Archives for July 2018

You stop at a fast food restaurant for a quick lunch before returning to work. It’s a sunny day but very windy. The weather service has a high wind advisory posted for the area. 

While sitting eating your sandwich you hear a loud crash. You turn and see a young man staggering through the broken glass door. The wind caught the door as he opened it and propelled him through the glass. 

You run over to help him and you see his arm has a deep laceration to his arm. It is bleeding profusely and the blood is spurting from his arm. You lay the victim down and apply direct pressure with your hand and clean handkerchief over the wound. The blood continues to pour from the wound. He is loosing massive amounts of blood.

You give your keys to a bystander and ask her to retrieve your first aid kit from the trunk of your car. She returns quickly and you  ask her to obtain the tourniquet from the side pocket of your kit.

Now you ask another bystander to take over applying pressure while you apply the tourniquet. You loop the tourniquet around the victims arm above the large laceration. You tighten the loop and begin tightening the device. (Tourniquets are very painful so inform the victim of the expected pain) The bleeding has stopped. 

911 has been notified and is in route. You now assess the victim for shock from blood loss. The signs you are looking for are:

Cool, clammy skin and pale skin

Rapid pulse and breathing

Weakness

Confusion

Thirst

In severe cases unconsciousness.

From you evaluation you determine he is in mild to moderate shock. You elevate the legs to move more blood to the core of the body and help stabilize him. EMS arrives and transport the individual to the hospital.

In this case the victim had a full recovery. But how would the outcome have been different if no one was trained to control the bleeding? What if there was no tourniquet at the scene? 

People in high risk jobs should carry a tourniquet with them. Police officers, farmers and those working in industrial complexes should have a tourniquet and know how to use it.

When a person is bleeding profusely it only takes a matter of seconds to lose most of their blood volume. Quick action such as applying a tourniquet to one self, can mean the difference between life and death. 

If not already trained please consider doing so. You never know when it may just save a life.

The prudent sees danger and hides himself, but the simple go on and suffer for it.

Proverbs 22.3

In order for the body to function normally the cells must receive sugar from the blood stream. A hormone called insulin aids this process under normal conditions. The imbalance of the production of insulin is called Diabetes. Today there are approximately 30 million diabetics in the United States.

CAUSES

Insulin production is altered and falls below normal levels. Sugar is no longer used for energy and the body cannot function properly.

DIABETIC COMA (Hyperglycemia)

A diabetic who does not receive the prescribed doses of insulin may become comatose if the sugar level increased. This condition is referred to as Hyperglycemia or Diabetic Coma.

INSULIN SHOCK (Hypoglycemia)

Having too much insulin in the blood stream can result in a serious condition called Insulin Shock or Hypoglycemia. Brain damage can occur if this condition is left untreated.

Insulin Shock can be caused by:

1. Taking too much insulin
2. Taking insulin and not eating
3. Taking insulin, eating and then vomiting

SIGNS and SYMPTOMS OF INSULIN SHOCK

Dizziness

Seizures

Pale Skin

Sweating/Clamminess

Weakness

Drooling from the mouth

Tremors

Normal breathing

SIGNS AND SYMPTOMS OF DIABETIC COMA

Confusion

Sweet or fruity odor from mouth

Intense thirst

Rapid deep respirations

Abdominal pain

Frequent urination

Dry, warm skin

May be unresponsive

EMERGENCY CARE FOR INSULIN SHOCK

The patient needs sugar.

If unconscious, give instant glucose or Kayro Syrup between cheek and gum. Be careful not to administer too much, which could cause the patient to choke.

Any type of sugar may be given to the patient if they are conscious.

If unconscious place on side.

Call 911 for local EMS

EMERGENCY CARE FOR DIABETIC COMA

Place on side if patient is unconscious.

Keep airway open and clear.

Call 911 for local EMS

Most people with diabetes can manage their sugar levels very well. But sometimes they may administer too much or too little insulin by mistake. This can cause one of the above conditions. Quick treatment by a bystanders can help the patient recover more easily.

“So whatever you wish that others would do to you, do also to them, for this is the Law and the Prophets.

Matthew 7:12

A 70 year old male was in cardiac arrest when the medic unit arrived at his home. We resuscitated the victim for thirty minutes with no sign of improvement. The patient was transported to the ER where he remained in cardiac arrest. When we left the hospital doctors were continuing resuscitation efforts. Two weeks later the patient came to our station and pointed out the two medics that had worked on him. Then he proceeded to explain in great detail all of the procedures and medications we administered.

The patient was totally unresponsive while in our care. He was in cardiac arrest with CPR being performed. Yet he was able to identify the very people who were resuscitating him. When asked how he knew all of these details, he stated that he was sitting on the bench seat in the medic unit watching us.

I know this sounds extraordinary but it is true. Some people call this a Near Death Experience (NDE). Many people are on record claiming similar situations. People who are, for all intents and purposes dead, have an out of body experience. They are very accurate as to their description of the activity taking place around them.

While working at the hospital years ago, I had several encounters with patients that claimed to have an out of body experience. One individual explained everything I did when I arrived in his room. He was in cardiac arrest but was able to call me by name. He stated that he was sitting on the sink watching the activity. He too was very accurate in the details.

Another interesting phenomenon is called the Lazarus Syndrome. This occurs when individuals have been pronounced dead, but later develop a spontaneous pulse. There are several theories as to why this happens, but no one knows for sure.

For example, a 27 year old drug overdose was pronounced dead. Thirty four hours later the individual was found snoring in the mortuary.

An 80 year old male was in cardiac arrest and was defibrillated multiple times. Each defibrillation resulted in the patient waking up for a few minutes. Each time he described what he saw. He stated that he was climbing a ladder that had a warm bright light at the top. Each time he would arrest he stated he would get closer to the light. Then after defibrillation he would wake up. 

This went on for sometime. The man had been defibrillated over twenty times. On the last defibrillation he told us that his deceased wife was at the top of the ladder reaching down for him. “I almost made it that time. I wish I could get to her.” Right after he made this comment he went into cardiac arrest again. The doctor told us to let him go. He was then pronounced dead.

So what issues does this phenomenon create for EMS and hospital personnel? It appears there may be both ethical and possibly legal issues.

Medical personnel sometimes talk among themselves during resuscitation efforts. Jokes may be made as a way to reduce the stress of the moment. If the patient has an out of body experience and hears what is being said, what repercussions could follow?

If a paramedic pronounced a patient dead and hours later the patient has a spontaneous return of pulse and breathing, are there possible legal implications associated with this incident?

These are just a few points to consider. It could be good subject matter for EMS and hospital personnel to have as open dialogue. Now be honest, you did have a few goose bumps when reading this. Didn’t you?

When he had said this, Jesus called in a loud voice, “Lazarus, come out!” The dead man came out, his hands and feet wrapped with strips of linen, and a cloth around his face. Jesus said to them, “Take off the grave clothes and let him go.”

John 11:43-44