national registry review

Cardiac Arrest/AED

Assessment
• Take BSI
• Scene Safe
• Question rescuers about arrest
• Turn on AED
• Attach AED to patient
• Direct everyone to “CLEAR!”
• Analyze
• Deliver shock (if indicated)
• Resume CPR

Transition
• Gather additional information about arrest event
• Confirm effectiveness of CPR (ventilation and compressions)

Integration
• Verbalizes or directs insertion of a simple airway adjunct (oral/nasal airway)
• Ventilates or directs ventilation of patient
• Assures high conc oxygen is delivered to the patient
• Assures adequate CPR continues without unnecessary/prolonged interruption
• Continues CPR for 2 minutes
• Direct rescuer to stop CPR, ensure “CLEAR!”
• Analyze
• Shock (if indicated)
• Resume CPR

Transportation
• Verbalizes transport

Oxygen Administration

• BSI
• Scene Safe
• Attach regulator to tank
• Open tank – blow out dust
• Check for leaks
• Check tank pressure (at least 200psi)
• Attach non-rebreather
• Prefill reservoir
• Adjust flow to 12L or higher
• Applies and adjusts mask to patient’s face

Examiner will say patient is not tolerating the mask, apply nasal cannula instead
• Attach nasal cannula to oxygen
• Adjusts liter flow to 6 liters per minute or less
• Applies nasal cannula to patient

Examiner must advise candidate to discontinue oxygen therapy
• Removes the nasal cannula from the patient
• Shuts off the regulator
• Relieves the pressure within the regulator


Bag Valve Mask – Apneic Patient

• Takes or verbalizes BSI
• Scene Safe
• Voice inserting an airway adjunct
• Select appropriately sized mask
• Creates a proper mask-to-face seal
• Ventilates patient at no less then 700-1000mL volume (at least 30 seconds)
• Connects reservoir and oxygen
• Adjust liter flow to 15L/minute or greater

Examiner indicates arrival of a second EMT. The second EMT is instructed to ventilate while candidate controls the mask and airway.

• Voices re-opening the airway
• Creates a proper mask-to-face seal
• Instructs assistant to resume ventilation at proper volume per breath


Immobilization skills – traction splinting

• Take BSI
• Scene safe
• Directs application of manual stabilization of the injured leg
• Directs the application of manual traction
• Assess CMS

Examiner will state CMS is normal

• Prepares/adjusts splint to the proper length
• Positions the splint next to the injured leg
• Applies the proximal securing device (ischial strap)
• Applies distal securing device (ankle hitch)
• Applies mechanical traction
• Positions/secures support straps
• Re-evaluates the proximal/distal securing devices
• Reassess CMS

Examiner will state CMS is normal
Examiner will ask the candidate how he/she would prepare patient for transportation

• Verbalizes securing the torso to the long board to immobilize the hip
• Verbalizes securing the splint to the long board to prevent movement of the splint

Spinal Immobilization – Supine Patient

• Takes BSI
• Scene Safe
• Directs assistant to place/maintain head in the neutral in-line position
• Directs assistant to maintain immobilization of the head
• Reassess CMS
• Applies appropriately sized extrication collar
• Positions immobilization device appropriately
• Directs movement of the patient onto the device without compromising integrity of the spine
• Applies padding to voids between torso and board as necessary
• Immobilizes the patient’s torso to the device
• Secures the patient’s legs to the device
• Secures arms to the device
• Immobilizes the patient’s head to the device
• Evaluate and pad the head
• Reassess CMS



Bleeding Control / Shock Management

• Take BSI
• Scene Safe
• Apply direct pressure to the wound
• Elevates the extremity

Examiner will say “it keeps bleeding”

• Applies an additional dressing to the wound

Examiner says it keeps bleeding

• Apply tourniquet
• Properly position patient
• Applies high concentration oxygen
• Provide warmth for patient (blanket during transport)
• Indicate need for immediate transport



Immobilization skills – Long Bone Injury

• Take BSI
• Scene Safe
• Direct application of manual stabilization of the injury
• Assess CMS

Examiner says CMS is fine

• Measures splint
• Applies the splint
• Immobilizes joint above the injury
• Immobilizes joint below the injury
• Secures the entire injured extremity
• Immobilizes the hand/foot in the position of function
• Reassesses CMS

Examiner says CMS is fine

Spinal Immobilization – Seated Patient

• Take BSI
• Scene safe
• Direct assistant to place/maintain head in neutral in-line position
• Direct assistant to maintain manual immobilization of the head
• Reassess CMS
• Applies appropriately sized extrication collar
• Positions the immobilization device behind the patient
• Secures the device to the patient’s torso
• Evaluates torso fixation and adjusts as necessary
• Evaluates and pads behind the patient’s head as necessary
• Secures the patient’s head to the device
• Verbalizes moving the patient to a long board
• Reassess CMS

I ran for an hour

I ran for an hour without stopping today.

Pros: I did it. I could do more. I could do a lot more if I was hydrating and eating along the way
Cons: My feet hurt.

Side note: Ran in these




In swimming news - I'm up to a mile nonstop in the pool. I did 41 laps 2 weekends ago. Similar to running, I was fine, but starving.

I think I need to figure out what to eat that will provide energy but not jack my stomach in knots.

not so huge of accomplishments

So, it's good for me to keep track of what happens (biking, weight, eating, etc) so i can go back and see what worked, what didn't, etc.

A couple things I wanted to do this year

1- bike a lot more at my aerobic pace... 150-160bpm with only surges above it, not extended efforts. If everyone else is going faster, that's fine, I need to build base.
2- because of the above, I shouldn't need to take in as much food while biking (aerobic exercise can burn fat for fuel--going anerobic can't). this is cheaper(carrying water), easier, and should help train my body to burn fat for fuel.
3- have more fun biking (again, biking at a comfortable pace is more fun than going all balls to the wall every day)
4- weigh less. 2 summers ago i got down to 253 at the end of july. I want to beat that this year (under 250) and go into winter slimmer.


I was just on the scale (woot! good numbers) and by every measurement I'm beating 31 year old Matt -- weight, the amount of biking/running/swimming done this spring, distance i can swim nonstop, the size of clothes i'm wearing (i'm on belt notch 4-5 instead of 2-3).

The only place I'm not significantly ahead is running- but I'm still getting my feet/calves/achilles in shape for forefoot landing. It's gonna be a few more weeks of this before I start putting on distance running, but it'll be worth it having a more efficient, less pain running stride.

Fit friends may help you lose weight

So, I was reading my latest copy of Men's Health and one of their little tidbits in the margin caught my eye. It referenced a study in the journal Obesity about how hanging out with fit friends may help you lose weight, even if you're not trying to.

Now, I'm pretty sure that hanging out with fit friends is already PHYSICALLY good for me. I run more/farther/faster, bike more/farther/faster, swim more/farther/faster, etc. But it's interesting that even if you aren't trying, there's a subconscious benefit where you try to emulate their behaviors (hopefully the good eating and exercise habits).

Now for a rant

WTF, we have an obesity epidemic and the frikkin journal that, literally, writes the book on the topic charges 32 dollars for a single article! You can get a year's worth of Men's Health (full of good information) for like 10 or 20 bucks. Maybe I'm not the target market for the fancy "journal". Guess I'll stick to my glossy magazine that shows up for nearly free in my mailbox every month.

Then again, I just read a bit of the abstract about the article...here, take a look

Despite significant efforts, obesity continues to be a major public health problem, and there are surprisingly few effective strategies for its prevention and treatment. We now realize that healthy diet and activity patterns are difficult to maintain in the current physical environment. Recently, it was suggested that the social environment also contributes to obesity. Therefore, using network-based interaction models, we simulate how obesity spreads along social networks and predict

blahblahblahblahblah. If the whole article is that long and drawn out maybe i should be happy with the 50 word version they stuck in my Men's Health

Oh yeah, thank's to my future brother in law Rob for the subscription-- great x-mas present bro

Cold, wet, miserable Triathalon (oh yeah, it was awesome!)

Bib number 125 didn't do nearly as bad as I thought I was going to at the Brookings "I'm Ready for Summer" Triathalon.

I woke up and looked outside this morning and said to myself

"Self--it's gonna be a cold, wet, miserable day".

And ya know what, I was right!

I loaded up my bike (in the car) and all my gear including essentials I'd packed last night like a sun visor (and neglecting unnecessary items like a stocking cap). After grabbing a quick breakfast to eat in the car and some coffee I was off-- headed north, jammin out to my new mix cd. About an hour later I showed up in Brookings and found the college wellness center and HPER. I looked at the drizzle and decided to leave my stuff in the car awhile while I looked around. Eventually I set up my bike in the transition area (with a plastic bag over the seat) near the exit.

A little before 10 (starting time) they gave us the pre-race instructions. Swimming was going to be 10 laps, 2 to a lane. They had a mat setup to walk across to start timing, then you could dive (or jump) in the pool to start swimming. After 9 laps the lap counter would put a kickboard in the pool to signal 1 lap remaining. I had a horrible lap partner (lane hog) which pushed me into the wall and ladder a number of times. grrr. My swim time ended up 11:36, or 65th overall.

After swimming I ran over to my clothes and towel and dried off as best i could, then slipped on my 2XU compression calfguards, socks, bike shoes, and long sleeve shirt. Down the stairs and outside to my bike where I put on my Heart rate strap, bike jersey, helmet and gloves(it was cold-- wish i had full coverage gloves). Out the T1 exit took just a few steps (I had a good spot) and I mounted up. I couldn't see anyone ahead of me to pass, so I just set my own pace. The heavy cross wind (from the east - 20mph or so) made the aerobars too tricky to use so I rode in the normal rode bike position. 3 miles in we turned East, directly into the wind. The aero bars were great on this stretch, letting me get lower on the bike. I kept seeing people coming back from the turnaround zone, but still nobody was around to pass (Did I mention I was 3rd from the last person in the water). I think if there'd been some rabbits I'd have gone faster on the bike.

Finally the turnaround zone beckoned, and I braked and pulled a quick U turn. Thank goodness the guys at Spoke just gave my bike a once over, the brakes (on such a wet day) worked great.

The next few miles until I turned south were fantastic. I averaged 25-26, slowing down to 22 on the gradual uphills. I passed one rider like he/she was standing still... and it felt GOOD!

After the turn south to town I saw another rider in the distance. I used the tree belts to drop in the aerobars and accelerate (rising back up when the wind came back) and caught & passed this rider as well. Eventually I made it in to T2 and hung up my bike. I pulled off my shoes (which were SOAKING wet) and debated changing socks- but then looked down at the puddle I was standing in and couldn't figure out how to change into dry socks and keep them dry. I ended up slipping my shoes on and taking off, ripping into some sport beans as I went.

The run around campus was wet. W E T. Well, to be fair, it was raining the entire time on the bike, but I didn't really notice it. Now I was cold and approaching miserable.

I kept sneaking glances behind me and saw 3 runners. They kept me going (the one guy blew by me-- he wasn't very fast on the bike but he sure could run)-- every time I thought they were catching up it'd give me another minute or two of running. At one point I could hear them talking and panicked, bursting forward for 100 yards or so. The folks putting on the tri had stationed college kids at nearly all of the turns- to check off as runners went by and to give encouragement/directions.

The most depressing stretch was when I saw the cone marking 3 miles and I couldn't see the finish. 3 miles! that's long enough. Where's the damn finish.

I hit the corner and turned and saw the finish and sprinted (just like Carl Lewis.. you should have seen it!) for the end. All my fans were cheering (oh wait, it was just the guy timing). I stumbled over to the door and heard them announcing winners and prizes inside. Apparently they figured I wasn't in the running and decided to start prizes without me.

Unfortunately, my times weren't in the computer when I left, so I had no idea how I'd done.

When I got home I pulled up my results on the computer

Swim: 11:36, 65th
Bike: 44:02, 40th
Run: 44:25, 90th (ouch. this needs work)
total with transitions 1:47:15, 75/95 overall

They didn't do a full breakdown by age, but I didn't do too bad for the 30-39 bracket. I did really well for the 30-39 Clydesdale bracket (pretty sure I would have gotten 1/1)

Now I need to figure out what race is next. The 10 day forecast for Siouxperman says no rain and 67 degrees... but can you trust a forecast 6 days out?

running shoes unnecessary

"I wanted the world to know that my country, Ethiopia, has always won with determination and heroism" -- Abebe Bikila, 1960 Olympic Marathon Gold Medalist. Barefoot.

I've been reading more about running barefoot (or nearly so). I saw on slashdot today an article where a ton of research was done (interviewing a bunch of runners before a race about their injuries). The biggest cause of injuries was not training, or age, or weight, or health-- but shoes. The more a person spent on expensive running shoes, the greater the injuries. Our foot was designed/evolved to need no padding or pronation control or shock absorbers. Also, the more expensive running shoes have big, heavy, powerful heels which make it nearly impossible to run without landing heel first.

Probably the most interesting part of the article is below-- I've copied the paragraph

In a paper for the British Journal Of Sports Medicine last year, Dr Craig Richards, a researcher at the University of Newcastle in Australia, revealed there are no evidence-based studies that demonstrate running shoes make you less prone to injury. Not one.

It was an astonishing revelation that had been hidden for over 35 years. Dr Richards was so stunned that a $20 billion industry seemed to be based on nothing but empty promises and wishful thinking that he issued the following challenge: 'Is any running-shoe company prepared to claim that wearing their distance running shoes will decrease your risk of suffering musculoskeletal running injuries? Is any shoe manufacturer prepared to claim that wearing their running shoes will improve your distance running performance? If you are prepared to make these claims, where is your peer-reviewed data to back it up?'

Dr Richards waited and even tried contacting the major shoe companies for their data. In response, he got silence.


There's also some interesting information about the Tarahumara tribe (apparently a short game of soccer/football for them is a couple hours of nonstop running. A longer game might last a couple days without stopping. They'd also hunt deer and other animals by literally running them to death-- as much as a hundred miles or more.

Another article from the New York Times discusses running shoes. A quote from the Doctor who's the medical director of the New York City Marathon, states

“Barefoot runners show up in my office very often because they’re not getting any control of their foot strike,” Maharam said.

The lesson here (which I've been focusing on) is that you can't just take away the padding and expect to have the same experience. Running barefoot (or in Vibrams) requires landing differently and (over time), strengthening the previously atrophied muscles. Walking and jogging barefoot it something that has to be worked into gradually-- a couple times a week.

On a side note, I decided since my calves are taking such a beating working far, far harder than normal, that some compression socks (minus the foot part) would be a good idea. My friends/workout partners/triathaletes Gabe and Jon have a triathalete supply store (www.trinationsports.com) hooked me up with a pair of 2XU Calf Guards (with personal delivery!).



I'm wearing them now and they're really cool. I think they work (they feel good) so if they only give me a placebo effect, it's still probably worth it.

Wedding

If it starts out with begging, it's probably not going to end well.

Wish us luck that the plane takes off and we get outta the state before it gets any worse here :)

My new shoes

my Vibram Five Fingers KSO (Keep Stuff Out)

There's no padding, just a rubber sole to protect your foot and teach your foot muscles not to be lazy. Since running (and landing on your heel) with a traditional heel strike is bad (braking action, and hurts your knees more) I'll wear these some of the time. Without the padding, it trains you to land with a midfoot strike, which is faster and easier on the joints.

Plus, they'll be great for the next couple weeks when I go here (with my soon to be wife) and here (for work).

Edited to add:

I wore these tuesday at the gym (walking and running). They feel great, nobody noticed (or they didn't say anything). I didn't have any pain in my shins/legs/knees from running, so that's good. I did notice the muscles in my calves/feet were getting tired quickly--they're so used to being lazy due to shoes -- so I kept it to 1.5 miles.

Then I took these to the pool. I swam 9 laps in them ( no problem) and then swam another 9 without. I didn't notice any difference in my times-- they don't help or hurt. They do stay wet a LONG time--I figure they'll be dried out by morning.

One of the nice things is that you can just drop them in the washing machine when they get dirty/stinky/sweaty and then hang em out to dry. Sweet!

What I'm reading

Chi Running - It's about teaching you how to run. Without pain, faster, etc etc. Seems important.

Ultramarathon Man - Dean Karnazes writes about his experience running really, really long distances.

and of course, too many twitter posts, facebook updates, and BikeSnobNYC snarkiness

I'm also done with the whole "being sick" thing of the past 2 days. Back to the gym/trail/rode tomorrow.

training slower to race faster

I was reading some information on Mark Allen's website about training and racing. (He did win the Ironman World Championships a record 6 times, including when he was 37 years old).

The relevant text

"So he told me to go to the track, strap on the heart rate monitor, and keep my heart rate below 155 beats per minute. Maffetone told me that below this number that my body would be able to take in enough oxygen to burn fat as the main source of fuel for my muscle to move. I was going to develop my aerobic/fat burning system. What I discovered was a shock.

To keep my heart rate below 155 beats/minute, I had to slow my pace down to an 8:15 mile. That’s three minutes/mile SLOWER than I had been trying to hit in every single workout I did! My body just couldn’t utilize fat for fuel."

Now, I'm not sure I can run at lower than 148 BPM (my number given the formula), but I can bike at that pace.

"And after nearly a year of doing mostly aerobic training, which by the way was much more comfortable and less taxing than the anaerobic style that I was used to, my pace at 155 beats/minute had improved to a blistering 5:20 mile."

So his speed increased from 7.2mph to 11.2mph at an aerobic pace, which burns lots of fat and causes fewer injuries. Sign me up!

Along those lines, I've been thinking about a lot while eating lately -- keeping out the processed carbs. I won't repeat the huge amount of information about insulin and glycemic index, but here's what I'm thinking...

1- If I don't eat as many carbs, I won't be able to work out at that HARD intensity that burns carbs instead of fat (see above). This forces me into lots of long, slowish miles which leave me feeling good and ready for more.

2- If I don't waste my calories on junk with no nutritional value (bread, pasta, potatoes, fried food, candy, etc) then I get to eat far more meat and real vegetables. More protein and nutrients has gotta be good.

3- When I need to, I can eat a bunch of sugar for extra energy. I don't know how this will affect biking--I'm thinking/hoping it'll be some sort of "rocket fuel" for the really tough times-- like the epic Bunyon to Bobs last year.

success

Success and failure. We think of them as opposites, but they're really not. They're companions - the hero and the sidekick.

~ Laurence Shames

Opportunity

"Opportunity is missed by most people because it is dressed in overalls and looks like work." - Thomas Edison

Cribbed from Keep it Street Level

failure

failure isn't falling down, its staying down

First ride of the year

Alex and I hooked up the half-wheel to the hybrid and went out for a ride today. We started from our place (right next to Sertoma park) and rode north. When we got up past the airport we struggled for the next 3 miles or so into furious headwinds (had to be 30mph). I think that stretch took us at least 20minutes, if not more. They hybrid is *NOT* good in winds.

Along that path some fab members came crusing by -- Darren, Greg, Gregg, Tammy and Road Legs. We met up at the falls ice cream shop for some treats before heading the rest of the way home.

Alex and I ran into Harlan, his wife and son by Spencer park so we chatted awhile before mounting back up (they were out walking because it was too cold to bike. hehe)

We made it through all the horrible puddles near Spencer park and eventually got home, just in time to pack up so he could head back to Mom's and so I could collapse.

As much as I complain about spin class, I have to change my tune
1- At least I had a dozen or so 'rides' in before today. Today wasn't so bad as a result.
2- 45minutes of non-stop legs spinning (the bikes are kinda like fixed gears in that they pull your feet through the motion) has really helped my pedaling. I used to have a lot of problems with "pedal, pedal, pedal, coast. pedal, pedal, pedal, coast". Today was great-- nonstop legs moving. When we got into the heavy headwinds it was hard, but my legs were up to the challenge.

tri training

Since my goals this year include

1- finishing a bunch of triathalons (preferably every one i enter)
2- not finishing last at each one
3- lose 50 pounds by september
4- not drown (again)
5- please my doctor (who would like numbers 3 and 4)

I hit the gym a ridiculous (for me) amount this week, including
210minutes of spinning class
36 minutes of running
157 laps in the pool
countless laps walking

The side effect of all this exercise is I have to go to bed early :( which I'm doing now.

spin spin spin to my lou

Spinning class is, umm, well, at least it gets my feet moving in a circle. I'd like to hit the pavement (when it warms up-- not from slipping on ice) in good shape ready to rock.

I've been hitting every spin class I can lately-- Monday, Tues, Thurs this week, with Friday at lunchtime. It still bugs me when the instructors give (in my mind) ridiculous instructions

"ok, we're coming to a hill, gear down and stand up". Yeah, when do i stand going up hills-- frikkin never.

or the most ridiculous, the one instructor wanted us to do some sort of standing sprint thing, but only 4 pedal strokes at a time! 4 pedals down, 4 up, 4 down, 4 up. I swear my knees were going to go flying across the room. I stopped that crap and just pedaled.

puppy

Omg I have a puppy!

First Tri

So the local gym (sanford) puts on an indoor triathalon each year (or at least, they did the past 2 years). Last year for various reasons I didn't go, and, well, we won't talk about that.

Anyway, I haven't looked at all the results, because seriously, it doesn't matter where I placed. I finished which was the only real goal. From here onward I'll worry about my relative times (Like I swam XX yards at YY pace). I don't need to win to prove anything to myself.

omg i'm not dead!

So yeah, poor blogging. Haven't been biking, so , eh.

What's new.

6 weeks to the wedding. invitations should have gone out. if you'd like to come and i didn't have your address or i didn't invite you send all complaints to my fiancee-- she's the reason you didn't get invited.

seriously tho, if you want to come (Friday, April 3 in SF) drop a note we can make something happen. Unless you don't like booze and cake.

Did a little run->swim brick today. Wow that was much harder on me than I'd have thought. The pool felt great after getting all sweaty.

Other than that, not much going on. The nice days lately make me want to get the bike out. Then we have a quick freeze and i retreat inside. Oh well, soon right?