Autistic EMT

An RN posed this question on Reddit, here are my thoughts.

I think there multiple reasons for this but I’d say one of the biggest factors is burn out associated with the realities we were oblivious to before the pandemic. It brought to light the truly horrific state of American healthcare. It all comes down to liability and monetary gain. Healthcare is run like a business first and the health of our community dead last. We all got into healthcare with the intention of helping people but what you don’t realize is how hard your hands are tied and its hard to accept that reality.

This is going to be a long post.

Stimming is a slang term in the autistic community derived from the medical term self-stimulation, although the term can be used for a wide variety of self-soothing behaviours as well. The term is used widely in the autistic community and can refer to more obvious stims like hand-clapping or more subtle ones like muscle clenching. 

Autistic people may stim either deliberately or automatically. Sometimes you’re not even aware that you’re doing it. Some stims might even feel like they happen to a person rather than are done by them, such as when they’re associated with zoning out or if the impulse is very difficult to suppress (if this is the case, it might even feel akin to OCD).

Some stims are very pleasing to engage in but other stims may be unwanted by the autistic person for a variety of reasons. For example, they may be harmful or perceived to be socially inappropriate. Unwanted stims can include jaw clenching, tooth grinding, hair pulling, skin picking, finger biting, and others. Sometimes these urges are there and can be avoided by switching to another stim, but other times they can cause problems for an autistic person.

Some autistic people are proud of their stims, and may even feel sorry for non-autistic people for not being able to enjoy the sensory experience of stimming as much as autistic people do. However, due to social stigma, other autistic may feel embarrassed or ashamed of their urge to stim and may suppress it or only do it in private. 

Stimming, in general, is life-enhancing. Many autistic people consider it essential to their mental health. Stims can provide an escape and act as a coping mechanism. 

Stimming can include any of the senses:

Sight: Visual stims might include zoning out while watching shadows of light on a wall, looking into a light source, rapidly blinking, and so on. 

Sound: Auditory stims can include listening to sounds, making sounds, or repeating them (such as repeating phrases or words over and over).

Taste: Eating spicy foods can be an enjoyable stim for some, or eating food with specific textures or colours.

Smell: This might include smelling “smelly” things like essential oils, or smelling different items like the sleeve of a jumper you are wearing, and so on.

Touch: Touch is a very common stim as it can be very subtle, such as tapping your fingers on your leg or holding your own hands, or touching things around you.

Temperature: Feeling hot and cold things, or making yourself either hot or cold.

Proprioception: This is the sense of self-movement and can involve running, rocking, pacing, spinning, jumping up and down, or dancing (even when there is no music!).

Pain: Pain can feel pleasurable to someone regardless of whether they are on the spectrum or not. The difference is context, quality, and amount. Examples of pain as a benign stim include gently biting your lip, pinching your skin with your fingernails, hair pulling, or eating a very spicy chilli pepper. 

Balance: Standing on one leg, spinning, walking on tiptoes are all examples of balance stims.

Vibration: Humming can cause one’s lips to vibrate, electric massagers can vibrate muscles, and so on.

Various internal stimuli: some autistic people might allow themselves to feel hungry or thirsty, or hold their breath.

There is also the sense of time, but I think you’d have to be another kind of being altogether to use that as a stim… that’d be, like, The Highest Level Autistic: Able to Stim With the Concept of Time.

Anyway, I digress. 

Non-autistic people “stim” as well, but not to the intensity as autistic people do. If you are reading this and thinking, “Well, everybody does that…” you’re partially right. Non-autistic people should be able to relate to some stims but won’t necessarily be able to relate to how important they are to autistic people. This is partially evidenced by non-autistic people telling autistic people to “just stop it”. Autistic people need to stim.  

Muscle tissue is made from a collection of highly specialised muscle fibres, formed by the fusion of individual muscle cells (myocytes).

All muscles are contractile and excitable and contain the proteins myosin and actin, which are responsible for contraction. 

Skeletal muscles 

Voluntary muscles

Attached to bones via tendons

Muscle tissue is surrounded by supporting and protecting bands of fibrous connective tissue called fascia

Plentiful nerve and blood supplies which an active muscle requires are located within fascia.

The muscle cells fuse into fibres and contain the contractile proteins actin and myosin, arranged in myofibrils, giving skeletal muscle its histological, striated appearance. 

Within a myofibril, actin and myosin are interleaved, producing the characteristic striated (striped) appearance, which can be seen under the microscope and is shown schematically in the figure below. When a muscle contracts the actin and myosin slide across each other, causing the striations to bunch up.

Energy is required to relax the muscle 

The default condition is contraction

When a muscle runs out of energy it contracts, as occurs in cramp and rigor mortis.

Overlapping proteins actin and myosin produce the characteristic pattern of striations in skeletal muscle. 

Smooth and Cardiac Muscle 

In contrast to skeletal muscle, both cardiac and smooth muscle are involuntary muscles, meaning that we cannot voluntarily control their contraction. 

In cardiac muscle the myocytes form a network, with crosslinks and intercalated discs between the cells. They have striations comparable to those in skeletal muscle.

Smooth muscle is found in the wall of blood vessels and many hollow organs, including the uterus, the bladder and along all parts of the gastrointestinal tract.

Divided into two subgroups; the single-unit (unitary) and multiunit smooth muscle. 

Within single-unit cells, the whole bundle or sheet contracts as a syncytium.

Smooth muscle cells are also present in the eyes and are able to change the size of the iris and alter the shape of the lens. 

Hormones

hCG - human chorionic gonadotropin - present in blood and urine, produced by blastocyst and placenta

Low levels of hCG could mean miscarriage, ectopic pregnancy, miscalculation of dates

High levels = molar pregnancy (cells that normally form a baby dysfunction and form cysts instead), multiple pregnancy (twins etc), miscalculation of dates

Progesterone increases fat deposition in early weeks and stimulates appetite

Increased oestrogen from corpus luteum promotes mammary gland development (breasts enlarge)

And inhibits ovulation via negative feedback [OES decreases GnRH release by hypothalamus –> linhibition of FHS and LH –> no ovulation]

Relaxin (secreted by corpus luteum) softens connective tissue in preparation for labour - not specific, all joints can be affected

Peaks in early and late pregnancy

Physical changes

Blood pressure

As early as 4 weeks into pregnancy 

plasma volume increase

caused by the affects of oestrogen and progesterone on the kidneys

OES and Prg cause vasodilation 

less resistance = less pressure

Heart rate increases by 25% to compensate

stroke volume increases 

increased overall cardiac output by 50% in third trimester

Direct action of enlarged uterus:

compresses the descending aorta and inferior vena cava 

decreased venous return - less blood in means less blood out, less blood in ventricle –> reduced pressure on walls –> reduced force to exit –> reduced placental perfusion

increased aortic pressure

increased heart rate

[shouldn’t sleep on back for this reason]

Outcomes:

Fall in blood pressure (can cause collapse if serious)

Can cause foetal hypoxia even without mother symptoms

Haematological changes

red cell mass increase by 20% (renal - increased erythropoietin production in response to detection of blood oxygenation and sodium/water balance)

Plasma volume increases more than RBC count does, causing the impression of decreased haemoglobin (anaemia)

Increased tendency to clot (hypercoagulable)

due to increase in clotting factors and plasma fibrinogen

platelet production increase (however count drops due to increase in activity and consumption) - function remains normal]

WBC count may increase due to an increase in granulocytes

Respiratory changes

Increased chest diameter, diaphragmatic expression and elevation

dyspnoea common (difficulty breathing)

breathing becomes more costal (mouth) than abdominal 

mainly mediated by progesterone levels (cause bronchial and smooth muscle relaxation and hypersensitivity to CO2)

Changes to the urinary system

cardiac output increase –> increase in renal plasma flow and glomerular filtration

increase in urea, creatinine, urate and biocarbonate clearance 

with progesterone, renin and aldosterone up water retention increases

can lead to urinary stasis and increased risk of UTI

Any drugs given that are excreted renally must be given in much higher quantities consequently

Gastrointestinal changes

Appetite increase + cravings 

Gastric reflux sphincter relaxation (increased indigestion, also due to increased intra-gastric pressure (expanding uterus)) 

gallbladder dilated 

GI motility decreased and transit time slower 

albumin and protein decrease 

cholesterol twice normal value

Muskuloskeletal 

Calcium reuptake into bloodstream results in mild decalcification of bones 

relaxin softens joints (pubic symphysis + alters gait (waddling))

abdominal muscles stretch to elastic limit 

stretch marks (stria gravidarum) caused by rupture of elastic fibres and small blood vessels 

Reproductive changes

Massive increase in mass

Placenta growth (nutrition, excretion, immunity, endocrine) 

Parental blood supply 

Some awesome graphics about different vaso-pressers from Paramedicine 101 over on Facebook.

If you’re especially into a piece of music, your brain does something called Autonomous Sensory Meridian Response (ASMR), which feels to you like a tingling in your brain or scalp. It’s nature’s own little “buzz”, a natural reward, that is described by some as a “head orgasm”. Some even think that it explains why people go to church, for example, “feeling the Lord move through you”, but that’s another article for another time. 

Turns out that ASMR is pretty special. According to a recently published study in The Journal of Prevention of Alzheimer’s Disease, the part of your brain responsible for ASMR doesn’t get lost to Alzheimer’s. Alzheimer’s tends to put people into layers of confusion, and the study confirms that music can sometimes actually lift people out of the Alzheimer'shaze and bring them back to (at least a semblance of) normality… if only for a short while. ASMR is powerful stuff! 

Read the full article at Big Think

Vessels of the Heart

Me: So do you have any history of heart disease such as a heart attack or needing stents?

Patient: No, but one time I was hospitalized because of a viral heart infection. They called it “mitochondria.”

A lil’ #scienceGeek humor.