conditional_soup

My local EMSA has approved IV Tylenol for pre hospital pain management in trauma patients. Supposedly, studies show that there's little clinical difference in the efficacy of acetaminophen and opioids in acute pain management. I've attempted to find this alleged research, and the link above is what I found. I can't quote it exactly because I'm on mobile and it's being weird, but the relevant section is towards the end and compares the efficacy of IV Tylenol to IV opiates. It leads with saying that the relevant evidence is considered low quality before indicating that (this is a VERY rough summary) IV tylenol seems to have a very similar though slightly less effective/durable analgesic effect. I recommend you read it for yourself. The study also doesn't seem to be limited to trauma patients, and seems to make no distinction between visceral and somatic pain, both things I was hoping to see.

Overall, I can see the benefits: it's cheaper, not addictive, less strictly regulated, doesn't alter consciousness or respiratory drive, and doesn't induce a bunch of histamine to tank a patient's blood pressure. I'm wondering if anyone has any experience with it, and if it works as well as advertised.

If you're like me, you've probably been bombarded with ads about how awful AB 886 is. You should know that AB 886 is an attempt to support local journalism by forcing large, for-profit platforms that share links to online local news articles, like Reddit, Xitter, Facebook, and Google, to pay money to those local news agencies for access to their work. The group behind the ads against AB886 is the CCIA, or the Computer & Communications Industry Association, which is a lobbying group whose membership includes such small, local journalism organizations as:

• Google
• Amazon
• Facebook
• Twitter
• And many more

Here's their Wikipedia page if you're interested: https://en.m.wikipedia.org/wiki/Computer_%26_Communications_Industry_Association

So, predictably, this is down to huge for profit companies wanting to continue getting access to other people's work for free. If you're feeling like taking memes seriously and getting into fights with strangers, you might think about calling your assembly member and letting them know that the CCIA can go fuck themselves and to support AB886.

Thought I'd get a near death experience thread going. Doesn't have to be crazy to share.

I had mine when I was about seven. I was living with my mom at a big house that the owner was letting rooms out in, and they had a pool without a fence around it. You probably already guessed by now, but I couldn't swim yet. I was in the back yard playing with the boy who lived down the hall when the frisbee we were playing with landed in the pool. I thought I could reach it, and the other kid encouraged me, so I knelt down and reached out as far as I could for the frisbee. It didn't happen immediately, I was reaching for a bit before the landlord's big dog came by and bumped into me. I fell in, struggled a bit, and ultimately went under. I remember looking up at the surface, seeing my dog, a black lab, swimming circles over me, and then just going to sleep. My life didn't flash, I didn't have a realization that I was going to die, no lights in tunnels, no voices, no being dragged through deep water or any of that. It was really just like "I'm tired now" and I went to sleep.

Somewhere in all this, someone told my mom I was in the pool. She ran out, jumped in, and dragged me out. My next conscious memory is her pumping on my chest and me throwing up and coughing up water (kinda felt like both anyway). We never went to the hospital, in hindsight I was damn lucky not to have died of dry drowning later. In fact, I've been a paramedic for 14 years, and I've seen my share of drownings in home pools, and it only reinforces for me how lucky I got. It's such a narrow window of survivability, and my mom threaded it. Pools are no joke, don't leave your kids unsupervised around pools, and never ever trust an unfenced pool.

This is a smaller note, but it happened to one of my patients, not me. I was treating a man having a massive STEMI, and when we were just thirty seconds from parking the ambulance, he coded on us. We'd seen it coming, though, and already had the defibrillator pads on him, so I had the firefighter start compressions while I charged up the monitor. Once it was charged, I cleared him and fired the shock, and we actually got Hollywood resuscitation, like his eyes popped open, he gasped, started looking around, the whole nine yards. Only time in my whole 14 years I ever saw that. But the guy looked terrified, way more than he had been before. I'm talking a real, fundamental lizard-brain terror in his eyes; it's possible you've never seen that look, but if you know, you know. I've always wondered if his experience was like mine, had he just gone to sleep and then been jolted awake when the monitor hit him like a freight train? Or did he experience something else?

Not my work, found it on YouTube and enjoyed this artist's work, so I thought I'd show my appreciation by sharing. Reminds me of the old school country vibes before it got taken over by make believe patriots.

EMS Expo 2024 is taking place in Las Vegas, September 9-13th.

I haven't been to an EMS Expo since 2010, and that one was pretty okay. Has anyone been recently / planning to go? Is it any good?

Going to lead with: no, this isn't a skinwalker story.

Back in the early 2010s, my friends and I would hold regular airsoft practice in the woods behind my house. A lot of it was the sort of dense, old growth that covers to southeast US. Our last practice back there, we were wrapping up when we heard a very distinct whistle. We figured it was probably one of my neighbors who might have gone back to see what we were up to, so we called out to them, and, after getting no response, whistled back at them. We got another whistle back within ten seconds, and while we could figure out a general direction the whistling was coming from, we couldn't find anyone there. Getting a little concerned, we called out again, and decided to just pack up and leave when we got no response again.

Everything seemed mostly normal while we were packing up, though two of the people in our group insisted that they'd seen a figure peeking out from behind a tree at us. It wasn't until we were leaving that things got a little more exciting. On the way up the trail, my friend's dog kept indicating to the same area of to our right. We also heard that whistle every few minutes, getting closer each time we heard it. My friend with the dog later insisted that he saw a dark figure ducking out of sight from just behind us and off to the right of the trail. Thankfully, that's about the point where we started coming to the edge of the woods, and the events mostly stopped. The whole time that we were packing everything in the trucks, though, my friend's dog was laser focused on the woods.

I had some other kinda weird stuff happen at that house, like something hitting the back wall so hard that I thought the refrigerator had fallen over. To this day, my friend who claims to have seen it is sure we encountered something paranormal, though I'm not convinced that the whole situation wasn't just a bunch of college guys getting freaked out by someone in camouflage having a laugh.

On Thursday May 2nd, at the Senior Center at 755 W 15th St, between 5-7pm, the High Speed Rail authority will be showing off a scale model of the proposed Merced High Speed Rail station, answering questions, and taking comments.

So, it'd be a good thing to go if you're curious or just need something to do, but there's also something important you can bring up. Currently, they haven't decided between surrounding all 8 blocks of the station with parking lots or mixed use, transit-oriented development. IMO, surrounding the station with parking lots the whole way round wouldn't only be ugly and hostile to anyone not driving a car, but it would be a major footgun moment for both Merced and the HSR at once. We can do better than eight parking lots. I plan on being there to let them know, I'd like your help, too.

So, I wanted to have a level-headed discussion about this case. I've been loosely following it since it happened, and I'm curious to see what others think of it, perhaps hear from folks who followed it more closely.

For those out of the loop, here's the JEMS article on it: https://www.jems.com/patient-care/two-co-paramedics-found-guilty-in-death-of-elijah-mcclain/

The tl;Dr is this: Aurora fire medics are dispatched to assist Aurora PD with a combative patient they believe is in an altered mental state. Aurora FD EMS crews identify this patient as qualifying for their excited delirium protocol based on PD and patient presentation, and administer the maximum dose of ketamine allowed under their weight-based dosing (which was well over what Elijah weighed). Now, there's other details (this IS a tldr), but after the ketamine, the patient goes into respiratory and cardiac arrest and is eventually declared. The paramedics involved were found guilty of negligent homicide. The FD has stood by their paramedics, saying that they followed their policies appropriately.

Let me lead with this: it seems to me that McClain's case was a foreseeable (albeit low likelihood) and unfortunate outcome that was the cumulative result of many lesser individual poor choices on the part of both law enforcement and EMS. We lack the personal context to really appreciate those choices, I think, and we're left to armchair quarterback those decisions with only the information available to us. I do believe that Mr. McClain should still be alive, and likely would be under different systems-level conditions, such as training and clearly defined interdepartmental operations protocols. Personally, I disagree with the conviction based off of my current understanding of the situation. My current understanding of the facts does not persuade me of the presence of gross, nevermind criminal, negligence on the part of the EMS crew. There absolutely is a conversation to be had here about PD leveraging field sedation and integrating field emergency care as a compliance and law enforcement tool as opposed to a healthcare response to a medical emergency. There's another conversation to be had about systems-level choices that likely influenced this outcome. I think that just throwing these guys in jail fails to accomplish anything on those fronts, and, as such, is a false justice.

So, I'd like to ask you guys for your thoughts. Was it preventable? Was the conviction helpful? What can be done to prevent this in future, if anything, and what's your take-away?

I was wondering how many of you have experience using pre-hospital ultrasound. I've heard for a long time that it's the "next big thing", and I can see it for rural systems or maybe even community paramedicine, but I've not seen much in the way of it actually getting adopted. Do you find it to be a meaningfully useful addition to your skillset and protocols? If you were around when it was introduced, how do you feel about the introduction? What were some lessons learned by you or the system along the way?

Hey, so, I was hoping someone could break down the strategy or rationale behind team Biden's current messaging? Cards on the table, I plan on voting for him in the general election and primary, but the Biden camp's messaging seems insane to me. I know a single person irl who's doing well financially right now, everyone else is feeling the pain. The messaging so far seems to be (and please correct me if I'm wrong): everything is fine actually, and we should all be praising him, and it doesn't matter if you disagree because the other guy is Hitler. It just comes across as super disconnected, I don't know any IRL left/Dem voters that resonate with it, and it honestly reminds me of the general vibe of the HRC campaign from 16. This election is too important to fuck up, so this messaging has got me concerned. Can someone explain how this is supposed to win Biden the election?

Yerba Santa is actually several closely related annual plant species native to California and Oregon. In my personal experience, Yerba Santa can frequently be found along roadsides and in disturbed soils in the Sierra Nevadas, but CalScape suggests that they're mainly found in the mountains around SoCal and along the Pacific side of the Diablo range. The leaves are tough and leathery with a rich, dark green coloration on top and a fuzzy underside that looks much paler. The plant can be a little unpleasant to handle due to the sticky resin it secretes. The leaves are long and toothed, and grow off of stems that don't branch. I've never seen a single yerba Santa plant by itself, it almost always grows in small, dense clusters like you see in the picture. Yerba Santa also puts off clusters of trumpet-like purple-white flowers from the top that are used by native butterflies, but I haven't seen this in person.

Multiple sources report the medicinal use of Yerba Santa by both First Nations peoples (Miwuks and Yokuts to name a few) as well as Spanish settlers to treat a variety of remedies. As bitter as the plant is (also, tar is another foraging red flag for me; where there's tar, I usually expect that there's some pretty bioactive compounds like Nicotine, and that's a recipe for a bad time), I can't help but imagine that there's probably some compounds in it that might not be great to put in your body all the time, so I highly recommend doing your own research here. Also, a lot of the information about the supposed medicinal qualities seems really apocryphal and like it's just something that people repeat but never verify; I'd want to follow up with some people who have real experience with this plant before just going and chewing on it. For animals, Yerba Santa provides food for butterflies, native bees, and birds in the form of nectar and seeds, and has been documented as a forage of last resort by native blacktail deer when most other plants have already died or gone dormant. Additionally, Yerba Santa has been documented as being useful for stabilizing disturbed or scorched soils. There's a few weeds that could conceivably appear similar to Yerba Santa due to their habit of growing as a cluster of dense, non-branching stalks, but the tell I would suggest is the leaves. Most weeds that have similar growth habits won't have the same thick, robust, tar-covered leaves that Yerba Santa has, and won't have the trumpet-like flowers. The most serious lookalike, imo, is Oleander. Oleander is a woody shrub that gets much larger than Yerba Santa, but has similar-looking, rich dark-green, tarry leaves with trumpet-like flowers. OLEANDER IS VERY POISONOUS AND WILL KILL YOU IF CONSUMED. Oleander is not native, and is widely used as an ornamental throughout California. As a rule of thumb, if it's woody OR big OR looks like it's supposed to be there, it's Oleander.

Yerba Santa varies in hardiness. Like many California natives, it is wholly unafraid of summer sun; though most natives do fine with at least a little shade in the day, Yerba Santa is beyond such weakness. Some species of Yerba Santa can grow quite aggressively in disturbed soils, while others in the Santa Barbara region are seriously endangered. If you want to get your hands on this plant, I'd advise against harvesting Yerba Santa from the wilderness for several reasons:

• you could be harvesting an abandoned Oleander plant, and Oleander will kill you if consumed.

• you might accidentally be harvesting one of the endangered members of the species, which is not only unethical but likely illegal.

• Yerba Santa ain't no slouch, that plant is doing work where it is, holding the disturbed soil together and providing forage for wild animals through parts of the year when forage is scarce. You're hurting a lot of things that depend on that plant by taking it out of the ecology.

Instead, I'd strongly recommend getting some seeds from a reputable source and trying to grow some from seed.