyone this is not normal for her. Yet, everyday a different doctor reviews her chart, see she has CP and when evaluating the patient sees no sign of anything outside the range of CP. Yet, the family still seems to be quite upset. Yet, every time the family explains this is not normal, the nurse are doctor is like "Oh! I saw she had CP. This is not normal for her?" "No! We have been telling EVERYONE this ALL ALONG." Still, nothing is being done other than the antibiotic.

Luckily, my sister's OB/GYN hears of my sister's plight. As with any woman who has just had a baby, she has recently seen her OB/GYN more often than any other doctor. The OB doctor immediately notices the difference in my sister yet cannot do anything for my sister herself. Thank God, though she did commit to contacting A LOT of "the right" people. The next day, my sister was having an MRI, a Neurologist was seeing her and they were doing further tests.

Today, my sister has been diagnosed with Guillain-Barre Syndrome. Seems that most occurrences of this syndrome are proceeded with an infection of some-sort. It's a rare syndrome, affecting one to two people per 100,000. The exact subtype is even more rare. Miller Fisher Syndrome only effect about 5% of those with GBS.

A description of Miller Fisher Syndrome:

"It is characterized by opthalmoplegia (eye muscle weakness), areflexia (absence of reflexes), ataxia (the inability to coordinate voluntary muscular movements such as walking), and, in some cases, facial and bulbar palsy (affecting vital functions, like breathing, and swallowing or speech)."

Today they began treatment. Family has been told that drastic improvement could be seen in a few days. But, if no improvement by then, it could be months... From what I read, it could be even more. Lots of medication and lots of physical therapy is in my sister's future.

It's baby's first Christmas. My sister should be spending this early time bonding with her child at home. Yet, now she is suffering from pain, near paralysis, and depression in a hospital bed. I wonder what today would be like if they could have started treating her a few days ago rather than just now.


Why haven't more healthcare workers realized they need to ask not what is normal, but what is normal for this patient? Many see a history of a disability and just assume that this patient is not normal. That this person is normally asleep, not walking, not talking. All of us need to remember to listen and to ask questions. Charts can be misleading. Treat the patient not the chart and remember, the family and the patient have a lot more history in dealing with their disability than any doctor who does not have the disease themselves.

In an emergency situation, family members will likely and understandably be anxious from the situation. So they might not give you all of the history without being prompted. If a patient's family member tells you that this is not normal, even when normal for this patient might not be "normal" for you and me...LISTEN. And, please, make sure to pass this observation on when you give your report and document your care.



Many American's know what what CPR is, even if they do not know how to do it. But, how many people actually know what the letters CPR stand for?

Cardiopulmonary Resuscitation

Cardio = Heart

Pulmonary = Lungs

Resuscitation = Reanimation...returning of life...etc.

As part of first aid class and every higher-level class I have taken since then, I have always been taught to check the ABC's and in that order. Airway, Breathing, and Circulation. They are important in THAT order. Your heart may be pumping, but without an open airway and respirations, the heart won't be helpful for very long.

Americans are learning CPR in greater and greater numbers. But, the public is also becoming a lot more aware of communicable diseases. This has caused a crisis for the patient in need of aid when only bystanders are around. People are doing nothing. Even when they may have at least a decent idea of what to do. It seems that people are afraid to do rescue breathing. Honesty, I don't blame them. Without a barrier between you and the patient, there is a good chance you could swap some germs...and maybe lunch.

So, it seems this thinking is now effecting how people are being trained to do CPR. The use of disposable masks and other barriers has been around for sometime. But, the big change that is just rolling out is scaring many professional rescuers. For CPR, the importance of ABC is being switched around to CAB.

I can understand training someone to at least do compressions if they are in a situation where they are nervous to do respirations. Yes, the residual Oxygen in the system will be circulated around. But, toxic Carbon Dioxide will build up if not given a chance to escape though respirations.

The American Heart Association has a major sway on how CPR is done in this county. With their current revision in their guidelines, they seem to hold the risk of alienating the professional rescuers. Below I have linked to a FOX News article that seems to show a fairly positive outlook on the new guidelines. I have also linked to a blog entry that goes into great detail about why many medics think the whole thing is messed up. Though the blog may be way to technical for readers outside the medical world, I highly suggest everyone read both.

My take on it?

I am about to get my CPR instructor certification for the American Heart Association. I will teach the new guidelines, as I am required. But, I will also talk about the impact of these guidelines depending on the level of my audience. If you have no medical experience at all and a stranger codes in front of you...Call 911 FIRST! After that, do everything you feel comfortable doing. If that is only compressions, so be it. If that is lots and lots of compressions and only a few breaths. Thank you. But, please realize that as professional rescuers, when we arrive, we are expected to deliver care at a higher level. This means making sure we do effective compressions and BREATHE FOR THE PATIENT. I recommend Oxygen delivered though an ET Tube/Bag-Valve. But, if you are a Basic service, please at least to a Bag-Valve-Mask. The key is to assess the patient and do what it best for that patient. Guidelines are just that guidelines (NOT LAW) ...follow your local protocols, they are what will help you keep your job...and hopefully save a life.

Like I said, read the articles.

Fox News

Paramedic Blog - 11/30/05


Anyone for a war on cars?

OK. Any of us who are in EMS should know that the field really started to grow out of a response to death from traffic accidents. That is why national EMS standards and governance comes from the Department of Transportation. Yes, this may change to the Department of Homeland Security. But, given this study, I wonder if it should.

News Articles:
Car deaths 400 times greater than terrorism
Death toll from road accidents 390 times that from terrorism

Now, if I can only find a link to the actual study...anyone? The articles I am finding annoy me because it seems one news source just uses another news source as it reference of information. Note the difference in the math...390 or 400? I have seen that the results of the study can be found in the journal Injury Prevention...now just to find a copy, preferably online.

OK. I found the article online...a very short abstract is free..but I have to pay for the full article. Now is not the time of year I can justify paying for something like this. Anyone out there read the actual article or study? Link to Abstract

The best quote I have found so far:

"In 2001, road crash deaths in the US were equal to those from a September 11 attack every 26 days."

Cool Job

Now, in the past, I definately felt I had a cool job as a US Park Ranger. But, occasionally, I come across something that makes me think the person has a really cool job and is lucky to get paid to do such things.

Here is another one. Make sure to look at the pictures. Such a great idea.

Fabien Cousteau, Swimming with Sharks
(NPR story w/ audio interview)

Shark-Shaped Submarine Is Latest Cousteau Star Vehicle
(National Geographic with more pictures than NPR)

Of couse, the grandson of legendary Jacques Cousteau is going to be doing something interesting! Lucky him. I hope he realizes it.


One thing about working in EMS is that you can think of worse-case scenarios very easily. Heck, it's what we do. The chest pain may be nothing, but we will rule out what we can and treat for the worse-case scenario.

My family is spread out all over. I grew up about 8 hours from where I currently live. Most of my family is still in that area. My mom, on the other hand, is doing the whole semi-retired lifestyle in the sunny southwest.

We get this email from my mom today:

"I don't know if you've heard, but [my 29yo sister] is in the hospital. [Her husband] took her in to the ER on Saturday morning. She wasn't able to walk and her speech was slow or actually nonexistent. They are running a battery of tests. Still no answers, but they say it doesn't look like a stroke. I am flying back tomorrow. Will plan on staying a week, but that is kinda up in the air till we know more. Just thought I'd let you know what's up. Please say and extra prayer for her. XOXO MOM"

My sister has cerebral palsy. She can walk and talk just fine..her balance is not the best and her speech pattern is slightly slow...just enough to notice. Also, she just gave birth to her first child about a week ago.

So, of course, I am now stressing about this. Yes, stroke is a possibility..but they say that is ruled out. I wish I was there. I am wondering if she accidentally OD'ed on a medication. I suspect they give new moms something for pain..I know they are in a bunch of pain from what their body went through.

I am awaiting more news...until then I am worrying.

Got all the right stuff from her mom

Our 15yo daughter is at the Christmas dance with her boyfriend tonight. She looked very pretty. I'm glad to have raised a daughter who isn't "high maintenance" but it would be nice to see her dress up more often. She tends to be a pony-tail and sweatshirt girl...nothing wrong with that. Just nice to see her clean up sometimes.

They (double date) are going to the dance, then glow-bowling, and finally end up at our house. They are all spending the night here...boys and girls in separate rooms, of course. Parenthood can be hard sometimes and very hard many other times. But, it is nice to see them growing up as good people.

A card can mean so much

My service got a thank you card in the mail from the daughter of my first code. It is nice to get things like this from time-to-time. I need to remember to make a copy of the card and send it on to the Fire Engine crew who helped us.

Here is what the note within the card said,

"Thank you for saving my mom's life 11/14/05 in the early morning. After her heart attack, she remained at (Hospital's Name) ICU for 10 days and returned home on Thansgiving morning! We were so thankful!

God Bless you for your help!"

Thank you for the thank you...it really means a lot.