Rose 🌹
@rosesusitation
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Paramedic Doodler 🚑🎨 Medical & Educational Illustration Live Minuting for conferences, symposiums & focus groups.
Joined June 2022
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Pinned Tweet
As promised here is a discount code for my new book :) this is for orders direct from the publishers so use this link
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On Friday we were looking at Palliative and End of Life Care. How many of you feel comfortable with the contents of Just In Case boxes? 💉💊
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Methoxyflurane. The little green whistle that acts like the green fairy without the hangover. What experience do you guys have of it?
#paramedic
#medicines
#pharmacology
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It's not an exaggeration to say that I was yesterday years old when I finally wrapped my head around what Mean Arterial Pressure (MAP) means in relation to Intracranial Pressure (ICP).
Remember, you guys don't have to know everything - I don't!!
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Paramedics, including me, often provide I.V. Paracetamol as an extra top-up of fluids when considering pain/pyrexia management in a hypotensive patient. It makes sense right? There's a wee 100ml of fluids to help out. No brainer right?
Wrong. 🧵1/8
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I was doing some bits on Atropine and kinda got myself confused let alone the students. So lets have another look over things....
#paramedic
#pharmacology
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I've been thinking a lot about 'being a paramedic' and how it can become a large part of your identity. It is a role I am proud of and fiercely promote (and apparently quite good at) but it is also a role that has irrevocably changed me and not always for the better. 🧵1/9
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Ever had a patient having an anaphylactic reaction who decides to start having a STEMI as well? No? Me neither, however if you do it's got a name: 'Kounis Syndrome'! Lets ahve a look: A 🧵
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Next in my
#alternativereadinglist
for
#paramedic
students is
@drkathrynmannix
's book on palliative and end of life care. It changed my opinion on aging and humanised death which allowed me to feel to turn difficult conversations into, it still feels wrong to say, enjoyable ones.
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With the start of a new term, I wanted to think about uncertainty (one of my favourite topics!).
A thread...🧵1/10
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How accurate are our expectations of ourselves and others when it comes to training as a paramedic? How do you feel your expectations as a student align with the educators around you? 🧵 1/10
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Ever feel like a pneumothorax? A bit deflated but equally under a lot of pressure (that you've mainly put on yourself)?
Yeah? Me too.
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For me, the secret to minor injuries is having a really good baseline knowledge of anatomy and physiology.
🚑As a paramedic, you don't need to know the names of all the ligaments etc but work as most injuries involve a combination of connective tissues.
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Teaching maternal complications today. Definitely a known rusty subject for lots of paramedics... Including me! I absolutely love learning from midwives - they make us look like a flappy bunch of muppets. I wonder how many services carry syntometrine? How did you use it?
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#Paramedics
, what is the most underrated yet useful thing that you use day to day as a paramedic? An amazing Pen? Caribener for the keys?
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Just saw a news report on the fact ambulance services are going to triage calls to GPs, nurses and paramedics rather than sending an ambulance. THIS IS NOT NEWS. WE ALREADY DO THAT.
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I had this realisation that one of the reasons, albeit a selfish reason, I like EoLC cases is because as a paramedic I always carried around such a high level of anxiety about any patients dying on me and it being because I did or didn't do something. 1/3
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#Paramedics
! Is anyone working in a
#notallparamedicsweargreen
role and willing to make a short clip about it for a HEI careers event?
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BOOK 2 In the "Alternative Reading List for Paramedics" is 'Listen' by
@drkathrynmannix
. I have been busy making up a session on difficult conversations for the first year students
@QMU_Paramedic
and it has been highly based on this wonderful book.
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Can we just take a minute to appreciate how unfriendly the maintenance of a CPD portfolio is for those with ADHD and/or dyslexia? Which most of the ambulance service is undiagnosed with. Surely a regulatory body could use other ways to monitor such as vivas?
#paramedics
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Well that's one way to knock the Imposter in my head out cold for a while...🥹⭐️
#STaRAwards23
@QMUniversity
@QMU_Paramedic
Thanks for the nomination - so grateful and honoured someone finds my doodles helpful ❤️
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Met office: We have some gusts of over 90mph coming. What warning do you want?
Orkney and Shetland: Ah yellow will be fine.
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Toxidromes are patterns of symptoms that can indicate an overdose of specific groups of drugs or medications. 💊
There are lots of similarities but also some specific symptoms to look for that can rule out one or another. 🧵1/6
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I'm doing a session on Coping with mistakes/failure/uncertainty/imposter syndrome for
@QMU_Paramedic
Any to add?
#parmedics
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I was speaking to some students about admistering
#naloxone
intranasally. They hadn't heard of these syringe toppers (a.k.a mucosal atomisation device) but only the prefilled nasal sprays. I loved using these south and maybe
@Scotambservice
would benefit from these on vehicles?
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@ScotRail
I am a paramedic sitting on the rear coach of the affected train and could assist but I can't get through to the front of the train!
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Alternative Paramedic Reading List BOOK 3 is "The Imposter Cure" by Dr Jessamy Hibbard. As paramedic we are constantly stretching our comfort zones which can leave us feeling exposed and vulnerable. When this happens over and over we can develop symptoms of Imposter Syndrome.
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Man, we paramedics need to get better at being like "oh you did that wrong ?" Me too! Rather than being like
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Exciting development. I have made a website (It's taken me a year to actually formalise this side hustle!) Feedback appreciated. I might even put some fun doodles on paper to buy... If you want it.
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Sorry it's been a while. Hope your hearts haven't *failed* without me...
👏
Segued perfectly, I'll be doing a wee thing on heart failure💔.
A Thread 🧵1/7
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On twitter I have posted books that I feel paramedics (students and qualified) should read. Typically in education reading lists are focused on textbooks however I think there are many books that might help create a more empathetic and resiliant paramedic. BOOK ONE🧵
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How many of you have heard of hEDS or HSD? Maybe some of you have heard of EDS or Ehlers-Danlos Syndrome? As a paramedic, I had heard of it but didn't really know much more than it being related to stretchy skin and being double-jointed. But there's waaaaay more to it than that!
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#Paramedics
we are running a session for our students on
#ImposterSyndrome
and would love to hear some of your experiences (especially at Uni, transition to qualified or maybe when you moved into a new role). Feel free to fill in the anonymous form below!
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I know it's impossible but I wish people could appreciate the ripple trauma affect suicides have on so many people from family, acquaintances, members of the public and even emergency service workers - we are not immune to it at all.
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FOR THE LOVE OF GOD PLEASE STOP REFERENCING THE MAYO CLINIC IN ESSAYS. Discuss.
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Just me having fun making slides for Abdomen pathophysiology for the second years next week.
Meet Gandalf the Brown.
P.S. Alright nerds, I know it is "You cannot pass in the books" :P
#paramedic
#lotr
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Because it's not like I had other things more important to do on the train this morning.
@Alex_Paramedic
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Good luck to my second years on placement. I hope you enjoyed your crafts and Pupsociate class today as a send off :) you'll be great! 🚑🐶🎨
@QMU_Paramedic
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#Paramedics
What's your weird and wonderful patients that give you the fear because they are so rare but can be really sick if things go wrong? I'm thinking tracheostomy, LVAD, sickle cell etc. Planning a session for
@QMU_Paramedic
Y3...
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I did something a bit different recently other than my standard paramedic doodles. Fancy something similar for your conference/lecture/symposium/focus group?
and following on from the spooky infographic... here is a fab representation of my talk
@lydiabonehealth
by the talented
@rosesusitation
👏🙏
@GCUEngagement
@GCUReach
@RoyalOsteoPro
@Sarah__Leyland
@KBrookeWavell
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I may still be using a visitor ID badge but at least I have a converted
@QMU_Paramedic
hoodie 🚑❤️
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Another interesting aspect of IV paracetamol is that one of the 'ingredients' is mannitol. Mannitol is used as a diuretic and therefore causes water loss, and therefore blood volume. Theoretically this alone might null the addition of 100ml additional fluid. 🧵6/8
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And this year's paediatric epidemic is Measles! Knocking Scarlet Fever off it's throne from last year. 👑
🧵1/7
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Laughed until I cried with a group of students today, that was a nice milestone in my teaching career 🤣
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Sneak peak of minutes from today's
@EuropeanLung
conference on Bronchiectasis. The final product will be available soon ☺️
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Yes, as clinicians we can make death better but the fact they die isn't surrounded by dread, fear and constant questioning from yourself and others. In EoLC cases, as you can stop worrying about your patient dying it becomes so much easier to focus on the person. 3/3
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@ScotRail
The conductor on this service has been spectacular at keeping us all informed. Hope the staff get the recognition they deserve 🙏
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This is an example of a time when being a paramedic who is aware of research and evidence-based practice is important. Paracetamol delivered by IV can actually exacerbate hypotension. 🧵2/8
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I tried to make one like this. This is better.
Shock: Key Features 🏥❤️🩹
#MedEd
#MedTwitter
#FOAMcc
#medicalstudents
#FOAMed
#TipsForNewDocs
#medicine
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This is how we need to change the culture of simulation in training paramedics. Mistakes are okay!
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BRACHIAL PLEXUS - Part 2 🧵
What parts of the upper limbs are affected? 🖐This diagram shows the different regions where the different nerves that make up the brachial plexus innervate.
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@Eurovision
I mean Abba have been right all along when they called us last night from GLASGOW 😉
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We can consider uncertainty as a form of failure. We don't know therefore = we are not good enough. We need to look at changing how we interpret uncertainty. Uncertainty does not equal incompetence. 10/10
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Were
@ParamedicsUK
looking into fatigue and looking at larks/owls and making rosters that fit into people's preferred sleep/wake cycles? I actually worked much better starting at 6am than finishing then. Do you think you could staff a station based on letting staff choose?
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What I think I find comfortable in EoLC is knowing that the patient is going to die and that's okay. I haven't done something wrong if that happens. That fear and responsibility is actually taken away from me as a clinician and more so in the patient's hands. 2/3
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On Saturday I am doing visual minutes for the Patient Bronchiechtesis Conference as part of the European Lung Foundation (
@european_lung
)
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We know that our dark humour and skeptical views don't always sit well with other HCPs let alone your friends and family. And it can be hard to adapt to normal life and people without things getting dark quickly. 🧵7/9
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Another way that Heart Failure💔 is categorised is by what part of the heart is "failing". This is mainly separated into left and right-sided heart failure.
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I would love to know how people go through life without losing every pair of sunglasses.
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Inadvertently on STV News last night...😅
Patients waiting 20 years for Ehlers-Danlos Syndromes diagnosis
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The cruelty of having a day off and craving a lie in but your brain is like "what is the German for chickenpox?" at 5:30am .
FYI it is Windpocken. 🐔
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Another fun arts and crafts session with
@QMU_Paramedic
3rd years looking at chronic diseases with a focus on the elderly. I was very close to bringing in some macaroni and clay...
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I would like to ensure my colleagues/students please do not panic re:my out of office. Please do not call mountain rescue. I am back at work but my phone fell down the mountainside. I am fine, but I can't change my OOO/see emails as I can't use Authenticator.😂🗻
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Can you guess who doodled that?
Week 2 of
#QMUFoodchain
free cooking classes for year 1 students. We made food to promote bone health. Tasty kale and broccoli salad with quinoa and tahini dressing, fish cakes and bean burgers. We even made crispy kale and butter bean humus. Yum! Still spaces available.
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It can be really hard to leave the job due to feelings of guilt, failure and a loss of purpose. There is the feeling of leaving a sinking ship and abandoning the rest of the crew(literally and metaphorically). Potentially feeling like you're not strong enough to do the job.🧵4/9
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Working as a paramedic, you have knowledge and skills that hold power and responsibility over the lives of others. The role can significantly and irrevocably change how you see the world and your way of thinking. Let alone all the unpleasant things that you can't unsee.🧵6/9
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If you liked the post on Uncertainty this book goes into waaay more detail. It's focued on Doctors but it can be applied to anyone making clinical decisions about a patients care (including paramedics). I'm hoping to write something more paramedic specific on the topic though!
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I always feel a massive wave of hypocricy when I comment that an essay is full of typos and grammatical errors then notice my feedback is also full of typos...
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When you have the best students in the world and they draw a picture of your child 😍
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Good luck to all my second years who are sitting their 💉Pharmacology 💊exam today! Please go enjoy the sunshine afterwards basking in the thought that it's done ☀️
@QMU_Paramedic
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Traditionally paramedics were trained to deal with life threatening emergencies. In the last decade that has changed. We are going to an increasing number of mental health concerns, minor illnesses, chronic diseases and lapses in personal and social care. 4/10
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Getting up at 5am and sorting out my uniform. Doing a shift? Naah just playing the crewmate for the first batch of
@QMU_Paramedic
3rd year OSCEs. Good luck guys! Just think, in a few hours the apprehension will be over ☺️
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The brachial plexus, what is it and why is it important?
Part 1🦴
The brachial plexus is simply the name for a bundle of nerves that travel out from the neck vertebrae and travel down through the shoulder to the arm where they innervate the arm and hand. 👋
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The mechanism behind this is not clear but several other drugs will cause hypotension when given IV or too quickly (TXA and morphine are others). However, due to the relative safety of IV paracetamol the fact that there are any risks at all could be ignored. 🧵5/8
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First off is "Poverty Safari" by Darren McGarvery
@lokiscottishrap
. It's no secret that a large portion of our patient population are living with the challenges of social and financial deprivation or involved with crime and addiction.
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So, altogether providing IV paracetamol as an additional 'fluid' is unlikely to be beneficial. This doesn't mean that you cannot provide it as an analgesic in a hypotensive patient, but just be aware that it will not be any benefit to their hypotension. 🧵8/8
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💊🧫💉One of my favourite jobs is when I can attribute a patient's symptoms to a medication. From a pesky side effect to a cascade of interactions that can result in a seriously unwell patient. A🧵1/4
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Unpopular opinion 2.0: Teaching everyone CPR is all dandy but what about teaching everyone the difference between when you need to see a doctor and when things get better on their own.
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I've had a lot of students with learning diffs come to me saying they find it easier to learn with my drawings. Ironically our automatic accessibility review software always says they are bad because they are not black and white and simple fonts.
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However, IV paracetamol preparations with mannitol resulted in more potent hypotension than those with the equivalent mannitol and saline. Therefore, although the mannitol may induce a diuretic effect, the paracetamol still has a more profound hypotensive effect. 🧵7/8
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I was speaking to the first-year students about grief yesterday and mentioned the concept of 'anticipatory grief'. The news of King Charles' diagnosis can be used to explain the concept. A 🧵1/10
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Another word that gets thrown around with heart failure is "ejection fraction" (EF). ⏏⌛This is the term used to describe the amount of blood pumped out to the body after cardiac systole. 1/9
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Just for clarification:
A) this is not saying don't give fluids in these patients, just IV paracetamol might not help patients who are hypotensive.
B) some people think that giving IV paracetamol might help a patient who is borderline hypotensive as a wee top up of fluids...
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... C) If you're confused by all this it probably just means you're already doing things right, as are those you practice with.
D) hey I used to do this and I've learned that it's not as clever as I thought. Reflection on action, we don't all qualify knowing everything .
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Did you know there are (at least) four kinds of Angina?
Stable❤️😶
Unstable❤️😮
Prinzmetal/vasospastic❤️😨
Ludwigs👅😰
Also, did you know that the word angina comes from the latin for "strangle" and that is due to the fourth form of angina - Ludwigs Angina.
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