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  1. Yesterday
  2. Posting EKG's Potential Hipaa violation

    ok, in a facebook thread today, someone brought up that posting a 12 lead or just a ECG tracing is a hipaa violation even though you black out the patient name and identifiers. NO, you say it isn't, say it aint so!!. Well actually it is according to the article I will post below. The event ID of the tracing of the 12 lead specifically identifies the patient, not by name but by piece of equipment and a specific patient and can be used to trace it back to that specific patient, and in effect IS a hipaa violation, Here is a great article that was posted to this facebook thread: Your cardiac monitor identifier numbers related to number 18, and even if you get rid of the first 17, a resourceful person, albeit not very bloody likely, could connect the monitor identifier, patient identifier back to the patient and thus hit you with a Hipaa violation. Advice on this situation - BLACK OUT all identifiers in the top and the bottom of the EKG tracing when you post it to facebook for a case study or you post it here. The facebook thread I was on even said that many of the EKG review sites and case study sites have as a rule for posting that ALL identifying numbers and codes, names and any other numeric identifiers be removed prior to posting or the post will be deleted. It's a one in a million chance that someone will connect the dots, but do you want to be that 1 instead of the 999,999? I sure don't. Be safe out there.
  3. Last week
  4. NREMT Written test Paramedic level

    Welcome. You're right. No sense worrying about it now. What's done is done. Wait and see what your score turns out to be. Let us know.
  5. Today I just took the NREMT paramedic level written test. It was very very very difficult. I know everyone says that it makes you feel like you failed no mater how good you did. I passed all the tests through paramedic school and feel that I adequately studied including 2 months of one of those online test prep sites. The test shut off way sooner then I was expecting which reading other forums could be a good thing or a bad thing. I called the NREMT to see the 2017 min number of questions to pass the test and the lady said between 80-150 and my test ended around mid to high 70 maybe 80 I was not really paying attention. I see other forums say that the ended in the 70's and passed but I dont know. I feel that the questions were either really easy or really hard. Every test I have taken in prep of the NREMT was had one or 2 key words that que you in on what is going on such as pin point chest pain or long flight with new onset SOB or some other word that you could say "hey this is a PE but a bunch of the questions had a set of vitals and what is the patient most likely having? It reminds me of those joke questions where they go "if you have 3 apples and 4 bananas, what color is the roof?" I felt like a good 60% of the questions were like this. I now have to wait through the weekend to find out how I did so no point on worrying.
  6. Earlier
  7. Upgraded Software

    Ok, my first club BIFP's Big Important Fluffy Paramedics Now get me some membership criteria. List em out here.
  8. Upgraded Software

    OMG, Calvin and Hobbes! My all time favorite comic stopped and I went into a six month funk. How about a Spaceman Spiff Club? This made my day! Spock
  9. Medical conditions causing crush syndrome

    Off Label has a great post. I really do believe that obese patients that fall and can't get up for an extended period of time will exhibit signs and symptoms of crush injury. How long does that take is unknown but I suspect it depends upon BMI and the amount of tissue compressed. I've had patients with crush injuries from traditional causes (building collapse) and medical causes and they are very challenging. Prehospital concerns are acidosis, hyperkalemia, low BP, and pain. A crushed extremity that does not hurt is a very bad sign and will result in amputation and possibly death. Saw far to much of that in Haiti. May the tube be with you. Spock
  10. Upgraded Software

    That's pretty funny, Mike. Well played.
  11. Upgraded Software

    LOL. I can add reaction icons. Do you have suggestions? I fixed a few of the things that made the site look odd, like margins, etc....
  12. Upgraded Software

    Clubs, OOOOOOOOOOOOOHHHHHHHHHHHH so you mean like the Calvin and Hobbes club GROSS (Get Rid of Slimy girlS) club??? Can I be the first to make one? Please please please.
  13. Upgraded Software

    I can check on the reaction Icons. I may be able to add more. There is a new area called clubs. Creates a separate area for those that want to set up their own groups and conversations. Not sure how it will be deployed yet. I can see it being used for those that want to talk about their department or service. I would be interested in your thoughts on it.
  14. Medical conditions causing crush syndrome

    sure, just call me Plain, it's easier to type.
  15. Medical conditions causing crush syndrome

    Not just the obese. I recall attending a pt, elderly, frail, and quite small that awkwardly fell and landed with most of one thigh basically under her squashed against the ground in what would have been quite an impressive accomplishment if she was doing yoga...unfortunately she wasn't and was found some 8-10 hours later with marked visible discolouration (of what could be seen) to said limb. She had multiple co-morbidities including renal failure. Anyways, we treated her as per crush injury though she ended up having a cardiac arrest after being moved. ps. can we start calling you Plain? And for the OP. there was quite a good topic some time ago on suspension trauma, if you have a chance its probably worth a look.
  16. Medical conditions causing crush syndrome

    This is perfect. I believe this is my exact form of thinking but put into words that I can digest and fully understand. Thanks so much! Hey Plain, You are right my friend I see not benefit it getting an "answer anyone can cut and paste but it doesn't help me to learn. Imagine showing upto treat a patient and being like huh? Where my cut and paste treatment haha. Stroke patient is definitely a candidate I think anyone that can be immobilized without help is something that is a potential candidate for crush syndrome. Thanks
  17. Upgraded Software

    Once I was logged in and then closed internet, I logged back in and had zero issues. Are there only 4 reaction icons?
  18. Upgraded Software

    No log in issues here.
  19. Medical conditions causing crush syndrome

    I've only had a crush injury patient in the truest sense, where the patient or the extremity has been crushed by a heavy weight such as a car or a large weight. Obese patients after thinking about the true etiology of a crush injury I do not believe would be able to cause enough force on the extremity to sustain a crush injury.
  20. Medical conditions causing crush syndrome

    You might be drifting into the tall weeds here. To break it down, "crush injury" for the purposes here is distinct from blunt trauma, although blunt trauma is obviously a major component in the crush syndrome. Crush syndrome or injury or whatever you want to call it is a constellation of problems that are superimposed on the blunt trauma problem, and, as your question suggests, does not require blunt trauma to set in motion. So....the problems we've identified so far... 1. Massive liberation of muscle protein, myoglobin, into the vascular space leading to renal damage/failure (rhabdomyolysis) 2. Sudden release of severe, blood flow restricting limb/pelvis compression after an extended period of entrapment. Accumulation of anaerobic metabolites and cellular release of potassium from cell death, (to say nothing of vascular injury and thrombus formation) is capable of causing sudden and catastrophic cardiovascular collapse via sudden and profound metabolic acidosis and hyperkalemia. How can these present through a medical mechanism? 1. Rhabdomyolysis can occur when a poorly conditioned athlete attempts an activity that is far out of his depth, ie a marathon. Hyperthermic emergencies, diabetic emergencies, drug reactions, certain infectious diseases can all have the same effect. 2. As far as this goes, a scenario will be instructive...Say a poorly conditioned alcoholic is on a binge one weekend and spends the weekend on the couch drinking and goes into a fib (maybe has a history of p-afib). He ignores it and continues to drink until Monday when he sobers up. As the week progresses he notices pallor pain in both legs which he ignores for a couple of days until the pain is unbearable. He's admitted to the hospital for pulseless lower extremities 2/2 embolization of thrombus most likely caused by is immobility and a fib. Several days of no flow to both legs from a clot does the same thing as a two ton concrete block on the pelvis. When the surgeon fishes out those clots and reperfuses the lower half of the body, that "acid wash" will occur and the consequences are the same as if he were extricated from a building collapse...get it? Obviously, the severity of the syndrome with vary with the situation. While these things can occur, most times the degree to which they present are not clinically significant and resolve on their own with no treatment except rest and fluids.
  21. Medical conditions causing crush syndrome

    The fact that you are still asking these awesome questions are going to get you props from all of us here brother. Shows that you want to learn and just don't want to get it spoon fed to you. I would definately put the obese patient down as a candidate, especially an extremity that gets caught under their weight after they fall and are unable to get up on their own. Depressed patients, I'm not so sure. What about the stroke patient who falls, lands on the affected extremity and is not found for 2-3 days or even 6-8 hours?
  22. Upgraded Software

    and when i went to log in it seemed to have messed with my saved log in.
  23. Medical conditions causing crush syndrome

    I put a question to all of you here. When speaking in regards to immobilized patients and the compression of muscle tissue in a specific area causing crush syndrome that will release toxic metabolites/enzymes. Would you consider the following as potential candidates for crush injuries. Obese patients who can't walk but and are alone in their homes? Chronically depressed patients who mentally cannot move and live independently? Please bear with me As I am still learning so if my answer are incorrect please just correct my constructively
  24. Medical conditions causing crush syndrome

    Hi. Just want to thank you for your answer. Crush injuries and their associated causes and effects on the body formed a portion of a test paper that I have already finished. What I found was that Mosbys Paramedic textbook didn't provide me with enough information to actually fully understand the effects behind crush injuries further than the aspect of natural disasters and obvious crush. What I want to know and understand is how can a crush injury be caused by a not so obvious MVA, Building collapse and so forth. I have read ncbi and found it to very useful in digging further into the whole "pre-cursor" for crush injuries. Especially in relation to crush caused by an excessively overweight patient who has suddenly become immobilized, this was a very interesting read. I do appreciate your help in pointing me in the direction of additional information. Hi Off Label. I agree with your reasoning. However would the end organ damage exist if the crush didn't occlude the anatomical process that would have taken place without the obstruction. From my understanding the end of organ damage is caused by the release of the crush object or by an occlusion met when the crush has occurred. So far I have found this topic very interesting. In Australia up until recently the ANZCOR actually advised against removal of crush objects, however have moved away from this and recommended where safe to do so that they are removed. Thanks again for your feedback. Hi Spock, Thank you for this, you are right in so far as the DKA from a diabetic patient, in fact this was a case scenario in my workbook. I found researching it interesting. What I was further trying to understand is not so much the "cut and dry" of crush injuries causing toxic releases but more the other side of the equation where a medical condition may promote a crush injuries (DKA diabetic who is immobilized).
  25. Medical conditions causing crush syndrome

    Crush injuries are well documented in the literature. They are usually caused by trauma but can be from medical conditions such as the diabetic patient that passes out and lays on the floor for days before being found. Glucose levels are through the roof and the patient is in DKA. We saw a lot of crush injuries in Haiti after the 2010 earthquake and amputated many limbs. Biggest concern for crush injuries is the sudden release of toxins when the offending structure is removed from the patient. They become acidotic and will crash as fast as you can say boo. Have the bicarb and calcium ready along with plenty of fluid. The PA Department of Health has a decent crush injury protocol but I am biased because I wrote it. Most of my references were from the Israeli military since they have more experience than most. Actually, the first SAR teams to arrive in Haiti were from Mexico, Israel, and Turkey. Compartment syndrome, renal failure, and gangrene are some of the more dire results of crush injuries. If this helps to lead you on the correct path for writing a paper then I hope it helps. There are many good search engines for medical conditions and you should avail yourself of all except Wikipedia which can be written by any knuckle head. Spock May the tube be with you.
  26. Upgraded Software

    Hello everyone, We just did an upgrade to the software that has some major improvements. It did seem to mess with the look of the site slightly, but we will be working on that.
  27. Medical conditions causing crush syndrome

    well I figured how can you go wrong with the Medical Journal of the Armed forces of India? They seem like a pretty good outfit.
  28. Medical conditions causing crush syndrome

    Good article, Ruff... there are "medical" v. "traumatic" causes of the syndrome, which is actually a misnomer, IMO, because while the syndrome can be caused by crush or blast injuries, the actual cause of end organ damage isn't exclusive to trauma. It'd be like calling the effects of acute, significant blood loss a "syndrome" like "penetrating hepatic trauma syndrome". You can have the same "syndrome" from an acute GI bleed. Might be kind of splitting hairs, but there is a lot in medicine that is confusing that doesn't have to to the OP, the cause of the end organ damage that is caused by blast or crush injury is identified in the posted link.
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