Wednesday, September 29, 2010
War on plants
I think that the silliness and futility of the 'war on drugs' is perfectly illustrated with this article here. Trying to eradicate a plant that grows wild. What would be especially funny is if there were some snail or bird that was endangered and required this plant to survive. What would the Feds do then?
Recession not over
You hear so much lately about how the recession is over, but one only has to look at the number of bankruptcies being filed to see that this is far from over. Looking at the statistics for the Bankruptcy court for the Middle District of Florida, we can see a trend. In August of each year since 2006, the bankruptcy filings for the year were:
2006 August filings to date: 9,547
2007 August filings to date: 16,263
2008 August filings to date: 26,723
2009 August filings to date: 40,536
2010 August filings to date: 45,600
As long as people are still going bankrupt and are still out of work, they will not have any money to spend. As long as they have no money to spend, there can be no recovery. Bankruptcy filings are still increasing, and even though 2009 was a record year for bankruptcy filings, 2010 is 10 percent higher than that.
The only year that came close to last year's record pace was 2005, when many people rushed to file bankruptcy in order to beat the effective date of the bankruptcy reform laws that the Republicans made law that year.
2006 August filings to date: 9,547
2007 August filings to date: 16,263
2008 August filings to date: 26,723
2009 August filings to date: 40,536
2010 August filings to date: 45,600
As long as people are still going bankrupt and are still out of work, they will not have any money to spend. As long as they have no money to spend, there can be no recovery. Bankruptcy filings are still increasing, and even though 2009 was a record year for bankruptcy filings, 2010 is 10 percent higher than that.
The only year that came close to last year's record pace was 2005, when many people rushed to file bankruptcy in order to beat the effective date of the bankruptcy reform laws that the Republicans made law that year.
Tuesday, September 28, 2010
The Big Red Taxi
Ask anyone who works in EMS, and they can tell you a hundred stories of people who abuse the EMS system. I have seen my share, and the stories have infinite variety:
The thermostat:
It was 2 o'clock in the morning when we went to this woman's house for a complaint of "difficulty breathing." When we got there, the "patient" didn't want to go to the hospital, she just wanted help. Having just moved into her house, she didn't know how to program her electronic thermostat and wanted us to show her how. It wsa 82 degrees in her house, nowhere near being a medical emergency.
Incarceritis:
People fake seizures, unconsciousness, chest pains, you name it, in the belief that they will not be arrested if they go to the hospital. The sad fact is that they are sometimes right. The officer sometimes doesn't want to sit around the hospital for several hours, waiting for his prisoner to be discharged for minor misdemeanors. Felony arrests? Forget it, you are going to jail as soon as the hospital is done with you.
A variation of this was one morning's call:
A man was required to be in court at 8 o'clock in the morning for a child support hearing. He walked from his home towards the courthouse 10 miles away. (Why he didn't take the bus is a mystery.) He made it about 3 miles, and then called 911 with reported shortness of breath and chest pain at about 10 after 7. When we arrived, he wanted to go to the hospital that, coincidentally, was two blocks from the courthouse. When we arrived and asked him what was going on, his first words were, "I am trying to get to court because my wife..."
We all knew that this was a fake call intended to get him to the hospital closest to the courthouse, so that he could walk out and be in court faster. Since there is no penalty for failure to pay for the ambulance ride OR the ER bill, this is the equivalent of a free taxi. We decided that the best thing for this patient was to go to a different hospital. Why? Well, if he really was having chest pain, the patient would be less likely to walk out of that one, opting instead to use the ER bill to show the court why he had a medical reason for missing court. IF he wasn't really having chest pains, then he didn't need to go anyhow. Besides, to reach the hospital he wanted, we would have had to pass another, closer one, and there was no medical reason to pass a perfectly good hospital to go to the other one.
Lest anyone think that we were being mean or lazy, he still got a complete workup. His vitals were: SaO2 98% on room air, 100% on 2 lpm of O2. HR 82, RR24, BP 142/94. Monitor showed SR, and 12 lead showed nothing important. He was hot and sweaty, but that is unsurprising considering that he was about 60 pounds overweight, and it was 82 degrees with 80% humidity. He still got 325 mg of aspirin, NTG spray x2, and transport to the closest hospital (rather than the one he wanted)
People abuse the system every day. This is why universal, "free" health care will never work.
The thermostat:
It was 2 o'clock in the morning when we went to this woman's house for a complaint of "difficulty breathing." When we got there, the "patient" didn't want to go to the hospital, she just wanted help. Having just moved into her house, she didn't know how to program her electronic thermostat and wanted us to show her how. It wsa 82 degrees in her house, nowhere near being a medical emergency.
Incarceritis:
People fake seizures, unconsciousness, chest pains, you name it, in the belief that they will not be arrested if they go to the hospital. The sad fact is that they are sometimes right. The officer sometimes doesn't want to sit around the hospital for several hours, waiting for his prisoner to be discharged for minor misdemeanors. Felony arrests? Forget it, you are going to jail as soon as the hospital is done with you.
A variation of this was one morning's call:
A man was required to be in court at 8 o'clock in the morning for a child support hearing. He walked from his home towards the courthouse 10 miles away. (Why he didn't take the bus is a mystery.) He made it about 3 miles, and then called 911 with reported shortness of breath and chest pain at about 10 after 7. When we arrived, he wanted to go to the hospital that, coincidentally, was two blocks from the courthouse. When we arrived and asked him what was going on, his first words were, "I am trying to get to court because my wife..."
We all knew that this was a fake call intended to get him to the hospital closest to the courthouse, so that he could walk out and be in court faster. Since there is no penalty for failure to pay for the ambulance ride OR the ER bill, this is the equivalent of a free taxi. We decided that the best thing for this patient was to go to a different hospital. Why? Well, if he really was having chest pain, the patient would be less likely to walk out of that one, opting instead to use the ER bill to show the court why he had a medical reason for missing court. IF he wasn't really having chest pains, then he didn't need to go anyhow. Besides, to reach the hospital he wanted, we would have had to pass another, closer one, and there was no medical reason to pass a perfectly good hospital to go to the other one.
Lest anyone think that we were being mean or lazy, he still got a complete workup. His vitals were: SaO2 98% on room air, 100% on 2 lpm of O2. HR 82, RR24, BP 142/94. Monitor showed SR, and 12 lead showed nothing important. He was hot and sweaty, but that is unsurprising considering that he was about 60 pounds overweight, and it was 82 degrees with 80% humidity. He still got 325 mg of aspirin, NTG spray x2, and transport to the closest hospital (rather than the one he wanted)
People abuse the system every day. This is why universal, "free" health care will never work.
Monday, September 27, 2010
Gerrymandering
Rigging elections. The Census is now complete, which means that the gerrymandering drawing of districts can now commence. The Democrats are angry because they don't rule Florida's electoral process. The areas of Florida that have historically voted Democrat are the southeast coast near Miami, and the area around Jacksonville. (The 2008 election saw other areas in blue, but in my opinion that was more a result of the Democrats all running against former President Bush than a true shift in political power.)
To counter this, the Democrats want to redraw districts to create an advantage for themselves. It won't work. You cannot thwart corruption in politics.
To counter this, the Democrats want to redraw districts to create an advantage for themselves. It won't work. You cannot thwart corruption in politics.
Sunday, September 26, 2010
Follow the money
From a recent Email:
Exactly. Look where the money goes:
The total Federal Budget is $3.7 trillion for FY'10
Income: $2.164 trillion
Outlay: $3.720 trillion
Deficit: $1.556 trillion
Here are the top 5 spending categories and the percentage of total outlays:
1 Social Security $722 billion 19.4%
2 Defense $719 Billion 19.3%
3 Welfare $557 billion 15%
4 Medicare $457 Billion 12.3%
5 Welfare, healthcare (like medicaid) $335 Billion 9%
Add together the money we give people not to work (all of the above, except Defense) and you get $2.071 trillion, or an amount equal to virtually all of the taxes collected.
For 2004 (the last year I could find data) The top 25% of wage earners in the country comprise everyone making more than $139,491 (per return, not per person). That top 25% paid 84.8% of all income taxes.
(Source: http://www.irs.gov/pub/irs-soi/04in06tr.xls)
Yeah, the problem is the rich.
Tax rate cuts don't give anything to the so-called rich. They don't "get" someone else's money. Tax cuts allow people to keep more of their own money to spend and invest as they see fit.
Exactly. Look where the money goes:
The total Federal Budget is $3.7 trillion for FY'10
Income: $2.164 trillion
Outlay: $3.720 trillion
Deficit: $1.556 trillion
Here are the top 5 spending categories and the percentage of total outlays:
1 Social Security $722 billion 19.4%
2 Defense $719 Billion 19.3%
3 Welfare $557 billion 15%
4 Medicare $457 Billion 12.3%
5 Welfare, healthcare (like medicaid) $335 Billion 9%
Add together the money we give people not to work (all of the above, except Defense) and you get $2.071 trillion, or an amount equal to virtually all of the taxes collected.
For 2004 (the last year I could find data) The top 25% of wage earners in the country comprise everyone making more than $139,491 (per return, not per person). That top 25% paid 84.8% of all income taxes.
(Source: http://www.irs.gov/pub/irs-soi/04in06tr.xls)
Yeah, the problem is the rich.
Saturday, September 25, 2010
GMAC caught in fraud, has to suspend foreclosures
This year, I have done quite a few posts illustrating how much fraud took place on the part of mortgage lenders. There are many conservative bloggers who have spent a lot of bandwidth spreading the theory that "the homeowners owe money to someone, so they should just pay. It is the homeowners' fault for taking out loans they couldn't repay," all the while denying that the banks had any responsibility in the mess we are in.
Those same people will probably not want to see this:
That is just from one paperwork factory. There are hundreds of these companies out there. But hey, those deadbeat homeowners should pay. The lawyers are never wrong. The courts use this paperwork, generated in less than a minute, to justify holding a hearing under "rocket docket" rules, where each homeowner is given an average of 60 seconds to argue his case, and that even assumes that the bank isn't granted summary judgment without a hearing, based upon the forged paperwork.
The same conservatives who complain that we can't trust the courts to safeguard our right to keep and bear arms, our freedom of religion, and our right to free speech trust the court to decide who takes a home and who doesn't.
Those same people will probably not want to see this:
Some of the nation's largest mortgage companies used a single document processor who said he signed off on foreclosures without having read the paperwork - an admission that may open the door for homeowners across the country to challenge foreclosure proceedings.In other words, these document factories are producing paperwork on demand, as the lawyer handling the foreclosure needs it. Read on:
The legal predicament compelled Ally Financial, the nation's fourth-largest home lender [ed. note: Ally used to go by the name GMAC], to halt evictions of homeowners in 23 states this week. Now Ally officials say hundreds of other companies, including mortgage giants Fannie Mae and Freddie Mac, may also be affected because they use Ally to service their loans.
As head of Ally's foreclosure document processing team, 41-year-old Jeffrey Stephan was required to review cases to make sure the proceedings were legally justified and the information was accurate. He was also required to sign the documents in the presence of a notary.10,000 times a month, this man testified in a sworn affidavit that he personally reviewed the records, and determined that the person whose home was being taken was rightfully losing his home. TEN THOUSAND TIMES A MONTH. That works out to over 500 people every business day who lost homes based upon FRAUD. At 8 hours per business day, this man reviewed the paperwork for each foreclosure and signed an affidavit swearing it was accurate in an average of 55 seconds per foreclosure. It is obvious that a person cannot review all of the mortgage paperwork and testify to its accuracy in only 55 seconds. For five years. This one man's fraud and lies were used to take 600,000 homes.
In a sworn deposition, he testified that he did neither.
The reason may be the sheer volume of the documents he had to hand-sign: 10,000 a month. Stephan had been at that job for five years.
That is just from one paperwork factory. There are hundreds of these companies out there. But hey, those deadbeat homeowners should pay. The lawyers are never wrong. The courts use this paperwork, generated in less than a minute, to justify holding a hearing under "rocket docket" rules, where each homeowner is given an average of 60 seconds to argue his case, and that even assumes that the bank isn't granted summary judgment without a hearing, based upon the forged paperwork.
The same conservatives who complain that we can't trust the courts to safeguard our right to keep and bear arms, our freedom of religion, and our right to free speech trust the court to decide who takes a home and who doesn't.
Friday, September 24, 2010
Time is not on your side
This illustrates why you should own a gun. Reading the story, I know it sounds like the gun caused the problem in the first place, but looking below the surface, the person on the killing spree caused the problem. The reason why owning a gun would have helped is illustrated by the fact that police did what they always do in a shooting situation: they set up a perimeter and waited.
In fact, they waited for over an hour. Shots were still being fired in the house when responders got to the scene, just after 1 o'clock. They locked down the local schools. They set up a perimeter. They set up a command post. They assembled a SWAT team. At about 2:15, a family member grew tired of waiting, broke the perimeter, and went inside himself. If he had not done that, who knows how much longer they would have waited? How many of those people in the house would have survived if the police hadn't have waited for over an hour?
If the day should ever come that you are involved in a shooting, will you want to wait for over an hour before the police come to help you? Or are you going to wish that you could take care of it yourself? When seconds count, the police are minutes away, and then spend an hour setting up.
In fact, they waited for over an hour. Shots were still being fired in the house when responders got to the scene, just after 1 o'clock. They locked down the local schools. They set up a perimeter. They set up a command post. They assembled a SWAT team. At about 2:15, a family member grew tired of waiting, broke the perimeter, and went inside himself. If he had not done that, who knows how much longer they would have waited? How many of those people in the house would have survived if the police hadn't have waited for over an hour?
If the day should ever come that you are involved in a shooting, will you want to wait for over an hour before the police come to help you? Or are you going to wish that you could take care of it yourself? When seconds count, the police are minutes away, and then spend an hour setting up.
Thursday, September 23, 2010
Answer to comment
In response to the comment from this post, Derfel Cadarn made this comment:
Who says they were in their cruisers? How are they supposed to arrest a car thief without getting out of their car? Even in the police remained in their cars, are you maintaining that a person in his car cannot be killed by someone else who is also in a car?
Two misconceptions for the price of one. The first one here is that you assume that deadly force is not justified unless someone is shooting at you.
Perhaps you do not understand what constitutes deadly force. Deadly force is defined as: force that is likely to cause death or great bodily harm and includes, but is not limited to the firing of a firearm in the direction of the person to be arrested, even though no intent exists to kill or inflict great bodily harm; and the firing of a firearm at a vehicle in which the person to be arrested is riding.
When anyone is being attacked by a person using deadly force, the person (and yes, cops are people) being attacked has the right to respond with equal force. The police in this case were being attacked by a person employing deadly force, and had the right to respond in kind. Since under the law, trying to run someone over is considered to be deadly force, they respond with deadly force: firearms.
The law is the same in this case as it is for you and I:
A person is justified in using force, except deadly force, against another when and to the extent that the person reasonably believes that such conduct is necessary to defend himself or herself or another against the other’s imminent use of unlawful force. However, a person is justified in the use of deadly force and does not have a duty to retreat if He or she reasonably believes that such force is necessary to prevent imminent death or great bodily harm to himself or herself or another or to prevent the imminent commission of a forcible felony
As for your claim that 133 shots shows poor marksmanship: How many of those bullets hit the car? How many missed? How many of the shots struck the car, but were deflected by the car and missed the driver? How many shots hit the driver, but did not stop his attack?
How good of a shot are you? Are you experenced with firearms? You do realize that a bullet is not a remote controlled punch or a magic talisman? This is real life, not the movies. Guns do not instantly stop people with one hit.
What about it? Missing when shooting at a person does not automatically mean that you met the definition of reckless endangerment. The term you are looking for is culpable negligence.
If anything, the decedent is the one at fault here, as his actions were the direct cause of the police having to fire. See Green v. State, 545 So. 2d 359 - Fla: Dist. Court of Appeal, 2nd Dist. 1989.
There are numerous self defense shootings where a private citizen is not charged with missing his target. No one else was hit, so that is a non-issue.
How were they to be run over while in their cruisers? 133 shots fired no return gunfire mentioned, should be fired for the poor shooting alone.What about reckless endangerment with depraved indifference.No possibility of collateral damage,oh that`s right those other are only serfs.I was going to answer in comments, but the length of my reply requires a post. I will answer his comment once sentence at a time:
How were they to be run over while in their cruisers?
Who says they were in their cruisers? How are they supposed to arrest a car thief without getting out of their car? Even in the police remained in their cars, are you maintaining that a person in his car cannot be killed by someone else who is also in a car?
133 shots fired no return gunfire mentioned, should be fired for the poor shooting alone.
Two misconceptions for the price of one. The first one here is that you assume that deadly force is not justified unless someone is shooting at you.
Perhaps you do not understand what constitutes deadly force. Deadly force is defined as: force that is likely to cause death or great bodily harm and includes, but is not limited to the firing of a firearm in the direction of the person to be arrested, even though no intent exists to kill or inflict great bodily harm; and the firing of a firearm at a vehicle in which the person to be arrested is riding.
When anyone is being attacked by a person using deadly force, the person (and yes, cops are people) being attacked has the right to respond with equal force. The police in this case were being attacked by a person employing deadly force, and had the right to respond in kind. Since under the law, trying to run someone over is considered to be deadly force, they respond with deadly force: firearms.
The law is the same in this case as it is for you and I:
A person is justified in using force, except deadly force, against another when and to the extent that the person reasonably believes that such conduct is necessary to defend himself or herself or another against the other’s imminent use of unlawful force. However, a person is justified in the use of deadly force and does not have a duty to retreat if He or she reasonably believes that such force is necessary to prevent imminent death or great bodily harm to himself or herself or another or to prevent the imminent commission of a forcible felony
As for your claim that 133 shots shows poor marksmanship: How many of those bullets hit the car? How many missed? How many of the shots struck the car, but were deflected by the car and missed the driver? How many shots hit the driver, but did not stop his attack?
How good of a shot are you? Are you experenced with firearms? You do realize that a bullet is not a remote controlled punch or a magic talisman? This is real life, not the movies. Guns do not instantly stop people with one hit.
What about reckless endangerment with depraved indifference.
What about it? Missing when shooting at a person does not automatically mean that you met the definition of reckless endangerment. The term you are looking for is culpable negligence.
Culpable negligence. Each of us has a duty to act reasonably towards others. If there is a violation of that duty without conscious intention to harm, that violation is negligence, but culpable negligence is more than a failure to use ordinary care for others.
For negligence to be called culpable negligence, it must be gross and flagrant. The negligence must be committed with an utter disregard for the safety of others. Culpable negligence is consciously doing an act or following a course of conduct that the defendant must have known, or reasonably should have known, was likely to cause death or great bodily injury. See Fla.Std.Jury Instr. (Crim.) 827.04.Good luck with that one.
If anything, the decedent is the one at fault here, as his actions were the direct cause of the police having to fire. See Green v. State, 545 So. 2d 359 - Fla: Dist. Court of Appeal, 2nd Dist. 1989.
No possibility of collateral damage,oh that`s right those other are only serfs.
There are numerous self defense shootings where a private citizen is not charged with missing his target. No one else was hit, so that is a non-issue.
Defending the cops
Anyone who reads this blog on a regular basis knows that I am not shy about pointing out when cops have overstepped their bounds. I am not a cop basher, I just call em like I see em, bashing them when they screw up and I support them when they deserve to be supported. This is one of those times.
Seven months ago, undercover officers of the Orlando police department had been watching a man who was driving a stolen SUV. They boxed him in with their cars to arrest him, but said he didn't stop. Undercover officers opened fire, but the car kept accelerating. That would mean the tires kept spinning and the engine kept racing. Confused and in fear for their lives, officers said they kept shooting until they fired 133 shots.
There has been a lot of claims from the public, and from some of my friends, that the force used was excessive, and 133 shots is too many. A man trying to run you over, even if all he is doing is trying to escape, is still trying to hurt you.
"Why was my brother killed? Why were guns fired at him when he was unarmed," questioned Tiffany Breedlove, the victim's sister. A man trying to run you over is armed with a deadly weapon called an automobile, that's why. In this case, how can a cop tell the difference between a man trying to escape, and a man trying to escape by running over a cop?
Another point is the number of shots fired. At what point are the cops supposed to stop shooting? 1 shot? 5 shots? Should they stop with 40? What is the magic number that guarantees that the threat to your life has ended? Or do you keep firing until the threat has ended?
After all, it is called DEADLY FORCE when you fire your weapon. It doesn't matter if you fired 6 shots, or 60, as long as the threat is present, deadly force can still be used. Even if they did fire too many shots, dead is dead.
Seven months ago, undercover officers of the Orlando police department had been watching a man who was driving a stolen SUV. They boxed him in with their cars to arrest him, but said he didn't stop. Undercover officers opened fire, but the car kept accelerating. That would mean the tires kept spinning and the engine kept racing. Confused and in fear for their lives, officers said they kept shooting until they fired 133 shots.
There has been a lot of claims from the public, and from some of my friends, that the force used was excessive, and 133 shots is too many. A man trying to run you over, even if all he is doing is trying to escape, is still trying to hurt you.
"Why was my brother killed? Why were guns fired at him when he was unarmed," questioned Tiffany Breedlove, the victim's sister. A man trying to run you over is armed with a deadly weapon called an automobile, that's why. In this case, how can a cop tell the difference between a man trying to escape, and a man trying to escape by running over a cop?
Another point is the number of shots fired. At what point are the cops supposed to stop shooting? 1 shot? 5 shots? Should they stop with 40? What is the magic number that guarantees that the threat to your life has ended? Or do you keep firing until the threat has ended?
After all, it is called DEADLY FORCE when you fire your weapon. It doesn't matter if you fired 6 shots, or 60, as long as the threat is present, deadly force can still be used. Even if they did fire too many shots, dead is dead.
Wednesday, September 22, 2010
Paramedicine: New drug problem
About three weeks ago, we ran to a local shopping mall for a 17 year old male who was telling us that he thought he was going to die. Our exam found: HR140 RR20 BP 140/96. Pt was agitated, paranoid, and very restless. He was acting like he was on speed.
Upon further questioning, he admitted that a friend had given him something to smoke, but he was not sure what it was, just that the friend had assured him that it was legal, and that it was called "spice." This was not only a new one on me, but the cops on scene had not heard of it, either. When in doubt, supportive care and transport. Enroute, the teen got a lecture about how stupid it is to take drugs without even bothering to find out what they are. I am sure that, being a teen, I was wasting my breath. He seemed to think that because it was legal, it was safe.
When we got back to the station, google was my friend. I found a few things, and here they are:
It turns out that although the drug is new to this area (according to my friends in the narcotics unit of the police department) it is a nationwide problem that began appearing in Europe in 2004, and North America in 2009.It is a synthetic cannabinoid, with effects similar to hashish or marijuana, but it is much more potent, due to a stronger affinity for the CB1 receptor.
Because the synthetic cannabinoids found in these products are new, they remain legal in many states. Kansas was the first state to pass a law banning sale of the products; similar laws have been proposed in Missouri, Tennessee, and several other states. It is undetectable by standard drug testing and standard tox screens in the ED. It is sold in head shops, convenience stores, and gas stations in my area, and a quick check of a few showed that about half of the local quikie marts had it for sale. Common brand names are K2, Spice, and Gold.
Several medics that I know have begun telling me of calls they are running involving this drug, and it seems like it is taking off in popularity. I have personally talked to 8 medics who have run on calls involving this drug in the last week or two. Reported symptoms are: pale skin, vomiting, hypertension, paranoia, restlessness, fever, tachycardia, dysrhythmias (including PACs and PJCs), as well as tremors, combativeness, seizures and hallucinations. The problem appears to be increasing nationwide.
The compound most commonly found in these products is JWH-018. Another compound, is an analog of CP-47,497, a cannabinoid developed by Pfizer over 20 years ago. Known as (1-pentyl-3-(1-naphthoyl)indole), or the more proper IUPAC name of Naphthalen-1-yl-(1-pentylindol-3-yl)methanone, JWH-018 is one of over 100 indoles, pyrroles, and indenes synthesized by the Huffman laboratory to develop cannabimimetics, drugs that mimic the effect of cannabinoids such as THC. The primary goal of these studies was to create pharmacological probes to 1) determine the structure-activity relationships of these compounds and 2) tease out the physiological function of subtypes of receptors we have for cannabinoids: the CB1 and CB2 receptors. JWH-018 binds to the psychotropic CB1 receptor with approximately 4 times the potency of the naturally-occurring THC. Unlike THC, which binds with almost equal affinity to CB1 and CB2 receptors, JWH-018 exhibits a 4-fold preference for CB1 receptors.
What does this mean? Well, the CB1 receptor is the primary means by which cannabinoids exert their psychotropic effects. The CB2 receptor, on the other hand, appears to be more involved in pain and inflammation and is therefore a very active area of research for new therapeutics. So while JWH-018 has four-fold greater potency for CB1 receptors than THC in an isolated receptor binding study, how its effect compares to plain-old marijuana depends on other factors such as the relative amount in the product, how stable it is to combustion, how it's metabolized in the body, among others. Smoking as little as 150mg has been known to cause symptoms such as tachycardia and hypertension.
Another report I found talked about withdrawals. The report describes a 20 yr old man with a little prior experience with hashish, some hallucinogens, minimal alcohol consumption and about 10 cigarettes per day. No other illicit drugs reported, nor detected in blood tests during the clinical care interval. He was smoking "Spice Gold." Initially 1 g daily, for eight months. Due to decreasing effect, he had rapidly increased the dose to a final value of 3 g daily--split into 3 to 4 doses, with the first dose early in the morning. Owing to the consumption of the substance, he had often recently been listless and had had problems in thinking clearly. During a phase of abstinence owing to shortages in supply, he had developed symptoms in the form of profuse sweating during the day and especially in the night, as well as internal unrest, tremor, palpitation, insomnia, headache, diarrhea, nausea, and vomiting. Additionally he had suddenly felt depressed and desperate. This had lasted for two days and had only abruptly disappeared after taking the drug again. Therefore, he no longer had the courage to discontinue the drug by himself.
I have no idea what we can do to treat this, except supportive care and treating the seizures. Any ideas?
Upon further questioning, he admitted that a friend had given him something to smoke, but he was not sure what it was, just that the friend had assured him that it was legal, and that it was called "spice." This was not only a new one on me, but the cops on scene had not heard of it, either. When in doubt, supportive care and transport. Enroute, the teen got a lecture about how stupid it is to take drugs without even bothering to find out what they are. I am sure that, being a teen, I was wasting my breath. He seemed to think that because it was legal, it was safe.
When we got back to the station, google was my friend. I found a few things, and here they are:
It turns out that although the drug is new to this area (according to my friends in the narcotics unit of the police department) it is a nationwide problem that began appearing in Europe in 2004, and North America in 2009.It is a synthetic cannabinoid, with effects similar to hashish or marijuana, but it is much more potent, due to a stronger affinity for the CB1 receptor.
Because the synthetic cannabinoids found in these products are new, they remain legal in many states. Kansas was the first state to pass a law banning sale of the products; similar laws have been proposed in Missouri, Tennessee, and several other states. It is undetectable by standard drug testing and standard tox screens in the ED. It is sold in head shops, convenience stores, and gas stations in my area, and a quick check of a few showed that about half of the local quikie marts had it for sale. Common brand names are K2, Spice, and Gold.
Several medics that I know have begun telling me of calls they are running involving this drug, and it seems like it is taking off in popularity. I have personally talked to 8 medics who have run on calls involving this drug in the last week or two. Reported symptoms are: pale skin, vomiting, hypertension, paranoia, restlessness, fever, tachycardia, dysrhythmias (including PACs and PJCs), as well as tremors, combativeness, seizures and hallucinations. The problem appears to be increasing nationwide.
The compound most commonly found in these products is JWH-018. Another compound, is an analog of CP-47,497, a cannabinoid developed by Pfizer over 20 years ago. Known as (1-pentyl-3-(1-naphthoyl)indole), or the more proper IUPAC name of Naphthalen-1-yl-(1-pentylindol-3-yl)methanone, JWH-018 is one of over 100 indoles, pyrroles, and indenes synthesized by the Huffman laboratory to develop cannabimimetics, drugs that mimic the effect of cannabinoids such as THC. The primary goal of these studies was to create pharmacological probes to 1) determine the structure-activity relationships of these compounds and 2) tease out the physiological function of subtypes of receptors we have for cannabinoids: the CB1 and CB2 receptors. JWH-018 binds to the psychotropic CB1 receptor with approximately 4 times the potency of the naturally-occurring THC. Unlike THC, which binds with almost equal affinity to CB1 and CB2 receptors, JWH-018 exhibits a 4-fold preference for CB1 receptors.
What does this mean? Well, the CB1 receptor is the primary means by which cannabinoids exert their psychotropic effects. The CB2 receptor, on the other hand, appears to be more involved in pain and inflammation and is therefore a very active area of research for new therapeutics. So while JWH-018 has four-fold greater potency for CB1 receptors than THC in an isolated receptor binding study, how its effect compares to plain-old marijuana depends on other factors such as the relative amount in the product, how stable it is to combustion, how it's metabolized in the body, among others. Smoking as little as 150mg has been known to cause symptoms such as tachycardia and hypertension.
Another report I found talked about withdrawals. The report describes a 20 yr old man with a little prior experience with hashish, some hallucinogens, minimal alcohol consumption and about 10 cigarettes per day. No other illicit drugs reported, nor detected in blood tests during the clinical care interval. He was smoking "Spice Gold." Initially 1 g daily, for eight months. Due to decreasing effect, he had rapidly increased the dose to a final value of 3 g daily--split into 3 to 4 doses, with the first dose early in the morning. Owing to the consumption of the substance, he had often recently been listless and had had problems in thinking clearly. During a phase of abstinence owing to shortages in supply, he had developed symptoms in the form of profuse sweating during the day and especially in the night, as well as internal unrest, tremor, palpitation, insomnia, headache, diarrhea, nausea, and vomiting. Additionally he had suddenly felt depressed and desperate. This had lasted for two days and had only abruptly disappeared after taking the drug again. Therefore, he no longer had the courage to discontinue the drug by himself.
I have no idea what we can do to treat this, except supportive care and treating the seizures. Any ideas?
Wrapping it up.
To wrap up our discussion of evacuation drills: We have the 90 minute and 9 hour drills. These assume a situation where we may never see the house again, but there is some time to prepare. The movie Red Dawn is similar to that. They evacuated the school to their first rally point, Dad's hardware store. Then they activated the 90 minute plan and headed for the mountains. (I had to throw in the obligatory 80s movie reference.)
To begin, we grab our 9 minute stuff. Add to that: 4 cases MREs, 4 boxes mountain house freeze dried, a case of pet food, and our camping box. This box contains a pair of two man tents, propane stoves, propane lamps, and all associated hoses, fittings, and camp cookware/flatware. Cans of ammo and the rest of the guns fill out the equipment. We also bring all of our important paperwork. That is the 90 minute drill.
The 9 hour drill is designed primarily for hurricanes, and is the same as the 90 minute one, except we take the time to board up the house, pick up debris and stuff outside and store it in the garage along with our second vehicle.
I have used the 9 minute version several times when being deployed for disasters and such, and it seems to work well, even though I refine it a bit every time it is used.
To begin, we grab our 9 minute stuff. Add to that: 4 cases MREs, 4 boxes mountain house freeze dried, a case of pet food, and our camping box. This box contains a pair of two man tents, propane stoves, propane lamps, and all associated hoses, fittings, and camp cookware/flatware. Cans of ammo and the rest of the guns fill out the equipment. We also bring all of our important paperwork. That is the 90 minute drill.
The 9 hour drill is designed primarily for hurricanes, and is the same as the 90 minute one, except we take the time to board up the house, pick up debris and stuff outside and store it in the garage along with our second vehicle.
I have used the 9 minute version several times when being deployed for disasters and such, and it seems to work well, even though I refine it a bit every time it is used.
Tuesday, September 21, 2010
The nine minute drill
This is the next installment in my planning for emergencies series. The nine minute drill is a rapid evacuation, where you need to leave in a hurry and can expect to be gone for 3 to five days. This is good for short to medium warning time threats with medium to high risk, like a neighborhood ordered to evacuate for an approaching fire, a chemical spill, or some other localized emergency.
Planning: We established this plan, where we grab the pets, our emergency kits (below), and we consider also grabbing long guns and ammo. If together, we leave in one vehicle. If not, you text the other that you are headed for (rally point) and go. The other will catch up. Don't forget to bring your wallet and any extra cash you have. If the power goes out, or it is a banking holiday, you may not be able to access cash or credit cards. I also have a WD external hard drive that has all of the backup files for my computer, and I try to grab that. Our rally points would be a little farther away. Six to 100 miles should do it.
To prepare for this, we had to get an emergency kit together. What I did was to pack emergency kits for everyone. There are tons of opinions on how to do this, and I will just throw out a few thoughts here:
I got pet carriers for our two pets. In each carrier, I put a small nylon bag with a collar, leash, 4 single serving cans of pet food, and 4 half liter bottles of water. A calming aid for pets should also be put in there. This will keep your animal family members calm when needed.
The bags for adults will vary, depending on where you live. For example, a person in Montana needs to worry about sub-zero temperatures, while a person in Florida needs sunscreen. Mine is designed to get me away from the house in a hurry and sustain me for three to five days. I put it in a backpack for easy portability. Here is what I think is a minimum: First Aid, heat and cooking, light, tools, communications, food and water,shelter, and security.
A first aid kit. (Note for you medics: You do NOT need ET tubes and bag valve masks. There is not going to be a need to set up your own EMS agency.) Make sure it does have: Sudafed, Ibuprofen, Immodium (diarrhea can be life threatening), Benadryl, Cough medicine (I like Mucinex, a pill is less likely to leak all over the place) antibiotic ointment (infections are nasty during disasters when health care is hard to come by) some baby wipes, mosquito repellent, sunscreen, Bandaids, medical tape, and small sterile dressings. 4x4s will do. A small container of gold bond powder is a life saver when your feet have been wet for days. Also, a spare pair of comfortable socks, underwear, a hand towel, and a tshirt.
Heat and cooking. Three different ways to make fire. I have waterproof matches in a pill bottle, a lighter, and one of these. Here is one in action.
Light A flashlight with spare batteries. I got this one. It takes a single AA battery and puts out 200 lumens, but only costs $40. I also threw 4 chem lights in there.
Tools A multitool (like the Leatherman) and a pocketknife are indispensable. So is a compass, and it helps to keep a GPS in the car. I also have good road maps of the entire state of Florida in the car under the seat, as well as AAA maps of Georgia, Alabama, and Mississippi. My pickup truck has a built in 500 watt inverter for charging stuff. There is an inverter under the spare tire that is powered by a cigarette lighter. A pair of gloves to protect your hands.
Communications I put a cell phone charger for our cell phones inside our vehicles, I put one of these that I bought at a local grocery store for $12 inside my kit, and got a pair of FRS radios that I keep on a charger. The wife and I are going to get a HAM license soon. That will expand our options for radios.
Food and water: I included some energy bars (less likely to melt in the heat than chocolate) oatmeal, granola, or similar bars will do. Four MRE meals, and 8 half liter bottles of water.
Shelter: A space blanket, and a cheap poncho.
Security I put a 20 round box of ammo and an extra mag sealed in a Ziploc bag with a desiccant in our kits. 9mm for her Glock 19 in her kit, .45 ACP for mine. I also put an envelope in each kit that contains $200 (20- one dollar bills, 16- five dollar bills, 6- ten dollar bills, and 2 twenties) and a credit card with a $1000 limit.
Remember that this is an emergency kit, we aren't trying to reestablish civilization or start a war. We just need a quick way to access supplies for a three to five day emergency. This bag has come inhandy when I had to leave to go somewhere in a hurry. Some stuff gets taken out, and some added, as I use the kit and see what works. For example, I deployed to Mississippi for Hurricane Katrina and discovered the need for Glod Bond. Next post will be about the 90 minute and 9 hour plans.
Planning: We established this plan, where we grab the pets, our emergency kits (below), and we consider also grabbing long guns and ammo. If together, we leave in one vehicle. If not, you text the other that you are headed for (rally point) and go. The other will catch up. Don't forget to bring your wallet and any extra cash you have. If the power goes out, or it is a banking holiday, you may not be able to access cash or credit cards. I also have a WD external hard drive that has all of the backup files for my computer, and I try to grab that. Our rally points would be a little farther away. Six to 100 miles should do it.
To prepare for this, we had to get an emergency kit together. What I did was to pack emergency kits for everyone. There are tons of opinions on how to do this, and I will just throw out a few thoughts here:
I got pet carriers for our two pets. In each carrier, I put a small nylon bag with a collar, leash, 4 single serving cans of pet food, and 4 half liter bottles of water. A calming aid for pets should also be put in there. This will keep your animal family members calm when needed.
The bags for adults will vary, depending on where you live. For example, a person in Montana needs to worry about sub-zero temperatures, while a person in Florida needs sunscreen. Mine is designed to get me away from the house in a hurry and sustain me for three to five days. I put it in a backpack for easy portability. Here is what I think is a minimum: First Aid, heat and cooking, light, tools, communications, food and water,shelter, and security.
A first aid kit. (Note for you medics: You do NOT need ET tubes and bag valve masks. There is not going to be a need to set up your own EMS agency.) Make sure it does have: Sudafed, Ibuprofen, Immodium (diarrhea can be life threatening), Benadryl, Cough medicine (I like Mucinex, a pill is less likely to leak all over the place) antibiotic ointment (infections are nasty during disasters when health care is hard to come by) some baby wipes, mosquito repellent, sunscreen, Bandaids, medical tape, and small sterile dressings. 4x4s will do. A small container of gold bond powder is a life saver when your feet have been wet for days. Also, a spare pair of comfortable socks, underwear, a hand towel, and a tshirt.
Heat and cooking. Three different ways to make fire. I have waterproof matches in a pill bottle, a lighter, and one of these. Here is one in action.
Light A flashlight with spare batteries. I got this one. It takes a single AA battery and puts out 200 lumens, but only costs $40. I also threw 4 chem lights in there.
Tools A multitool (like the Leatherman) and a pocketknife are indispensable. So is a compass, and it helps to keep a GPS in the car. I also have good road maps of the entire state of Florida in the car under the seat, as well as AAA maps of Georgia, Alabama, and Mississippi. My pickup truck has a built in 500 watt inverter for charging stuff. There is an inverter under the spare tire that is powered by a cigarette lighter. A pair of gloves to protect your hands.
Communications I put a cell phone charger for our cell phones inside our vehicles, I put one of these that I bought at a local grocery store for $12 inside my kit, and got a pair of FRS radios that I keep on a charger. The wife and I are going to get a HAM license soon. That will expand our options for radios.
Food and water: I included some energy bars (less likely to melt in the heat than chocolate) oatmeal, granola, or similar bars will do. Four MRE meals, and 8 half liter bottles of water.
Shelter: A space blanket, and a cheap poncho.
Security I put a 20 round box of ammo and an extra mag sealed in a Ziploc bag with a desiccant in our kits. 9mm for her Glock 19 in her kit, .45 ACP for mine. I also put an envelope in each kit that contains $200 (20- one dollar bills, 16- five dollar bills, 6- ten dollar bills, and 2 twenties) and a credit card with a $1000 limit.
Remember that this is an emergency kit, we aren't trying to reestablish civilization or start a war. We just need a quick way to access supplies for a three to five day emergency. This bag has come inhandy when I had to leave to go somewhere in a hurry. Some stuff gets taken out, and some added, as I use the kit and see what works. For example, I deployed to Mississippi for Hurricane Katrina and discovered the need for Glod Bond. Next post will be about the 90 minute and 9 hour plans.
Monday, September 20, 2010
Evacuation groundwork
Continued from part one
The first thing you need to do in order to have a successful evacuation is to prepare. I fully believe in the seven P's: Proper prior planning prevents piss poor performance. To really prepare, your significant other MUST be on board, but don't force it. My convincing the wife to get into preparedness started as a "Hurricane Kit" and now the wife is as into it as I am. Don't overdo it, or the wife will think you are nuts and will not help you.
When you evacuate, the event will be much smoother if you can safeguard your life and not be living as a refugee for the next few years. To do this, we need our vital documents. This is how I did it.
I got three 4 GB USB thumb drives. You can get them for about 5 bucks each. I installed a strong encryption program (TrueCrypt- it works, and the price is right- free) on the drive, with a 1 GB partition. Instructions come with the software. I put a copy of the software on the drive, so I could use it from any computer that I could find.
In that encrypted partition, I put a copy of my Quicken file, along with scans of birth certificates, licenses, certifications, transcripts, credit cards (front and back), medical histories, credit records, diplomas, and any other documents I could think of. In the remaining unencrypted space, I put copies of things like pictures I didn't want to lose, and other keepsakes that were not sensitive in nature.
I then put a copy on my keychain, and one each in my glove box, and my wife's glovebox. (I later bought a fourth, and store it at work in my locker). I update them as needed, including a monthly update of the Quicken file. That way, if I evacuate due to a Katrina style disaster, I have everything I need to get started rebuilding my life.
Then, we plan out our rally points. The closest could be the mailbox in the front yard. Then, in order of distance, my friend's house (1 mile away), her mom's house (5 miles away), my office (12 miles), a friend's house (40 miles), her dad's house (200 miles), and a certain undisclosed hotel that is about 230 miles away. Depending on the disaster and its scope, we can head for any one of these places.
The 90 second plan is an emergency evacuation plan where there is not much time to get out- like a house fire. Emergencies that are high risk and short time are what this is for. This plan involves nothing more than us each grabbing a pet, our keys, and (optional) a sidearm and getting the heck out of the house. We meet at a rally point in the front yard, or if that is dangerous, we head for one of the next two closest ones.
The first thing you need to do in order to have a successful evacuation is to prepare. I fully believe in the seven P's: Proper prior planning prevents piss poor performance. To really prepare, your significant other MUST be on board, but don't force it. My convincing the wife to get into preparedness started as a "Hurricane Kit" and now the wife is as into it as I am. Don't overdo it, or the wife will think you are nuts and will not help you.
When you evacuate, the event will be much smoother if you can safeguard your life and not be living as a refugee for the next few years. To do this, we need our vital documents. This is how I did it.
I got three 4 GB USB thumb drives. You can get them for about 5 bucks each. I installed a strong encryption program (TrueCrypt- it works, and the price is right- free) on the drive, with a 1 GB partition. Instructions come with the software. I put a copy of the software on the drive, so I could use it from any computer that I could find.
In that encrypted partition, I put a copy of my Quicken file, along with scans of birth certificates, licenses, certifications, transcripts, credit cards (front and back), medical histories, credit records, diplomas, and any other documents I could think of. In the remaining unencrypted space, I put copies of things like pictures I didn't want to lose, and other keepsakes that were not sensitive in nature.
I then put a copy on my keychain, and one each in my glove box, and my wife's glovebox. (I later bought a fourth, and store it at work in my locker). I update them as needed, including a monthly update of the Quicken file. That way, if I evacuate due to a Katrina style disaster, I have everything I need to get started rebuilding my life.
Then, we plan out our rally points. The closest could be the mailbox in the front yard. Then, in order of distance, my friend's house (1 mile away), her mom's house (5 miles away), my office (12 miles), a friend's house (40 miles), her dad's house (200 miles), and a certain undisclosed hotel that is about 230 miles away. Depending on the disaster and its scope, we can head for any one of these places.
The 90 second plan is an emergency evacuation plan where there is not much time to get out- like a house fire. Emergencies that are high risk and short time are what this is for. This plan involves nothing more than us each grabbing a pet, our keys, and (optional) a sidearm and getting the heck out of the house. We meet at a rally point in the front yard, or if that is dangerous, we head for one of the next two closest ones.
Shelter in place, or run?
Anyone who is into personal preparedness has go to have a contingency plan. A plan for what, you ask? Whatever happens. One of the best tools in your arsenal is the ability to get the heck out of dodge. There was a man at the World Trade Center by the name of Rick Rescorla. If you are not familiar with the man known as the "man who predicted 9/11," you can go read about him later, because he is not the subject of this post, but I will say that I admire the man. He single handedly saved 2,700 lives on 9/11 by knowing when to get out, and he gave his own life in the effort.
I was watching a show about him on 9/11, and I was reminded of what happened to folks in the South Tower of the WTC on that day when they tried to evacuate after the first plane struck the North Tower: as they were trying to evacuate, the police herded them back into the building, claiming that the untouched South Tower was safe. They were performing an act called "shelter in place." Many people returned to their offices, only to be killed when the second plane struck the South Tower 18 minutes later. Those who ignored the cops and left, lived to see another day.
Shelter in place is not put into motion for the benefit of the people being sheltered. Primarily, it benefits the people who are charged with controlling the disaster, who do not need large amounts of refugees underfoot, getting in the way of rescue efforts. Yes, there are times when it is safer to to stay put where all of your supplies are, but there are also times to run. It is up to you to determine when that is, and have a plan to do so. Remember that hesitating will mean you are going to be in the middle of the fleeing herd, or possibly trapped in the disaster area, instead of being safe somewhere else.
When it is time to go, go. Don't wait, don't dally, and don't hesitate. If your instincts are telling you to go, then go. The key to an orderly evacuation, as opposed to a panicked flight is easy: preparation. The first thing is to have criteria that you will use to determine when you will go, and when you will stay. Make it flexible, because when that time comes, it may be an event that you have not planned for.
Evaluate the disasters that will force you to consider evacuating, and rate them according to warning time and risk- with the ratings of low, medium, and high. This is the same system that emergency professionals use:
For example: A fire in your house is Little warning, high risk. A hurricane in Florida's interior is long warning time, medium risk, but on the coast it may be high risk. Once we do that, we come up with plans for evacuating or dealing with the emergency, based on the time we have to evacuate and the severity of the disaster.
For example, in the event of a break in to our home while we are sleeping, we have plans to "shelter in place" in the bedroom and call 911. Anyone who enters the bedroom gets shot. That works for us, because the police have an average 6 minute response time in my city, and I can hold out for 6 minutes with the two handguns we have in the bedroom. I don't need to take the risk of clearing the house, I will let the cops do it for me.
On the other hand, we evacuate for any hurricane above class 3 that is due to hit in my area. Being 50 miles inland means that the risk is one I can bear in my location for a three or less.
Our evacuation plans vary. We have four plans, each one named for the amount of time we have to execute it. These plans are: 90 second, 9 minute, 90 minute, 9 hour. The next post will deal with evacuation plans. In the hurricane example I just gave you, we would activate the 9 hour plan (the 9 hour plan includes taking the time to board up windows). The last time we considered evacuating, I boarded up the windows and pre packed my vehicle when we were 5 days from landfall. My neighbors thought I was nuts. I was the only boarded up home in the neighborhood, but had we decided to evacuate, I could have gotten out of here with the 9 hour plan fully executed in only 90 minutes.
More on that later in part 2...
I was watching a show about him on 9/11, and I was reminded of what happened to folks in the South Tower of the WTC on that day when they tried to evacuate after the first plane struck the North Tower: as they were trying to evacuate, the police herded them back into the building, claiming that the untouched South Tower was safe. They were performing an act called "shelter in place." Many people returned to their offices, only to be killed when the second plane struck the South Tower 18 minutes later. Those who ignored the cops and left, lived to see another day.
Shelter in place is not put into motion for the benefit of the people being sheltered. Primarily, it benefits the people who are charged with controlling the disaster, who do not need large amounts of refugees underfoot, getting in the way of rescue efforts. Yes, there are times when it is safer to to stay put where all of your supplies are, but there are also times to run. It is up to you to determine when that is, and have a plan to do so. Remember that hesitating will mean you are going to be in the middle of the fleeing herd, or possibly trapped in the disaster area, instead of being safe somewhere else.
When it is time to go, go. Don't wait, don't dally, and don't hesitate. If your instincts are telling you to go, then go. The key to an orderly evacuation, as opposed to a panicked flight is easy: preparation. The first thing is to have criteria that you will use to determine when you will go, and when you will stay. Make it flexible, because when that time comes, it may be an event that you have not planned for.
Evaluate the disasters that will force you to consider evacuating, and rate them according to warning time and risk- with the ratings of low, medium, and high. This is the same system that emergency professionals use:
For example: A fire in your house is Little warning, high risk. A hurricane in Florida's interior is long warning time, medium risk, but on the coast it may be high risk. Once we do that, we come up with plans for evacuating or dealing with the emergency, based on the time we have to evacuate and the severity of the disaster.
For example, in the event of a break in to our home while we are sleeping, we have plans to "shelter in place" in the bedroom and call 911. Anyone who enters the bedroom gets shot. That works for us, because the police have an average 6 minute response time in my city, and I can hold out for 6 minutes with the two handguns we have in the bedroom. I don't need to take the risk of clearing the house, I will let the cops do it for me.
On the other hand, we evacuate for any hurricane above class 3 that is due to hit in my area. Being 50 miles inland means that the risk is one I can bear in my location for a three or less.
Our evacuation plans vary. We have four plans, each one named for the amount of time we have to execute it. These plans are: 90 second, 9 minute, 90 minute, 9 hour. The next post will deal with evacuation plans. In the hurricane example I just gave you, we would activate the 9 hour plan (the 9 hour plan includes taking the time to board up windows). The last time we considered evacuating, I boarded up the windows and pre packed my vehicle when we were 5 days from landfall. My neighbors thought I was nuts. I was the only boarded up home in the neighborhood, but had we decided to evacuate, I could have gotten out of here with the 9 hour plan fully executed in only 90 minutes.
More on that later in part 2...
First guns, then the rest
Once the citizens of a nation lose the ability to effectively defend themselves, dictatorship inevitably follows. History has proven this universal truth again and again.
So, in the country formerly known as Great Britain guns have been virtually outlawed since 1997. Abuses follow:
Britain bans the free press
Cops in Britain force their way into private hoes to enforce debts
Govt employee Doctors in Britain on house calls inspect homes for compliance with safety and health laws
British right to jury trial is gone
Ignoring the fact of increasing crime, we should note that the people there are now defenseless against any thing or act the Government decides to do. I have talked about this in the past, and had several British citizens argue that I am wrong.
Let's see what they say about this:
So, in the country formerly known as Great Britain guns have been virtually outlawed since 1997. Abuses follow:
Britain bans the free press
Cops in Britain force their way into private hoes to enforce debts
Govt employee Doctors in Britain on house calls inspect homes for compliance with safety and health laws
British right to jury trial is gone
Ignoring the fact of increasing crime, we should note that the people there are now defenseless against any thing or act the Government decides to do. I have talked about this in the past, and had several British citizens argue that I am wrong.
Let's see what they say about this:
The UK's tax collection agency is putting forth a proposal that all employers send employee paychecks to the government, after which the government would deduct what it deems as the appropriate tax and pay the employees by bank transfer.Once you cannot defend yourself from theft, you leave yourself at the thief's mercy. It doesn't matter if that thief is the man robbing you at the ATM, your neighbors robbing you at the polling booth, or a cop with a badge robbing you with regulations. Theft is theft. This is why we have a Second Amendment.
Sunday, September 19, 2010
Interesting details: Officers down, 2010
There have been 121 officers killed in the line of duty so far this year.
57 were killed in vehicle collisions of some sort
12 died from heart attacks
2 died in falls
1 killed by a person with his bare hands
2 drowned
46 were after being shot by people using firearms. Of these:
3 were actually shot in previous years and died from complications in 2010 (1996, 1998, 2009)
16 were killed by people with guns of a type that I could not identify
1 was killed by a man with a shotgun
17 were killed by people wielding handguns, including
- one in American Samoa, where handgun ownership is already illegal
- one by an illegal alien with an illegally possessed handgun
- two in Puerto Rico, where permits are required to own handguns
- One, Travis Murphy of the Phoenix PD, was listed by ODMP as having been killed by a man with a rifle, but he was actually killed by a Convicted Felon who was armed with a handgun.
- One was shot by the son of a police chief using his father's weapon (in addition to the other four below)
- Four of them were killed by other police officers, or by a handgun taken from a police officer by the suspect
- One by an armed security guard during a domestic disturbance involving the guard and his wife
Of the nine killed by people wielding rifles:
1 died in a hunting accident
One was killed by a man with a .30-30
One by a man with an SKS
Two by a man with an AK-47 type rifle (the only case this year that I could confirm involved a weapon that was on the Clinton gun ban list)
In short,
- more cops are killed in traffic accidents than by gunfire
- More cops were killed by other cops' guns than by so-called assault weapons
- Of the 43 deadly police officer shootings that occurred in 2010, at least ten of them were perpetrated by people who were prohibited from gun ownership already, and therefore more gun control laws would have been useless. It was already illegal for them to have guns, and making it double illegal would have done absolutely nothing.
Source is the Officer Down Memorial Page
57 were killed in vehicle collisions of some sort
12 died from heart attacks
2 died in falls
1 killed by a person with his bare hands
2 drowned
46 were after being shot by people using firearms. Of these:
3 were actually shot in previous years and died from complications in 2010 (1996, 1998, 2009)
16 were killed by people with guns of a type that I could not identify
1 was killed by a man with a shotgun
17 were killed by people wielding handguns, including
- one in American Samoa, where handgun ownership is already illegal
- one by an illegal alien with an illegally possessed handgun
- two in Puerto Rico, where permits are required to own handguns
- One, Travis Murphy of the Phoenix PD, was listed by ODMP as having been killed by a man with a rifle, but he was actually killed by a Convicted Felon who was armed with a handgun.
- One was shot by the son of a police chief using his father's weapon (in addition to the other four below)
- Four of them were killed by other police officers, or by a handgun taken from a police officer by the suspect
- One by an armed security guard during a domestic disturbance involving the guard and his wife
Of the nine killed by people wielding rifles:
1 died in a hunting accident
One was killed by a man with a .30-30
One by a man with an SKS
Two by a man with an AK-47 type rifle (the only case this year that I could confirm involved a weapon that was on the Clinton gun ban list)
In short,
- more cops are killed in traffic accidents than by gunfire
- More cops were killed by other cops' guns than by so-called assault weapons
- Of the 43 deadly police officer shootings that occurred in 2010, at least ten of them were perpetrated by people who were prohibited from gun ownership already, and therefore more gun control laws would have been useless. It was already illegal for them to have guns, and making it double illegal would have done absolutely nothing.
Source is the Officer Down Memorial Page
When does a drunk become a patient?
In a previous post, I discussed the criteria for refusal competency. We covered the reasons why a paramedic would transport a person who has impaired faculties to the hospital. The question we will explore today is another tricky one: When does a person who is impaired by alcohol or other intoxicants become a patient?
This was brought on by a call I ran recently that put my opinion at odds with the opinion of another medic. In this incident, we had been sent to the scene of a home where the caller had dialed 911 because a man was unconscious in his yard, and then woke up and stole a bicycle. When we arrived, a cop was already there. I asked the cop what the guy's problem was, and got the answer: "He's an idiot."
The subject (note that I did NOT say patient) was standing there talking to various bystanders, and only spoke Spanish (not an uncommon occurrence) but the caller/homeowner was translating. The subject also reeked of booze, denied having ID, and was from Mexico (all pretty common conditions in these parts). He denied having been unconscious, and claimed he was just sleeping. He also said that he did not want to go to the hospital. The translating bystander said that his Spanish seemed normal and unslurred.
A brief huddle ensued, and the following decisions were reached:
- The cop didn't want to arrest him for petty theft, saying the jail wouldn't take him since he was drunk, until he had been to the ER for evaluation. He also didn't want to take him to the ER, because it would be hours before the prisoner would be released from the ER to go to the jail, and the cop had better things to do with is time.
- The medics decided that he was not a 'refusal' because in order to be a refusal, people who are drunk cannot refuse. Besides, in order to refuse, you must first be a patient.
- An hour later, another crew found him passed out drunk in the gutter, and transported him. This medic was pissed and wanted to know why we didn't transport him against his will, seeing as how he was drunk.
So what makes a patient? When does a person with whom you have made contact become a patient?
I claim that a person who either has a medical complaint, or a visible medical problem is a patient.
The other medic states that since alcohol intoxication has a diagnosis code, that all intoxicated people are patients and must be transported, even if they have no other complaint or injury. The medic says that drunk people can possibly step out in front of cars, and he doesn't want the liability.
I responded by pointing out that male pattern baldness also has a diagnosis code, and unless the intoxicated person is drunk to the point where he cannot stand, is passing out, or has some other problem, he is not a patient. I also point out that people have rights, and I am not going to infringe upon them by forcing a person to the hospital simply because they are drunk.
What say ye? At what point does a person who is drunk become a patient? When do you begin the chain of events that forces a person to go to the hospital against his will?
This was brought on by a call I ran recently that put my opinion at odds with the opinion of another medic. In this incident, we had been sent to the scene of a home where the caller had dialed 911 because a man was unconscious in his yard, and then woke up and stole a bicycle. When we arrived, a cop was already there. I asked the cop what the guy's problem was, and got the answer: "He's an idiot."
The subject (note that I did NOT say patient) was standing there talking to various bystanders, and only spoke Spanish (not an uncommon occurrence) but the caller/homeowner was translating. The subject also reeked of booze, denied having ID, and was from Mexico (all pretty common conditions in these parts). He denied having been unconscious, and claimed he was just sleeping. He also said that he did not want to go to the hospital. The translating bystander said that his Spanish seemed normal and unslurred.
A brief huddle ensued, and the following decisions were reached:
- The cop didn't want to arrest him for petty theft, saying the jail wouldn't take him since he was drunk, until he had been to the ER for evaluation. He also didn't want to take him to the ER, because it would be hours before the prisoner would be released from the ER to go to the jail, and the cop had better things to do with is time.
- The medics decided that he was not a 'refusal' because in order to be a refusal, people who are drunk cannot refuse. Besides, in order to refuse, you must first be a patient.
- An hour later, another crew found him passed out drunk in the gutter, and transported him. This medic was pissed and wanted to know why we didn't transport him against his will, seeing as how he was drunk.
So what makes a patient? When does a person with whom you have made contact become a patient?
I claim that a person who either has a medical complaint, or a visible medical problem is a patient.
The other medic states that since alcohol intoxication has a diagnosis code, that all intoxicated people are patients and must be transported, even if they have no other complaint or injury. The medic says that drunk people can possibly step out in front of cars, and he doesn't want the liability.
I responded by pointing out that male pattern baldness also has a diagnosis code, and unless the intoxicated person is drunk to the point where he cannot stand, is passing out, or has some other problem, he is not a patient. I also point out that people have rights, and I am not going to infringe upon them by forcing a person to the hospital simply because they are drunk.
What say ye? At what point does a person who is drunk become a patient? When do you begin the chain of events that forces a person to go to the hospital against his will?
Friday, September 17, 2010
Redefining rights
A lot of bandwidth has been spent trying to define just exactly what the Second Amendment means. We all know the words:
The one Congress passed:
The one passed by the States:
I believe that arms are - well, arms. That is weapons. All weapons. That includes everything from pocket knives to tanks, artillery, jet fighters, and yes, even nukes. You see, I believe that the Constitution means exactly what it says. It says arms, and it is just as dishonest to redefine the words that were used in drafting it to change it as it is for others to do the same.
If you can redefine "arms" to exclude nukes, then why can't someone else redefine "militia" to mean the National Guard? Or define free speech to mean only speech within your own home is free? The answer to that is: you can't.
Now I am not saying that I think people should own nukes. I am saying that the Constitution as written prohibits the Republic from infringing on your preexisting right to bear arms. If you want to add an amendment that says: "Arms, for the purposes of the Second Amendment to this Constitution, does not include Nuclear Weapons or Biological Weapons" then the problem would be solved, and solved in the way that the founders intended.
The one Congress passed:
A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.
The one passed by the States:
A well regulated militia being necessary to the security of a free State, the right of the People to keep and bear arms shall not be infringed.The words of this Amendment have been repeatedly debated. One word that is continuously debated and changing is "arms." The collectivists believe that arms means what the founders had access to: muskets. Many pro-gun people believe that arms means the individual arms of the soldier, and that crew served weapons, artillery, and nuclear weapons do not count. Justice Sotomayor believes that nunchuks are not "arms."
I believe that arms are - well, arms. That is weapons. All weapons. That includes everything from pocket knives to tanks, artillery, jet fighters, and yes, even nukes. You see, I believe that the Constitution means exactly what it says. It says arms, and it is just as dishonest to redefine the words that were used in drafting it to change it as it is for others to do the same.
If you can redefine "arms" to exclude nukes, then why can't someone else redefine "militia" to mean the National Guard? Or define free speech to mean only speech within your own home is free? The answer to that is: you can't.
Now I am not saying that I think people should own nukes. I am saying that the Constitution as written prohibits the Republic from infringing on your preexisting right to bear arms. If you want to add an amendment that says: "Arms, for the purposes of the Second Amendment to this Constitution, does not include Nuclear Weapons or Biological Weapons" then the problem would be solved, and solved in the way that the founders intended.
Wednesday, September 15, 2010
The problem with US healthcare
Pictured is a young physician by the name of Dr. Roger Starner Jones. He works in the emergency room of a hospital in Jackson, MS. His short two-paragraph letter to the White House accurately puts the blame on a "Culture Crisis" instead of a "Health Care Crisis." This letter appeared in the "Letters to the editor" section of the August 29, 2010 edition of his local newspaper. It's worth a read:
Dear Mr. President:
During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ringtone.
While glancing over her patient chart, I happened to notice that her payer status was listed as "Medicaid"! During my examination of her, the patient informed me that she smokes more than one pack of cigarettes every day, eats only at fast-food take-outs, and somehow still has money to buy pretzels and beer. And, you and our Congress expect me to pay for this woman's health care? I contend that our nation's "health care crisis" is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a "crisis of culture" a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one's self or, heaven forbid, purchase health insurance. It is a culture based in the irresponsible credo that "I can do whatever I want to because someone else will always take care of me". Once you fix this "culture crisis" that rewards irresponsibility and dependency, you'll be amazed at how quickly our nation's health care difficulties will disappear.
Respectfully,
ROGER STARNER JONES, MD
Jackson, MS
Tuesday, September 14, 2010
Fed to buy $1 trillion in US debt
Monetize the debt. What this means is the Federal Reserve would create a trillion dollars with the click of a mouse, and buy $1 trillion of the US debt. This would increase the amount of money in circulation by a similar amount, and make the dollar worth less.
There is currently $8.6 trillion in circulation. After this move, there would be $9.6 trillion, making the dollar worth 11% less. This is how the Fed is going to improve the debt situation that is threatening the economy, they are going to print our way out. They are taking the expedient way out of paying off a debt that is equal to more money than exists, by simply creating more money. That is why gold closed today at a record $1,270 an ounce. When Obama took office, gold was near $700 an ounce, and when Bush was inaugurated, it was near $300 an ounce.
Hyperinflation is coming. I am thinking it is time to convert those savings dollars to gold, if you haven't already. My guess is that the big monetization will start after the November meeting of the Fed, scheduled for the day AFTER the election, so the inflation that follows will not affect the elections.
At least the money is going to worthy causes, like the stimulus money that was spent teaching African men how to wash their dicks.
There is currently $8.6 trillion in circulation. After this move, there would be $9.6 trillion, making the dollar worth 11% less. This is how the Fed is going to improve the debt situation that is threatening the economy, they are going to print our way out. They are taking the expedient way out of paying off a debt that is equal to more money than exists, by simply creating more money. That is why gold closed today at a record $1,270 an ounce. When Obama took office, gold was near $700 an ounce, and when Bush was inaugurated, it was near $300 an ounce.
Hyperinflation is coming. I am thinking it is time to convert those savings dollars to gold, if you haven't already. My guess is that the big monetization will start after the November meeting of the Fed, scheduled for the day AFTER the election, so the inflation that follows will not affect the elections.
At least the money is going to worthy causes, like the stimulus money that was spent teaching African men how to wash their dicks.
Saturday, September 11, 2010
Ground Zero Mosque, Quran burning, and the First Amendment
I support the Muslims who want to build a Mosque near ground zero. If they buy the property, they pay for the building, and they want to worship there, then that is their right to do so, and I support that. After all, it does not infringe on the rights of one single person. With that being said, the only possible reason for them to do this, is so they can be "in your face" and provoke outrage. I disagree with them. It is still their right.
I support the Preacher who wants to burn Qurans today. If he buys the books, has the burning completely on his own land, and that burning does not infringe on the rights of others, then it is his right to do so, and I fully support that. With that being said, the only possible reason for him to do this, is so he can be "in your face" and provoke outrage. I disagree with him. It is still his right.
The First Amendment protects your right to say what you want, and to worship as you please. I will defend your rights under that Amendment, even when I do not agree with you. That is the real test of freedom: will you defend the rights of someone with whom you do not agree? If you will not, then you are not for freedom, you just want freedom for those with whom you agree, and that is not freedom, it is conformity.
For those who cry that the military will be placed in harm's way because of the speech of the preacher, I say to you that our military is SUPPOSED to be in harm's way to protect the rights of her citizens. When I enlisted, I swore to support and defend our Constitution from all enemies, foreign and domestic. That was not an idle promise.
For those who are opposed to book burning, I say to you that book burning is stupid, but in this age of instant publishing, I say that burning a book is more a statement than it is a real threat. I cannot state it any better than Breda has:
Book burning is wrong, because it has been used in the past to stifle free speech. In this case, it is the opposition to this preacher that concerns me. The police and FBI threatening a man with prosecution for speech is far more chilling and worrisome than his act of burning a few of his own books that he purchased with his own money in a mutually beneficial transaction.
Who could doubt that this looks suspiciously like threats and intimidation?
- Police announce that they are taking down license numbers of all who attend the church's Koran burning
- Eric Holder states that Terry Jones (the preacher) will be charged with a hate crime if he burns the Korans.
- The FBI meets with Jones on Thursday
- Thursday afternoon, Jones announces the burning is off.
I support the Preacher who wants to burn Qurans today. If he buys the books, has the burning completely on his own land, and that burning does not infringe on the rights of others, then it is his right to do so, and I fully support that. With that being said, the only possible reason for him to do this, is so he can be "in your face" and provoke outrage. I disagree with him. It is still his right.
The First Amendment protects your right to say what you want, and to worship as you please. I will defend your rights under that Amendment, even when I do not agree with you. That is the real test of freedom: will you defend the rights of someone with whom you do not agree? If you will not, then you are not for freedom, you just want freedom for those with whom you agree, and that is not freedom, it is conformity.
For those who cry that the military will be placed in harm's way because of the speech of the preacher, I say to you that our military is SUPPOSED to be in harm's way to protect the rights of her citizens. When I enlisted, I swore to support and defend our Constitution from all enemies, foreign and domestic. That was not an idle promise.
For those who are opposed to book burning, I say to you that book burning is stupid, but in this age of instant publishing, I say that burning a book is more a statement than it is a real threat. I cannot state it any better than Breda has:
In an age where I can carry the complete works of William Shakespeare on a device small enough to fit in my pocket, book burning is primitive and irrelevant. I can download and delete the Qur'an over and over, all day long. It means nothing. And in the end, all books will succumb to the rot of time, crumbling to dust, without the help of a zealot's flame. There are no sacred objects.
Book burning is wrong, because it has been used in the past to stifle free speech. In this case, it is the opposition to this preacher that concerns me. The police and FBI threatening a man with prosecution for speech is far more chilling and worrisome than his act of burning a few of his own books that he purchased with his own money in a mutually beneficial transaction.
Who could doubt that this looks suspiciously like threats and intimidation?
- Police announce that they are taking down license numbers of all who attend the church's Koran burning
- Eric Holder states that Terry Jones (the preacher) will be charged with a hate crime if he burns the Korans.
- The FBI meets with Jones on Thursday
- Thursday afternoon, Jones announces the burning is off.
Friday, September 10, 2010
You can't stop the signal
There have been some complaints about.. irregularities at gPal. They have a section over at Calguns where people's posts are reportedly being edited and deleted. At this point, I cannot recommend that anyone do business with them.
Proving to me that CalGuns.net and GPal are criminal enterprises, they have deleted the thread at CalGuns where customers were posting their complaints that gPal is not paying out funds, and is not responding to emails and telephone calls.
This proves, at least as far as I am concerned, that I will never do business with either party, and will advise everyone I know to refuse to deal with them. Dirty business, indeed.
Proving to me that CalGuns.net and GPal are criminal enterprises, they have deleted the thread at CalGuns where customers were posting their complaints that gPal is not paying out funds, and is not responding to emails and telephone calls.
This proves, at least as far as I am concerned, that I will never do business with either party, and will advise everyone I know to refuse to deal with them. Dirty business, indeed.
Wednesday, September 8, 2010
Wide complex Tachycardias
I want to take a couple of minutes to follow up on my tachycardia post from the other day. I left off on wide complex tachycardias, and I feel like this is a follow up that needs to be done.
As I said in the other post, we assume that all wide complex tachycardias are VT unless proven otherwise. The first question that we need to know is: does this wide complex tachycardia have a pulse? If the answer is no, then we work the patient as if it was a VF/VT code. If there is anything that a person with an ACLS card in his pocket should know how to do, it is work a VF/VT code. For crying out loud, they train cashiers at WalMart how to do most of this, and if you can't, then maybe you should turn in that ACLS card and throw in an application to WalMart.
Anyway, if the patient has a pulse with this tachycardia, the next question we should ask ourselves is whether or not this patient is critically unstable as a result. There is only one thing that counts: Are we perfusing the brain? There are two fairly reliable indicators that we can use to determine this: mental status and blood pressure.
If the patient has altered mental status, or has a systolic blood pressure of less than 90mm Hg, then this patient is critically unstable and needs immediate intervention. Synchronized cardioversion is the way to go here. Time is tissue. Going with drugs at this point is costing you brain tissue: time to get the IV, time to drip amiodarone over 10 minutes, or time to push the lidocaine is going to cost the patient brain tissue.
If the patient is not critically unstable, then we have time to find out what we are dealing with: Is this VT or is it SVT with an aberrancy? We can tell by running a 12 lead. Run a 12 lead EKG, and if leads aVF and I are both showing negative deflection, then your QRS axis is in the upper left quadrant, meaning XAD or Indeterminate axis. This is an indicator that your patients heart is experiencing retrograde conduction. The foci, or pacemaker, in this heart is in the ventricles, and you are dealing with VT. Otherwise, it is SVT with an aberrant conduction.
Hope this helps. Good luck out there!
As I said in the other post, we assume that all wide complex tachycardias are VT unless proven otherwise. The first question that we need to know is: does this wide complex tachycardia have a pulse? If the answer is no, then we work the patient as if it was a VF/VT code. If there is anything that a person with an ACLS card in his pocket should know how to do, it is work a VF/VT code. For crying out loud, they train cashiers at WalMart how to do most of this, and if you can't, then maybe you should turn in that ACLS card and throw in an application to WalMart.
Anyway, if the patient has a pulse with this tachycardia, the next question we should ask ourselves is whether or not this patient is critically unstable as a result. There is only one thing that counts: Are we perfusing the brain? There are two fairly reliable indicators that we can use to determine this: mental status and blood pressure.
If the patient has altered mental status, or has a systolic blood pressure of less than 90mm Hg, then this patient is critically unstable and needs immediate intervention. Synchronized cardioversion is the way to go here. Time is tissue. Going with drugs at this point is costing you brain tissue: time to get the IV, time to drip amiodarone over 10 minutes, or time to push the lidocaine is going to cost the patient brain tissue.
If the patient is not critically unstable, then we have time to find out what we are dealing with: Is this VT or is it SVT with an aberrancy? We can tell by running a 12 lead. Run a 12 lead EKG, and if leads aVF and I are both showing negative deflection, then your QRS axis is in the upper left quadrant, meaning XAD or Indeterminate axis. This is an indicator that your patients heart is experiencing retrograde conduction. The foci, or pacemaker, in this heart is in the ventricles, and you are dealing with VT. Otherwise, it is SVT with an aberrant conduction.
Hope this helps. Good luck out there!
Tuesday, September 7, 2010
Unions hire nonunion workers
After all, it is hot out there, so the union workers hire non-union labor to picket in their place. At minimum wage, with no benefits. They are everything they accuse the businesses of being. Hypocrites.
Trials of being a parent
I have two children. I divorced my wife when they were young. My son was eight years old, and my daughter was six. I know it was hard on them, and I always regretted that. When my ex wife and I divorced, both of the kids took it pretty hard.
I paid my court ordered child support, which in Florida is a punishing amount (payroll deducted). My child support was $1400 a month, and that left me only $800 a month after taxes. I was always broke.
The actions of my ex wife didn't make things any easier. When I would go to pick the kids up for visitation, the ex-wife would refuse to let them see me unless I gave her more money, and when I refused, she would tell the kids that I didn't take them with me because I didn't love them. My son wouldn't believe it, and would tell his mother to stop badmouthing me.
When the kids were allowed to come over, they always came without clothes, and the ones they were wearing were so worn as to be unsuitable for going anywhere. When I would ask about that, she told me that if I wanted to take them anywhere, I had to buy them clothes.
The kids would come to me and tell me that their class was going on a field trip, or they needed supplies for school, or some other event that required money, and their mother told them if I didn't pay, they would do without. Of course I paid.
Once, the mother's new boyfriend called me at home and told me, "Your daughter just called me daddy. Just thought you should know," then laughed and hung up. That incident alone shows how restrained and in control I am, since I did not go down there and... well.
Just before my son turned 15 and he started costing more to raise, his mother threw him out- she said he was too hard to control. He came to live with me, got straight A's, and graduated high school two years early, at the age of 16. He graduated college and the fire academy, all before he turned 20.
When my daughter turned 15, her mother caught her hanging around with a ne'er do well boyfriend with an arrest record, doing drugs, and skipping school. She sent my daughter to live with me. It was three years of fighting. Three years of school skipping, catching her with drugs, her being brought home by the police, her getting arrested, and me being threatened with violence by her boyfriend for interfering. The cops were not help, and neither were the courts. Three years of being told that she couldn't wait to move out and be rid of my "bullshit rules" so she could live with her "soul mate."
On her eighteenth birthday, she left and went to live with her boyfriend and his parents. A few months after she left, I was at her high school graduation. That was the last time I saw her until Christmas, when she came by to ask if I had bought her a present. She had broken up with her "soul mate" and he stalked her for six months or so, until she got a restraining order.
That was over two years ago. My daughter now lives in an apartment with 8 roommates, and has another skeezy boyfriend who uses all sorts of mind expanding chemicals. They both wait tables for a living. Still, I try not to express my displeasure, after all, I remember what it was like to be 20. We have been speaking, off and on for about the last year.
Until this morning. She had friended my brother and my nephew on a social networking site, and it seemed like family relations were improving. Then, my daughter began posting pictures of her illegal substance use, pictures of partial nudity of her and her friends partying, and other mature themes. My brother asked her to tone it down, as her 9 year old nephew could see it. She replied that she would not censor herself for anyone.
I jumped in and asked her to keep in mind that what goes on the internet can hurt you later in life, and also reminded her of the importance of family. She promptly told all of us to f- off.
They joys of parenthood. Why am I expected to endure behavior from relatives that I would never tolerate from strangers?
I paid my court ordered child support, which in Florida is a punishing amount (payroll deducted). My child support was $1400 a month, and that left me only $800 a month after taxes. I was always broke.
The actions of my ex wife didn't make things any easier. When I would go to pick the kids up for visitation, the ex-wife would refuse to let them see me unless I gave her more money, and when I refused, she would tell the kids that I didn't take them with me because I didn't love them. My son wouldn't believe it, and would tell his mother to stop badmouthing me.
When the kids were allowed to come over, they always came without clothes, and the ones they were wearing were so worn as to be unsuitable for going anywhere. When I would ask about that, she told me that if I wanted to take them anywhere, I had to buy them clothes.
The kids would come to me and tell me that their class was going on a field trip, or they needed supplies for school, or some other event that required money, and their mother told them if I didn't pay, they would do without. Of course I paid.
Once, the mother's new boyfriend called me at home and told me, "Your daughter just called me daddy. Just thought you should know," then laughed and hung up. That incident alone shows how restrained and in control I am, since I did not go down there and... well.
Just before my son turned 15 and he started costing more to raise, his mother threw him out- she said he was too hard to control. He came to live with me, got straight A's, and graduated high school two years early, at the age of 16. He graduated college and the fire academy, all before he turned 20.
When my daughter turned 15, her mother caught her hanging around with a ne'er do well boyfriend with an arrest record, doing drugs, and skipping school. She sent my daughter to live with me. It was three years of fighting. Three years of school skipping, catching her with drugs, her being brought home by the police, her getting arrested, and me being threatened with violence by her boyfriend for interfering. The cops were not help, and neither were the courts. Three years of being told that she couldn't wait to move out and be rid of my "bullshit rules" so she could live with her "soul mate."
On her eighteenth birthday, she left and went to live with her boyfriend and his parents. A few months after she left, I was at her high school graduation. That was the last time I saw her until Christmas, when she came by to ask if I had bought her a present. She had broken up with her "soul mate" and he stalked her for six months or so, until she got a restraining order.
That was over two years ago. My daughter now lives in an apartment with 8 roommates, and has another skeezy boyfriend who uses all sorts of mind expanding chemicals. They both wait tables for a living. Still, I try not to express my displeasure, after all, I remember what it was like to be 20. We have been speaking, off and on for about the last year.
Until this morning. She had friended my brother and my nephew on a social networking site, and it seemed like family relations were improving. Then, my daughter began posting pictures of her illegal substance use, pictures of partial nudity of her and her friends partying, and other mature themes. My brother asked her to tone it down, as her 9 year old nephew could see it. She replied that she would not censor herself for anyone.
I jumped in and asked her to keep in mind that what goes on the internet can hurt you later in life, and also reminded her of the importance of family. She promptly told all of us to f- off.
They joys of parenthood. Why am I expected to endure behavior from relatives that I would never tolerate from strangers?
Monday, September 6, 2010
BATFE ice wine ruling
Bureau of Alcohol, Tobacco, Firearms and Explosives (BATFE) has a great many responsibilities, one of which is determining how wine is labeled and sold. BATFE ruling 27 CFR 4.39(a)(1)states that a wine made with grapes that are frozen after harvest may not be labeled “ice wine”. True ice wine is made from grapes that are frozen on the vine, according to ATF Ruling 78-4, 1978 C.B. 61. This ruling was made because this is misleading the public and true ice wine has particular property and characteristics that are not achievable by freezing the grapes after picking.
I wonder if BATFE conducts raids on wineries like they do gun stores and gun owners? Torching wine casks open, stomping on kittens, confiscating wine. Remember the good old days, when BATFE ruled on things like declaring a shoestring to be a machine gun?
I wonder if BATFE conducts raids on wineries like they do gun stores and gun owners? Torching wine casks open, stomping on kittens, confiscating wine. Remember the good old days, when BATFE ruled on things like declaring a shoestring to be a machine gun?
Saturday, September 4, 2010
Call of the week- is it SVT or do you need a refresher?
54 year old golfer who was struck by lightning 3 years ago and now lives in a local nursing home. We get called to the establishment for a report of rapid heart rate. Nevermind that he had been convulsing for over 45 minutes, they were worried about his heart rate of 160. The fact that the seizure was causing the poor, bedridden man to run a marathon never crossed her mind. She was locked on to the fact that his heart was racing.
At that point the RN was trying to explain to me that a HR over 140 is SVT. For all of you who are rhythm challenged, we will have a quick ACLS review here:
SVT means Supraventricular Tachycardia, or literally "a tachycardia occurring above the ventricles." Theoretically, it means any tachycardia that is not ventricular in nature, and this would include a Sinus Tachycardia that is a part of the body's normal response to physiological demands.
In reality, when people talk about SVT, what they are really referring to is a tachycardia that is caused by an electrical problem within the heart. This can include Multifocal Atrial Tachycardia (MAT), Atrial Fibrillation (Afib), Atrial Flutter (Aflutter), Atrioventricular Nodal Reentrant Tachycardia (AVNRT), and a few others.
How do we tell the difference? Assessment is the key to medicine. If the patient is exerting himself and placing major metabolic demands on his body, the problem is not in the heart. Seizures, heavy physical activity, trauma, as well as other metabolic and neurological conditions will cause the heart to beat rapidly. A man watching TV who experiences sudden tachycardia is not responding to metabolic demands.
Don't let anyone tell you that a HR over 140 is automatically SVT, and below that is not. A good example of why the "140 rule" is a bad one is Aflutter with an atrial rate of 330 and 3:1 conduction. That will give a heart rate of only 110, yet such a patient is in SVT.
In the call we are talking about at the beginning of this post, the man has a heart rate of 160 because of the heavy metabolic demands that the 45 minutes of seizure activity is placing on his normally sedentary body, not because he has a heart problem.
We treat a sinus tachycardia that is caused by metabolic demands in a simple way: we correct the metabolic problem. In this case 10mg of diazepam by IVP stopped the convulsions, and within 15 minutes his heart rate was back to normal.
But how do we treat PSVT? This is an abnormal condition, and should be treated as a cardiac rhythm disturbance per the ACLS tachycardia card. We can consider synchronized cardioversion, and if we don't know the origin, just start at 100 joules.
If we don't go with electrical therapy, the problem gets a bit stickier. Narrow complex tachycardias are usually AVNRT, and we can just try Adenosine (6mg initial dose, followed by 12mg and 12mg more if unsuccessful) to see if that corrects it. Be sure to run a strip while you are giving the drug, so you can perhaps see if the rhythm is actually Afib or Aflutter.
If that narrow tachycardia turns out to be Afib or Aflutter, then you can try a calcium channel blocker like Diltiazem. I would not go with a calcium channel blocker in AVNRT though, because that rhythm is caused by an accessory pathway, and giving these drugs to a patient with AVNRT will shut down the calcium driven AV node, and make the sodium driven accessory pathway the king of the highway. Now you have converted a patient from Aflutter with 3:1 or 2:1 conduction into a patient with 1:1 conduction, and a HR of 300!
You can also try cordarone, which is pretty effective on wide and narrow tachycardias, just watch out for cordarone's most common side effect: hypotension.
Speaking of wide complex tachycardias, they are a bit different. First, determine if that tachycardia comes with a pulse. If not, it is VT. If it does have a pulse, we consider synchronized cardioversion, and if we don't go that way, we need to consider drugs. All wide complex tachycardias are to be treated as ventricular tachycardia until proven otherwise. More on determining that in a later post. For now, we can just try antiarrhythmics like cordarone or lidocaine for treating wide complex tachycardia. (Important caution: corddarone and lidocaine should not both be given to the same patient. Since cordarone lengthens the refractory period by blocking potassium channels, and lidocaine blocks fast sodium channels resulting in a slower conduction velocity, the two together can cause asystole.)
This post is long enough for now, so good luck.
Edited to add: Here is the wide complex post
At that point the RN was trying to explain to me that a HR over 140 is SVT. For all of you who are rhythm challenged, we will have a quick ACLS review here:
SVT means Supraventricular Tachycardia, or literally "a tachycardia occurring above the ventricles." Theoretically, it means any tachycardia that is not ventricular in nature, and this would include a Sinus Tachycardia that is a part of the body's normal response to physiological demands.
In reality, when people talk about SVT, what they are really referring to is a tachycardia that is caused by an electrical problem within the heart. This can include Multifocal Atrial Tachycardia (MAT), Atrial Fibrillation (Afib), Atrial Flutter (Aflutter), Atrioventricular Nodal Reentrant Tachycardia (AVNRT), and a few others.
How do we tell the difference? Assessment is the key to medicine. If the patient is exerting himself and placing major metabolic demands on his body, the problem is not in the heart. Seizures, heavy physical activity, trauma, as well as other metabolic and neurological conditions will cause the heart to beat rapidly. A man watching TV who experiences sudden tachycardia is not responding to metabolic demands.
Don't let anyone tell you that a HR over 140 is automatically SVT, and below that is not. A good example of why the "140 rule" is a bad one is Aflutter with an atrial rate of 330 and 3:1 conduction. That will give a heart rate of only 110, yet such a patient is in SVT.
In the call we are talking about at the beginning of this post, the man has a heart rate of 160 because of the heavy metabolic demands that the 45 minutes of seizure activity is placing on his normally sedentary body, not because he has a heart problem.
We treat a sinus tachycardia that is caused by metabolic demands in a simple way: we correct the metabolic problem. In this case 10mg of diazepam by IVP stopped the convulsions, and within 15 minutes his heart rate was back to normal.
But how do we treat PSVT? This is an abnormal condition, and should be treated as a cardiac rhythm disturbance per the ACLS tachycardia card. We can consider synchronized cardioversion, and if we don't know the origin, just start at 100 joules.
If we don't go with electrical therapy, the problem gets a bit stickier. Narrow complex tachycardias are usually AVNRT, and we can just try Adenosine (6mg initial dose, followed by 12mg and 12mg more if unsuccessful) to see if that corrects it. Be sure to run a strip while you are giving the drug, so you can perhaps see if the rhythm is actually Afib or Aflutter.
If that narrow tachycardia turns out to be Afib or Aflutter, then you can try a calcium channel blocker like Diltiazem. I would not go with a calcium channel blocker in AVNRT though, because that rhythm is caused by an accessory pathway, and giving these drugs to a patient with AVNRT will shut down the calcium driven AV node, and make the sodium driven accessory pathway the king of the highway. Now you have converted a patient from Aflutter with 3:1 or 2:1 conduction into a patient with 1:1 conduction, and a HR of 300!
You can also try cordarone, which is pretty effective on wide and narrow tachycardias, just watch out for cordarone's most common side effect: hypotension.
Speaking of wide complex tachycardias, they are a bit different. First, determine if that tachycardia comes with a pulse. If not, it is VT. If it does have a pulse, we consider synchronized cardioversion, and if we don't go that way, we need to consider drugs. All wide complex tachycardias are to be treated as ventricular tachycardia until proven otherwise. More on determining that in a later post. For now, we can just try antiarrhythmics like cordarone or lidocaine for treating wide complex tachycardia. (Important caution: corddarone and lidocaine should not both be given to the same patient. Since cordarone lengthens the refractory period by blocking potassium channels, and lidocaine blocks fast sodium channels resulting in a slower conduction velocity, the two together can cause asystole.)
This post is long enough for now, so good luck.
Edited to add: Here is the wide complex post
Thursday, September 2, 2010
Tight schedule
Excuse the lack of posting lately. I work two jobs, and I am taking 22 credit hours of college this semester. I am trying to get in to school to get a Master's degree, so the prerequisites are eating up my time. More details on that later.
Last week's schedule was 48 hours at my fire department job, 12 hours teaching classes, and my time in school TAKING classes.
This week I work 64 hours at my fire department job, and 10 hours teaching, as well as classes.
On top of that, I have to mow the lawn each week. No time left for posting.
Last week's schedule was 48 hours at my fire department job, 12 hours teaching classes, and my time in school TAKING classes.
This week I work 64 hours at my fire department job, and 10 hours teaching, as well as classes.
On top of that, I have to mow the lawn each week. No time left for posting.
Subscribe to:
Posts (Atom)