conditional_soup

My local EMSA has approved IV Tylenol for pre hospital pain management in trauma patients. Supposedly, studies show that there's little clinical difference in the efficacy of acetaminophen and opioids in acute pain management. I've attempted to find this alleged research, and the link above is what I found. I can't quote it exactly because I'm on mobile and it's being weird, but the relevant section is towards the end and compares the efficacy of IV Tylenol to IV opiates. It leads with saying that the relevant evidence is considered low quality before indicating that (this is a VERY rough summary) IV tylenol seems to have a very similar though slightly less effective/durable analgesic effect. I recommend you read it for yourself. The study also doesn't seem to be limited to trauma patients, and seems to make no distinction between visceral and somatic pain, both things I was hoping to see.

Overall, I can see the benefits: it's cheaper, not addictive, less strictly regulated, doesn't alter consciousness or respiratory drive, and doesn't induce a bunch of histamine to tank a patient's blood pressure. I'm wondering if anyone has any experience with it, and if it works as well as advertised.

Thought I'd get a near death experience thread going. Doesn't have to be crazy to share.

I had mine when I was about seven. I was living with my mom at a big house that the owner was letting rooms out in, and they had a pool without a fence around it. You probably already guessed by now, but I couldn't swim yet. I was in the back yard playing with the boy who lived down the hall when the frisbee we were playing with landed in the pool. I thought I could reach it, and the other kid encouraged me, so I knelt down and reached out as far as I could for the frisbee. It didn't happen immediately, I was reaching for a bit before the landlord's big dog came by and bumped into me. I fell in, struggled a bit, and ultimately went under. I remember looking up at the surface, seeing my dog, a black lab, swimming circles over me, and then just going to sleep. My life didn't flash, I didn't have a realization that I was going to die, no lights in tunnels, no voices, no being dragged through deep water or any of that. It was really just like "I'm tired now" and I went to sleep.

Somewhere in all this, someone told my mom I was in the pool. She ran out, jumped in, and dragged me out. My next conscious memory is her pumping on my chest and me throwing up and coughing up water (kinda felt like both anyway). We never went to the hospital, in hindsight I was damn lucky not to have died of dry drowning later. In fact, I've been a paramedic for 14 years, and I've seen my share of drownings in home pools, and it only reinforces for me how lucky I got. It's such a narrow window of survivability, and my mom threaded it. Pools are no joke, don't leave your kids unsupervised around pools, and never ever trust an unfenced pool.

This is a smaller note, but it happened to one of my patients, not me. I was treating a man having a massive STEMI, and when we were just thirty seconds from parking the ambulance, he coded on us. We'd seen it coming, though, and already had the defibrillator pads on him, so I had the firefighter start compressions while I charged up the monitor. Once it was charged, I cleared him and fired the shock, and we actually got Hollywood resuscitation, like his eyes popped open, he gasped, started looking around, the whole nine yards. Only time in my whole 14 years I ever saw that. But the guy looked terrified, way more than he had been before. I'm talking a real, fundamental lizard-brain terror in his eyes; it's possible you've never seen that look, but if you know, you know. I've always wondered if his experience was like mine, had he just gone to sleep and then been jolted awake when the monitor hit him like a freight train? Or did he experience something else?

EMS Expo 2024 is taking place in Las Vegas, September 9-13th.

I haven't been to an EMS Expo since 2010, and that one was pretty okay. Has anyone been recently / planning to go? Is it any good?

Going to lead with: no, this isn't a skinwalker story.

Back in the early 2010s, my friends and I would hold regular airsoft practice in the woods behind my house. A lot of it was the sort of dense, old growth that covers to southeast US. Our last practice back there, we were wrapping up when we heard a very distinct whistle. We figured it was probably one of my neighbors who might have gone back to see what we were up to, so we called out to them, and, after getting no response, whistled back at them. We got another whistle back within ten seconds, and while we could figure out a general direction the whistling was coming from, we couldn't find anyone there. Getting a little concerned, we called out again, and decided to just pack up and leave when we got no response again.

Everything seemed mostly normal while we were packing up, though two of the people in our group insisted that they'd seen a figure peeking out from behind a tree at us. It wasn't until we were leaving that things got a little more exciting. On the way up the trail, my friend's dog kept indicating to the same area of to our right. We also heard that whistle every few minutes, getting closer each time we heard it. My friend with the dog later insisted that he saw a dark figure ducking out of sight from just behind us and off to the right of the trail. Thankfully, that's about the point where we started coming to the edge of the woods, and the events mostly stopped. The whole time that we were packing everything in the trucks, though, my friend's dog was laser focused on the woods.

I had some other kinda weird stuff happen at that house, like something hitting the back wall so hard that I thought the refrigerator had fallen over. To this day, my friend who claims to have seen it is sure we encountered something paranormal, though I'm not convinced that the whole situation wasn't just a bunch of college guys getting freaked out by someone in camouflage having a laugh.

So, I wanted to have a level-headed discussion about this case. I've been loosely following it since it happened, and I'm curious to see what others think of it, perhaps hear from folks who followed it more closely.

For those out of the loop, here's the JEMS article on it: https://www.jems.com/patient-care/two-co-paramedics-found-guilty-in-death-of-elijah-mcclain/

The tl;Dr is this: Aurora fire medics are dispatched to assist Aurora PD with a combative patient they believe is in an altered mental state. Aurora FD EMS crews identify this patient as qualifying for their excited delirium protocol based on PD and patient presentation, and administer the maximum dose of ketamine allowed under their weight-based dosing (which was well over what Elijah weighed). Now, there's other details (this IS a tldr), but after the ketamine, the patient goes into respiratory and cardiac arrest and is eventually declared. The paramedics involved were found guilty of negligent homicide. The FD has stood by their paramedics, saying that they followed their policies appropriately.

Let me lead with this: it seems to me that McClain's case was a foreseeable (albeit low likelihood) and unfortunate outcome that was the cumulative result of many lesser individual poor choices on the part of both law enforcement and EMS. We lack the personal context to really appreciate those choices, I think, and we're left to armchair quarterback those decisions with only the information available to us. I do believe that Mr. McClain should still be alive, and likely would be under different systems-level conditions, such as training and clearly defined interdepartmental operations protocols. Personally, I disagree with the conviction based off of my current understanding of the situation. My current understanding of the facts does not persuade me of the presence of gross, nevermind criminal, negligence on the part of the EMS crew. There absolutely is a conversation to be had here about PD leveraging field sedation and integrating field emergency care as a compliance and law enforcement tool as opposed to a healthcare response to a medical emergency. There's another conversation to be had about systems-level choices that likely influenced this outcome. I think that just throwing these guys in jail fails to accomplish anything on those fronts, and, as such, is a false justice.

So, I'd like to ask you guys for your thoughts. Was it preventable? Was the conviction helpful? What can be done to prevent this in future, if anything, and what's your take-away?

I was wondering how many of you have experience using pre-hospital ultrasound. I've heard for a long time that it's the "next big thing", and I can see it for rural systems or maybe even community paramedicine, but I've not seen much in the way of it actually getting adopted. Do you find it to be a meaningfully useful addition to your skillset and protocols? If you were around when it was introduced, how do you feel about the introduction? What were some lessons learned by you or the system along the way?

Headlines have never made me watch ads or accept cookies

Kanye is getting less and less excited as the ACE rail extension to Merced gets more and more delayed. I reckon they're doing it like this to tie in to the HSR station, but come on, man.

c/ca_native_plants https://lemm.ee/c/ca_native_plants

!ca_native_plants!ca_native_plants@lemm.ee

This community is for identifying, promoting, and discussing plants native to California, as well as encouraging their use in landscapes and gardens. Questions about identification are welcomed, but the community should be only ever considered a second opinion for foraging purposes.

https://www.youtube.com/watch?v=gkQUE8Xr-cc

Bigfoot came out just to watch the train. A true Renaissance Man.

My personal favorite genre of ghost story is the healthcare ghost story. Nurses have told me some stories that have made my eyes water, though that's not the tale I came to tell, because for all of my later attempts, I've never been able to do it justice. Let's share our medical spooks

I have 13 years of experience working on an ambulance as a paramedic. I've seen a lot of things, some horrible, some funny, some downright bizarre, but nothing I'd really classify as paranormal. This story was told to me by a co-worker on another ambulance shortly after it happened to her, while she was wrapping up documentation at the hospital.

They'd been dispatched to a sick person, which is sort of the catch-all complaint when dispatch doesn't have a more applicable complaint. When they arrive at the house, they find that the patient is a man in his late fifties who's gone unresponsive. Thankfully, the man's parents are able to let them inside the home and provide them with the information they need. Suspecting Sepsis, they try to hustle and get the guy out and down to the hospital. He dies shortly before arriving at the ER. Despite the efforts of both the crew and the emergency room, they can't get him back and the man is declared dead. Law enforcement comes by to start writing up their report and starts asking for information that the crew didn't obtain. It's no problem, though, the crew tells law enforcement to just do a 911 callback to the house and ask the guy's parents. So, the officer tries it, but gets no response. Having exhausted the easy stuff, the officer goes out and decides to visit the guy's parents. When he arrives, however, the doors are locked up tight, and there's no sign of anyone else. As the officer's poking around, a neighbor notices and goes to ask if he can help. The officer tells the neighbor what's happened and asks if he can help him contact the man's parents. The neighbor looks very surprised and says that the guy's parents have both been dead for years. And that's the story of how a co-worker got medical history from a dying patient's dead parents.

I feel like this is a really obvious one, but I can't find it. Is there a community for requesting features and reporting bugs in Lemmy?