The concept of Emergent Leadership is evolving as another practical leadership theory; we here at rightseatmedicine believe you may find inherent value in this concept for the prehospital enviornment.
What is Google saying about their hiring practices? Well, lots of things, (you can read the full article in the New York Times here) yet in summary; this is what one of the most successful companies is finding in relation to ideal candidate identification, successful behaviours and subsequent emergent leadership within their community.
“G.P.A.’s are worthless as a criteria for hiring, and test scores are worthless. … We found that they don’t predict anything.” He also noted that the “proportion of people without any college education at Google has increased over time” — now as high as 14 percent on some teams.
For every job, though, the No. 1 thing we at Google look for is general cognitive ability, and it’s not I.Q. It’s learning ability. It’s the ability to process on the fly. It’s the ability to pull together disparate bits of information. We assess that using structured behavioral interviews that we validate to make sure they’re predictive.”
AVR STEMI, Left Main Coronary Occlusion (LMCA), proximal LAD occlusion, triple vessel disease… worthy of your attention…for sure.
Will your LP15 flag this one as a STEMI for you. Unfortunately not.
In the setting of ACS, STE in aVR…
+ STE in avL = LMCA occlusion
+ STE in V1 = LMCA or proximal LAD occlusion
STE in avR > STE V1 = LMCA occlusion
STE in aVR not applicable in setting of SVT or in asymptomatic patients without ischemic symptoms
Regardless, the literature continues to show with increasing consistency that STE in lead aVR in patients with ACS is associated with more ominous coronary occlusions¹˜². aVR positivity was an independent predictor of in-hospital death³. As Dr Amal Mattu presents,
STE in aVR with other ischemic findings on ECG is BAD!
The National Outdoor Leadership School (NOLS) succinctly defines leadership as; situationally appropriate action/s that direct/s or guide/s your group to set and achieve realistic goals, and here at Right Seat Medicine we believe both highly appropriate and easily transferrable to the prehospital environment.
The NOLS 4:7:1 Leadership model allows us to separate the often ambiguous and overused term of ‘leadership’ into three distinct categories of 4 roles, 7 skills and one style. Continue reading →
Capnography now readily available to most paramedics and should be the prehospital standard of care for confirmation and continuous monitoring of intubation, as well as for monitoring ventilation and perfusion in any respiratory pt encountered. Additionally, it should see increasing use in the monitoring of any unstable patient of any aetiology, as well as optimizing trending within your perfusion assessment.
Traditionally (here in the Lower Mainland of BC) in line ETCO2 was used only for the confirmation of tube placement in the intubated patient. Many resourceful practitioners saw the value of this tool and creatively would snip away the in line T piece, inserting the now open hosing into a simple face mask and then having access to microstream™ capnography technology and real time ventilatory telemetry in the conscious patient. Continue reading →
Another exceptional text for the pre hospital diagnostician.
In the absence of lab results or technological wizardry to the street based pre hospital practitioner (here in the Lower Mainland or any service), this text will serve you well in providing the evidence based weighting of physical findings for application throughout your differential diagnoses.
McGee presents to us likelyhood ratios and statistical findings based in evidence that allow one to appropriately weight those physical findings of our patients as presented.
A thorough text that nicely encompasses the subtitles of our craft and assists with the evolving differential diagnosis of the pre hospital patient.