That smells like ...

Have you ever noticed that Parmesan cheese smells like vomit?  Why you ask? Because Parmesan cheese and vomit is full of butyric acid.  Scientist will say that we traded our olfactory acuity for better color vision a long time ago, and therefore, smell has become a subjective experience.

This does not make our noses simple. Actually, three percent of our genome is dedicated to the evolution of 350 separate receptor types.  We have 10 million odor receptors lined in our nasal passage in an area the size of a thumb print.  Yet, we are comparatively less efficient in the sense of smell than other animals.  The point is this, when you smell something, the context in which you experience the odor is important.

So the next time your partner piles a mountain of Parmesan cheese on his plate of spaghetti, tell him to take a deep breath as you remind him of the last vomiting call you guys ran …


I know; that’s mean …but, how about it?

Let no man's ghost return to say ...

Most first responders are familiar with the “fight and flight” principle - our sympathetic reaction to a stressful stimulus, like fear.  Anatomically speaking, the amygdala, an almond shaped mass of nuclei located in the temporal lobe, is the structure at the very center of this fear response.  Its function includes arousal, memory, hormone secretion and emotional regulation, especially autonomic responses to fear.  It has been indicated in disorders like Post Traumatic Stress Disorders and panic attacks, to name a few.

The amygdala and our fear response are vital.  It prepares us to avoid or ward off danger; however, it can easily overcome our rational senses and ability to perform critical thinking.  After all, the amygdala is an “emotional” system.  The good news is that the amygdala’s complex circuitry is directly connected to our higher regions of the brain, like the prefrontal cortex, where decision making takes place.  The constant feedback loop embedded in our system allows for us to control our emotions - if we have practiced to do so.

As an example, pilots use a technique called “deliberate calm.”  When everyone else is panicking from fear of crashing, the well trained pilot remains calm and performs the necessary actions to avoid or reduce casualties.  Remember Captain Chesley "Sully" Sullenberger, the US Airway Pilot that successfully crash landed flight 1549 in the Hudson River? This is a perfect example of “deliberate calm.”

An interesting case study that more emergency services persons can relate to is the Mann Gulch Fire of 1949.  On August 5^th that year, smoke jumpers where dispatched to Helena National Forest in Montana for a small wild land fire. Of the 19 man crew, only three survived that day.  View this link to the Forest Service report written by Richard C. Rothermel in 1993. A must read for all firefighters.

The long story short, the fire conditions changed rapidly and pursued the smoke jumper crew up a hill.  The crew could not out run the advancing fire and 16 of the men perished. This tragedy was a severe blow to the Forest Service, which had not experienced a fatality during a decade of smoke jumping.  One of the survivors was the foreman, Wag Dodge. This excerpt from the fore mentioned report explains Wag Dodge’s actions:

“Dodge must have realized they could not reach safety and conceived the idea of burning away a small clearing. This escape fire, as it has come to be called, would quickly clear an area where the crew could go, after the fine fuels burned away, giving them a chance to escape the flames of the main fire. … Dodge sized up the situation better than most of his crew … No one stayed with Dodge.”

This ingenious idea of Wag Dodge to burn the fuel away from around him, giving him an island of safety, saved his life.  In more modern times, this technique is used by Wildland firefighters.  The escape fire technique was used by 73 firefighters who avoided injury and death after being trapped on the Butte Fire in 1985.  “The crews were well disciplined; no one attempted to run from the fire. They stayed together and followed orders even though they were badly frightened” (Rothermel).

The point of this post is this: Fear is a natural and vital emotion build into our neural circuitry. It can be helpful and detrimental.  As first responders, we walk into situations other people run away from; therefore, we have to train to control our response to the amygdala’s emotional input.

A quote from my first department’s training philosophy: "Let no man's ghost return to say, ‘My training let me down’."

“How about it!”

Anosognosia

Anosognosia is a condition in which a patient has a total lack of awareness about an impairment. A famous example of this is Supreme Court Justice William O. Douglas, when a debilitating stroke in 1974 paralyzed his left side and confined him to a wheelchair.  However, Justice Douglas completely denied his very obvious disability - calling it a myth.

Once again, the elegant writing of David Eagleman explains this syndrome effortlessly.  In his book, Incognito, he explains that “it’s not that Justice Douglas was lying – his brain actually believed that he could move just fine….The point about anosognosia is that the patients are not lying, and are not motivated by neither mischievous nor by embarrassment; instead, their brains are fabricating explanations that provide a coherent explanation about what is going on with their damaged bodies.”

As I hope you can realize, this is not a defense mechanism like denial.  These patients have a true syndrome rooted in physiological damage.  Anosognosia is common following brain injuries like strokes, but can occur in combination with other neurological impairment, too. However, it is not related to global mental disabilities like dementia or Alzheimer’s.  “Anosognosia can be selective in that an affected person with multiple impairments may seem unaware of only one handicap, while appearing to be fully aware of any others*.”

*Re: Hirstein, William (2004). Brain fiction: self-deception and the riddle of confabulation. MIT Press.

The Camel Hump

If you are a paramedic and learned to read ECGs, you are an expert at locating the J-point.  It’s not hard to do; the J-point is the point in the ECG where the QRS complex joins the ST segment.  Simply put, it represents the end of the ventricular contraction.  When the J-point deviates from the baseline along with the ST-segment, we should become a little concerned.   We will quickly look for the infamous STEMI, or try to identify a STEMI imitators like early repolarization or a bundle branch block, to name a few.  But when the J-point itself forms a deflection, spike or dome, or like I like to call it a “bump”, we refer to this most commonly as an Osborn wave.

Pictures copyright J.A.M.B-ing

It is called an Osborn wave, as you may have guessed, because it was named after a doctor named Osborn - although he was neither the first to discover this deflection nor describe it.  A quick search on Wikipedia will present you with other names for this wave, such as late delta wave, prominent J wave, hathook junction, hypothermic wave, and my favorite, the camel-hump sign.

J-waves--or Osborn waves--appreciated in the lateral precordial leads

Picture courtesy of sixlettervariable.blogspot.com/. Reproduced with permission.

The causes for an Osborn wave are varied.  Hypothermia and hypercalcemia are some of the more common reasons, however - to keep with the current topic of this blog - brain injury, subarachnoid hemorrhage, and damage to sympathetic nerves in the neck have been reported to cause this wave, too.

How about that?

Do you want some Cheese with that MAOI?

In this past century, neuroscientist have discovered many details involved in psychiatric and neurological disorders. They have also worked hard at developing pharmacological options with mechanisms that effectively cause “antidepressive” feeling in patient suffering disorders like depression and anxiety.  We have all heard about these drugs: the selective serotonin reuptake inhibitors (SSRI), tricyclics (TCAs), and the designer drugs like Prozac.  One other drug, the monoamine oxidase inhibitors, or MAOIs, will be the topic of this post.

One of the interesting facts about MAOIs is that although they are generally as effective as SSRIs and TCAs, they are used less frequently because of adverse reactions when mixed with certain foods containing tyramine.  Tyramine is a naturally occurring monoamine compound that acts as a catecholamine. As you may have guessed from the title of this post, this amino acid is found in cheese.

MAOIs act by inhibiting the activity of monoamine oxidase, thus preventing the breakdown of monoamine neurotransmitters and thereby increasing their availability.  When you combine the endogenous levels of increased monoamines with amino acids found in certain foods, you can quickly cause an overload of dopamine, norepinephrine and serotonin known as the “Cheese Effect.”

This can cause a storm of problems resulting in migraines and high blood pressure, just to name a few.  In the worst case scenario, a hypertensive crisis occurs that results in a hemorrhagic stroke. Ouch!

So tell me, how about it ... Do you want some cheese with that?

A Matter of Terminology

If you have ever walked into a nursing home, the chances are you have seen someone affected by Parkinson’s disease. Parkinson’s is the second most common neurological syndrome in the U.S. characterized by tremor, hypokinesia, rigidity, and postural instability.  This disease was named for Dr. James Parkinson, after he was the first to describe this “Shaking Palsey” that is a result of damage to the “black substance” in the brain we call the substania nigra.

In medicine, the term Parkinson’s disease is attributed to the syndrome when it results from an unknown cause.  If someone develops “Parkinson’s” as a result of a known reason, like carbon monoxide poisoning or medication toxicity, then it should be referred to as Parkinsonian signs and symptoms.

“How about that…”

Just a little nice-to-know side for EMS workers, one of the most common causes of Parkinsonian signs and symptoms is the long term use of antipsychotics drugs such as Haldol.

Some of my Photographs

One of my job responsibilities at my department that falls under the "as the chief deems necessary" is photographer.  One of my more favorite alternative responsibilities as a firefighter/paramedic.

Save the Penumbra

“Save the Penumbra” will be the new mantra of paramedics all over the United States.  This phrase will replace “Time is Brain”, an off-shoot of “Time Is Muscle” that is most commonly applied to heart attack treatments.  The issue is that understanding the processes that occur during a cerebral vascular accident is a little more complex than a myocardial infarction.

To start, the etiologies of stroke are varied.   We can place strokes into two broad categories.  We know about the hemorrhagic stroke that results in a space occupying lesion.  These CVAs account for about 20 percent of strokes.  The other category is ischemic stroke, which will be the main focus of my next few posts.

Ischemic stroke refers to a stroke that is caused by thrombosis or embolism.  These thrombi, or clots, can be caused by a number of pathologies, but most of my patients suffering a CVA have had a number of the underlying risk factors such as cardiovascular disease, atrial fibrillation, diabetes and hypertension, just to name a few.

Now, let’s imagine that a small terminal artery supplying a cortical region of the brain is compromised by a thrombus.  The distal tissues supplied by that artery will quickly infarct.  That is because neural tissue is not capable of storing any oxygen and glucose.  In my previous post, I mentioned that the brain consumes twenty percent of our energy. To put this into perspective, it only takes 10 seconds of disruption of blood supply to the brain to cause syncope.  The region of the brain immediately affected will die irreversibly in just a few minutes.  Our job is to recognize the signs and symptoms of stroke and get our patients to definitive care quickly.  So we can “SAVE THE PENUMBRA!”

Think of the penumbra as an umbrella.  Just picture the area surrounding the immediate infarct forming a cone shape around the dead tissue like an umbrella covering a head in a rain storm.  That is the tissue that can be saved.  The penumbra, therefore, is the “zone of reversible ischemia around the core of irreversible infarction.”

I will get into more detail in the next few posts, but until then ...

"How about that?!"

Our amazing Brain

Our brain is so amazing. I first got interested in neurology when I discovered a book written by David Eagleman, called “Incognito: The Secret Lives of the Brain”.  In it, he refined a complex subject into a compelling read -- and made me realize that I knew very little about the mission control center of my body.  Just to introduce the subject of neurology, I like to sum up some of the basic facts about the brain.  I have always appreciated facts and statistics that relegate the importance of a subject. So here is my version to introduce the human brain.

This pink-ish three pound organ encapsulated in your skull accounts for only 2 percent of your mass but consumes 20 percent of your resting cardiac output. It is an intricate system of 100 billion neurons “connected to one another in a network of such complexity that it bankrupts human language and necessitates new strains of mathematics” (Eagleman).  One-hundred billion is the same number as stars found in our galaxy. Each one of these neurons can make a thousand individual connections with other neurons, which communicate with each other at speeds faster than a race car can drive.  At its slowest, impulses travel between neurons at 260 mph.  And finally, try to put this into perspective: more electrical impulses are generated in one day by a single human brain than by all the telephones in the world. 

"Now, how about that..."

So This Is Blogging?!?

Hello world of blogging? I am "Just Another Medic Blogg-er" trying my hand at filling the world with more information.


I'm doing this at the moment because I am out on injured leave from a job I love.  I am trying to use my down time productively and read as much as I can, listen to as much as I can, and learn as much as I can ....


I believe in the motto: "See One, Do One, Teach One!" ... well, this is my attempt at "doing" and "teaching" ... hope it works out.


Currently I am learning a lot about neurology and neuroscience as a whole.  This is a subject that is so under taught to folks in the EMS and the First-Responder world, (at  least in my opinion.)  I will attempt to provide some "nice-to-know" info into this blog that I have been learning, and then we will see where it takes me...