HDR Redux

I got a few pointers on HDR.  After the HDR software does its magic, I learned to tweek it a bit in Photoshop, and this is the result:

Compare it with the first image…

Really pops, doesn’t it?

What I’ve Learned Today

From one of my patients, even:

Drinking beer can cure both hives (urticaria) AND vomiting blood (hematemesis).

Really!

Why are we carrying Benadryl, when for just a few bucks (and a cooler), we have a much more popular & effective cure? 

I’m thinking our patients will really like us now…

HDR

I’ve been playing with a new tool for my images.  It’s called High Dynamic Range, and it takes three (or more) of the same image, shot with different exposures, and combines them into one image with high & low points.

I’ve applied it to a recent image from my most recent photo project – working with my employer on new PR images.

You can see more here.

Re-Motivated!

Assumptions

Dispatch:  Chest Pain

Location:  School

Patient:  12-year old.

The patient is found laying in the middle of the gymnasium floor, crying and writhing around, surrounded by firefighters, family & a few staff members. 

Vital signs as reported by the firefighters were entirely normal.

The patient been playing sports when he/she collapsed.

Mom is there, watching.

I’ll be honest.  My initial assessment was something not very appropriate.  “Hispanic Panic” it’s termed.  With the normal vital signs, brown skin, and recognition that occasionally, people tend to over-exagerate their conditions, I really felt this was bullshit.  but, chest pain is chest pain & needed to be evaluated.

The patient was rapidly lifted to the gurney & moved out to the ambulance, still crying & carrying on.

Once inside, I told the patient to stop with the histronics.  She did, which further cemented my ‘diagnosis’.

I could have stopped there.  Other medics certainly would have.

But I’m not that type of medic.  Even if I think something is bullshit, I tend to make sure there’s nothing else going on.  I and other medics have been burned with this attitude.

So I did a chest pain workup.  And I was surprised to find that the patient’s pulse was not 90 as reported.  The monitor showed a heart rate of 180!

I re-checked the radial pulse, and confirmed that it was, in fact, 90. 

And she did have chest pain.   I was continuing the chest pain eval. 

My plan was to perform a vagal maneuver first, then re-evaluate.  I decided to obain a 12-Lead prior to that, to document exactly what I was seeing.

With all the electrodes in place, I was reaching over to punch the appropriate button, when the patient self-converted, and the heart rate settled to just above 100.

And the anxiety was gone, along with the chest pain.

In the remaining transport time, I learned that the patient was not, in fact, hispanic, but from the South Pacific.  His/her name meant ‘beautiful angel’ in Micronese.

I learned that this event had happened several other times previously, but no cause had found.   I guess now we knew, or were at least headed in the right direction.  I saw some more testing in the patients’ future.  I did have the ECG strip, even if we didn’t have the 12-Lead I wanted.

And I learned that, sometimes, assumptions can be bad.  Deadly, even. 

——————————————————————————————————————————————————————

Oh, so why was the radial pulse 90, when the ECG rate was 180?  It’s my belief that his/her heart was beating so fast that it did not have time to completely fill on every beat.  So for every other beat, there simply was not enough blood to perfuse and therefore create a pressure wave (pulse).

——————————————————————————————————————————————————————

Oh, and the phenomenon of conversion just as the finger nears the monitor has been studied.

Professionalism vs Cockiness

The Scene:  A small exam room in a satellite clinic.

The Cast:  Yours Truly, The Patient, Fire Dept. Medic, and various other assorted firefighters, staff & family.

Scene 1:  The Patient came in for a routine visit.  He/She was found to have an abnormal, potentially harmful, heart rhythm.  The physician had requested emergency transport to the E.D.

The patient is conscious, alert, in no distress, no pain, and has a good blood pressure. 

The patient is connected to our monitor & the rhythm confirmed.  Pacer/Defib pads are placed as a precaution.

The plan is to rapidly transfer the patient to the gurney, obtain the paperwork on the way out the door, and get the IV & vitals in the ambulance.

<Screeeeeeeech!>

FDM:  We need an IV!  Let’s get set up for an IV!  Did you bring in your IV stuff?  Go out and get the IV stuff!

YT:  Well, OK…

FDM:  Do we have an accurate blood pressure?  Let’s get one of our own!

YT:  Well, OK, but he/she is PWD, smiling, laughing, in no pain, but I’ll indulge you.

The Fire Dept Medic jabs an 18-gauge in the patients’ hand, and the patient’s vein blows up in his face, like Tiger Woods’ marriage.

Yours Truly deftly slips an 18-gauge in the antecubital on the other arm & secures the tubing.

YT:  Oh, and the B/P is 160/P.

The FDM is crestfallen.  You can see it on his face.  He is quiet for the remainder of the encounter.

Now, granted, FDM was not entirely wrong about his rationale & wants.  But I was first there, and it was my call & my patient.  He came in like the Pro From Dover and tried to assert himself.

There is a difference between professionalism (assuredness) and cockiness.  Sometimes, Grasshopper, it is a fine line.  But it is there, nonetheless.

I’ve learned it.  Many years ago. 

Yes yes yes, I occasionally probe that line with my toe.  And am usually rewarded with a minor failure or embarrassment.  Occasionally I’ll be rewarded with a major win. 

But for the most part, if I brag on my skills, I’m done.  I might as well turn in my patch for that call.

The time to brag is AFTER the call…

Photo Shoot

I’m currently working on a project with Rural/Metro Ambulance to create images for marketing, PR, the internet, and to replace the old wall hangings in the lobby.

Shoot #1 is under the belt.

You can see the rest here.  At least several more shoots coming up.

Odors

The end of a 12-hour shift.

With one exception, every patient was whacked. 

Strange.

Something wrong.

And smelled.  Something somewhere in the call.  Either it was the patient themself, or their spouse, or their surroundings, or their pastime.

And these odors had some serious hang time.

So at the end of the shift, I had the smell of human shit, bird shit, body odor, alcohol, and something else I couldn’t put my finger on, each more obnoxious than the other, stuck in my nose, competing for my attention.

Ah, the scents of EMS.

E.M.S.

Enjoy Many Smells

Thanks to some eucalyptus scent, I was able to eradicate the odors, and sleep the sleep of a wierd days work.

Where’s The Haiku?

Snoozing in the cab

My arm is numb, drool pooling

On my faux pillow

End-Tidal CO2 Presentation

I’ve had a few requests for my world-famous EtCO2 presentation, so here it is!

 

EtCO2 For Web