MEDIC MASTERY
July 21, 2020
Read this on the Medic Mastery web site.
New Format!
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The goal is to send one of these out every other Tuesday.
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Topics at a Glance:
I. Post-Traumatic Growth [Optimizing for Medics]
II. iGel Mastery [Clinical Pearls]
III. 25x Your Anaphylaxis Treatment [Evidence Based Practice]
I. Post-Traumatic Growth [Optimizing for Medics]
Over the years I’ve heard a lot about Post-Traumatic Stress Disorder. I’ve heard, for example, in this heart-rending CBC documentary, "After the Sirens", that 1 in 4 Canadian paramedics may experience PTSD (that’s about 18,425 paramedics in Canada). That, for some reason, paramedics experience higher rates of PTSD than firefighters and police officers.
It’s critically important that paramedics continue to familiarize themselves with the symptoms of PTSD so that they can recognize it in themselves and their peers. They need to be equipped with the resources to seek help or provide support as necessary.
In Jim Rendon’s book Upside: The new Science of Post-Traumatic Growth, I was introduced to an in-depth review of the factors that contribute to growth after experiencing Post-Traumatic Stress. I had heard of the concept before, but I did not know very much about it.
Here are a few highlights from the book:
On what Post-Traumatic Growth looks like...
“... people were reporting positive change in one or more of the following five distinct areas as a result of their trauma:
1. Increased inner strength
2. An openness to new possibilities in life
3. Closer and often deeper relationships with friends and family
4. An enhanced appreciation for life
5. A stronger sense of spirituality” (16)
On common humanity and not minimizing suffering…
“For Frankl, the suffering that can result from trauma - depression, anxiety, and many of the other symptoms - are not always maladies to be cured, like a sore throat or a broken leg. Instead they can be important indications of inner turmoil. They are normal. More than that, he says, they are an achievement. These problems demand attention and will only be cured in the course of resolving the underlying conflict. In many cases, treating the symptom only prolongs the disease in his view.” (25… emphasis mine)
On the importance of talking about growth...
“Weiss found that just having contact with someone who had grown was one of the biggest factors in predicting post-traumatic growth” (74)
On the importance of knowing about growth…
“Because Skelton understood growth, he realized early on that these terrible injuries might hold something positive for him, that he might find something different, better, as a result.” (181)
In the next email I’ll dig into some of the big ideas behind what drives growth in the context of Post-Traumatic Stress and PTSD.
For now, watch that CBC documentary (43:48), if you haven’t already, and pass it along to some peers.
I think it’s must-watch TV for paramedics because we need, first of all, to get in touch with this idea of common humanity. That’s the kind of stuff that makes us more ready to get help when we need it.
P.S. In this context, that concluding line of the documentary just fuels my fire. Please consider sharing this email newsletter with other peers so we can start spreading the word that there may be “more hope” for paramedics when we start learning to optimize our lives within the constraints of our reality.
II. iGel ® Mastery [Clinical Pearls]
A few great tips from BCEHS on troubleshooting iGels:
- In context of COVID-19 and other infections diseases, make sure that the filter is placed before you insert the iGel;
- Lubricating the spine of the iGel, in addition to the cuff, reduces resistance to insertion;
- It’s important to secure the iGel with downward pressure in order to help keep it in place during resuscitation.
- More tips on suctioning before insertion, while in place and during/after removal...
If IGel’s are in your scope it’s definitely worth the watch!
III. 25x Your Anaphylaxis Treatment [Evidence Based Practice]
One of my favourite insights from research over the years is that there is potentially a vast difference in treating anaphylaxis with IM epi in the deltoid vs the vastus lateralis.
This study (performed in Winnipeg, by the way) found that:
- Injecting a healthy adult male with 0.3mg IM epinephrine in the deltoid scarcely raises plasma levels of epinephrine over placebo (normal saline).
- Inject the epinephrine in the vastus lateralis and you get about 25 times the result.
You can read the full text of the study in the reference below. I highly encourage you to do so!
Abstract of the study:
“We report a prospective, randomized, blinded, placebo-controlled, 6-way crossover study of intramuscular versus subcutaneous injection of epinephrine in young men. Peak plasma epinephrine concentrations were significantly higher (P < .01) after epinephrine was injected intramuscularly into the thigh than after epinephrine was injected intramuscularly or subcutaneously into the upper arm. We recommend intramuscular injection of epinephrine into the thigh as the preferred route and site of injection of this life-saving medication in the initial treatment of anaphylaxis.”
Simons FE, Gu X, Simons KJ. Epinephrine absorption in adults: intramuscular versus subcutaneous injection. J Allergy Clin Immunol. 2001;108(5):871-873. doi:10.1067/mai.2001.119409
IV. Please consider sharing this with your friends
If you like the content of this newsletter then one of the best ways to support me is to share it with a friend. Please consider forwarding this to a friend or sharing it on social!
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V. Coaching
Did you know that I offer coaching? Figuring out fitness, nutrition and healthy habits within the constraints of your reality is my specialty. I’ve been at it for over 16 years. Consider making a short-term (3 month) commitment to getting yourself dialled in with individualized coaching. Reply to the email if you’re interested! Since y’all hold a special place in my heart, I have special pricing for EMS.
VI. Consider Joining Optimize Coach Class III
As I’ve shared before, the Optimize course has been an incredible catalyst for my personal growth. If you’re interested in doubling down on personal development this year, then consider joining Optimize Class III (currently $600 off with early-bird pricing). The next class starts August 24!
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