Wednesday, December 16, 2009

Hemos and Pneumos and Tamponades Oh My!

Yes, I have a bizarre and possibly unhealthy love of all things trauma. So needless to say, when I could finally take ITLS (International Trauma Life Support) a few weeks back, I was quiet the happy camper. The material itself is an intensified version of all the trauma I learned in EMT class, but having taken that over four years ago, it was really nice to have it again. Personally, I would have loved to have more time for the course, but I understand the need to get as much in as fast as possible (aaaah budgets).

Additionally, my EMS response area has very little regular trauma, so being able to do several rapid trauma assessments with the seasoned guys was really nice. I do have to say I enjoy assessment quiet a bit, though I know I need to get my routine down better. Practice is again rearing its head and yelling at me to do more of it.

Sunday, December 13, 2009

Practice - Under Pressure

A significant portion of my time in lab deals with setting up bone marrow transplants in mice. Wait, let me correct that. A significant portion of my stress in lab deals with setting up bone marrow transplants, for I inevitably don't have enough cells, I can't find the container for the irradiator, or I the mice I need seemingly vanish. Of course, then I wait over a month for results, but back to the set up.

No matter what happens in the set up, my stress relief/ reward for such a crazy set up is being able to go to my mice rooms and easily inject around 30 mice intravenously (IV) with a 27 gauge needle (read really small, as in smaller than an average pediatric needle, maybe even smaller than a neo natal needle). Wasn't always this was, as in the beginning to took much effort and practice on my part to be comfortable doing IV injections (no catheter, just needle into vein and inject cells), but I have become very comfortable. A bit proud even that I can successfully inject 30 mice without a problem.

Well the other day taught me a very good lesson. I had 45 mice to inject, not really a numbers problem, but I had limit cell numbers (thus very little wiggle room in terms of volume) and very limited time due to an evening class. I even enlisted help, something I don't do often anymore.

Needless to say, the looming time in my mind messed with my head and my skills. Normally, these injections would have been a synch for me but I was suddenly missing vein after perfectly visible vein. This of course only frustrated me, causing more missed veins till I could calm myself down enough to find a stable rhythm.

In the end all the mice were injected, a very necessary step, though I was late to class. The take home lesson, that seems to becoming a theme in my life (lab and ems) is not only is practice necessary, but practice under pressure is needed so that level headedness and steady skills become second nature instead of added stress. Being clear headed and calm on those high adrenaline calls is just as useful as being efficient in lab under a time crunch.

Thursday, December 3, 2009

And all those little mistakes come back to you

Not long after I got my first code, my station did a CPR class (mostly for several new people who needed CPR training, but I took it for re-certification reasons). As I sat through the class, it seemed like every little scenario reminded me not only of my call, but what I could have done better. I felt like a brand new EMT again who was just trying to figure out what on earth to do with cardiac patients. I should have been more prepared. I should have done better. I guess the lesson learned was practice, practice, practice.

Tuesday, November 24, 2009

You know your experiment may in fact be too big when...

1. It takes nearly an hour to simply label all the tubes you will need for your experiment.

2. Once your raw samples are in their first set of tubes, they take up three ice buckets (two is typically a large experiment).

3. Your processed samples take up five sample racks (I think the most I ever did before was three).

4. You work for 6 hours during the day, go study for an hour and a half, take a test, go home, shower, come back to work to then work another 5 hours. Being in lab at 0330 is a wee bit creepy.

5. You still have two hours of prep work the next day before you can even think about running your samples.

Note to self, never ever do a take down with 30 mice, 60 organs, and 180 processed sample tubes again!

Tuesday, November 10, 2009

It only took four and a half years...

But I finally worked my first code. I know, ridiculously long time for being an EMT and not having worked a code, but then again, I have always worked low call volume places. It was an interesting mix of emotions, to say the least, and surprisingly ended on a good note.

Tones went out at the crack of dawn, and I was uncharacteristically awake and rested the moment I sat up (I am NOT a morning person in the least bit and have a very bad habit of staying up late when I am at the station). Ambulance (first!) and engine go out with only a minor hitch and I know the medic unit will be responding.

Get on scene, trying to orient myself as well as possible (I am the "Aide" on the ambulance) as our entire station basically moves itself into the house. We find the patient in the back bedroom, relatives trying to do CPR, frightened as they say they had checked on her an hour ago and she was fine. Something had happened in that hour as we find the woman, mouth open, lying bed with no movement. Warm. No breath. No pulse. No cardiac history. In fact, very little wrong with her to begin with.

We get her on a backboard and get to work. I end up with the bag valve mask (BVM) trying to ventilate her as one of our firefighters starts CPR. I check the airway, clear, and try to ventilate. I can't get the breaths to go in, adjust the airway and add an oral airway. Still nothing. Great.

The characteristic 'Stand Clear' of the AED rings in and my partner snags my shoulder to pull me back. I can't tell you enough how much I love my duty crew, because we always have each others backs. "No shock advised." Well that's odd, but we get back to work, still no air going in, as we make it to the stretcher outside and into the rain. Did I mention it was raining and cold too?

Still ventilating, we hand her off to the now present Medic Unit and they go into full swing. I can feel myself still jazzed on adrenaline as I look around and suddenly do a double take. One of the firefighters from my station and the current shift is present who was not at the station last night. Did I miss something??? Later find out he was on one of the other engines that was called to the scene.

Seeing as the Medic Unit had our stretcher and some of our staff, we follow them to the hospital, and I hate to say it but I fully expected our patient to be declared dead at the hospital. While I am a very optimistic person, I just didn't think this was going to end well. After a few moment of getting things together in the E.R., I poke my head into the room they wheeled her into and see the last thing I had expected. A beautiful EKG with a pulse of 74. I just blink. We saved her? I thought that almost never happens?

The Medic said that once they intubated a pulse came back, which makes me wonder if she had a pulse and we missed it. It would be a good reason why the AED wouldn't shock. I have so many more questions than answers when it comes to what went on in the back of the Medic Unit but I don't know if they will be answered any time soon.

During the entire event I felt oddly calm but wired at the same time. I know I came across as a bit frazzled but, honestly, it was the first time and I was trying to rapidly go through everything in my head. I know I could have done better. I know I should have done some things differently, but in the end, she didn't die and that is what counts, though I think I will always remember how we found her in the room.

On a lighter note, I was trying to get a replacement oral airway from the E.R. staff (we restock at the hospital) only to have this conversation.

Me: I need a purple OPA.

Nurse: Purple? What size is that?

Me: I don't know, ::shrugs:: purple.

Nurse: Hrmmm, does it have a size label on it?

I go grab one from one of the numerous bags we have to check.

Me: Nope, its just... purple.

In the end, we matched up sizes and got the right one, but its one of the many moments I love. Our OPA's are color coded to be idiot proof. :)

Sunday, November 1, 2009

Western Blot Woes (And Happy Endings!)

Not an EMT post to start, but at least this lab one has a happy ending!

To preface this post, one of the fellows in a neighboring lab told me this when I was trying to work this assay out months ago. “For a technique that is so commonly used in biology to prove ideas, it is by far the most fickle technique used.”

Day 1: Extract protein, quantify it, prep it, load it on a gel, get it to a membrane, incubate it with antibody to find protein of interest. A day of far too many samples with so little reward. I can’t even tell if I have screwed anything up yet!

Day 2: Finalize antibody stain to visualize protein with fun florescent molecules. After a bit of trial and error, produce a good looking film (yup, its just like x-ray film, but without the x-ray part. Photo sensitive instead).

But there is a problem. The antibody for my protein has previously, and consistently, been giving me only one band when I do this technique. Now I have two bands, at least about the same size (which is key), but two bands nonetheless. The difference between this run’s source of protein and the previous run’s source of protein: minimal.

I haven’t the foggiest why I now have two bands at the right size.

Day 3: Repeat staining process with a control protein antibody. Prep and visualize. Perfect film. Well, at least I know my technique isn’t off!

Day 4: Quantification. After imaging films, followed by far too much thought, and a fair amount of math, pretty graphs get to be formed! And on top of the fact that graphs in and of themselves are pretty, IT DID SOMETHING! My assay, done months ago with the cells saved in a -80°C freezer and a week spent working on the same Western Blot, did something!

I cannot begin to tell you how happy this makes me! Particularly since this means we may now have a mechanism for one of our models, and having a mechanism can be just the thing that is needed to get a paper published!

Thursday, October 29, 2009

A bit of the Basics

'ello! I am a scientists/EMT in the post schooling transitional phase of my life. I am a molecular biologist by training and work in a fantastic lab. I actually have my own project (which is amazing seeing that most of the time one needs to be a Ph.D. student before they can have their own project) working on finding ways to treat complications after bone marrow transplants in kids. I love molecular biology and playing genes, but I know that the lab is not where I want to end up in life.

On a bit of a whim (and the need to find out if medicine really was what I wanted to do with my life), I took an EMT-B class at my local community college and basically fell in love. I have been a certified for almost four and a half years now, starting my Basic time at an all volunteer station in NY state before moving to my current station outside of NY state. While I have never worked a high volume ambulance, I love the time I do spend on the rig and the interactions I get with patients. Being an EMT has become so much more than just a test to see if I would enjoy the medical field.

I currently volunteer at a county fire station on the ambulance, supplementing the career staff who are absolutely amazing and dual fire/EMS certified. We are a small volunteer group of both fire and EMS but we are growing in strength and numbers! While the time I have spent being a Basic has been a decent amount, I will by no means claim to know everything about being an EMT. If anything, I am still a bit of a fledgling trying to find my wings as I am now in charge of the ambulance calls on my shifts at my new station.

If you cannot already tell, I live in two very different worlds striving to do the same thing; helping people get better. I will do my best to give more of the ups rather than the downs of lab life and my time on the ambulance, but at times there will be rants on the less than pleasant aspects. Life is both the good and the bad, what matters is what you take away from both.

I hope that you will enjoy this blog!