Mar 7 2015

Right Place. Right Time.

I saw someone die today.

It’s something I see nearly every day. It’s a normal part of the cycle of life, and within the hospital we have so many tools at our fingertips to keep it at bay. We can allow it or we can fight it. We regulate it.

Outside of the hospital… is where things get scary, we don’t always have everything we wish we did. Death is not regulated, it’s messy, it’s brutal.

11024636_10100310680795281_3078368369315217540_nI love my job, I love the skills I have learned and the years of training I have gone through. But using these skills off duty always leaves its mark. I saw someone die today. And there was nothing I could do. Nothing. Which burns a hole in my heart and brain. What could I have done differently? Could I have prevented the loss of another soul?

I saw someone die today.

But I also helped save the lives of many. I witnessed this accident. Actually, if my car was only 2 cars ahead of where we were stopped, it would have been our bodies laying in the morgue and not his.

The second I saw it my EMT brain took over, and I jumped out of my car, yelling for sawyer to call 911, immediately accessing the scene and triaging within my head. I found myself running towards the red Vibe, the first vehicle that was hit, and the one with the most visible damage. I saw many others running to the silver Malibu, that had hit the car I was nearing. The driver, a middle aged male was slumped over, I braced his c-spine and felt for a Carotid pulse. None. Radial. None. Femoral. None. Shit.

I hear screaming. “What do we do next?” Over and over again, it’s repeated. I suddenly realize they are asking me. My brain untunnels. I quickly scan the scene and see smoke coming from the vehicle that took this mans life. I direct all the others to check for breathing and consciousness of everyone in all of the other cars as I run towards the smoking car.

Thankfully, two gracious souls had already began to extricate the elderly couple from the car. The passenger has a gnarly head wound and looks like he’ll pass out any second. I yell for more hands to come help. The driver is a larger woman, for which I am thankful that adrenaline give you super powers, and that she had a seated walker in her car that miraculously was not crushed. It took what seemed like forever to remove her from the vehicle, she kept grabbing the seat belt, almost as though she though we were kidnapping her.

Eventually, we got her, and her mangled legs out of the car, as we quickly as possible, wheeled away to safety. She kept mumbling that she “couldn’t find the brakes”, and that “Peanuts” was in the car. I turn around only to see the engine compartment spewing flames. And thankful to see a young woman carrying a shaking poodle walking towards us.

Taking a quick traumatic assessment of her mental status and injuries, I noted a slow pulse, her hyperventilating and pinpoint pupils. Great, she’s going into shock, and I don’t even hear sirens yet. About 2 questions in, just to keep her talking, I finally hear sirens.

Praise the good Lord, Hallelujah!

I begin breaking down the situation for the Police, and that I believe this lady should be transported first. She continues to panic. Do you know how hard it is to calm am elderly woman going into shock is?? We get her ready for transport and she refuses to let go of my hand, stating I can’t leave her. I finally convinced her that she will be ok, and I can’t come.

We wait, for what seems like hours for the humane society to come retrieve their dog, and to give our eyewitness statements to the police. Which is when the officer tells me that my actions kept many alive today. My actions. My situational awareness. My directing of responders.

Regardless of training, isn’t it something anyone would do?

If it was me in one of those affected vehicles, I hope someone else would have done the same thing.


Jul 18 2013

ePortfolio: Association between Tuberculosis and Diabetes in Texas

Association Between Tuberculosis And Diabetes In The Mexican Border And Non-Border Regions of Texas Full Text

Abstract

A study of the association between Tuberculosis and Diabetes, in the Mexican border and non-border regions of Texas; Performed by The University of Texas, and published by the American Society of Tropical Medicine and Hygiene. History shows a positive association between incident rates of Diabetes and Tuberculosis, specifically in populations with low socio-economic status and high immigration rates.

Three scientists at the University of Texas; Adriana Perez, H. Shelton Brown III, and Blanca I. Restrepo, sought to find if there was an association between Tuberculosis and Diabetes. They set their study in the state of Texas with specific interests on the regions bordering Mexico. They began with these 2 facts that propagated their study: History has shown a positive association between Diabetes and Tuberculosis, as areas with low socio-economic status have high incidence rates for both diseases; 14 of the border regions on the Texas-Mexico border are among the poorest in the United States. In 2002 the Tuberculosis incidence rate in the United States was at an all time low with only 5.6 occurrences per 100,000 people, whereas in Mexico this rate was nearly double at 10.1 per 100,000 people. These incidence rates dramatically spike as we decrease our scope and zoom in on our zone of interest, within the state of Texas, 7.2 cases per 100,000 people, and the border regions are at 13.1 cases per 100,000 people. Two cities on the border of Texas that have the highest incidence rates are McAllen and Brownsville, whose rates roll in at 12.8 and 17.4 per 100,000 people, their sister cities on the Mexican side of the border Reynosa and Matamoros, spike at 43.9 and 70.3 per 100,000 people.
Both Diabetes and Tuberculosis are increasingly prevalent in Texas, and both are ongoing major public health problems. The large rates of Mexican immigrants that live in Texas have posed a large problem with control of the spread of Tuberculosis – in 2002, 51.6% of the cases in Texas were born in the United States, 24.6% were from Mexico, and 17.8% were from other countries. As more people immigrate between these areas the higher risk of exposure to the bacterium that causes Tuberculosis, may continue the upward association and trend between Diabetes and Tuberculosis.

Materials + Methods

A case-control analysis was done with cross-sectional data from Texas’ database of hospital discharges from 1999-2001. For this study they separated the state into 2 groups, the 15 border counties {Brewster, Cameron, El Paso, Hidalgo, Hudspeth, Jeff Davis, Kinney, Maverick, Presidio, Starr, Terrell, Val Verde, Webb, Willacy, and Zapata} and the remaining 239 “non-border” counties. To determine the region these patients were from, patient’s data was classified by zip code, county code and state code. Every individual that was discharged from a facility with a diagnosis of Tuberculosis {via ICD-9 codes} were admitted into the study. Many co-variables were extracted via individual’s demographics {age, sex, race, and insurance type} and any comorbidity factors {diabetes, renal failure, alcohol/drug use, cancer, surgeries, and nutritional deficiencies}. All patients were 15 years are older, and every readmission was listed as a new patient variable within the study. Income and education were taken from the US census from 2000 for each zip code area, and adjusting for socio-economic status via the 1999 median household income by zip codes.
Four thousand nine hundred and fifteen Tuberculosis hospitalizations were tracked from 1999-2001; with 1,244 in border regions and 3,671 non-border regions of Texas. The three main reasons for hospitalization of these cases contained: Tuberculosis infection, Pneumonia, and rehabilitation care. The control group {patients without diagnoses’ of Tuberculosis} contained 70,808 with 12,563 from the border regions and 58,245 individuals from the non-border regions. The three main reasons for hospitalization of these cases contained: acute appendicitis, acute pulmonary heart disease, and phlebitis/thrombophlebitis.

Results

– Hospitalized Tuberculosis cases more likely to come from neighborhoods with lower median incomes in all regions of Texas.

– Tuberculosis cases were less likely to be located in areas with high percentage of higher education graduates for both border and non-border regions.

– Patients from the border were more likely to have co-morbidities of diabetes, chronic renal failure, or have a nutritional deficit, and less likely to have cancer than the controls.

– Hospitalized Tuberculosis cases are more likely to be Hispanic men ≥ 45 years.

– Tuberculosis patients were 10x as likely to be alcohol users compared with the controls.

– Having Medicare/Medicaid or private insurance was associated with a lower risk in both border and non-border regions.

– Federal insurance/ VA/ or military insurance was associated with a higher risk in the non-border regions.

– Border region patients with Diabetes had more that twice the risk of Tuberculosis than those without diabetes.

– Non-border patients with Diabetes had 1.5 times the risk of Tuberculosis as those without Diabetes.

– Border patients with Diabetes had a 1.3 times the risk of Tuberculosis that those who lived in non-border regions.

– Hispanics with diabetes have over 2 times the risk of Tuberculosis as those without diabetes.

– Those with diabetes and without insurance have a greater risk of developing Tuberculosis than those who only have exposure.

– Nutritional deficits lead to decreased immune ability and increased risk of Tuberculosis.

Conclusion

Diabetes is a risk factor for developing Tuberculosis, and those living close to the Texas border are at a high risk for exposure due to the rate of those living in the area with latent Tuberculosis infections. The Hispanic population has an opposite effect as those living in the non-border regions are 23% more likely to develop Tuberculosis than those living in the border regions, as most Hispanic are immigrants from areas that are Tuberculosis endemic countries and are likely to have latent Tuberculosis infections. Those with latent Tuberculosis infections have a higher probability of reactivation of this infection with the development of Diabetes. These numbers will continue to grow as we see an ever-looming number of Diabetes rates increasing year after year.


May 4 2013

Dirty Shoes. Dirty Dog. Darn Good Days.

20130503-010321.jpgWe recently took a sweet little mini vacation to celebrate our two year anniversary (I can’t believe two years have passed so quickly!) Our little 3 day adventure took us away from the monotony of work and school and we traveled down to Escalante, Utah with exploring on our minds. We planned a trip that we could take our dear 1.5yr old pup, Penny, on and have some good off leash wandering for our little adventurer. This was Penny’s first camping trip and she handled it like a champ, despite having trouble with being able to hear and not see the outside sounds from within the tent at night. We wore her out on the second day of hiking after a good 10 miles she was totally pooped for the next few days. There are a lot of really great pet friendly areas to hike in southern Utah, however be sure to stay away from National Parks as they are NOT pet friendly. We really enjoyed the calf creek falls trails, red canyon and the petrified forest.

It was really amazing to just get away from the city for a few days. A definite must when there is school and work always pulling us in different directions. Can’t wait for our next adventure!

IMG_3709 IMG_3774 20130503-010357.jpg


May 3 2013

MATH 1040 – Final Project

MATH 1040 Final Project
MATH 1040 – Group 3 Term Presentation

 


May 3 2013

SuperSize Me

Supersize Me
Katilyn Pangborn
HEALTH 1020-SP13

[ABSTRACT: In attempt to dramatize the human condition of the fat epidemic in America, Morgan Spurlock created an experiment in which he ate only McDonalds food for one-month time. This is a deconstruction of his film and the nutrition perspectives that are present throughout his montage.]

Background
The documentary Supersize Me is an experiment completed by Morgan Spurlock to emphasize the fat epidemic that is currently plaguing the United States. Spurlock is an independent filmmaker with a Bachelor of the Fine Arts that he received in 1993 from New York University, he wrote, directed and was the main star of this documentary. This film was produced in 2004 in various locations of the United States. Spurlock would eat at McDonalds everyday for one month; this experiment had 5 simple rules:
– He must fully eat 3 meals from McDonalds every day; breakfast, lunch, and dinner
– He must consume every item on the McDonalds menu at least once throughout these 30 days.
– He must only consume items throughout these 30 days that are on the McDonalds menu. No outside consumption was allowed.
– He must supersize the meal when offered, but only when offered.
– He will walk only as much as the average American– 5,000 steps a day.
The central theme of this film was to point out how unhealthy large portions of American’s eat, as well as how unhealthy their diets are when lacking in exercise, known as the “fat epidemic”. Throughout this film Spurlock documented how the fast-food industry encourages poor nutrition that takes a dramatic toll on its consumers for its own profit. These themes are strongly applicable today as we continue to see the decreasing cost of fast food and the ever-increasing cost of produce and organic, healthy goods. In America, as a nation we continue to eat fast food and blame its effects on our bodies on the industry and neglect our own personal responsibility. There are many factors that have caused the “fat epidemic” although the three that will be highlighted here are, variety in meals, nutrient density/ caloric content, and limited exercise.
Nutrition Concepts Continue reading