cardiac arrest

anonymous asked:

Natasha/Carmilla in glasses is my actual kink 😂

Any girls wearing glasses makes me sweat.  Any girls asking to wear my glasses with permission and putting it on makes me go into cardiac arrest.

I NEED Carmilla to wear glasses 😩  BIG NEED.

Over a Year

I meant to do this in March, on my one year EMS anniversary, but… well, it’s almost June. That’s actually almost more appropriate, because I think I started in earnest at RVAC in June 2016, so that means I’ve actually been actively *working* in EMS in NYC for a year.

Holy hell. I love it. I still feel like I have a ton to learn, but I do, at the very least, feel a bit more confident going out on calls and even making (gasp!) medical decisions.

Here are a few particularly memorable experiences from the last few months, and some overall thoughts:

– I had my very first cardiac arrest about a month (maybe 2, ha, life is insane right now) ago, and it was powerful stuff. By the time we had arrived on scene, Medics were there, and had intubated. They were doing CPR and got a pulse, and I got to bag the pt. for a bit while they got him ready to transport.

It was… powerful. It was a crazy scene, but somber. Inside an apartment stairwell. It was an opioid overdose, but too late for narcan (they gave him a bunch, but he was gone, obvi). All the neighbors were lined up on the stairs, watching silently. Several medics and EMTs already there. It was my first call of the night, so when I got on the ambulance, my crew was like “how’s your CPR?” as we rushed over.

So, it was a surreal and powerful feeling to bag a live patient. Literally breathing for someone. I know those who have been to a million arrests will probably roll their eyes a bit, but it was… it was extremely powerful and weirdly quiet. Everyone was just working, just professional, just getting it done.

The patient lived, by the way—we saw him in the hospital later. I have no idea what his overall outcome was, but… well, I hope he got the help he needed.

– Often, for tours, I’ll do events and training stuff, and i’ve even been training a brand-new EMT. One memorable event had us showing community members how to do hands-only (no AED) CPR, so we taught a ton of kids (and plenty of adults) the basic skill. It actually felt really cool and helpful? I mean, I hope they remember it in a time of need, but it seemed… useful.

– Sometimes, I do worry about the value of what we do on a volley ambulance, buffing calls. What that means: we don’t often get “assigned” to calls, we just go when we hear one, and either assist the FDNY crew or take it off their hands. I like to think it is helpful—Bushwick is a super heavy call area, and we really do help with a lot of the less exciting calls, hopefully giving crews a good break.

FDNY crews often thank us for taking stuff off their hands, or just helping out - moving patients and equipment, etc. The other night, we assisted with a very violent pt. (a tiny woman, my size!) and the crews were super appreciative.

And I also like to think we are providing a real service to the community, helping wherever we are needed, not trying to charge people with no insurance, etc.

So, I do feel good about what we do. And holy shit, do I love it.

But I’m always going to question if I’m doing enough. Am I really helping, am I doing this for me—putting myself out there so I can feel good about it, etc.—more than I am providing a real service.

And honestly, I’m glad that I question it? Like, I should very fucking well question whether I’m doing all I can.

– There are times, often enough, when I think about whether I could swing a career in medicine (maybe as an NP?) and I don’t know! I love doing this as a volunteer, not having to get caught up in what is a completely fucked up system (in the US, for sure), I love doing patient care, I like being out there and seeing how the world works in certain ways. 

Things to think about, going into this second year of service, and to always be aware of.

Cardiac distress symptoms in women

In the wake of Carrie Fisher’s death four days after she suffered a massive heart attack, one thing that was reported by some news outlets was that she had been in “significant distress” on the flight. We don’t know the exact details of this, but in my experience as an EMT, it often means “hysterical woman having a panic attack and thinking she’s dying…*woman dies* …oops, guess she really was dying.” 

It is SO IMPORTANT to remember that many women present in what medicine considers an ‘atypical’ manner for heart attack, but it actually IS typical…for women. Women are more than twice as likely to die from cardiac emergencies, not because our physiology is that much different than men and thus gives us a worse chance at survival (it’s actually better if treated promptly and adequately), but because our symptoms are more likely to go unrecognized or to be dismissed entirely.

Thus, please take a moment to review and pass on this list of cardiac distress symptoms as seen in women: 

Shortness of breath - This is the most common one. If a woman, especially one without prior history of respiratory issues or shortness of breath, seems to be having trouble catching her breath and/or complains of such, pay very close attention. If she continues to feel winded after sitting or laying down, it’s probably time to call for help.

Feeling of impending doom - This can range from a sense of general unease to a full-blown panic attack. This one is extremely important, and is the symptom most commonly disregarded by doctors and hospital staff. If a woman tells you that she feels ‘not quite right,’ or like something terrible is about to happen, or that she’s about to die, LISTEN TO HER FFS. 

Nausea and “indigestion” - Also common. Heart attacks frequently present as a feeling of vague nausea or indigestion, but unlike typical heartburn, antacids and other OTC treatments will not alleviate the symptoms.

Hiccups - Unexplained hiccups, especially if seen with any of the other symptoms listed above, can be indicative of heart muscle that is being acutely or chronically starved of oxygen.  The exact mechanism isn’t known, but it’s thought that the enzymes released by the dying muscle irritate the pericardium and adjacent diaphragm, causing spasms in the healthy muscle. 

Fatigue - This is another commonly seen symptom, and is often overlooked or ignored as just transient tiredness. Many women having a heart attack will complain of feeling “flu-like” symptoms of nausea, sweating, fatigue, and shortness of breath, and they’ll lie down for a nap and never wake up. 

Lightheadedness - A feeling of being lightheaded or about to faint isn’t terribly uncommon in many benign conditions, and many women experience it on a monthly basis. However - be aware when it appears unexpectedly or unexplainedly, and/or with one or more of the other symptoms on this list. 

Sweating (diaphoresis) - Heart attack does funny things to the sympathetic nervous system, which is behind reflexes such as sweating and hiccups. If a lady is experiencing unexplained or excessive sweating, pay attention to anything else that might be going on with her. 

Tingling or numb extremities - A feeling of numbness or “pins and needles” tingling in the extremities can be an important sign that cardiac function is being impaired and those body parts aren’t receiving enough oxygen. 

Peripheral and/or central cyanosis - Often accompanies tingling or numbness, and is considered a later-stage symptom of cardiac distress and heart failure. Finger and toe tips will turn pale or blue first, and lips and gums after that. Important to remember that darker-skinned women may present cyanosis as ashen, grey, or darker purple rather than pale or blue. 

Back pain - Pain between the shoulder blades, in the cervical spine, or even further down in the torso or lumbar region can be a symptom of heart attack. Alone, it isn’t that suspicious, but if it’s unrelenting and presents with any of the other symptoms above, keep a watchful eye on things. 

Classic “crushing” or “tight” chest pain or pressure - Women DO experience this classic pain, too, just not as frequently as men do. This may be due to our higher pain threshold, or differences in blood volume, or maybe we’re just not sure because nobody’s bothered to really study it. Whatever the reason, some women do still experience the crushing or tightening pain, and others may experience less painful pressure or tightness that doesn’t seem to be relieved by anything.

Arm and jaw pain - Another “classic” heart attack symptom, and a bit more common than central chest pain. Unexplained pain in the left arm or shoulder, and on the left side of the neck or jaw, should not be ignored by anyone.

Confessions of a day shift nurse...

Well, well, well… that is the second time I have had one of the hardest, most trying shifts in my career… on a night shift. Kudos to all the night shifters out there. You don’t get enough credit for what you go through…. isolated and yet overwhelmed. Night shift is hell, Ya’ll.

lakritzwolf  asked:

Hey Auntie! I have a character who ODs himself with sleeping pills that he washes down with vodka. His friends find him just before he goes into CA, they call an ambulance and do CPR. (One is a nurse.) After following you for a while I’m sure what I wrote is a medical BS Trope, so what actually happens when the Paramedics arrive? (I have a DeusExMachina to save him and everything after he arrives in the ICU falls under the I-break-it-I-buy-it-rule, so I just need to get him there.) Thank you!

Hey there! Welcome back!

Okay. Your character surviving a cardiac arrest from sleeping pills washed down with alcohol is, unfortunately, a slim shot. (Fiction writers live for long shots, so no judgment.) The reason for that is that most sleeping pills, in overdose, suppress cardiac function, which means that even if they get his heart beating again, it won’t be beating well.

So here’s what happens when EMS roll up on a cardiac arrest. I’ll give you a few high-tech and low-tech options, because of course I will!

1) They get their stuff off of the truck (usually 2-3 bags and a cardiac monitor).

2) They come in, ask a few questions – “What happened? Did you see him stop breathing? How long has he been down? How long have you been doing CPR?”

3) They’ll take over CPR, and hook up their monitor to check a rhythm. If it’s a shockable rhythm (V-tach / V-fib) they’ll shock every 2 minutes, though rhythms can change with no rhyme or reason. They may need a few rounds of CPR before they’re “shockable”.

           a) Chest compressions may be done by a device such as a LUCAS or AutoPulse, both of which wrap around the chest and do CPR for you. This is the “high tech” option, if you want a touch of sci-fi. It really does free up providers to do the non-mechanical stuff. With the AutoPulse, you basically haul the patient up by their arms, wrap the device around their chest, lay them down, and it just goes to town.

4) In addition to CPR (hands-on-chest), they’ll use a bag-valve-mask to “bag” the patient / breathe for them.

5) One of the EMSkin will start an IV and start giving drugs. If you want to be fancy, have them have trouble finding a vein, and use an IO gun – basically a hand drill – to put a needle in the lateral shoulder. It works like an IV, it’s just infinitely more brutal.

          a) Sample meds might include epinephrine (1mg, every 3-ish minutes), D50 (25g, usually just called “1 amp”, sugar water, given once); if the person has been shocked  more than twice, a med called amiodarone (300mg, given once).

6) Another will perform intubation, place a breathing tube, by putting a metal blade into the mouth and sliding a plastic tube down the throat and into the airway, then secure it with tape. It’s a thousand times harder than that description makes it sound.

7) Moving a cardiac arrest patient to an ambulance is a theatrical production of its own. The medics will bring a stretcher to the front of the house and, if there are no steps or just one or two, into the house. If there are steps or the patient is upstairs, they’ll grab something called a scoop stretcher, which is a metal carrying stretcher that literally breaks apart, “scoops” under the patient, and then they’ll be strapped down (with the cardiac monitor and oxygen tank), and carried down the stairs. The scoop will likely just stay under them for transport, because taking it off with all that stuff strapped in is a pain in the ass.

8) The beatings CPR and bagging will continue until morale the patient improves.

You ultimately wanted the resuscitation to be successful. So let’s have it be successful. At one point during a pulse check someone should, in fact, find a pulse! This can happen on the scene or in the ambulance, up to you.

Once pulses come back, they might – actually will probably – need to give a drip of a vasopressor like Levophed (norepinephrine) to maintain a blood pressure.

Alternatively, you could have them go to the ER, and have the ER put them on a type of heart bypass called ECMO, which will do the circulaty bits for them while the heart itself recovers. This is, again, the super high tech road, and involves putting some VERY BIG LINES into the leg and the neck.

Whew! That was a lot of work! And, if you’re following your EMS characters, they’ll be sweating, tired, etc. – it’s pretty back-breaking. 

I hope this gets you down the right road!!

Oh, one note: you say once the Paramedics arrive, but it’s actually just once the paramedics arrive. Professions aren’t capitalized unless they’re being used as part of a direct call-out of a particular person’s name; for example, Scripty is a paramedic, but you might refer to her as Paramedic Scripty (the same way Jackie is a nurse, but she might be Nurse Jackie). Capitalization FTW!

xoxo, Aunt Scripty

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So about those space orcs...

I’ve seen a lot of posts about humans pack-bonding with frankly everything, no matter how big, scary, threatening, lethal or oozy.

But you know what I haven’t seen?

Humans entrusting their young to their pack-bonded friends. Because that’s a thing we do. We entrust our children to our friends. We entrust our children to our dogs. We befriend the biggest, meanest, scariest shit, and then we dump our defenseless, hasn’t-even-got-a-fully-fused-skull-yet offspring on them. Half for shits-and-giggles, half because it’s cute, mostly because children are exhausting and we need a nanny.

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Got some sick patients lately in my MICCU...

In the past two weeks, we’ve lost six patients. Unplanned. What I mean from that, I mean deaths with no impetus from hospice.

I was in the room twice when we had code blues. One with a 22 year old, another with a heart failure patient who went into a fib w/ rvr in the 200s.

The 21 year old died. It was the longest code I’ve ever been in. We coded for an hour. He was a sick boy. This kid came in with a blood sugar in the 1000s, his pH was 7.08, his liver was failing, he had an upper GI bleed, his kidneys were shot (pre-renal), and he was in severe sepsis.

We intubated when he came up, and then we placed lines (art and central) and put him on flo-track to get numbers–cardiac numbers like SVR and PAs. So we got them and of course couldn’t get reliable numbers bc one, the central line was through a femoral central line, and two, we all know that femoral central lines won’t read CVPs accurately.

So this was around 3am. Fast forward to 7pm when I get to my unit after a restful four hours of rest. I look at his monitor, his HR was in the 170s, on three pressors (Levo, neo, vaso), his central got replaced for a dialysis cath, CRRT ready to be started, and five family and friends at the bedside with ~30 others in the small 20 by 15 ft waiting room.

I clock in early with my orientee and we go into the room to introduce ourselves. We didn’t get report yet, and we were just assessing everything, looking at his chart in the room. I see his art line waveform start to dampen. I press the BP button, throw some gloves on and feel for a pulse.

NO PULSE, CODE BLUE I yell. My orientee grabs the crash cart, the bed flattens down and I start compressions.

We go for an hour.

One hour, compressions, pulse checks, multiple rounds of epi, multiple rounds of bicarb, three shocks, sore muscles, limited number of compressors, crying family members, 50 people on our floor, family standing from afar, sitting everywhere.

time of death, 2016.

There were at least 100-150 people who came to see this kid that night. It was a parade of them. All very nice people. People of the south Asian Christian community. A text message had went out to the whole Chicago Indian community about this kid. It was beautiful. But it was tragic. Feeling that warmth and closeness of the community tore at my heart. I felt for those people. His mother. His brother. His elders. I sobbed in the stairwell. It was a tough…

But life goes on. Not for this kid. He’s probably dancing in paradise somewhere. Probably drinking a beer with some other kids that were taken too soon. No more suffering for him.

The team work on that floor was amazing. All of us new nurses. But with more experience. Me, 4 years. My charge 3 years, two just right out of orientation. It felt cohesive. It felt right, and we did our best.

Nursing. What a brutal profession. But we came to this profession for a reason.

{goddess of love and beauty}

i. primadonna girl // marina and the diamonds ii. addicted to you // avicii iii. all this and heaven too // florence + the machine iv. alphabet boy // melanie martinez v. roman holiday // halsey vi. elastic heart // sia vii. strange love // halsey viii. sleeping with a friend // neon trees ix. overdrive // katy rose x. bubblegum bitch // marina and the diamonds xi. bedroom hymns // florence + the machine xii. carousel // melanie martinez xiii. dream lover // the vaccines xiv. chandelier // sia xv. love love love // of monsters and men xvi. new americana // halsey xvii. take me to church // hozier xviii. girls like girls // hayley kiyoko xix. blank space // taylor swift xx. someone new // hozier xxi. girls / girls / boys // panic! at the disco xxii. she’s a riot // the jungle giants xxiii. from eden // hozier xxiv. cardiac arrest // bad suns xxv. runaway love // diamond rings || LISTEN

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“I wanna hear you! I want everyone here to yell as loud as they can, because I want fucking Donald Trump to hear everyone in Polska, everyone in Europe, everyone in Africa, everyone everywhere to tell this motherfucker to fuck off!
I WILL NOT OBEY ANYTHING THAT THAT MAN SAYS! I believe in equality! I don’t believe in fucking racism, I don’t believe in fucking sexism, I DON’T BELIEVE IN FUCKING ALL THE BULLSHIT THAT HIS CAMPAIGN FUCKING REPRESENTS! FUCK THAT MOTHERFUCKER! NOT MY PRESIDENT! NOT MY PRESIDENT! NOT MY PRESIDENT!”

(21st January 2017)

(I was going to gif this but fuck that, you need the full experience, you need to hear and see him say it.)

JINX | Taehyung (M)

Originally posted by kimthwriter

Fluff | Crack | Smut | Neighbor!Taehyung | EMT!Taehyung | Enemies → lovers

You’ve had your sights set on Kim Taehyung ever since you’ve moved into the apartment next door to him, the only problem is that your klutz gene makes it difficult to get within three feet of the boy before a freak accident of some sort occurs

word count: 29k+

A/N: first of all i blame @bxebxee for the cumplay that occured in this hot mess, second of all IM SORRY its so long and third taehyung ended up a lot more… toxic than i anticipated so i wanted to warn against that and that i dont condone a lot of his actions/reactions or the toxicity of the relationship but its how his character and OC came out.

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