Month: January 2012

RINSE and repeat.

The service I work in has very recently began collaboration in a pretty cool (pun intended) trial – the RINSE Trial (Rapid Infusion of Normal cold SalinE).

Why: Current guidelines only support the use of therapeutic hypothermia post ROSC (Return Of Spontaneous Circulation) – see the Australian Resuscitation Council (ARC) guidelines or the International Liaison Committee On Resuscitation (ILCOR) advisory statement. The RINSE trial was initiated to find out if there is any clinical benefit in commencing therapeutic hypothermia during resuscitation efforts by paramedics.

Background: Basically Therapeutic Hypothermia (TH) aims to slow the rate of metabolism down, reducing the body’s consumption of O2, and also lessening the chemical reactions that lead to reperfusion injury (reference). For a even more info on TH, visit the ever excellent Life In The Fast Lane and EMCrit.

How: Paramedics will be inducing TH by means of IV chilled Normal Saline, checking temperature via tympanic thermometers.

Who: This study is currently running in three states in Australia, by the three statewide Ambulance Services and a participating university in each of those states:

 

Please check out the link for more and in-depth information!

RINSE trial ClinicalTrials.gov: http://clinicaltrials.gov/ct2/show/NCT01173393

 

Has your service implemented TH for cardiac arrest?

Cycle of extinction

Sprawling

We haven’t even been able to check the van, and already we are called out for the first emergency of the day.

Entering the house, our ears are flooded with wailing, crying – a scream of helplessness mixed with fear and despair. Our patient is lying on the floor, lifeless; the wife hovering around him in panic and tears.

After it becomes apparent that further efforts are to be discontinued, we remove all evidence of medical intervention, and pack our gear together. We declare life extinct. The defibrillator sits unevenly on the ground – it is crushing a little toy dinosaur, which I rescue from any further trauma by putting it on a nearby table. As if on narration, it starts raining outside, just in case the current situation wasn’t gloomy enough.

It is nearly the end of the shift. It hasn’t been too bad. We have been back at the station for a while, only little longer to go. Then the alarm rings – the last emergency of the day.

Navigating heavy rain, we arrive at scene. I wheel the stretcher in…and get stuck. It will not go any further.

A little toy dinosaur has budged itself in the wheels.

Luckily, this time the patient lives. As we leave, the clouds part.

Further education

As you are probably aware, I recently graduated with a Bachelor of Science in Paramedicine.

I’m also bored.

So I’m looking to advance my education. Trouble is, there is so much out there! Picking a university isn’t the only thing. It’s deciding what to study too!

Now for a little crowdsourcing, some participation from you, the reader: Any experiences/recommendation for a university or even a particular course? I’m open for any suggestion! I am primarily looking at Australian universities, but have also taken a peek at UK universities – the stratosphere is the boundary.

Feel free to leave a comment below, email me or tweet me. Thanks!

In or Out?

I sit here, body tired and weak from the previous nights ordeal. It should have been my second night shift, but it turned out to be a rather unpleasant bout of diarrhoea and vomiting, resulting in my early departure from work.

After getting through the ‘D’ part of the night with multiple desperate visits to the loo, morning broke, and with it the urge for the ‘V’ to make an appearance…with an additional V for Violent. Whilst my intestinal tract was as good as emptied after the night, lunch (18 hours prior) was still sitting in my stomach in the morning, until deciding upon a sudden explosive appearance.

Which got me thinking. Obviously my body wanted to get rid of something nasty. Step one: don’t absorb anything in the intestines, and let it all run through until there is nothing nasty left. Step two: eliminate stomach contents…apparently only very slowly via passing some semi-digested foodstuffs to the small intestine, but later rather quickly via the route it originally had entered my body. And, Oh, the immediate relief post emesis. Headache, nausea, dizziness as good as gone.

Which got me thinking. Obviously my body wanted to get rid of something nasty. Had I have been a paramedic attending to myself, I would have had the option of administering Ondansetron (Zofran), an anti-emetic. Definitely indicated for severe nausea, it may well have got my nausea under control.

Which got me thinking. Obviously my body wanted to get rid of something nasty. Giving a drug in order to keep the nasties inside your body might be counterproductive to the body’s fight towards homeostasis.

Which got me searching. Admittedly, I am still a little dazed and hazed, but that won’t stop a quick Google Scholar search on antiemetics and gastroenteritis. Funnily enough, all relevant articles were in relation to paediatric patients. I am not aware how much different the results would have been with an adult population, that’s for you to decide.

The findings from a number of articles pointed in to decreased vomiting from the groups assigned to antiemetics, especially ondansetron – and also points to longer duration of diarrhoea. Makes sense, if you don’t vomit the bad stuff out, your body will want to get rid of it as quickly as possible out the other way.

– ~ –

So I haven’t been able to ascertain if nature should take its course (no drugs and vomit), or if intervention is better (drugs and more diarrhoea). Does anybody have any evidence they would like to thrown in the ring? Would love to learn more about this subject – we do encounter this quite a lot (as paramedics, hopefully not as patients ourselves!).

Personally, I’ll stick with option a. If my body tells me it going out, then that stuf is going out. Professionally, I’ll give patients their choice.

And in the end, it was a good reminder how rubbish one feels with a Gastro-Intestinal system gone haywire.

Nightshift

I love night shift.
The day slowly comes to an end, and with it, daylight. The masses return home, to hermit themselves for the night, shielding themselves from the darkness. In darkness, strange creatures emerge from the fringes of society, emitting a multitude of cries varying from the joking, the drunk, the desperate to the downright insane.

Nachts sind alle Katzen Grau – at night, all cats are grey. The Germans have a great proverb for darkness. Streets begin to look the same, shadows become familiar, everything blurs in to multiple shades of grey; one suburb being a clone of them all.

Unless we are called. Our emergency lights bounce and ricochet off walls, street signs, windows; our siren wails a lonely echo between family homes; our floodlights pierce the darkest shadow in desperate search of a house number. Life and action is focussed for a moment at the scene of the emergency – until the scene is under control, we take off, and everything falls back in to quiet, soothing, yet eerie darkness.

– ~ –

I hate nightshift.
The restlessness, a pathetic excuse for sleep, comes abruptly to an end. The dreaded alarm bells have rung, tearing me from the temporary safe cradle of my comfy chair, releasing me in to a blurred stumble to grab van keys, glasses, a whiff of fresh air, and – hopefully en route – wakefulness. Eyes as dry as the Sahara and sticky as treacle don’t help the cause, neither does a mind as fuzzy as a duckling with an Afro. Moves are automated rather than thought through, communications at hospital are grunted rather than eloquently executed. The clock ticks by at quarter speed, every second seeming like a minute, every minute seeming like an hour until the end of the shift.

Once back in own bed, sleep is a raw necessity rather than something of pleasure or, heaven forbid, beauty. Raw, basic, primeval need for sleep drives me in to bed, hopeful to make up for some of the rest lost over the past hours. Never enough, but enough to keep going.

Limbs as heavy as lead, a feeling like your body is wading through the thickest of syrup, every move is a double effort. And that’s just to get to the fridge for some food. No motivation to go anywhere apart from a shower, and then maybe back to the fridge. You know your day is wasted, the lack of motivation stealing your day away, the lack of sleep stealing your health away.

But we still do it. Like an alcoholic, ecstatic about his next drunken stupor we knowingly race in to, and through, the night – just to awake with a giant hangover the next morning.

Like an addict, we keep coming back to the drug until it consumes us.