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    Monday, October 24, 2005

    ACLS

    Advanced Cardiac Life Support... I'm studying a bunch of squiggly lines trying to figure out what kind of heart rhythm each squiggly represents. The test is Monday (written and practical); I have to know a bunch of squiggly algorithms after recognizing the squiggly heart rhythm, and which drugs to treat the squiggly with. It's a lot of info for one week. Really it's squiggly that we only have a week, but as always we'll get it together by Monday. Then I'll be on to Combat Trauma Mgmt, Pediatric Life Support, and then finally Rotations at a Metro Hospital, hopefully Tampa, FL.

    Squiggly, squiggly. I've been dreaming of squigglies all weekend. Squiggly.

    Friday, October 21, 2005

    Quote of the Week

    "The longest way around is the shortest way home."

    - C.S. Lewis

    Wednesday, October 19, 2005

    Gotta Save My Buddy!

    So, I had my practical exam on Monday for Trauma Lanes, and I was a "no-go". Basically, truama lanes is a simulated scenario where you have to go in and save your buddy who has some sort of crazy combination of injuries ranging from gunshot wounds, impalements, eviscerations, burns, squirting arterial bleeds, and at least one major fracture. It requires you to go through an initial, rapid, and detailed trauma sequence. You have 6 mintues to finish the intital, 29 minutes to get the rapid done, and then 30 minutes once you get your buddy to the safe location of the medical tent to package and treat your patient in more detail. The first two portions take place in the woods, and you get a helper endearingly known as "Haji" who can't speak much English, but can bag a patient for you and hold pressure on bleeds as well as maintain C-spine stabilization for you. You're in full battle rattle (Kevlar helmet, weapon, LBE, and medical bag) and the patient is moulaged up with all kinds of Hollywood-like fake blood, gratuitous injuries, and even some arterial squirting. Patients take great pride in their acting skills as well, so it tends to turn into mass chaos out there at times. Anyhow, so here's what happened to me...

    My Haji and I were all ready to go, it was about 0700 and the sun had just peaked it's little halo upon the horizon, so it was still quite dark out. I knew it would be a challenge to see, but I was ready to show off my skills, as I've been practicing night after night. Nothing was stopping me now. I had two cups of Joe at this point as well which added to my adrenalin pump as I waited for the familiar call... "Medic!"

    We were off- I could hear the screams a hundred meters away, and we hauled ass through the woods to our desiganted site. The brief was simple- an IED had hit one of my teammates' Humvee and it flipped and caught fire. One survivor had pulled himself out and crawled his way to a berm where he was waiting for his buddies to come get him the hell out of there. As soon as we found our man, it was obvious he was in pain. His entire right arm, neck, and face were covered in black soot- a burn patient. His left arm was shot up, revealing an open radial/ulnar fracture, and he was having serious trouble breathing. I immediately got to work, and I was moving fast. By the end of the intitial and rapid I had cut off all his clothes, did a thorough head to toe assessment and began treating each wound. I wrapped the burns in Kurlex, converted a tourniquet to pressure dressing on the open fracture, and splinted it up using my handy dandy articulating splint. The patient went apneic during the rapid sequence due to his airway being burned up and swelling, thus cutting off his way of breathing. Only one thing to do... I had to perform a cricothyroidostomy and insert an endotracheal tube. No problem, I was the man. I finished all this in 18 minutes flat, and I was pretty sure I hadn't missed a single detail. One thing left to do, I had to give this guy some fluids via an IV stick. Normally, on test day at least one of the arms are available for a stick in the antecubital vein, but my patient had traumatic arms, and that meant that I wasn't allowed to go there for test purposes. So, I had to go to the feet, and hope that this guy had some good Saphenous veins. Well, my patient happened to be one of the Navy Corpman guys. He's 42 years old, and let's just say he isn't in the best shape. His little bird legs had nothing popping out for me. Granted it was about 45 degrees out that morning, so he was probably shunting really bad due to the cold, but I was getting nothing and cursing the guy in my head "Bastard why don't you work out or something, and did you even hydrate last night to get some more blood volume?". I put two constricting bands on both feet and started rubbing and flexing them hoping to get something to pop out in one of them. I even pulled out my BP cuff and had it on one foot as well. Finally I saw one on the top of the foot, it was crooked, but I've gotten the catheter to curve with those before- it was my only shot. I stuck him, got flash in my tube, and began advancing the catheter carefully trying to get it in, but I met some resistance, and I could see below the skin that the end was about to infiltrate through. "Can't stop now", I thought, but sure enough there was the hematoma bubbling like a balloon. One down. I kept looking in this guy's foot and if you look at your feet, it's tough to find a straight vein there. I knew I had to try the saph stick blind. I knew anatomically where it lied so I started going at it. Another needle down, and another, then another, no flash. I kept going in both feet, but couldn't get it. I was down to my last needle. I then requested to do an EJ stick (the big one on the neck), but the instructor said "no can do", I then said, well, at this point if I were in the field for real I'd have to do that or a venous cutdown as the patient has no vein access in his feet. "Yes, you would, but I can't let you do that today". I was stuck. Here goes nothing! After another minute or so torturing my patient with my last needle I took it out and called for end of clinic. 25 minutes and 50 seconds. This was after 7 sticks total. Oh, was I infuriated! My instructor pulled me aside afterwards and showed me my scorecard- as I expected it was perfect, and had I got my first stick it would have been by far the fastest clinic. Hell, had I got my last stick, it would have been one of the fastest still. (Most guys average bt 25-28 minutes). The instructor went on to say that I just got some bad luck and just needed to come back on Wednesday, and do the same thing and that I should get an arm next time. So, I didn't make it to the tent, and I was pretty discouraged, but I knew I'd get my day of redemption which was today.

    Once again- Haji and I took off at the call for medic. Once again I was pumped on my double dose of caffeine, and adrenalin. Once again I utterly destroyed the initial and rapid like a good SF medic should. This time the brief was to get a buddy out after a fire fight with some enemy troops. He was all shot up. One chest wound and an exit wound on his back. He had an open tibula/fibula fracture with an entrance and exit wound there as well, and another gunshot in his left leg. So, I packaged this guy up with a splint, two occlusive dressings on his chest wounds, a couple of pressure dressings, and even performed a needle decompression in his chest due to his tension pneumothorax from the sucking chest wounds. Once again, I was a machine. This time, fortunately, I had an arm to stick for my fluid resuscitation. No problem. I called end of clinic at 23 minutes after my stick and taking some vitals. It was a little slow for me, but I was a "go". I then proceeded to get my buddy out of there and into the detailed medical tent where I continued to treat my patient for hypovolemic shock, infection, and perfomed a chest tube.

    Good times, good times indeed. So, another target down in this never ending story of the 18D medic course.

    Monday, October 03, 2005

    Quote of the Week

    "Courage is the first of human qualities, because it is the quality that guarantees all the rest."

    -Winston Churchill