Ethics and DNR

Emergency medicine can be a tough field. We don't have pre-existing relationships with most of our patients, nor do we have time to discuss the intricacies of their wishes when things are going poorly. Last night with very little warning a patient rolled in from a nursing home who was profoundly bradycardic (HR 7 - 10) with a BP in the 50s.  Due to inadequate respirations the patient had a combitube (which is a supraglottic airway) placed by EMS through which the patient was receiving assisted respiration  This paperwork accompanied the patient. What would you do?  

This case demonstrates to me the need for physicians and families to have candid discussions with each other regarding end of life care. To me it seems medically futile to perform chest compressions without giving drugs and without establishing an airway. I think part of our duty as physicians and healthcare providers is to have these difficult conversations and help guide people to make the right (and medically appropriate) decisions for their loved ones. 

Wilderness First Aid Course

One of the cool things about my job is getting to teach wilderness medicine to lots of different skill levels. Admittedly I have a lot more experience teaching medical students and residents and other healthcare professionals. Sometimes its tricky to flip out of "healthcare" language and teach others in plain english. 

Mike and I had fun teaching a Red Cross Wilderness First Aid course to a group of boy scouts and scout leaders on Jan 11-13.  We taught CPR on Friday night and then a two day WM course out a Daniel Marshall Camp - which is a camp located out on Strom Thurmond lake just west of Augusta. 

I did several lectures and led some hands on scenarios. We covered numerous topics from primary and secondary survey to wound care and splinting.

Airplane wilderness

I've always wondered if I'd ever be on a plane when there was a need for medical personnel. Guessing it is sort of fitting that the first flight I take with my new "silver medallion" status some medical skills are needed.

An older gentleman (80s) slowly made his way down the aisle in front of me after getting out of a wheelchair on the jetway. While the flight attendant assisted him in taking off his jacket it became apparent his upper left arm was bleeding. Nothing scary - just oozing from his dialysis site and from what he described as a skin year. I guess I was looking a little too intently as the flight attendant ask me, "you aren't a nurse by any chance are you?" I replied "no, I'm actually a doctor". She asked if I could help. I agreed. She asked what I needed and I asked for some gauze and tape.

I don't think they wanted to breakout the real kit so I was presented with a couple paper towels, several band aids, an alcohol pad and some gloves. No gauze or tape on this flight - however eventually was given a roll of masking tape.

Improvising with the super absorbent and masking tape plus some patient applied pressure the bleeding stopped.

Another life saved:) planes are a lot like the wilderness...

Florida bound

Today I'm heading down to Bonita springs for the wilderness EMS director course! I've spent the past week working on lectures for the WMS student elective, irb proposals and various research stuff.

Over New Years several friends and I rented a cabin in Boone. It was an awesome time - got to Mtn bike at Ricky knob twice and ski at sugar mountain. Plus hang out in the hot tub and test some fireball whiskey.... Which is surprisingly tasty.

Christmas Update

Hey!

Since I posted this link on the bottom of my Christmas card figured I should update this with a quick synopsis of the year.

I finished residency at Wake Forest in Emergency Medicine in July and moved down to Augusta, GA to work at MCG (Georgia Health Sciences Univ) and now Augusta Regents University as a wilderness medicine fellow. I work attending shifts in the emergency dept - and then get to do a lot of wilderness medicine stuff which includes courses, conferences, trips, etc.
most of these adventures are chronicled here.

Next year I've accepted a position in the emergency department at Carilion in Roanoke Virginia. I'm hoping to eventually help contribute to wilderness medicine opportunities for in Roanoke.

I'm also a co-founder of blue ridge adventure medicine llc which is a new organization designed to offer hands on scenario based wilderness medicine education.

Interesting ingestion

Patient ingested all of these substances in a suicide attempt! Pretty much covers most toxic ingestions. Hydrocarbon, alcohol, alkali, acid, Tylenol, surfactant...

Updates:

Its sort of been a while since I've posted anything. Just a quick summary of the past month or so.

I took EM written boards November 12th. I'm glad its over.

I spent Thanksgiving at home in Charlotte with my family!

Liz came down Nov 23-25th and we hung out, compared war stories and did lots of mountain biking. We accomplished my goal of riding all the FATs trails in one day :) Somewhere in the ball park of 37 miles.

The next weekend I headed up to Winston-Salem and did the mistletoe half marathon. Nothing about my performance was impressive - but it was the furthest by 6 miles I've ever run in my life - and I sort of never trained for it - so I was just happy I managed to run the whole way.

The weather has been mild, which has allowed me to continue to get in some good mtn biking. Rich and I have gone night riding twice this week at FATs. The trails are even more fun in the dark.

Work in the ED over the past month has been busy. Plenty of critical patients - and plenty of the flu to keep me and the residents very busy!

Today (Thursday) I went to an ultrasound course for the critical care docs. Its awesome to work in a place where you can learn so much!

My upcoming projects include: MedWARs on April 20th and the 6th Annual Southeastern Student Wilderness Medicine Conference on April 13-14.
This spring it looks like a Wilderness EMS director course, WMS conference in Park City, Med support for racing the planet in Chile, and the completion of the WMS DiMM course at Rainier!

I've also got some research projects cooking...