I’ve got a review coming for the statgear stethoscope tape holder. They were generous and send out to extra. If we get to two hundred likes I will finish the review and ship out five of these great gadgets.

Get your friends on board!

Test

of “alcohol on her breath”. I’ve started a lot of charts like this. Seen PD run reports that said the same. I’ve seen it testified to in court….  And it is pretty interesting, in part because you can’t smell alcohol. Sure, you can smell booze–the other crap in the alcoholic beverage. But nope, you can’t smell “alcohol” on someones breath.

Smell of alcohol on the breath. There is a very poor correlation between the strength of the smell of alcohol on the breath and the BAC. Pure alcohol has very little smell. It is the metabolism of other substances in alcoholic beverages that produces most of the smell. This explains why a person who drinks large amounts of high-proof vodka (a more pure form of alcohol) may have only a faint smell of alcohol on the breath. On the other hand, a person who drinks a modest amount of beer may have a strong smell of alcohol on the breath.

 

This is hammered on by DUI lawyers, with mixed results:

“I Smelled a Strong Odor of Alcohol on the Suspect’s Breath”

Posted by Lawrence Taylor on June 23rd, 2006

You will never see a DUI case where the officer does not report an odor of alcohol on the suspect’s breath. Never. The officer expects to smell it and it is a psychological fact that we see, hear and smell what we expect to see, hear and smell. In fact, most police DUI reports are formatted for the usual symptoms: there will be a box for “odor of alcohol”, which the officer checks off. There are often three boxes, labelled “strong”, “moderate” and “weak”; there is no box for “none”, so that is not an option for the officer.  The ”strong” box is almost always checked.  Presumably, the stronger the odor of alcohol, the more intoxicated the person arrested.

Assuming the officer actually does smell an odor on the breath, what he is smelling is not ethyl alcohol but the flavoring in the beverage. And the flavoring can be deceptive as to the strength or amount consumed. Beer and wine, for example, are the least intoxicating drinks but will cause the strongest odor. A much stronger drink, such as scotch, will have a weaker odor. And vodka leaves virtually no odor at all.

Consider a simple experiment. Have a friend drink a can of “near beer” — the stuff that looks, smells and tastes like beer but has no alcohol in it. Then smell his breath. You will smell an “odor of alcohol” — and maybe a strong one.

And, of course, there can be any number of causes of an “odor of alcohol” on a person’s breath: mouth wash, throat spray, cough syrup. Illness, indigestion or simple bad breath has been the cause of more than one officer’s trigger-quick conclusion that the suspect has an “odor of alcohol on his breath”.

The point of all this is that the odor of alcohol has very little relevence in a drunk driving case. It may or may not indicate that the person has consumed alcohol. It has absolutely no evidentiary value on the much more important question of how much the person has consumed — orwhat he had to drink, or when. Depending upon circumstances, a person with a single drink can have a “strong odor of alcohol on his breath”, and an extremely inebriated person can have a “weak” odor. And an experienced and honest DUI officer will readily admit this….if he is ever asked.

Unfortunately, evidence of the odor of alcohol on a person�s breath can have a significant impact on a DUI case. This is because most officers who pull a driver over for some driving irregularity at night are looking for further signs of drunk driving. When the officer approaches the driver’s window and smells alcohol, that confirms his suspicions. Since few can pass the “field sobriety tests”, particularly under the conditons in which they are given, an arrest is likely.

Are there any scientific studies to back up my claim that breath alcohol odor is largely irrelevant yet disproportionately weighted as “evidence” of intoxication?

In 1999, the same scientists whose federally-contracted studies became the basis of the so-called “standardized” battery of field sobriety tests conducted another study on the effectiveness of alcohol odor in detecting intoxication. These researchers used 20 experienced officers working with 14 subjects who were tested at blood-alcohol concentrations (BACs) ranging from zero to .13 percent. Over a four-hour period, the officers smelled the subject’s breath odor under optimal conditions, with the subjects hidden from view.

The conclusions of the study: Odor strength estimates were unrelated to BAC levels. In fact, estimates of BAC levels failed to rise above random guesses. Further, officers were unable to recognize whether the alcohol beverage was beer, wine, bourbon or vodka. According to the scientists, these results demonstrate that even under the best of conditions, breath odor detection is unreliable. Moscowittz, Burns & Furgeson, “Police Officers’ Detection of Breath Odors from Alcohol Ingestion”, 31(3) Accident Analysis and Prevention 175 (May 1999).

 

Walking into the foothills of South Dakota’s badlands tomorrow morning…. If you don’t here back from me in a day or two just assume the deer won!

On EMS news, I ran my first call at “second job” today. 9 shifts, 1 call.   LOVE IT!

Kohler. Or maybe “Sir Pterry(the Pterrydactyl) quackin duck.”

Do you ever feel like we’re playing a losing game?

The other day I went through my cardiac arrest statistics. Dispatched to 91 cardiac arrests since I became a medic. ~30/year. I have worked approximately 50% of those. I have EXACTLY 1 cardiac arrest save.

ONE!.

If this were baseball, I’d have a batting average of 0.01098901098901099.  OOOH! If we call all of the no start calls “sacrifices” I’d have an average of 0.021739130434782608. If we only say that the ~45ish times I’ve actually worked an arrest count as “at bats”, then I have an amazing 0.022222222222222223.

In baseball the record for lowest career batting average for a player with more than 2,500 at-bats belongs to Bill Bergen, a catcher who played from 1901 to 1911 and recorded a .170 average in 3,028 career at-bats. I’m well below the “Mendoza Line”

What is YOUR batting average?

Seriously. It did. I take ambien for sleep(12.5mg XR), as the chances of me sleeping on my own are not so good. But if I am awake past that first 40 minutes it makes me do crazy crap. Like post on my blog. Or clean out the fridge. OR trim, cut and cure 40 lbs of deer meat for Jerky slices. I’ve rearranged my 75 gallon aquarium and not remembered. I’ve don a LOT of things and not remembered.

It is mildly terrifying to know how much can happen with so little control. MY wife sure like the cleaning version of me though, so I doubt I’ll be changing over soon.

Do any of you have first hand experience of the crazy things meds made you do?  We hear stories all the time from patients and coworkers, but I’d like to hear your own stories.

ON a clinical note, what do we need to look for with these odd situations? Can a patient sedated with ambien be reliable?

Drop me a line!

Ambien Side Effects

• Constipation
• Difficulty with coordination
• Hallucinations
• Disorientation
• Anxiety
• Depression
• Binge eating
• Memory problems (see Ambien CR and Memory Problems)
• Spinning sensation (vertigo)
• Nausea
• Gastroesophageal reflux disease (GERD) – heartburn is the most common symptom
• Heart palpitations
• Fatigue
• Muscle pain.

We all joke in ways our families, friends and patients don’t understand. See around the 3:20 mark of this video:

Godspeed, friends!

…Make me do stupid things.

Very stupid things.

Today during an extrication, in the middle of the city, just blocks from the newspaper office I stood by as FD was extricating our very obese patient from the SUV she somehow smashed into a parked car on a residential street.

I just stood there.

And picked my ass.

In front of the camera.

And imagine that, of the 350 pictures he took in those 20 minutes…. he chose the one of me picking my ass to be the lead photo for that section.

I can already sense how  my day at work is going to go.

So, this is the M3 PSA: If you think there are cameras around, don’t go digging for gold in your bum or up your nose. They’ll catch you and almost without doubt, they will run it.

Harvard has a new “healthy plate” out to give guidance on how we should eat. Here it is:

Here is the MedicThree version of a healthy plate:

It’s ok. I’m sure Harvard will figure it out eventually.