Good morning guys. Another nice spring morning here in the city. There is a bird on my fire escape…no, not a pigeon but an actual bird. I’m having my cup of Ethopian roast from Red Rooster Coffee in VA (I use Trade Coffee subscription to get an assortment of freshly roasted coffee every few weeks). I used the Hario V60 pour over with a Niche coffee grinder. Weighed 25 grams of beans, ground to about medium-fine. 360 grams of 210F hard NYC tap water. 30 sec bloom (allows the CO2 to bubble out so I can evenly extract flavor during the rest of the brew). Around 4 pours. Total brew time was 3:30 min. Not the best cup I’ve made. Rating: 6/10. 7/10 because of the coffeeshop Spotify playlist playing the background — currently listening to Opaline by Novo Amor.
What can I fix? Make the grind coarser. And maybe reduce the ratio a bit. 25:340. Until the next morning brew.
So what here is my ramble of professional goals as a PA.
I have so many ideas and things that I want to achieve because lately, I’ve been reading or coming across things that peak my interest.
Pre-hospital Hypothermia/Cold Infusion
Having read half of Dr. Parnia’s Erasing Death, I’m inclined to see where there can be improvement in our outside hospital/pre-hospital resuscitation efforts. Does there need to be improvement? According to Dr. Parnia, yes, based on his comments on “zip code- based mortality.” Some areas get better survival rates based on EMT response, FDNY response, and proximity to hospitals that require hypothermic management post-cardiac arrest. Quality of compressions matter. Time is brain. I recently had a patient brought to the hospital with a downtime of about 20 minutes before EMS arrived at his home. What if there was a way to bring hypothermia to him before the hospital? What if we can train them to do this? What if I could somehow lead the effort to bring arctic suns to rigs? Or somehow place central catheters in the field for cold infusion? Of course, would have to also place a probe and make sure the patient is not in pulmonary edema or acute heart failure. I’m not thinking logistics now but these are ideas.
In order to achieve this “goal” I would have to train to become an EMT, EMT2 or a paramedic in order to become immersed in the pre-hospital scene. That would take less than a year to train but then to become experienced is another thing.
This bridges me to…
Mobile ECMO units. Europe and Japan are well known for their ability to cannulate in the field. These cannulations are usually performed by cardiac surgeons in the field (eCPR). However, what if the US was able to do “in-field eCPR” as well? Most countries don’t have Physician Assistants so what if we joined the effort with the cardiac surgeon? A mobile ECMO unit in the local area around the hospital would be cool. I would have to probably go into a cardiac surgery residency for a year and probably go to an ECMO program (like the Reanimate Conference) to learn and even start to achieve this. Again, the logistics would be so difficult and it sounds expensive to do, but I’m just rambling about random cool ideas.
Pulmonary embolisms intrigue me. Most of you know that about me already. PE diagnosis and management is constantly evolving. New thrombectomy and thrombolysis catheters are emerging. Trials are ongoing. The PE registry is growing. How cool would it be to be a PA on PERT? There aren’t any on there but to be part of the discussion with the cardiac surgeon, MICU attendings, IR and cardiologist would be awesome. One would have to be really well-versed in the latest PE stuff and trials. The MICU attendings at our hospital center are already so involved and on top of this stuff. There may not be a utility to having a PERT PA, but it does sound cool.
I can’t think of any more aspirations at the moment. But feel free to comment on what you think is cool or realistic. Or just read this and indulge me. Until next time.