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Rod Brouhard, EMT – P

First Aid Blog

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Teen Stows Away on a Flight to Hawaii and...Lives!

Monday April 21, 2014

Stunned.

That was my reaction to the 15 year old who climbed in the wheel well of a Hawaiian Airlines Jet and rode all the way to Maui. Apparently, he's fine!

This isn't a likely scenario. The air is thin. The temperatures are -80 degrees. He spent more than 5 hours in there.

He should've died.

At the very least, severe hypoxia or severe hypothermia should have left him incapacitated for longer than an hour, which is reportedly how long it took him to wake up and climb out of the plane. How about a touch of frostbite? Anyway you cut it, this kid should be dead. For such a ridiculous screwup, he's lucky beyond belief.

Santa Clara teen stowaway's survival in jet's wheelwell was literally death-defying - San Jose Mercury News.

Everything in Healthcare Affects Patient Care

Sunday April 20, 2014

A children's hospital in New Orleans admitted 5 years after the fact that 5 kids died from hospital acquired infections at its facility. It's a nightmare for any parent: take your child to the hospital only to have the hospital kill your child.

I regularly tell my team that there is nothing we do on the ambulance that isn't directly or indirectly related to patient care. It's the same in the hospital. In this case, the infections reportedly came from a fungus on bed linens. The hospital said in a statement last week that the linens were cleaned by a vendor, which doesn't change my point: everything done in a healthcare setting affects patient care.

Even work by a vendor affects patient care.

These infections started as innocuous little bumps and grew into ugly necrotizing sores. These are the types of skin infections that are regularly misdiagnosed as spider bites or stings by some other critter. Unfortunately, recognizing that they came from the hospital is nearly impossible until there are multiple patients that authorities could tie together as all having been admitted to the same facility.

By that time, the damage is done.

This story illustrates how important it is for everyone in healthcare to take his or her job seriously and how important for healthcare leaders to take every worker's contribution seriously. The folks who stock the shelves mean the difference between whether or not there are supplies ready for emergencies. And we've seen how the folks who clean the sheets could mean the difference between life and death.

Healthcare is serious business, all of it.

Opioid Antidotes for All?

Tuesday April 15, 2014

Naloxone sold over the counter? An article in the San Francisco Chronicle today talked about a new bill that would make the "overdose antidote easier to buy." AB1535 would allow naloxone (brand name Narcan) to be sold without a prescription in California. The idea is to more quickly treat patients of opioid overdoses before they die.

The most common serious opioid overdoses come from heroin, which is a narcotic deemed to have no medicinal use according to the DEA. While heroin might not be medicinal, its cousins are. You might've heard of a few of them: Oxycontin, Vicodin, Norco, methadone,  morphine, Percodan, Percocet, Darvon, Darvocet...

The list goes on.

When one overdoses on these opioids, breathing can stop. There are some other physiological signs, but the lack of breathing really gets in the way of living a full and meaningful life. Not every opioid overdose patient stops breathing, but those who do stop often don't start again.

Naloxone makes one breathe again.

It's pretty dramatic. A few seconds after receiving naloxone by injection, overdose patients take a deep breath and wake up, usually with protests of "I didn't take anything" or "I only had a few drinks." For future reference: alcohol kills in a completely different way and naloxone absolutely only works on opioids. It doesn't do jack for anything else.

And therein lies my only concern with this plan.

I don't see a ton of issues with a naloxone autoinjector lying around here and there for the heroin overdose patients to try. Indeed, these folks are professionals and so are their friends. It's entirely probable that they would be able to recognize and reverse the overdose with naloxone.

I am a little concerned about the other use mentioned in the article: prescription overdoses. People who use the medicines I listed above or any of the other countless derivatives might try to have a dose of naloxone around the house just in case. It's not that big of a deal if they're right. Naloxone would certainly fix the problem.

But folks who take these medications rarely take only these medications. And remember: naloxone doesn't do squat for anything that's not an opioid, even the stuff that's mixed with the opioids. Naloxone won't fix the acetaminophen overdose that goes with the Vicodin overdose, even though it will reverse the Vicodin. Once the Vicodin is gone, the acetaminophen will still kill the patient.

Sedatives that aren't opioids won't be reversed, either. So if valium, ambien, alcohol or carisoprodol are the drugs causing the patient not to wake  up, giving naloxone will only stall real help.

The article suggests there are only two options: take naloxone immediately at home or wait until the ER, where it might be too late. I suggest there's a third option: Call 911. Ambulances carry naloxone. They have for decades. And, paramedics are trained to recognize the signs and symptoms of an opioid overdose. If the issue is not a opioid overdose, they'll recognize that, too.

And they won't waste time trying naloxone when it's something else, like a stroke.

Are Your Kids Prepared? Here's What They Need to Know

Monday March 31, 2014

We teach kids not to get in a car with strangers. We teach them how to answer the door -- or not to -- when we're not home. We teach them to look both ways before crossing the street. We teach them not to play with matches.

That's good, but it's not enough. Your kids need to know more about safety.

What if they do play with matches? Do your kids know what to do if they catch their clothes on fire or burn themselves?

Part of growing up is becoming more independent. Your teenagers probably have cell phones. One of the reasons you purchased it for them was for safety. Did you know there's a difference between calling 911 on a cell phone and calling 911 from your house phone? Your kids need to know what to expect when they dial 911 from their cell phone -- and what will be expected of them.

They should know how to Stop, Drop and Roll if their clothes catch fire and how to treat the burns.

Small kids should know how to protect themselves from stray dogs. Bigger kids are strong enough to do CPR.

Teaching kids to avoid strangers and look both ways are both good starts on being safe, but kids can and should learn a lot more. Empower your youngster to be independent and respond to dangers quickly and decisively. They might even save you some day.

Are You Anemic?

Sunday March 30, 2014

Have you felt tired and couldn't figure out why? How about short of breath or bruising easily?

Anemia is a medical condition related to the lack of a component of blood. In most cases, it's from an iron deficiency. Iron is essential for the body to metabolize oxygen. If you don't have enough, you can't use all the oxygen you inhale.

Iron deficiency also leads to difficulty of creating clots, which means that people with anemia bleed and bruise more than healthy patients.

Anemia can be treated with iron supplements, but only if it's diagnosed. It's important to tell your doctor if you're feeling tired, bruising easily or feeling short of breath for no obvious reason.

First Aid Phraseology: First, Second and Third Degree Burns

Friday March 28, 2014

News accounts of burn injuries almost always include statements like "more than 30 percent of his body was covered in third degree burns."

What does that mean, exactly?

Burns are complicated. Burn injuries come from lots of different causes: heat, chemicals and the sun are the most common. Regardless of the cause, burns are almost exclusively injuries to the skin.

Determining the extent of a burn injury requires knowing two things: how deep the burn goes and how much of the skin is affected. Figuring out the amount of skin (called the body's surface area or BSA) can be a convoluted process and we'll save that discussion for another day.

Burn depth, on the other hand, is easier to understand and to identify. Skin consists essentially of three layers:

  1. Epidermis is the outer layer of dying or dead skin cells that provides a barrier to moisture and infection.
  2. Dermis is the main layer of raw skin that contains all of the parts we associate with skin: hair follicles, nerve endings, sweat and oil glands, etc.
  3. Subcutaneous is not really skin but is a thin layer of fat tissue we all have, no matter how skinny we are (or aren't).

Burn depth refers to how much of each layer is either damaged or destroyed.

  • First degree burns: the top layer (epidermis) is only damaged. The skin turns red, but it stays whole and intact. First degree burns are also known as superficial burns.
  • Second degree burns: the middle layer (dermis) is damaged and begins to swell. The epidermis is damaged bad enough to separate from the dermis, which leads to blisters and sometimes leads to the epidermis coming off and leaving raw, weeping skin. Second degree burns are also known as partial thickness burns.
  • Third degree burns: the epidermis and dermis are completely destroyed, leaving dead, sometimes charred, tissue behind. The damage extends all the way down to the subcutaneous fat. Third degree burns are also known as full thickness burns.

So, the next time you see a blister after a burn, you'll know you're seeing a second degree, partial thickness burn.

First Aid Phraseology is an occasional look at the common words and phrases used in first aid and emergency medical services. Have a term you'd like to know more about? Email me and I'll touch on it in a future post.

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Arachnophobia

Wednesday March 26, 2014

The spiders are coming out.


Spider Bite

 

You never know what these critters can do to you
Image © P. Kennedy, About.com Guest

It's almost spring and as it warms up it becomes perfect spidey weather. The little 8-legged monsters are lurking under every woodpile and old tire just waiting for a chance to nibble on your nether regions.

Will you know?

Some folks report feeling a little pinprick. Others say they felt nothing at all. Many just show up to the emergency department with their skin rotting off.

Don't wait too long before you get help. Spider bites are real problems, but many wounds blamed on spiders aren't from arachnids at all. There aren't too many spiders known to leave massive wounds. The brown recluse is the best known for its nasty bite, but most of the disgusting, infected sores attributed to the recluse probably didn't come from a spider at all.

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Washington State Officials Should've Been More Clear

Tuesday March 25, 2014

There are reports that 176 people are missing after a landslide in Oso, Washington. In press conferences today, officials tried to clear up a misunderstanding: there aren't necessarily 176 missing persons, but there have been 176 reports of missing persons.

This is a great example of how important it is to have a public information officer (PIO) who is a professional. An experienced PIO would've vetted the information before releasing it. Officials should have reconciled the reports to identify how many actual missing persons they were dealing with before releasing anything.

They didn't have to give a number. They could have simply said there were reports of several missing persons and cleared it up later. Now we're spending time on the number instead of the point.

In the grand scheme of things, the number of possible missing persons or getting information to the media isn't as important as responding to the crisis. As far as I can tell, officials are doing as good a job as they possibly can. This is just an example of how difficult it is to balance the desire of the public to know what's happening with the needs of the response.

Basically, the PIO is not too different from the reporters he or she is responsible for briefing. In an emergency operations center, the care and feeding of the PIO is not always at the top of the priority list. That changes when authorities need the public to do something specific, but usually the PIO has to ask the operational side of the house for updates. It is quite conceivable that someone told the PIO in Washington that there were as many as 176 missing persons and that number made it into the media.

First Aid Phraseology: Inferior or Superior, It's Not About Quality

Monday March 24, 2014

Medical terminology has all kinds of odd words that may seem to the layperson to be complete nonsense. While some of the terms are certainly not mainstream (proximal, medial and mandibular all spring to mind), the fact that each word has its very specific meaning is necessary so that all healthcare providers understand each other.

Superior and inferior are two of my favorites. I like these because they have totally different meanings in nonmedical life. In most cases, superior is vastly...well...superior to its counterpart. It's the better product or the better service. Superior is one of the boxes you check on those internet surveys you fill out when you're trying to get a free coffee.

Inferior is an insult. It's the ground level, the worst case scenario. Nobody wants to feel inferior. Indeed, it even has its own condition: the inferiority complex. Inferior objects are beneath the superior ones.

And that's how it connects to medical terminology. Read More...

California is Falling into the Ocean

Sunday March 16, 2014

So, the good news is that I finally found a great place to live literally across the street from the ocean. The bad news is: it's falling in.

My wife and I have always wanted to live near the water. I wanted a water view--and I have one, if you count sticking your head sideways into the window box in the kitchen--and I wanted to hear the waves. I got what I'd always hoped for, but unfortunately it won't be here forever.

I know that's kind of a silly thing to say. We all know that buildings get old and landscapes change. New York City is layered like an onion from all the building that's happened there. Even San Francisco, just a few miles from my new abode, looks a lot different today than it did during the Gold Rush years.

But in this case I mean it won't be here by the time my kids are retiring. The bluffs are falling into the ocean. Quickly.

For as long as I can remember, California falling into the ocean has been a running joke. The gag is usually that we'll just go under one day as a result of a giant earthquake. Luckily for us, it doesn't quite happen that way.

What does happen is that rainfall soaks into the soft soils of the earth here. Those soft soils are beautiful and overlook the crashing waves of the ocean, which also eat at them from underneath. People build homes on the tops of these soaked, soft, shaky bluffs and wonder what happened when the excess weight causes them to crumble.

It's happening in Malibu, which gets plenty of media attention because of the magnitude (and cost) of the homes. But Malibu isn't the only place where the cliffs are falling and taking manmade structures with them. In Pacifica, California there was a street that collapsed into the water and a few apartment buildings were declared unfit for human habitation when their backyards went swimming.

Don't get me wrong, if a major earthquake happens, there will be more collapsing. I'm far enough away from the edge to be safe, but if the unthinkable does happen, I could truly have that water view I was looking for--right out my living room wall.

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