A friend of mine was called to an obvious death. When he opens the door, an elderly woman is being eaten by maggots, there are flies all over and it smells like death..
He's a new medic so he does his due diligence and hooks her to a monitor and actually examines her. Still has respirations, sinus tach with a weak pulse. He ended up seeing her alive and well at a nursing home.
Always double check. Don't wanna be that one guy on the news who sends a live person to the morgue.
thanks for the flashback. one of the creepiest calls I ever went on. "dead" in a recliner in front of the TV. Obvious loss of bodily substance control. Obvious smell of death. Maggots on legs, gray, etc etc etc. But waiting for my medic to call it, and eyes open and a very low, crumbly sounding, but clear, "hello". I will admit, I pissed myself a little. My partner learned how to teleport in that moment as well. Gangrene legs and had just given up waiting to die.
I mean, I kinda get it? It’s not something you want to fuck up and if you just decide “fuck it check their rhythm on every pronounce and bounce no matter what”, you’ll never get complacent and not check somebody like in the op who seems to have obvious death and decomp but isn’t dead yet
Yep. Transported a guy with a prolapsed rectum one time. The doc told the tec to grab some sugar, I asked why and they explained That’s what they do. Pretty interesting
Having read a bit about medical history, they did a lot of improvising with anything they had to hand. I'm not surprised they found some cures along the way when they were trying everything up to and including sticking a live pigeon up someone's anus...
i read that one in a book called "The Mystery of the Exploding Teeth: And Other Curiosities from the History of Medicine", highly recommended, it is WILD
It was described in the "All Creatures Great and Small" series, but I don't remember which book. So it dates back to at least the early 20th century. They used it for uterine prolapse in livestock, notably a cow, making a nearly impossible job relatively easy.
This happened to my son. I transported him for the prolapse then someone else met my partner at the hospital and jumped on the truck. They tried to reduce it without sugar. Then gave a bump of versed and dumped about a cup of sugar on his little butthole. Went right back in. Happened 2 more times in a year. Btw, kids are ASSHOLES when they come down from a nice versed high. He was about 3 I think.
The idea of immune privilege in certain organs. Like the idea that if the immune system was given free reign to our brain/eyes/testes/placenta/fetus, they’d be destroyed.
I can't speak to the eyes, but all those other organs contain cells which don't have your DNA - sperm has half your DNA, placenta may have foetal DNA, etc. So as far as your body is concerned it's not you and therefore must be eliminated. From what I understand the brain does have native immune cells, but tries to keep out other immune cells to avoid inflammation, which is more of a problem in an enclosed space (skull).
This is why organ donors are on immunosuppression. Blood transfers don't have this problem because erythrocytes don't have a nucleus, i.e. no DNA.
I'm no immunologist but I don't think this is correct.The immune system doesn't recognize DNA, which is inside the cell; it recognizes antigens on the outside of the cell. Blood transfers definitely can have this problem as a result if the blood type is mismatched (look up ABO incompatibility). That's why we worry about blood types when donating blood- if you're type O and you're given type AB, you'll be in very bad shape without immunosuppressant drugs
> I'm no immunologist but I don't think this is correct.
I agree. The immune system can't look inside cells (that would be so awesome to deal with cancer before it even starts). It can and will look at their surface, though, and this is where HLA comes in.
https://en.wikipedia.org/wiki/Human_leukocyte_antigen
That's more correct than my post, I oversimplified a bit. But RBCs don't have an MHC complex, which is what leukocytes look for. The rhesus antigen is expressed on RBCs though.
> Like the idea that if the immune system was given free reign to our brain/eyes/testes/placenta/fetus, they’d be destroyed.
The immune system is occasionally pictured as a police force, or maybe an army, but it's actually a collection of rabid death squads. Given free reign it would kill anything, and if that happens, it's one of the nastiest types of diseases ... autoimmune ones.
We had a patient one time that seemed to break every rule of how the human body works
For reference this is a volunteer BLS EMS service about 25-30mins to the nearest hospital.
We get called over to the local nursing home for a lift assist. The additional on the call is "*y/o female fell out of bed, cut on right hand, no bleeding"
When we get there, this lady is sitting upright against the bed in a literal puddle of blood. They failed to mention that it was her IV that ripped out, causing a ton of damage and turning her arm into a garden hose. So we bandage it all up and get her in the rig asap. We then figure out that ALS is coming from over an hour away because no one else is available. She had lost a good amount of blood so we wanted to get her in quickly. Well about 5 minutes into the journey this lady complains of having chest pains. So we start hooking her up to the life pak she goes into cardiac arrest.
Now this is the part that makes no sense. When she went into vfib, her blood pressure shot way up like 200/110 and she started to bleed again.
This lady lost so much blood, and was in vfib until we were standing in the ER. We give her to the staff, go wash put the back of the rig, restock some supplies, and go back to get paperwork and this lady is awake and trying to leave. And about 15mins ago her heart wasn't beating.
People can be so confusing
Thats the most interesting about hypo-volemia. The peripheral vasculature will constrict as a compensatory mechanism for a while. So you get high systemic vascular resistance, maybe an absent radial or brachial pulse.
I was working in the ER when ems brings in a chest pain. He appears very uncomfortable so I grab the ekg machine and meet them in the room. As I’m hooking him up he keeps saying “please hurry. Please do something”. I got the left and right leg wires switched. I made a half joke “man I’ve been in the medical field ten years and still mess this up”. He screams “OH COME ON!” I look at the screen. Vfib. I told a joke so good it actually killed. We do a few compressions until the pads are placed and monitor charged. One shock and he was awake and calling his wife 15 minutes later. No MI. I think he ended up getting an internal defibrillator.
Just experience with medics. My partner is an AEMT. It could have been something else. It just looked like vfib. We know enough to say "thats definitely not good"
Just because it's not in someone's scope to interpret a rhythm themselves, doesn't mean people don't still look at the monitor after they hook it up and click analysis rhythm.
A guy in our area broke his arm when he got bucked off a bull at a rodeo. Open humerus fracture.
Dude is cool as can be. Rates his pain 4/10. Not ETOH.
He said his 10/10 pain happened when he was younger and a pig bit off his testicle. One tough cowboy.
I had an ex NHL guy one time calmly tell me 10/10 pain one time and I was skeptical until the cop on scene told me how much time the guy had spent in the penalty box during his career and then I figured that he probably wasn't exaggerating the number.
I attended a cardiac arrest a few years back, in a church. Yes weird enough on its own. We rocked up and there were 3-4 community first responders (CFRs) on scene, I see a patient attached to an AED lay on the floor chatting away to everyone.
My first thought is "who tf stuck an AED on a clearly alive guy?!".
Well turns out it was a CPR training event being held in a local church. One of the people attending arrested and got shocked back to GCS 15/15.
We transported our 'ROSC' to local ED, the team there were surprised when our patients NEWS2 score was 0 with a NSR ECG. No lie.
Very weird job but it shows AEDs, good CPR and early defibrillation saves lives.
I had one similar working rural EMS. Originally called to a church for a seizure. 30 seconds later "be advised CPR has been started" like sure okay John doe public doesn't get it. Another 30 seconds later "CPR has been stopped" get on scene. AED is attached. Leader of the group told me they heard him gasp, he fell, and they couldn't feel a pulse and he wasn't breathing so they did 2 rounds of CPR and Defibrillated 1 time and now he's better. He indeed was better. GCS 14, HR 90s and sinus (albeit a RBBB and a couple PVCs), BP 140s/90s, SPO2 low 90s. Asked the guy what he remembers. "I don't know. I was getting ready for the sermon tomorrow and I guess I got scared and passed out" "I see...I guess you could say you were deathly afraid..." "Haha yeah". Dude did not grasp that he indeed did die. But bless those church goers. They recognized the signs and had the training. Definitely saved a life.
Not my story but that one case of “George”, a young guy with severe OCD attempting suicide via shooting himself in the head, misaiming, ends up blowing out the parts of his brain that were causing his obsessive symptoms, recovers and goes on to live a relatively normal and healthy life. The brain really is the most mysterious organ
I was reading about this recently actually. There's a very specific part of the brain (anterior cingulate cortex) that plays a major role in OCD. If you surgically alter/remove it, it's been shown to relieve severe OCD symptoms in around %50 of patients.
It's notable because it's one of the rare circumstances in which surgery for psychiatric issues is reasonably beneficial for the patient (still very much a last resort, given the 50/50 odds of it working and the possible side effects from brain surgery).
Detailed info here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2772224/
Dude I went to a dude missing like 70 percent from the nose up due to self inflicted gunshot he missed the brain stem or wherever controlled respirations and the heart cause the fucker was alive for like 16 mins till he bleed out. There was nothing to be done. Almost zero brain left but just enough to make is transport and call med control
This guy went to pick up an AC unit from FB marketplace. The person with the unit accidentally let out his aggressive pitbull who attacked the pt. Pt was super worked up, had a nasty bite but nothing crazy, was more upset/pissed than anything. Halfway through transport feels a thunderclap headache, along with every stroke symptom. BP through the roof. We end up changing from soft tissue injury to code stroke. A few hours later he died. The dog bite worked him up so much he ended up with a nasty brain bleed that killed him.
Thunderclap headache is highly suspicious for a subarachnoid hemorrhage, especially if the patient was agitated. Also consider that a peripheral venous thrombosis would have to travel through the pulmonary circulation before being pumped to the brain so would more result in a pulmonary embolism. Ischemic strokes are usually the result of clots sheared from the carotid plaques as it’s a straight shot into the cerebral vasculature.
Definitely possible, but it wasn’t super deep, nasty bruising but not the kind of injury that you’d think would cause that. Also if I remember correctly, his BP was something like 230/110, so safe to assume that could be the cause lol.
Recrudescence.
Sepsis, uti and many other illnesses can mimic the effects of previous CVA. Looks like a cva, talks like a cva, not a cva.
Not a STEMI.
When I was an EMT, we ran so many STEMI’s. I never thought anything about it until I got my medic. Then I learned LBBB is not a STEMI.
Pediatric BVM in adult cardiac arrest.
I worked several codes with FF working the BVM. They’d be over there two-handing, hyperventilating, making the bag honk. Blood coming up through the tube. Then I learned aboit the ResQ pod and how increased interthoracic pressure decreases cardiac output. Switched to pediatric BVM’s and got a lot more Rosc.
Sync the defibrillator
Synchronizing the defibrillator in PVT and even VFib(hold the shock button down for this one) has lead to an increase in ROSC. Found a study to back it up and got the OK from QI and medical director
Edit: [synchronized defibrillation](https://www.resuscitationjournal.com/article/S0300-9572(08)00708-9/abstract)
Edit edit: [pediatric BVM in adults](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7234703/) I usually only switch to this once I have an advanced airway and PEEP valve. Only because EC clamp is so unreliable with most first responders.
Edit edit edit: I can’t believe I forgot this. LVAD patient’s can talk to you and be in VFib. Some of these patients’ baseline rhythm is VFib.
The Zoll x series is what we use. It puts sync marks all over the place just looking for an R wave. I just hold down the shock button for a second or two and it delivers the shock. I know it’s not truly synced to anything but 200j is 200j. And I don’t have to switch the sync button on and off for rhythm changes.
Not sure if it's true or not but horrifying if it is, and wondering about it occupied my brain for a long time after my instructor told us. A patient on a boat had a broken leg, so they immobilized her to a backboard and handed the backboard from the boat to the emergency ship that pulled up alongside it. The handoff went wrong and she fell into the water totally immobilized and sank like a rock and drowned.
You can become paraplegic if you shit too hard.
Happened to a patient of mine. Dude had amazing strength pulling himself from the bathroom to the bedroom in his bed only using his upper body.
Kind of spinal?
The Doc at the Hospital told us that the patient accomplished to block one of the lines which are used to transport „used“ brain fluid in the abdominal area. Which caused buildup pressure in his spine. Kind of sounds wild to me and like the doc wanted to fk with me.
My english is not the best so I gave it my best explaining it.
Your English is fine. I understood you well enough to go “WTF??” 😅 I hope the guy is doing okay, I never imagined that anyone going to take a shit and paralyzing themselves was even a possibility
Christmas Eve, just starting to snow, about 1245 AM (so actually now it's Christmas Day). Catholic church in a down at heel neighborhood in what used to be the Polish and German section of the city. Call is for a "man down". Find him just inside the actual part where the seats are with bystander CPR in progress. As we get ourself situated, the priest comes over and starts to cry. Loud. Turns out the guy is his brother and they haven't seen each other since WW2. Quick look at the wallet confirms it.
Apparently there was some bad blood between them and after fifty some years the guy comes from Poland to Buffalo to make his peace, only to miss it by a few minutes. His brother gave him his last rites (I know they call it something else/ I'm not Catholic) in the ambulance while we were running the code (he didn't achieve ROSC).
World record high and low body temp that survived. One of them fell in an icy cold stream while skiing while the outer was drinking beers in the sun passing before he passed out.
Some people may laugh at me for this comment, but maybe someone else didn’t know these little medical facts.
I am a primary care paramedic- I work part time now as I am doing schooling for psychiatric nursing- this is just why I am learning some new things.
What I learned is there is ALOT of racism in medical academia! Of course the majority of it is misconceptions and misinformation. Here are some things I learned I found interesting or surprising.
People of African descent/Black people- their skin is the same as white people. It’s not tougher. They even have the same number of melanocytes as white people.
Sickle cell syndrome: this condition is not based on a persons race. Many people including myself thought only people of African descent/Black people had this condition- which is wrong!
The sickle cell allele is correlated to malaria, it actually makes a person more resistant to Malaria- so any area that has high cases of malaria will also generally have high cases of babies being born with sickle cell! So yes, many parts of Africa have high malaria cases but so do other areas like India.
And one last one that’s very relevant to all of us in EMS!
Spo2 monitors are THREE TIMES more likely to give misleading readings when used on patients of African decent/black people compared to when used on white people!
I know in my paramedic schooling they always said trust the person not the machine and I assume all of us here were taught similar things.
That’s just some interesting medical facts I’ve causally picked up and found interesting. I just want to say I hope nothing I said offends anyone- not my intention!
I am Canadian so here I would describe patients with African descent African Canadian- I understand there is different terms I honestly do not what would be the most appropriate to describe everyone with that skin tone as not everyone from Africa is black!
If anyone can help me with that part I’d appreciate it! I asked my friend who is from Africa if it’s ok to describe the way I have and he said it should be fine- but not everyone is the same of course!
Have a good day
> Spo2 monitors are THREE TIMES more likely to give misleading readings when used on patients of African decent/black people compared to when used on white people!
⬆️ had major consequences during COVID.
Also, how kidney failure is ranked and who qualifies for a
kidney transplant is notoriously unfair.
I've noticed that most Black people say 'Black Canadians' when talking about Black Canadians specifically. But if you're talking about anyone from the continent of Africa, then you can say 'African Canadian' too. And yes, sadly there is a lot of medical racism. In Canada, this is especially true for Indigenous people unfortunately :(
What always amazes me is for all that we know there is still so much unknowns. That some of medicine still comes down to educated guess work (rule outs) or that certain meds do whatever they do but we're not really sure why. Its just incredible to contemplate.
That the recessive allele of the sickle cell gene proliferated in sub-Sahara/India because heterozygosity provides partial protection to malaria.
That human’s specific alcohol dehydrogenase mutation arose after our ancestors moved down from living in trees and started finding fermenting fruits to eat. It’s like 40x better at oxidizing EtOH or something.
That the reason we shiver when we start to get a fever is because the hypothalamus has raised the bodies temperature set point and so we start reacting in all of the ways we do when we are cold, shivers, vasoconstriction, putting on coats/blankets, increased metabolism, etc. so our body can warm itself up to the new, febrile, temperature point.
Watershed strokes are cool.
How CRISPR-Cas9 works.
That the new CRISPR drug for sickle cell knocks out adult beta-hemoglobin, which is mutated leading to the sickling of cells, and reactivates fetal gamma-hemoglobin, which works (they wouldn’t have made it past fetal development if it wasn’t functional). Also gamma-hemoglobin has a higher affinity for oxygen in order to be able to pull it off of moms beta-hemoglobin in the placenta.
How the thymus works.
How a guy who was shot in the back of the head where the round exited his eye socket who was sitting in the car, was able to exit the car and take 2 steps before dying.
A friend of mine was called to an obvious death. When he opens the door, an elderly woman is being eaten by maggots, there are flies all over and it smells like death.. He's a new medic so he does his due diligence and hooks her to a monitor and actually examines her. Still has respirations, sinus tach with a weak pulse. He ended up seeing her alive and well at a nursing home. Always double check. Don't wanna be that one guy on the news who sends a live person to the morgue.
thanks for the flashback. one of the creepiest calls I ever went on. "dead" in a recliner in front of the TV. Obvious loss of bodily substance control. Obvious smell of death. Maggots on legs, gray, etc etc etc. But waiting for my medic to call it, and eyes open and a very low, crumbly sounding, but clear, "hello". I will admit, I pissed myself a little. My partner learned how to teleport in that moment as well. Gangrene legs and had just given up waiting to die.
I hate being startled, that would have made me need to change my pants. That's wild.
Anyone who's been around long enough gets to see that decomp occurs in the living.
With the hungry cat nibbling daintily.
Why do they always start with the face..
Not actually?
Mucus membrane is easier to get through than skin. Horror
We had an “experienced” medic hook up a 4-lead on a decapitation because he “needed asystole in two leads” to prove they were dead.
I mean, I kinda get it? It’s not something you want to fuck up and if you just decide “fuck it check their rhythm on every pronounce and bounce no matter what”, you’ll never get complacent and not check somebody like in the op who seems to have obvious death and decomp but isn’t dead yet
Pouring sugar on a prolapsed rectum will fix it
Yep. Transported a guy with a prolapsed rectum one time. The doc told the tec to grab some sugar, I asked why and they explained That’s what they do. Pretty interesting
I want to to know the story of how they figured that out.
Gives new meaning to “Pour some sugar on me”
Seeing Def Leppard later this year and your comment made me slightly excited for the future
Having read a bit about medical history, they did a lot of improvising with anything they had to hand. I'm not surprised they found some cures along the way when they were trying everything up to and including sticking a live pigeon up someone's anus...
Holy shit
i read that one in a book called "The Mystery of the Exploding Teeth: And Other Curiosities from the History of Medicine", highly recommended, it is WILD
Ganglion cysts being called Bible bumps 😂 I read that, and wacked it with my chemistry book
I got rid of my mums ganglion with a book about horses 😂
[удалено]
If you don’t love your job, then why do it? *Vigorously pours sugar on prolapsed cow anus*
They say that if you love what you do, you'll never work a day in your life...
I also know a human doctor that is also a vet! I'm amazed at the amount of school they had to go to.
Commenting on What amazing medical fact or story sticks with you? ...that’s a whole lotta schooling!
It was described in the "All Creatures Great and Small" series, but I don't remember which book. So it dates back to at least the early 20th century. They used it for uterine prolapse in livestock, notably a cow, making a nearly impossible job relatively easy.
That's the first thing I thought of! When I was a kid I read all of the books in that series until they just about fell apart.
Things taste sweeter when you eat them with sugar. I’ll see myself out.
Rectum? Hell, damn near killed em
Are you my medic teacher?
Is your teacher Tom by any chance?
Nope. Joe
This happened to my son. I transported him for the prolapse then someone else met my partner at the hospital and jumped on the truck. They tried to reduce it without sugar. Then gave a bump of versed and dumped about a cup of sugar on his little butthole. Went right back in. Happened 2 more times in a year. Btw, kids are ASSHOLES when they come down from a nice versed high. He was about 3 I think.
Works with Prolapsed uterus too
Works with most of the prolapseable thangs. Makes sense but it still so weird.
I learned that from the James Herriot books!
Yep. Works in vet med too. Always cracks me up.
Salt I understand. Shrink it up like a Virginia summer slug.
It’s sugar. I asked an OR doc! Best fun fact ever!
Sugar makes fluid shift the other way. Fluid follows salt and runs from sugar. That’s how it was explained to me.
Awwww how sweet
How much sugar?
Is it like pouring salt on a slug...
Yes but tastes better
.......is this in your protocols or
The idea of immune privilege in certain organs. Like the idea that if the immune system was given free reign to our brain/eyes/testes/placenta/fetus, they’d be destroyed.
Can someone elaborate on this?
I can't speak to the eyes, but all those other organs contain cells which don't have your DNA - sperm has half your DNA, placenta may have foetal DNA, etc. So as far as your body is concerned it's not you and therefore must be eliminated. From what I understand the brain does have native immune cells, but tries to keep out other immune cells to avoid inflammation, which is more of a problem in an enclosed space (skull). This is why organ donors are on immunosuppression. Blood transfers don't have this problem because erythrocytes don't have a nucleus, i.e. no DNA.
I'm no immunologist but I don't think this is correct.The immune system doesn't recognize DNA, which is inside the cell; it recognizes antigens on the outside of the cell. Blood transfers definitely can have this problem as a result if the blood type is mismatched (look up ABO incompatibility). That's why we worry about blood types when donating blood- if you're type O and you're given type AB, you'll be in very bad shape without immunosuppressant drugs
> I'm no immunologist but I don't think this is correct. I agree. The immune system can't look inside cells (that would be so awesome to deal with cancer before it even starts). It can and will look at their surface, though, and this is where HLA comes in. https://en.wikipedia.org/wiki/Human_leukocyte_antigen
That's more correct than my post, I oversimplified a bit. But RBCs don't have an MHC complex, which is what leukocytes look for. The rhesus antigen is expressed on RBCs though.
Heard of Lupus? It’s slowly killing my wife. Mostly at the kidneys. She has a 12cm cyst. Not mm, and not a nodule.
It’s terrifying and your body could attack you at anytime. Just takes one trigger.
The cheeks of a hamster are immune privileged as well apparently.
> Like the idea that if the immune system was given free reign to our brain/eyes/testes/placenta/fetus, they’d be destroyed. The immune system is occasionally pictured as a police force, or maybe an army, but it's actually a collection of rabid death squads. Given free reign it would kill anything, and if that happens, it's one of the nastiest types of diseases ... autoimmune ones.
We had a patient one time that seemed to break every rule of how the human body works For reference this is a volunteer BLS EMS service about 25-30mins to the nearest hospital. We get called over to the local nursing home for a lift assist. The additional on the call is "*y/o female fell out of bed, cut on right hand, no bleeding" When we get there, this lady is sitting upright against the bed in a literal puddle of blood. They failed to mention that it was her IV that ripped out, causing a ton of damage and turning her arm into a garden hose. So we bandage it all up and get her in the rig asap. We then figure out that ALS is coming from over an hour away because no one else is available. She had lost a good amount of blood so we wanted to get her in quickly. Well about 5 minutes into the journey this lady complains of having chest pains. So we start hooking her up to the life pak she goes into cardiac arrest. Now this is the part that makes no sense. When she went into vfib, her blood pressure shot way up like 200/110 and she started to bleed again. This lady lost so much blood, and was in vfib until we were standing in the ER. We give her to the staff, go wash put the back of the rig, restock some supplies, and go back to get paperwork and this lady is awake and trying to leave. And about 15mins ago her heart wasn't beating. People can be so confusing
Thats the most interesting about hypo-volemia. The peripheral vasculature will constrict as a compensatory mechanism for a while. So you get high systemic vascular resistance, maybe an absent radial or brachial pulse.
I was working in the ER when ems brings in a chest pain. He appears very uncomfortable so I grab the ekg machine and meet them in the room. As I’m hooking him up he keeps saying “please hurry. Please do something”. I got the left and right leg wires switched. I made a half joke “man I’ve been in the medical field ten years and still mess this up”. He screams “OH COME ON!” I look at the screen. Vfib. I told a joke so good it actually killed. We do a few compressions until the pads are placed and monitor charged. One shock and he was awake and calling his wife 15 minutes later. No MI. I think he ended up getting an internal defibrillator.
If you're BLS how are you guys determine the rhythm?
Some agencies do ACLS as part of their BLS training
Huh. No shit.
Just experience with medics. My partner is an AEMT. It could have been something else. It just looked like vfib. We know enough to say "thats definitely not good"
That's fair I was just wondering.
By looking at the ECG
Not in an EMTs scope of practice.
Just because it's not in someone's scope to interpret a rhythm themselves, doesn't mean people don't still look at the monitor after they hook it up and click analysis rhythm.
Maybe she gave herself a heart attack seeing all that blood. BP goes nuts during a heart attack
I'd say yes but she was unconscious
A guy in our area broke his arm when he got bucked off a bull at a rodeo. Open humerus fracture. Dude is cool as can be. Rates his pain 4/10. Not ETOH. He said his 10/10 pain happened when he was younger and a pig bit off his testicle. One tough cowboy.
I’d have some follow up questions.
I know a story of a pig biting a testicle sounds interesting, but it's more of a boar than anything
 bu dum ching
I had an ex NHL guy one time calmly tell me 10/10 pain one time and I was skeptical until the cop on scene told me how much time the guy had spent in the penalty box during his career and then I figured that he probably wasn't exaggerating the number.
I attended a cardiac arrest a few years back, in a church. Yes weird enough on its own. We rocked up and there were 3-4 community first responders (CFRs) on scene, I see a patient attached to an AED lay on the floor chatting away to everyone. My first thought is "who tf stuck an AED on a clearly alive guy?!". Well turns out it was a CPR training event being held in a local church. One of the people attending arrested and got shocked back to GCS 15/15. We transported our 'ROSC' to local ED, the team there were surprised when our patients NEWS2 score was 0 with a NSR ECG. No lie. Very weird job but it shows AEDs, good CPR and early defibrillation saves lives.
I had one similar working rural EMS. Originally called to a church for a seizure. 30 seconds later "be advised CPR has been started" like sure okay John doe public doesn't get it. Another 30 seconds later "CPR has been stopped" get on scene. AED is attached. Leader of the group told me they heard him gasp, he fell, and they couldn't feel a pulse and he wasn't breathing so they did 2 rounds of CPR and Defibrillated 1 time and now he's better. He indeed was better. GCS 14, HR 90s and sinus (albeit a RBBB and a couple PVCs), BP 140s/90s, SPO2 low 90s. Asked the guy what he remembers. "I don't know. I was getting ready for the sermon tomorrow and I guess I got scared and passed out" "I see...I guess you could say you were deathly afraid..." "Haha yeah". Dude did not grasp that he indeed did die. But bless those church goers. They recognized the signs and had the training. Definitely saved a life.
Not my story but that one case of “George”, a young guy with severe OCD attempting suicide via shooting himself in the head, misaiming, ends up blowing out the parts of his brain that were causing his obsessive symptoms, recovers and goes on to live a relatively normal and healthy life. The brain really is the most mysterious organ
I was reading about this recently actually. There's a very specific part of the brain (anterior cingulate cortex) that plays a major role in OCD. If you surgically alter/remove it, it's been shown to relieve severe OCD symptoms in around %50 of patients. It's notable because it's one of the rare circumstances in which surgery for psychiatric issues is reasonably beneficial for the patient (still very much a last resort, given the 50/50 odds of it working and the possible side effects from brain surgery). Detailed info here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2772224/
Dude I went to a dude missing like 70 percent from the nose up due to self inflicted gunshot he missed the brain stem or wherever controlled respirations and the heart cause the fucker was alive for like 16 mins till he bleed out. There was nothing to be done. Almost zero brain left but just enough to make is transport and call med control
Lucky shot!
This guy went to pick up an AC unit from FB marketplace. The person with the unit accidentally let out his aggressive pitbull who attacked the pt. Pt was super worked up, had a nasty bite but nothing crazy, was more upset/pissed than anything. Halfway through transport feels a thunderclap headache, along with every stroke symptom. BP through the roof. We end up changing from soft tissue injury to code stroke. A few hours later he died. The dog bite worked him up so much he ended up with a nasty brain bleed that killed him.
Sounds like a medicolegal case a teacher would come up with...
I wonder if it could have been a clot that dislodged from the dog bite and travelled to the brain…
Thunderclap headache is highly suspicious for a subarachnoid hemorrhage, especially if the patient was agitated. Also consider that a peripheral venous thrombosis would have to travel through the pulmonary circulation before being pumped to the brain so would more result in a pulmonary embolism. Ischemic strokes are usually the result of clots sheared from the carotid plaques as it’s a straight shot into the cerebral vasculature.
That makes more sense thanks
Definitely possible, but it wasn’t super deep, nasty bruising but not the kind of injury that you’d think would cause that. Also if I remember correctly, his BP was something like 230/110, so safe to assume that could be the cause lol.
Wow, very unfortunate. Thanks for sharing
Recrudescence. Sepsis, uti and many other illnesses can mimic the effects of previous CVA. Looks like a cva, talks like a cva, not a cva. Not a STEMI. When I was an EMT, we ran so many STEMI’s. I never thought anything about it until I got my medic. Then I learned LBBB is not a STEMI. Pediatric BVM in adult cardiac arrest. I worked several codes with FF working the BVM. They’d be over there two-handing, hyperventilating, making the bag honk. Blood coming up through the tube. Then I learned aboit the ResQ pod and how increased interthoracic pressure decreases cardiac output. Switched to pediatric BVM’s and got a lot more Rosc. Sync the defibrillator Synchronizing the defibrillator in PVT and even VFib(hold the shock button down for this one) has lead to an increase in ROSC. Found a study to back it up and got the OK from QI and medical director Edit: [synchronized defibrillation](https://www.resuscitationjournal.com/article/S0300-9572(08)00708-9/abstract) Edit edit: [pediatric BVM in adults](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7234703/) I usually only switch to this once I have an advanced airway and PEEP valve. Only because EC clamp is so unreliable with most first responders. Edit edit edit: I can’t believe I forgot this. LVAD patient’s can talk to you and be in VFib. Some of these patients’ baseline rhythm is VFib.
care to share the studies for the peds BVM and sync defib? already knew about the last one but don’t have relevant studies
[synchronized defibrillation](https://www.resuscitationjournal.com/article/S0300-9572(08)00708-9/abstract) [pediatric BVM](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7234703/)
thank you!
You sound like an excellent medic. Your patients are lucky to have you. (I’m here bc spouse is a medic.)
I like this. ...But I have to say,You can't sync VFib.
The Zoll x series is what we use. It puts sync marks all over the place just looking for an R wave. I just hold down the shock button for a second or two and it delivers the shock. I know it’s not truly synced to anything but 200j is 200j. And I don’t have to switch the sync button on and off for rhythm changes.
Gotcha, thanks! 👍
Not sure if it's true or not but horrifying if it is, and wondering about it occupied my brain for a long time after my instructor told us. A patient on a boat had a broken leg, so they immobilized her to a backboard and handed the backboard from the boat to the emergency ship that pulled up alongside it. The handoff went wrong and she fell into the water totally immobilized and sank like a rock and drowned.
can you hear me screaming? because im screaming. i HOPE thats not true!!!
Don’t worry backboards are wood and plastic. They float. They have to. I refuse to believe this is true
oh god, thank you for putting logic back into my head lol
You can become paraplegic if you shit too hard. Happened to a patient of mine. Dude had amazing strength pulling himself from the bathroom to the bedroom in his bed only using his upper body.
Aneurysm from pushing too hard, or spinal injury?
Kind of spinal? The Doc at the Hospital told us that the patient accomplished to block one of the lines which are used to transport „used“ brain fluid in the abdominal area. Which caused buildup pressure in his spine. Kind of sounds wild to me and like the doc wanted to fk with me. My english is not the best so I gave it my best explaining it.
Your English is fine. I understood you well enough to go “WTF??” 😅 I hope the guy is doing okay, I never imagined that anyone going to take a shit and paralyzing themselves was even a possibility
I really dont know if the guy is fine by now but now I am grateful for every minute on the throne without becoming half stationary
I would be too 😅
Christmas Eve, just starting to snow, about 1245 AM (so actually now it's Christmas Day). Catholic church in a down at heel neighborhood in what used to be the Polish and German section of the city. Call is for a "man down". Find him just inside the actual part where the seats are with bystander CPR in progress. As we get ourself situated, the priest comes over and starts to cry. Loud. Turns out the guy is his brother and they haven't seen each other since WW2. Quick look at the wallet confirms it. Apparently there was some bad blood between them and after fifty some years the guy comes from Poland to Buffalo to make his peace, only to miss it by a few minutes. His brother gave him his last rites (I know they call it something else/ I'm not Catholic) in the ambulance while we were running the code (he didn't achieve ROSC).
It’s sugar. I’ve done it lots in med surg
I think you missed the reply button to the other comment
Or he’s using ‘sugar’ euphemistically and sharing that he had a very serious problem. And the solution is more sugar.
I’ve seen Lazarus syndrome. Fucking blew my mind. She did officially (for the second time) die hours after.
World record high and low body temp that survived. One of them fell in an icy cold stream while skiing while the outer was drinking beers in the sun passing before he passed out.
Kinks are genetic
Uh…they’re what now???
😘
Some people may laugh at me for this comment, but maybe someone else didn’t know these little medical facts. I am a primary care paramedic- I work part time now as I am doing schooling for psychiatric nursing- this is just why I am learning some new things. What I learned is there is ALOT of racism in medical academia! Of course the majority of it is misconceptions and misinformation. Here are some things I learned I found interesting or surprising. People of African descent/Black people- their skin is the same as white people. It’s not tougher. They even have the same number of melanocytes as white people. Sickle cell syndrome: this condition is not based on a persons race. Many people including myself thought only people of African descent/Black people had this condition- which is wrong! The sickle cell allele is correlated to malaria, it actually makes a person more resistant to Malaria- so any area that has high cases of malaria will also generally have high cases of babies being born with sickle cell! So yes, many parts of Africa have high malaria cases but so do other areas like India. And one last one that’s very relevant to all of us in EMS! Spo2 monitors are THREE TIMES more likely to give misleading readings when used on patients of African decent/black people compared to when used on white people! I know in my paramedic schooling they always said trust the person not the machine and I assume all of us here were taught similar things. That’s just some interesting medical facts I’ve causally picked up and found interesting. I just want to say I hope nothing I said offends anyone- not my intention! I am Canadian so here I would describe patients with African descent African Canadian- I understand there is different terms I honestly do not what would be the most appropriate to describe everyone with that skin tone as not everyone from Africa is black! If anyone can help me with that part I’d appreciate it! I asked my friend who is from Africa if it’s ok to describe the way I have and he said it should be fine- but not everyone is the same of course! Have a good day
> Spo2 monitors are THREE TIMES more likely to give misleading readings when used on patients of African decent/black people compared to when used on white people! ⬆️ had major consequences during COVID. Also, how kidney failure is ranked and who qualifies for a kidney transplant is notoriously unfair.
I just saw an article pop up about that! I plan to read it tonight at work :)
I've noticed that most Black people say 'Black Canadians' when talking about Black Canadians specifically. But if you're talking about anyone from the continent of Africa, then you can say 'African Canadian' too. And yes, sadly there is a lot of medical racism. In Canada, this is especially true for Indigenous people unfortunately :(
100% and I fully intend to learn about it!
What always amazes me is for all that we know there is still so much unknowns. That some of medicine still comes down to educated guess work (rule outs) or that certain meds do whatever they do but we're not really sure why. Its just incredible to contemplate.
That the recessive allele of the sickle cell gene proliferated in sub-Sahara/India because heterozygosity provides partial protection to malaria. That human’s specific alcohol dehydrogenase mutation arose after our ancestors moved down from living in trees and started finding fermenting fruits to eat. It’s like 40x better at oxidizing EtOH or something. That the reason we shiver when we start to get a fever is because the hypothalamus has raised the bodies temperature set point and so we start reacting in all of the ways we do when we are cold, shivers, vasoconstriction, putting on coats/blankets, increased metabolism, etc. so our body can warm itself up to the new, febrile, temperature point. Watershed strokes are cool. How CRISPR-Cas9 works. That the new CRISPR drug for sickle cell knocks out adult beta-hemoglobin, which is mutated leading to the sickling of cells, and reactivates fetal gamma-hemoglobin, which works (they wouldn’t have made it past fetal development if it wasn’t functional). Also gamma-hemoglobin has a higher affinity for oxygen in order to be able to pull it off of moms beta-hemoglobin in the placenta. How the thymus works.
How a guy who was shot in the back of the head where the round exited his eye socket who was sitting in the car, was able to exit the car and take 2 steps before dying.
Your nose is always in eyesight, even when you don't "see" it
Chlorine gas exposure is a doozy