Don’t Forget To Ask The Patient

Let the young know they will never find a more interesting, more instructive book than the patient himself. ~Giorgio Baglivi

It was nearly two decades ago that I knelt on the floor before Sammy in the Santa Clara County Sheriffs booking facility. I remember him so vividly that it’s hard to believe so much time has passed. There was nothing exceptional about him. Handcuffed to the waiting area bench, he looked very much like you might expect a man high on drugs, being booked for petty larceny, might look.

Sammy felt like his heart was racing and, given his drug history, the officer thought that he needed a once-over before heading off to the county lock-up. I, the young, scared, mostly clueless paramedic intern was doing my best to evaluate him. Growing up in a quaint California suburb I hadn’t crossed paths with to many folks like Sammy. He, quite frankly, terrified me. My preceptors stood back and observed.

“Sammy did you do any drugs tonight?” I asked.

“Yeah, I did a speedball about an hour ago.” He casually offered.

I looked over at my preceptor Mark hoping for clarification. I got nothing. I looked back at Sammy and then again at Mark who smiled demurely. “What’s a speedball I asked?” Mark knew the answer but he had other ideas. He gestured toward Sammy. “Ask him. He’s the one who took it.”

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The C-Spine Immobilization Controversy

C-spine immobilization is not a benign procedure.

It’s not something that’s always worth doing “just in case.” It’s not risk free, comfortable or even practical. And, now, recent research from the Washington University School of Medicine suggests that it may not even do such a good job of keeping the patient’s head still.

Does anyone else agree that we’ve seen enough bad news about c-spine now that we can stop the massive overuse that plagues our industry? Can we start evaluating people and deciding who does and doesn’t meet criteria for spinal immobilization. Please?

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Are All Aspirin Created Equal?

“I took an Aspirin when I started feeling the pain.”

Close to a decade after the Aspirin for chest pain idea hit the main-stream, more and more folks are medicated themselves at the onset of chest pain. But are all Aspirin created equal? Does chewing make any difference in the rate of absorption?

No … and yes.

A recent study out of the University of California, San Diego took 14 healthy volunteers and feed them a moderate dose of Aspirin on three separate occasions. First they were asked to swallow adult size tablets, then they were asked to chew adult sized tablets and last they were asked to chew children’s chewable Aspirin tablets. After each administration the volunteers had blood drawn at set intervals. The results were predictable, but telling. After swallowing the adult tablets, 6 of the 14 volunteers had no detectable levelsof Aspirin in their system 45 minutes post swallow.

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Chest Pain: Is EMS Really Best?

Short answer: Yes.

Score one for EMS. A study published last January in the American Heart Journal evaluated transport and treatment times of patients who called 911 for their chest pain and patients who sought private transportation.

They found that patients who transported themselves to the emergency room arrived at the hospital in 35 minutes while patients who called 911 arrived in 39 minutes. (On average.)

Hold the phone. Before you tell grampa to forget the phone call and jump in the car, consider this; The study also concluded that the patients who dialed 911 received initial stabilizing treatments faster AND definitive treatments faster as well.

Those who called the ambulance received initial care like oxygen, aspirin and nitro in approximately six minutes as opposed to the self transporters who took 32 minutes to receive these interventions.

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