My feet are planted firmly on the rock, hands gripping the rope. My friends are beaming some light down for me, but everything besides myself, the rope and the rock has been swallowed by midnight darkness and fog. There are no trees, ground, or people. Just me, the fog, and the rock face. It's like being wrapped in some kind of warm fuzzy nothingness, and it's a beautiful feeling.
"Whatever you do, don't take your right hand off that rope," my friend told me before I went over the edge for my first rappel.
My heart is racing, but I'm far from fearful. It's exhilarating to force your body to do things that it instinctively dreads. My mind trusts my harness and the rope and the BFR (big fucking rock) I am anchored to... it understands the physics and the systems of things. My body doesn't. There is no fighting that epi dump of instinctual fear when walking backwards off a cliff, and why would you want to? The contradiction provides that lovely rush of risk that is like no other feeling in the world.
I rappel down until I'm about 5-10 feet from the ground and it's still barely peeking through the murky shadows. I'd like to ascend a tad and return to dangle there in divine suspended animation for a bit longer, but I can't. It's someone else's turn to give it a go.
5.30.2008
5.28.2008
Let's Talk About Capillaries.
I retain information best when I write about it. So I'm going to try to post some edubloggins, if you will, on a regular basis. I'm going to focus on topics in anatomy and physiology as they relate to EMS. Here goes episode 1.
Capillaries: your cells need gases, nutrients and hormones to survive... and these microscopic blood vessel wonders deliver. The average capillary has such a small internal diameter that red blood cells are just able to march through it in single file. They are the transition from arterial blood flow to venous blood flow.
Capillaries are not lone rangers, however. They work together in interweaving systems called capillary beds. These capillary beds are more complex than one might think. Mechanisms at play in the capillary beds contribute to many of the skin signs we see in hypovolemic shock... pallor, coolness, clamminess, blueness.
You may recall that in a hypovolemic state, the body will shunt blood away from the surface and into the core, where vital organs are located. When faced with limited resources (blood) the body says "screw you skin, we're giving this stuff to the organs that really count." But how does the body actually do this shunting stuff? Vasoconstriction is far from a complete answer. Much of this action goes down in the capillary beds themselves.
Okay, don't be intimidated by the crazy diagram I made in paint. We'll start left to right, which is the direction that blood flows. The capillary bed is fed by the terminal arteriole, a baby artery. Blood passes into the metarteriole, the intermediate between an arteriole and capillary. The metarteriole is continuous with the thoroughfare channel, the intermediate between a capillary and a venule. Blood flows from the thoroughfare channel into the postcapillary venule, which is a baby vein. This is obviously a direct route, so what about that crazy web of capillaries?
The capillaries in that web are known as true capillaries, and they branch off of the metarteriole. So those green things in my diagram, the precapilllary sphincters? Those are simply cuffs of smooth muscle that surround the root of every true capillary. When these sphincters are relaxed and open, blood flows freely into the true capillaries and can make exchanges with tissue. When these sphincters are contracted and closed, blood cannot flow into the true capillaries and is forced to take the direct route (terminal arteriole > metarteriole > thoroughfare channel > postcapillary venule) and bypass the surrounding tissues.
To give you a better picture, imagine that the above diagram has the precapillary sphincters open and all the color in the true capillaries represents blood flowing. Here's what the diagram would look like with the precapillary sphincters closed:
When the body is responding to a condition such as hypovolemic shock, it tries to compensate and keep the blood pressure up. In addition to shunting blood to vital organs, widespread vasocontriction will occur, keeping BP up and increasing venous return. The body can keep this act up for a remarkable amount of time and maintain a stable BP, which is why a decreased BP is an ominous sign in someone in shock. The body is failing to compensate for the loss of blood volume and organ damage and/or death is likely to occur due to immense hypoperfusion. Any questions?
Reference:
Marieb, E. N., & Hoehn, K. (2007). Human Anatomy and Physiology (7th ed.).
San Francisco: Pearson Benjamin Cummings
Capillaries: your cells need gases, nutrients and hormones to survive... and these microscopic blood vessel wonders deliver. The average capillary has such a small internal diameter that red blood cells are just able to march through it in single file. They are the transition from arterial blood flow to venous blood flow.
Capillaries are not lone rangers, however. They work together in interweaving systems called capillary beds. These capillary beds are more complex than one might think. Mechanisms at play in the capillary beds contribute to many of the skin signs we see in hypovolemic shock... pallor, coolness, clamminess, blueness.
You may recall that in a hypovolemic state, the body will shunt blood away from the surface and into the core, where vital organs are located. When faced with limited resources (blood) the body says "screw you skin, we're giving this stuff to the organs that really count." But how does the body actually do this shunting stuff? Vasoconstriction is far from a complete answer. Much of this action goes down in the capillary beds themselves.
Okay, don't be intimidated by the crazy diagram I made in paint. We'll start left to right, which is the direction that blood flows. The capillary bed is fed by the terminal arteriole, a baby artery. Blood passes into the metarteriole, the intermediate between an arteriole and capillary. The metarteriole is continuous with the thoroughfare channel, the intermediate between a capillary and a venule. Blood flows from the thoroughfare channel into the postcapillary venule, which is a baby vein. This is obviously a direct route, so what about that crazy web of capillaries?The capillaries in that web are known as true capillaries, and they branch off of the metarteriole. So those green things in my diagram, the precapilllary sphincters? Those are simply cuffs of smooth muscle that surround the root of every true capillary. When these sphincters are relaxed and open, blood flows freely into the true capillaries and can make exchanges with tissue. When these sphincters are contracted and closed, blood cannot flow into the true capillaries and is forced to take the direct route (terminal arteriole > metarteriole > thoroughfare channel > postcapillary venule) and bypass the surrounding tissues.
To give you a better picture, imagine that the above diagram has the precapillary sphincters open and all the color in the true capillaries represents blood flowing. Here's what the diagram would look like with the precapillary sphincters closed:
When the body is responding to a condition such as hypovolemic shock, it tries to compensate and keep the blood pressure up. In addition to shunting blood to vital organs, widespread vasocontriction will occur, keeping BP up and increasing venous return. The body can keep this act up for a remarkable amount of time and maintain a stable BP, which is why a decreased BP is an ominous sign in someone in shock. The body is failing to compensate for the loss of blood volume and organ damage and/or death is likely to occur due to immense hypoperfusion. Any questions?Reference:
Marieb, E. N., & Hoehn, K. (2007). Human Anatomy and Physiology (7th ed.).
San Francisco: Pearson Benjamin Cummings
5.27.2008
2008, so far, in life experiences.
20 Things I've done this year that I'll probably never forget:
1. Learned how to drive.
2. Learned how to self arrest on a glacier.
3. Got promoted to Sgt., then Lt.
4. Became a legal adult.
5. Started my EMT class. (almost done!!)
6. Stuck a tube down someone's nose. Scrubbed a burnt hand. Cut away some clothes. Cleaned up a ton of blood, vomit, and poo.
7. Cut a vehicle into pieces using powerful hydraulic tools.
8. Celebrated New Years in Miami
9. Battled the DMV, causing a huge stink which eventually lead to them changing an unfair rule.
10. Landed a helicopter.
11. Held a human heart that was nearly the size of a basketball.
12. Graduated from High School.
13. Played paintball with the SWAT team in the interest of training.
14. Received the Danny Dietz Scholarship of Honor.
15. Treated my first patient.
16. Did a bust with the Sheriff's Office.
17. Did my first rappel in the middle of the night in death fog on wet rocks.
18. Published my last newspaper.
19. Finally started physical therapy for my jacked up knees.
20. Learned how to talk to patients.
It's been an amazing year so far. I've learned and experienced so much, and I feel so incredibly blessed. I hope I never lose this sense of wonder, anticipation and enthusiasm that I have for life right now, even though I probably will. It seems that the real world tends to beat that out of people. Oh well, I'll find my way.
1. Learned how to drive.
2. Learned how to self arrest on a glacier.
3. Got promoted to Sgt., then Lt.
4. Became a legal adult.
5. Started my EMT class. (almost done!!)
6. Stuck a tube down someone's nose. Scrubbed a burnt hand. Cut away some clothes. Cleaned up a ton of blood, vomit, and poo.
7. Cut a vehicle into pieces using powerful hydraulic tools.
8. Celebrated New Years in Miami
9. Battled the DMV, causing a huge stink which eventually lead to them changing an unfair rule.
10. Landed a helicopter.
11. Held a human heart that was nearly the size of a basketball.
12. Graduated from High School.
13. Played paintball with the SWAT team in the interest of training.
14. Received the Danny Dietz Scholarship of Honor.
15. Treated my first patient.
16. Did a bust with the Sheriff's Office.
17. Did my first rappel in the middle of the night in death fog on wet rocks.
18. Published my last newspaper.
19. Finally started physical therapy for my jacked up knees.
20. Learned how to talk to patients.
It's been an amazing year so far. I've learned and experienced so much, and I feel so incredibly blessed. I hope I never lose this sense of wonder, anticipation and enthusiasm that I have for life right now, even though I probably will. It seems that the real world tends to beat that out of people. Oh well, I'll find my way.
5.20.2008
Honor
It's hard to describe how flattered and privileged I feel. I have just received the Danny Dietz Scholarship of Honor.Here is an excerpt of an article about the amazing man this scholarship was created in honor of:
"The rescue helicopter had crashed. The Navy SEALS were wounded by Taliban gunmen, vastly overpowered and outmanned in the remote region of Afghanistan.
Danny P. Dietz kept fighting.
More than a year after the 25-year-old Navy SEAL from Littleton was killed, he has been awarded the nation's second-highest military honor, the Navy Cross.
The award - one of only 20 given for valor since fighting began in Afghanistan and Iraq, and second only to the Medal of Honor - will be presented to Dietz's widow and parents during a ceremony at the U.S. Navy Memorial in Washington, D.C. on Sept. 13. The medal will also be presented posthumously to the family of Dietz's teammate, Matthew Axelson, of Cupertino, Calif.
The pair were part of an elite team of four SEALs on a reconnaissance mission "tasked with finding a key Taliban leader in mountainous terrain near Asadabad, Afghanistan," according to a Navy news release.
On June 28, 2005, "They were spotted by anti-coalition sympathizers, who immediately reported their position to Taliban fighters. A fierce gunbattle ensued between the four SEALs and a much larger enemy force with superior tactical position," the Navy release said.
The SEALs radioed for help, and a responding Chinook helicopter was shot down by a rocket-propelled grenade, killing eight more SEALs and eight Army NightStalkers. It was the worst single combat loss for the SEALs since the Vietnam War.
According to the Navy, "Despite this terrible loss, the SEALS on the ground continued to fight. Although mortally wounded, Axelson and Dietz held their position and fought for the safety of their teammates despite a hail of gunfire. Their actions cost them their lives, but gave one of the other SEALs an opportunity to escape."
That SEAL, who has not been publicly identified, was sheltered by a friendly Afghan, then turned over to the U.S. military."
Tonight I was awarded the medal and a scholarship by Danny's family and a SEAL who was involved in the battle that took Danny's life. They are all truly remarkable people and I am extremely grateful that they chose me to receive their son's Scholarship of Honor.
Danny's father was a Hospital Corpsman and he spoke to me about the struggles and gratification of fighting to save the lives and limbs of others. He told me that things will get difficult... in school, in the hospital, or wherever my passion will take me, but to never give up. Keep fighting. Like Danny did.
The man who presented me the medal was critically injured in Afghanistan and reminded me of the sheer magnitude of the work I'm going in to. He would not be alive today if it were not for those doctors and nurses who fought endlessly to keep him going.
This award has inspired and touched me deeply. It gives me an even deeper sense of purpose and duty as I prepare to go off to college. Danny, his family, and the people he served with will always be on my mind and near my heart. I will strive to serve Danny's memory with passion, honor and determination.
5.18.2008
Justice
I can definitely see myself as the person who changes up careers. I honestly wouldn't be surprised if I ended up doing nursing, law enforcement, and firefighting over the span of my lifetime.
That law enforcement bit may shock some people, but I think I would really enjoy doing investigations. I enjoy digging for clues, imagining all of the possibilities, understanding people's motives and what makes them tick, and eventually putting all of the pieces together. I would love to spend some time busting up drug and gang operations. One of my secret dreams is to work undercover to bust meth operations. I hate meth. It's by far the most evil and destructive drug in America right now.
The thing that bothers me about law enforcement is that regardless of how much the criminal deserves it, your actions often result in the devastation of their life. I'm not saying that LEOs are evil or bad at all, in fact, I respect them highly because of their ability to cope with that fact. They see crazy, evil, disturbing things just as much as anyone who works in EMS, but they have the responsibility of inflicting harm. Yes, the ends justify the means and they are keeping everyone safe, saving lives, and making society better, but to reach that goal they have to make life worse for certain people.
The event that really made this clear for me was my participation with law enforcement in a bust. I can't divulge too much information, but I will tell you that I was trying to purchase items from businesses that they were not legally allowed to sell to me while an investigator observed. Out of the countless businesses that I visited that day, only one was busted. Was it some seedy, immoral crook with a rap sheet a mile long that did the illegal deed?
Of course not. It was a very pleasant and friendly old man who was just running the family business and unfortunately made a mistake. An illegal and costly mistake.
I felt like utter shit. It gave me endless respect for the men and women of law enforcement who deal with these nagging moral dilemmas on a daily basis. We all want justice, but how many of us could wield the force of it while looking into the eyes of another human being who has for one reason or another, found themselves on the wrong side of the law?
That law enforcement bit may shock some people, but I think I would really enjoy doing investigations. I enjoy digging for clues, imagining all of the possibilities, understanding people's motives and what makes them tick, and eventually putting all of the pieces together. I would love to spend some time busting up drug and gang operations. One of my secret dreams is to work undercover to bust meth operations. I hate meth. It's by far the most evil and destructive drug in America right now.
The thing that bothers me about law enforcement is that regardless of how much the criminal deserves it, your actions often result in the devastation of their life. I'm not saying that LEOs are evil or bad at all, in fact, I respect them highly because of their ability to cope with that fact. They see crazy, evil, disturbing things just as much as anyone who works in EMS, but they have the responsibility of inflicting harm. Yes, the ends justify the means and they are keeping everyone safe, saving lives, and making society better, but to reach that goal they have to make life worse for certain people.
The event that really made this clear for me was my participation with law enforcement in a bust. I can't divulge too much information, but I will tell you that I was trying to purchase items from businesses that they were not legally allowed to sell to me while an investigator observed. Out of the countless businesses that I visited that day, only one was busted. Was it some seedy, immoral crook with a rap sheet a mile long that did the illegal deed?
Of course not. It was a very pleasant and friendly old man who was just running the family business and unfortunately made a mistake. An illegal and costly mistake.
I felt like utter shit. It gave me endless respect for the men and women of law enforcement who deal with these nagging moral dilemmas on a daily basis. We all want justice, but how many of us could wield the force of it while looking into the eyes of another human being who has for one reason or another, found themselves on the wrong side of the law?
'Copters and cutters and spreaders, oh my!
A couple of weeks ago my EMT class did our extrication/helicopter lab day. We started our morning by landing the back-up helicopter (AKA the ghetto bird) of my future employer, AirLife. This was after the lecture on "the tail rotor will slaughter you" and "powerlines will slaughter us" safety type stuff.
It's not the roomiest office, but it has killer views.
Here's a patient's POV. You can see why tall people, obese folks, Hare traction splints, and anything that needs to be done on the patient's left side can be a problem.
After helicopter-landing, it was time for car-cutting. I felt really silly, like a little girl playing dress-up, except with bunker gear and heavy hydraulic tools.
Now that my friend is stress relief.
Die post, die.
Classic pin-up, eh?
Sometimes I wish I could be a fire medic. It would be a nice variety... one call you're taking a chest-painer to the hospital, the next you're battling a structure fire, the next you're rescuing someone trapped in an elevator. However with my gender, smaller stature, knee issues, and respiratory problems (I apparently grew out of asthma) it would be a long shot. Besides, I appreciate the academic rigor and endless opportunities that nursing presents.
It's not the roomiest office, but it has killer views.
Here's a patient's POV. You can see why tall people, obese folks, Hare traction splints, and anything that needs to be done on the patient's left side can be a problem.After helicopter-landing, it was time for car-cutting. I felt really silly, like a little girl playing dress-up, except with bunker gear and heavy hydraulic tools.
Now that my friend is stress relief.
Die post, die.
Classic pin-up, eh?Sometimes I wish I could be a fire medic. It would be a nice variety... one call you're taking a chest-painer to the hospital, the next you're battling a structure fire, the next you're rescuing someone trapped in an elevator. However with my gender, smaller stature, knee issues, and respiratory problems (I apparently grew out of asthma) it would be a long shot. Besides, I appreciate the academic rigor and endless opportunities that nursing presents.
5.08.2008
Lt. Lucid returns
Hello everyone. First of all I am still alive. My home computer is dead, and I've just been unbelievably painfully busy with taking in the new class for my SAR team, overhauling all of our medical equipment and reorganizing our cabinets, helping with the rebirth of our bike team, finishing up my requirements for my EMT class, responding to calls, meeting newspaper deadlines, etc etc.
On Tue. I worked my ass off from 4 am - 9:30 pm, on 3 hours of sleep, with no break. There's been plenty of 17-18 hour days. It's hellish, but I love being so productive. I have the art of biting off the maximum that I can chew and nothing more down to a science.
Second of all... I've been promoted! Yay. You can call me Lieutenant now. I'm now in charge of training, operations, and two sergeants & their field teams, in addition to the tasks I already have.
I have three events on my list to recount for you once I get the chance - my extrication lab in which we cut up cars and landed a helicopter, my 2nd ambulance ride-along in which I got my first real taste of trauma, and the search I went on Tuesday, in which I hiked for miles looking for someone who would run away from his rescuers once found. Stay tuned.
I'll also be checking out your bloggins that I have missed so much as soon as I have the time!! :)
On Tue. I worked my ass off from 4 am - 9:30 pm, on 3 hours of sleep, with no break. There's been plenty of 17-18 hour days. It's hellish, but I love being so productive. I have the art of biting off the maximum that I can chew and nothing more down to a science.
Second of all... I've been promoted! Yay. You can call me Lieutenant now. I'm now in charge of training, operations, and two sergeants & their field teams, in addition to the tasks I already have.
I have three events on my list to recount for you once I get the chance - my extrication lab in which we cut up cars and landed a helicopter, my 2nd ambulance ride-along in which I got my first real taste of trauma, and the search I went on Tuesday, in which I hiked for miles looking for someone who would run away from his rescuers once found. Stay tuned.
I'll also be checking out your bloggins that I have missed so much as soon as I have the time!! :)
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