#emsblog

From @resuscitationist on Facebook:

CASE: 43yo pedestrian struck by car (~30mph) arrived to ER GCS (14) = Eyes4 Verbal4 Motor 6 and quickly decompensated secondary to a "brain bleed" specific epidural hematoma.

With the bleed anatomically located via CT imaging, the decision was made for immediate decompression at the bedside as the patient was on the verge of herniation and death. A procedure typically done by drill (burr hole) or craniotomy (removal of skull) in an OR.

An EZ-IO intraosseus drill (15guage) needle was used to evacuate the blood from underneath the skull. This is NOT what the drill is intended for and off lable. Do NOT attempt unless specifically training, in a unique situation, and know where the bleed is located. Not a standard approach, but an awesome moment of ingenuity and what extent we in this field go to, to save our patients lives! .

EPIDURAL HEMATOMA:

1. classically from blunt trauma over temporal bone.

2. brief loss of consciousness ?LOC) then an awake "lucid period" prior to acute decompensation

3. typically the Middle Menengial Artery is source of bleed

4. CT outline shape described as "football" .

"Mayor de Blasio, asked during a press conference about the wide gap in salaries between Emergency Medical Service workers and other first-responders that accounts for a high turnover rate at EMS, replied, ‘We are trying to make sure people are treated fairly and paid fairly, but I do think the work is different.’ So EMS doesn’t compare to The Work that PD and FD does?.. my job isn’t as dangerous or strenuous as other first responders? So your telling me I don’t run up with PD when shots have been fired? I don’t fight off attackers because of the environment we’re forced to work in. I don’t stand right next to the “fast team” waiting for a “mayday” to come over the radio on a structure fire? I don’t put on a bullet prof vest on a scene of an active shooter or a barricaded EDP with a weapon? I don’t get mistaken for a police officer wearing a blue uniform in a bad neighborhood; possibly get attacked for it? I don’t drive by a building on fire, which people are trapped on the fire floor and rescue those civilians, then containing the fire from spreading to other floors or potentially another building because FD aren’t on scene yet ? Well I can tell you right now Mr. Mayor, I have done all those things in EMS. On every FD call, EMS is there. On high priority PD jobs, we are there. Listen to FD & PD radio frequencies, count how many times they say “request EMS” “what’s the ETA for the bus” “RUSH THE BUS TO THIS LOCATION !!” The roles may be different, but the work is the same. It’s time we get recognized for our contribution to the work we do along side our brothers and sisters in FD & PD. In our profession, we get injured, assaulted and die. On 9/11 the 8 EMTs/Paramedics didn’t think “the work is different” they also ran into those buildings to save civilians. How can it be justified that the crew that picks up your garbage makes 40k more than the crew who goes through all of this every single day. So, are we “treated fairly and paid fairly”?"

-Rich Ard

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

Every shift. Every day.