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flobach.com

Contemplating life.

Pregloved and Prepared!

Here a few tricks I found really helpful when I was brand spanking new out on the road. Sharing is caring, as they say, so here you go:

  1. When en route to a call, write down a matrix of vital signs including the time they were taken time on your glove. That way, when you at the patients bedside (or roadside), you will have a stuctured table to write down vital signs in, tracking trends, plus you won’t forget any specific vital signs (I like to forget the BP cuff every now and then)
  2. Also, when you are en route, write down the name of the patient on your glove (provided you are given a name). I always like to forget names, but patients respond much better to being called by their name (it does makes it more personal). Plus, if you are picking a patient up from a nursing home, you won’t have to run back to the van to get that name you forgot about.
  3. Carry a whiteboard marker with you. At the end of a call, write up the items you ned to restock you need on the inside of the van windscreen or side window. Also, if you are driving and you hear something in the back that you want to ask the attendant about later, you can whip out the pen when you are stopped at a red light, write it down and ask later. Also good for temporarily vandalising colleagues vans ūüôā

Respect

We have a communal laundry where we live. Recently, I put on a few loads, went to my flat to wait for the cycle to finish, and got distracted by a phone call. My clean washing was finished, but lying in the washing machine taking up space, prohibiting someone else from using it. I have had ‘machine block’ happen to me, and it is annoying, but with patience comes victory (and clean laundry). Annoyingly, my two loads of ‘civilian’ laundry had been taken out of the machine and dumped on the countertop in the corner (collecting some of the accumulated dust). My ambulance uniform however was untouched with just the machine lid open; the back reflective panel “AMBULANCE OFFICER” shining clean and brightly to whoever peered in to the machine, accompanied by the shoulder patches, and various reflective striping amongst a sea of green fabric:

This enforces my experiences of others perceiving me being a better, more respected person when on duty – but just another idiot who forgot his washing off duty. I have had similar experiences whilst driving – in my own car, it’s midtown madness. In the ambulance the minute you indicate to change lanes, a gap will magically appear. Drivers are much more courteous and forgiving when driving around in the green and white van.

It’s great that we have so much respect as a profession amongst the population here in Australia. Paramedics have been voted #1 mot trusted profession in 2010 (for the 7th consecutive time!)¬†by Readers Digest. Sure, it’s Readers Digest – but 7 consecutive years nonetheless. There have been other surveys, unfortunately they didn’t have a specific ‘paramedic profession’ option, so we probably got tucked in with nurses and doctors, who won anyway. That, in its own right shows that we are respected, but not well represented. But that is another topic (and organisations like Paramedics Australasia are working hard on that issue).

From what I read in the UK, I believe paramedics conduct a similarly high respect, a little more than the US. Germanys Paramedics are definitely not as respected as Australian ones, but then again, their system is entirely different, using doctors for their ALS response.

Another thing I aim to find out on my trip – respect levels of paramedics within the community!

Segue

Hello!

Moving right along from my last post, I would like to announce my way of making sure I keep sane, seeing ‘the big picture’.

I’m coming to see YOU!

Holidays are quickly approaching my republic. I thought travel would be a great way to spend my time. Plus, I thought to myself, I would try to turn as many virtual¬†acquaintances¬†in to meeting and seeing the real person behind all the text they write. So, dear tweeters and bloggers – if you want to know what a real Australian looks like, your out of luck. But I am able share some great insights in to Australia (yes, including the the ambulance service), and can come up with a bad joke or three if required as well (check my facebook profile as a repository for them…).

I might even bring my pet kangaroo Skippy with me, and whack a croc meat steak on the barbie, if quarantine allows…

If you’re close to any of the following cities at or around the following dates, give us a shout (comment, email, tweet or telex). My travels will be taking me to the UK first, and InsomniacMedic and I have organised a tweetup in London for the¬†4th May, exact location to be confirmed. I will be then travelling up to Scotland (why? why not! Kal seems to like it there), and hopefully stopping on the way¬†somewhere, maybe Newcastle if Mister and Mrs 999 are around!

…and then I’m off to the US and Canada – again, let me know if you are around, and what date suits you best!

  • NYC: around the 17th of May
  • Toronto: around the 21st of May
  • San Francisco (hopefully with Monsieurs Schorr and Setla): around the 25th of May.

Oh, and if any of you need a hand on a shift, I’d be thrilled for a ridealong!

See you all out there under the CoEMS banner ūüôā

The Big Picture

As a kid, I always loved staring up in to the sky, trying to grasp the vastness of the universe. Then, from an imaginary point in space, I would turn around and look at the earth, imagining the millions and billions of people hurrying and scurrying across the surface, all individual little inhabitants with with their own little goals.¬†Makes you feel quite small and inconsequential. All our problem, all our sorrows, all our highs, all our lows…just one of many. Big deal?!

On the other hand, if we all didn’t give a toss, where would society be if the world sank in to mass anarchy because nobody cared? We would all die and destroy the planet. Then again, so what, since we would all be dead anyway. But I digress in to philosophical debate – another time maybe.

This Slideshow was part of my first lecture I attended for Mental Health – it left a lasting impression on me. Starting right from a macroscopical perspective of the universe, and zooming in to a microscopical view of the world. This really struck a chord with me. Relaxing back, my mind still likes to wander and wonder, just like when I was a kid. I¬†realise¬†my¬†problems¬†aren’t as bad as they are sometimes made out to be. Looking at them from a birds eye, semi-detached point of view gives you a great alternative stance.

But zooming in, focussing on details emphasises the importance of doing your best, being a functioning part of society, and helping each other on our journey upon earth that nobody really understands. Yet until somebody comes up with hard facts that life is pointless, I’ll err on the side of caution and be a good boy. I suspect those facts may take a while to collect, seeing that a randomised, double-blinded controlled study on the meaning of life may present with some minor difficulties.

a picture

Since I got some good feedback when I showed this picture to some, I thought I’ll share it with everyone: Yours truly, in truly loved overalls (a.k.a. onesies), backgrounded by one of our current Mk VI ambulances and beautifully finished off by the vastness of the Indian Ocean.

(click for full picture)

Atropine induced hyperthermia

A good friend recently asked me whilst studying: “Atropine can cause hyperthermia – why?”

He had only learnt this a few hours prior, and I had heard this for the first time at all. I am not very familiar with atropine – we don’t use it in our service. All I really knew until then that it is a parasympatholytic – and purely based on that word, it became my favourite drug. Parasympatholytic. Para-sympatho-lytic. What an excellent word. Mmmh. Medical Terminology Porn.

Anyway…enough drooling.

This article came up in a quick search, and put me on the right track. Read it for an in depth look; here is my simple version:

Atropine antagonises central muscarinic receptors (remember, the parasympathetic nervous system is made up of muscarinic and nicotinic receptors). This muscarinic receptor antagonising alters temperature regulation in the hypothalamus – the mechanism how it works is unfortunately not understood. But is is known that it reduces blood flow to the skin, thus reducing the ability for the body to lose heat and increasing body temperature. Similar to Adrenaline (Epinephrine for you North American types) I take it, although a brief search could not link adrenaline to hyperthermia (if you know of anything, please let me know).

And as a nice bit of side information the article describes the difference between fever and hyperthermia. So, go on, have a read!

Mechanisms, management and measurement in atropine induced hyperthermia (Anaesthesia and Intensive Care, March, 2009 by K. Gillman)

myPhone

Following my recent theme of technology, and spurred by the Podmedic‘s question “What smartphone apps do you use?” (MedicCast Episode 256), I will present my setup, an iPhone 4 32GB running iOS 4.2.1.

This is my home screen:

I tend towards minimalism in life (less junk to get in the way of really important things, check out these sites), so I only have one page, with all my similar apps bundled in to one of four folders. Here are the relevant two with all the installed apps, from left to right, top to bottom:

Medical/Info

  • Oxford Concise Medical Dictionary (paid): Useful reference with all data stored locally, great if no networks are available. As the name suggests, it is concise, lacing in depth knowledge and some more nichey terms, but overall helpful and well written.
  • Instant ECG (paid): Again, all data on the phone – which include 12 lead pics, ECG videos and a heap of knowledge. Really like this app, both from a reference and a learning point of view: it has a quiz mode tucked inside.
  • Medscape (free): Used infrequently, but not bad for reference. Menu sometimes a little misleading.
  • iBooks: Se my last two posts.
  • EMT Plus (paid): This came in real handy on a long haul flight from Frankfurt to Singapore. Take a test, either the whole one, or just a few from a category (airway, trauma etc), and tap the correct choice it will tell you if you are right or wrong, and why! Generally up to date, only one or two answers I didn’t agree with.
  • iTranslate (free): This handy app enabled me to ask my Dutch nanna in (not so) fluent Dutch which pub she would like to be taken to, and why her sausage dog is green. Also good for serious communications.
  • Remote (free): Umm, wrong category. Note to self: must change.
  • Maps (pre installed): Navigation device and the map book giving you grief? Got lost on the way to work at a new depot? Use maps!
  • Clock (pre installed): need to know the time? Anywhere in the world? Gotcha. Also with a nifty stopwatch feature. So nifty I’ve never used it.
  • Calendar (pre installed): Umm, when am I working again? Oh yeah, I’m at work now. Just doesn’t feel like it, sitting at the cafe staring at all the hot girls walking by…
  • Engin (paid service):nHmm, need to change category. VoIP.
  • Pkt Weather (paid): Do I need my rain jacket today? Or will I be melting out in the sun? I love this (australian) weather app – with infos sourced directly from the BoM (Bureau¬†of Meteorology)

Internet/Information (all free)

  • Safari: on the job, a great way to access Wikipedia and other websites
  • Mail: email, duh!
  • Twitter: @flobach, if you haven’t found me yet
  • Facebook: my outlet for silly jokes
  • Dropbox: I cannot recommend Dropbox enough: for backups, for sharing, for having all your documents available on the go – brilliant!
  • Google Reader: A bookmark, to keep up with all the blogs.
  • Simplenote: I keep a to do list, and my shopping list on here.
  • Skype: Well, it’s Skype.
  • Consume: How much data do I have left to flick through blogs until the shift finishes?
  • ABC: Australian Broadcasting Corporation, my source of national news.
  • Thousands:¬†Restaurant/Gig guide.

There you go, thats the main bits of my phone explained. What apps do you use?

Note: All apps from the Australian iTunes store. The background picture was taken on my iPhone mid last year on the ferry crossing Sydney Harbour – yes, it’s the Sydney Habour Bridge (but you knew that anyway, didn’t you?). Original pic here.