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).

 

Only because I think I said it right the first time.

<strong>WE’VE ALL BEEN THERE….

Sad as it may be, many medics spend a great deal of time trying to get out of doing their jobs. We’ve all been there: annoyed, over tired, and over worked. We don’t get paid any more to transport, so sometimes we seem to think that maybe the patient doesn’t really need an ambulance….

I can see how it plaid out in my head. I really can… and that is what scares me the most. In 2008, 39 year old Edward Givens died shortly after EMS saw him at his home. The medic that day told Mr Givens he was just having acid reflux and recommended Pepto Bismol. Two hours later Mr Givens was dead.

You can see it now, can’t you? Maybe the patient is being overly dramatic, or maybe it is the family. You’ve been working for 20 hours and this is your 30th call. You’re 8 charts deep and know that another refusal or no ambulance needed is less work than the transport…

But here is the problem…. it is our job to transport people to the hospital. It isn’t our job to determine whether they need an ambulance or not. If someone wants to go, we take them. Regardless of whether you think they are sick or not. We don’t diagnose. We don’t cure. We are in the business of transporting patients.

I don’t know what really happened that day in 2008, but I do know that we’ve all been there before. We’ve all spent a considerable amount of energy on not transporting someone. Maybe you’ve even had a close call. A stroke you thought was a diabetic… or an AMI that you thought had reflux… But until now you’ve skated by.

Well stop. Stop expending so much energy trying to get out of doing your job. If you’re no longer interested in transporting patients, find a new line of work. When it comes down to it, is it worth risking someones life, your job, and your family’s livelihood on it? The medics in question here were not found to have violated any policies or procedures by their employer…. but do YOU want to live with that on your shoulders?

What do you think about it now?

September 14, 2009 at 0500 my on-call beeper went off with a STEMI notification. Within seven minutes I was in my car and on the way to the hospital. At 0519, I was stopped by a patrol car for failure to come to a complete stop at a stop sign. I told the young officer that I was on my way to an emergency case. I was in full scrubs, wearing my ID badge, and carrying the beeper with the texted message. The officer apologized for the inconvenience. He then went on to explain to me that he had to write a ticket because I did run the stop sign. It took him twelve minutes to complete writing out the ticket, then explain my court date. I reached the hospital at 0545. I was the lead RN in the cath lab crew.

The American Heart Association and the American College of Cardiology have set the door-to-balloon time that is most fortuitous for ST-segment elevation myocardial infarction patients as 90 minutes or less. Here at St. Luke’s Episcopal Hospital, in Houston, Texas, we have gotten our after-hours door-to-balloon time down to an average of about 50 minutes. Studies have shown that the sooner the occluded vessel is opened, the more heart muscle is saved from infarction.

Although that young officer was polite and professional in doing his job, he made a serious error in obstructing me from doing my job. I accepted my ticket, then proceeded to the hospital. Luckily another nurse just happened to be in the lab early that morning and was able to help with the case.

When I got home that night, I thought about the options open to me in dealing with the ticket. I had three. I could pay the $230.00 ticket outright, I could plead guilty and ask for defensive driving class, or I could plead not guilty and fight. If I plead guilty, the ticket would go on my driving record (raising my insurance premium). If I pled guilty and asked for defensive driving my record would be clean, but I would still have to pay $110.00 for the privilege to take the class, which then cost an additional $45.00. If I pled not guilty and lost, I could still take the defensive driving course. I was mad and full of righteous indignation. So, I pled not guilty.

November 2, 2009, I went to court. I did not hire an attorney. I didn’t believe that any attorney could tell it like I could. Now Shakespeare has written that anyone who represents himself in court has a fool for a client. Giving Mr. Shakespeare his respect, he wasn’t an attorney or a nurse.

Before court, I searched the literature supporting door-to-balloon times. I got a letter from our STEMI Coordinator, Larry Brown, RN, verifying the page and the importance of my presence in the case. I had a copy of the staff assignments for that day with my name as the lead call nurse. I had also pranced around in front of my mirror for a month practicing my defense.

My husband went with me for moral support. I really appreciated him at my side. I was ready for battle. When my turn came, the case was thrown out because the officer did not appear. I had mixed feelings about that. I was relieved that it was all over. But, I also felt that I had been denied my day in court. I wanted to tell the judge, the jury, the policeman, and that courtroom just how important it was for me to get to the hospital expeditiously. I wanted to say that I did not recklessly blow a stop sign or drive dangerously.

I was not able to tell my story in court, so here I am now to tell the tale.

I am currently working on getting an appearance before the City Council. They need to know that each one of them, as well as I, could fall victim to myocardial infarction. I want them to realize that there is not a single cath lab in Texas, along with most of the U.S. (that I know of, and I have searched) that has twenty-four hour in-house trained cath lab coverage. I am aware of programs that have trained emergency department (ED) staff and rapid response (RR) nurses to take steps to getting patients steps closer to the lab before the trained team arrives. As a matter of fact, here at St. Luke’s, our ED and RR nurses are trained to take steps to getting the patient to the lab and set up for the cath team. However, the training and expertise to proceed with the case rests with the cath team.

So, for each minute that a cath team member is delayed receiving a traffic ticket, one minute is lost to getting the most expert care to a heart attack victim.

I am conducting this fight not just for myself, but for the many other team members that have received and are still receiving tickets. As I asked around, I also encountered several doctors who also said they received tickets en route to STEMIs and other cardiac emergencies.

When I approach City Council, I will present my case, and possible solutions. This issue can be addressed in several ways. First, when appropriate ID and evidence of a call is presented to the officer, I would like a city ordinance passed to allow the driver to go without further action.

Next, if the driver is caught on the red-light camera, he/she should be able to present evidence of a call and be forgiven (if an adequate stop was made). I have also received a ticket from the camera. I was answering a call at 0200 on another day. I stopped, checked for oncoming cars, then went through the light. That ticket was $75.00. The third option is for the officer to accompany the driver to the hospital to verify the call.

With hospitals all over the nation pushing (and rightfully so) the door-to-balloon initiatives, there must be some cooperation between local police and healthcare professionals. I live in a large metropolitan city. The average employee lives thirty minutes away. There are six red lights and four stop signs on my way to the hospital. Although I do my best to get to the bedside as quickly as possible, my brush with the law has made me more cautious. I in no way condone reckless driving or speeding. However, I really feel that we should be allowed some leeway, especially in the pre-dawn hours when the streets are barren (except for the lurking officer).

I am writing this article before I go before City Hall because I want readers to send me emails to take with me from around the nation. I want the Houston City Council to know just how seriously we take our business of saving heart muscle and lives.

The one sure way to get the absolute best door-to-balloon time is to have twenty-four hour in-house cath lab staff coverage. In these trying economic times, I do not see that as a viable option any time soon. So for now, we must work to get the best times as safely possible.

Yvonne B. Singletary can be contacted at zybs01@yahoo.com. She notes that she did make it to City Hall and addressed the City Council, but will address the results in a future article. She welcomes your emails.

Dear Yvonne B. Singletary, RN, BS, RCIS, CCRN, CVRN (your must be awfully proud of yourself with all those fancy letters after your name…)

I wish the officer would have been there in court that day. You have no right to disobey traffic laws when you are not in an emergency vehicle. You have not taken Emergency driving courses. You do not drive a vehicle equipped with emergency lights and sirens. You do not have the RIGHT to put others at risk.

YOU were at fault. It is YOUR fault that your patient had to wait 12 minutes for him to write a ticket–all because you couldn’t wait mere seconds at a stop sign.

YOU do not have the right to put other drivers at risk when responding for a hospital page. In fact, you very likely could create a whole new(and more critically injured) patient in the process.

Do not speed. Do not blow stop signs/lights. Do not complaint about being caught breaking the law.

The fact of the matter is that ambulance transporting code 3 do not save much time at all. Whatever made you think you deserved some privilege to break the law is foolish, at minimum.

In my state Volunteer Firefighters, even with flashing blue lights, cannot speed. Why should you be able to run lights and break the law? WHY?

The 3 seconds you would have wasted at that sign are not worth putting the citizens of your community at risk. It is your fault that the patient waited 12 minutes to see you, not the fault of this officer.

Obey the God Damn Law.

Sincerely,

MedicThree–the guy who will have to scrape up the the poor sap you or your colleagues run over…

I encourage my readers to contact her(as she wishes) at zybs01@yahoo.com

Probably one of the most tragic, yet somehow sweet deaths I’ve ever heard of:

Elderly couple dies while trapped in home elevator‎

While I imagine dying trapped in a closet size elevator for likely days prior to dying would be terrifying, I think that if I had to go this way being with the love of my life would offer some solace, no?

“Police discovered the Wadsworths’ bodies lying in a fetal position, facing each other…”

I can picture this pretty well… and won’t deny having lost a tear or two over it.

“We always said we hoped they would go together because if one went, the other wouldn’t survive long,” the couple’s son, Wesley Wadsworth of Blue Bell, Penn., said Thursday. “They were so dependent on each other.”

Godspeed.

Woman charged in breast milk assault on jailer

OWENSBORO, Ky. — A woman in jail for public intoxication was accused of assaulting a jailer by squirting breast milk at her. WYMT-TV reported that a 31-year-old woman was arrested Thursday on a misdemeanor charge of public intoxication. But as she was changing into an inmate uniform, she squirted breast milk into the face of a female deputy who was with her.

The woman now faces a felony charge of third degree assault on a police officer. Her bond was set at $10,000

wha… tha…. fa….

Sadly this sounds like more than one of my patients this last week.

I don’t appreciate when people can’t admit they are wrong. Especially medical professionals.  So here is a conversation I had on twitter today(me in RED):

At the allergist.Allergist found nada. Ugh.

@medicTHREE What are your symptoms? Sometimes allergies cant be picked up by allergists (IE: Celiac)

@EMTDani pretty much celiac or lactose intolerance. Doing full celiac panel.

@medicTHREE just do an at home test. Go 7 days without wheat. If u still feel crummy do a week without corn, lactose or egg

@EMTDani gluten stays in your system upwards for 40 days It isn’t just wheat either Take a look at what really has gluten in it (sans wheat)

@EMTDani I have been tested for common food allergies. All negative. They say 90 days gluten free before relief of sx.

@medicTHREE I have celiac with corn and wheat. Dad is severly wheat intolerant also

@EMTDani celiac is gluten intolerance. Wheat and corn are allergies. You could be allergic to wheat and still eat gluten

@medicTHREE celaic has 4 categories to it. Gluten. Lactose. Egg and corn.

@EMTDani Not trying to be a jerk… but that is incorrect. “The cause of Celiac Disease, also known as gluten sensitive enteropathy (GSE)”

@EMTDani https://celiac.org/index.php?option=com_content&view=article&id=5&Itemid=11

@EMTDani Again, Gluten is not the same as wheat, and wheat, corn, and egg are allergies. Technically you can overcome many food allergies

At this point @EMTDani stops responding DIRECTLY to me and just tweets publicly….

I love how people argue with me on shit I’ve lived with for nearly 10 years. I think I know what I live with guys.

So I responded….

@EMTDani No need to get all cranky about reality.

@EMTDani Celiac A disorder resulting from an immune reaction to gluten, a protein found in wheat and related grains, and present in many foo

@EMTDani http://www.celiac.com/articles/39/1/The-Standard-Definition-of-Celiac-Disease/Page1.html

@EMTDani http://www.mayoclinic.com/health/celiac-disease/DS00319

@EMTDani I tried to be polite. Simply Put. Use google.

@EMTDani http://dictionary.webmd.com/terms/celiac-disease

@EMTDani http://www.cancer.gov/dictionary/?CdrID=377726

@EMTDani http://www.merriam-webster.com/netdict/celiac%20disease

@EMTDanihttp://www.fda.gov/Food/LabelingNutri

She responded with….

Some people are pricks. Hello block button.

Do people really take pleasure out of turning into a troll? Really?

So here’s the thing……. Never was I refuted. Why? Because you can’t refute this. I might be a prick. But I’m a prick who is right.

In the time since the American Heart Association has begun advocating Compression Only Layperson CPR, I haven’t really heard and stories of confirmed success. While we all know that layperson CPR tends to be inadequate and layperson CPR breathing tends to end up in the stomach, there has been little to indicate that the outcome was any different than before.

Well, JEMS has a story that might just give us some hope that the AHA did the right thing. CNN has the full story. There are some interesting facts to consider in this story. First, the patient was a 33 year old female–not a likely case for sudden cardiac arrest, under most circumstances. Second, she was otherwise healthy, with no known cardiac history. Third of importance to me is that her husband is a Sheriff’s deputy–While he says that it was “different” that being at work, there is little doubt in my mind that his training and experience helped in some way. Fourth, but maybe the most important thing here–a skilled dispatcher walked him through CPR–Compression Only CPR. All of these factors are important.

Lets examine what we can–33 year old women rarely experience sudden cardiac arrest. When they do it is usually caused by other (known or unknown) serious medical conditions–cancer, immune disorders, cardiovascular disease, etc. Initially it was uknown what caused Kathie Harden to die for 18 minutes that night. Kathie being just 33, her husband actually waking up just prior to her losing pulses, outstanding Dispatch direction, quick EMS response, and skilled hospital care can all be thanked. After her initially recovery it is found that she contracted a flu-like virus that attached itself to the left side of her heart, deteriorating heart muscle and function until the Right side of her heart could no longer function. She now lives with an internal cardiac pacer/defirilator.

After arriving at the hospital, Post-Arrest Cardiac Hypothermia was used to cool Kathie’s body to abnormally low temperatures. This is useful in protecting heart and brain function. It allows the body time to repair and recover before trying to fully “restart”. Initially neuro exams did not look good, but after just a few hours Kathie had started to show signs of improvement. After 18 hours Kathie was back from the grips of death. Theraputic Hypothermia was discontinued. She was soon on her path to recovery and “life went on”.

So here’s the thing: what saved Kathie? Was it Compression only CPR? Was it her skilled husband? How about fast EMS response? Her age? All signs indicate that all of these factors were essential to her survival. Most Certianly the Flagstaff EMS Calltaker that helped Scott pound on his wife’s chest that night deserves more than just a little credit. Arizona has worked hard to increase Cardiac Arrest Survivability and this is proof they are winning the battle. Keeping callers calm while giving them the tools to prolong life until destination care can be provided is no easy task and the fine people in EMS call centers everywhere need to be given credit.

Does this mean Compression Only CPR is the end all of Cardiac Arrest Care? Obviously not. Kathie recieved several rounds of CPR and several shocks from the AED brought by EMS. In the end cardiac drugs(epi) and defibrilation saved Kathie. But without early Compression only CPR it is certain that the tools EMS brought with would have had little chance to obtain ROSC.

I’d like to congratulate Flagstaff EMS Dispatch, Scott Harden, and the men and women of Flagstaff Medical Center EMS for providing outstanding care to Kathie that night. Every one of them did their part in saving a life–something that sadly most of us rarely get the opportunity to do, despite our profession.

Bad.

I should clarify. The SERVICE at HuHot sucks. I love the food, but I do damn near all of the work, so I SHOULD love it. I get the bowl, pick the meat and noodles, grab the veggies and mix the sauce. What do they do? Take entirely to long to put it on the “grill” and push it around for a while. Only to hand me back my plate without so much as an “enjoy your meal”.

Yup. Service at HuHot sucks. Seriously, every time we go to HuHot we think this. Well, HuHot. I’m done with you. I’m breaking off this on again/off again relationship. I’m sick of waiting 10 minutes for my soda refill(especially since I used entirely too much Kung Pao…Yow!). What is so god forsakenly hard about bringing me a bowl of rice and keeping my god damn soda full? I can get better service from Dairy Queen. I’m sorry, but your food is NOT so good that it makes up for exceptionally crappy service. To make matters worse, this visit was at 2:30 in the afternoon. There were a measly 21 people in the restraunt. There were no less than 7 employees present. 3:1 ratio and you still can’t do your job?

I don’t get it. So… I’m done with you. I’m done with your crappy servers who can’t figure out that their job is sooooo simple. Greet me. Ask if I have been here before. Ask if I’d like to try an over priced appetizer. Bring me rice. Bring me soda. Keep soda full. Bring me Check. Cash in. That is IT! You might wonder why you never get tips? Well… this is why.

Goodbye, HuHot. I hate you.

kthxbai.

Called at 0700 for a a Man Down. As we near the scene the update indicates it is a 93 year old woman in her driveway, confused and cold. I honestly expected the typical fall, and, it being 60 degrees out, she was likely a bit chilly….

What I FOUND was actually much more serious. We found a woman, lying on the driveway, wet clothes, and COLD. Very cold. No longer shivering cold. Cardiac dysrhythmia cold. She could tell me her name, and that was it. Neighbors had found her while out walking, and told me she lived alone in this huge old house in the old money neighborhood of little big town.

She was cold. Seriously cold. It is August, we’re not supposed to have hypothermia cases… but a few things left her little chance… She weighed… soaking wet, might you say… 80 pounds. I suspect that even without the dampness she would be damn cold. I suspect she has been down a long time. She has abrasions on her hips and shoulders from dong what some call the “crappie flop”. Further, at 0700, it is rare to find an elderly fall victim fully dressed. She had jeans, blouse, and shoes on. Most of our early morning fall victims have their pajamas on still.

What got me was that she was wet. Not damp, but soaked. No sprinklers near, no pool. I KNEW she had been out since 10pm last night… in the middle of a 3/4 inch downpoor. Poor thing had laid in her driveway, alone and affraid in the middle of a god damn thunderstorm. Then laid out all night, till a passerby noticed her–and I don’t know how they did! She lives on a secluded street up a bendy driveway. Lucky, if you can call her that.

In the field we can do little for cases like this. Warmed IV fluid, blankets, and heat packs in the arm pits is all I had. Fortunately it is a short jaunt to the ED.

Guess her core temp….

84.7 degrees. Yup. Thats cold. Beyond Stage 3 hypothermia. She was in V-Tach(which we did NOT treat due to temp), respiration of 9, but her eyes were open, almost as if they were trying to say something to me….

I’m not sure if she survived. Often times Stage 3 Hypothermia ends in Organ Failure and cell death. This call just goes to show you that you can’t walk into a call close minded. It is flipping August and I just ran a severe hypothermia call.

http://www.youtube.com/watch?v=0v_85tAey9s

Taken from Amateur Scientist via www.everydayskeptics.com