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I'm a medical provider, not a god. I can't make decisions whether a person lives or dies, I can only do what I can to a point, then nature is going to decide the outcome. If all the medicine in the world isn't going to save my patient, well, people die. It's their grief, it shouldn't be yours. Does it suck? hell yeah, you want to be empathetic, but when you have a run of bad calls like that you need to go back and think about the good ones where you were actually able to make a difference, because sometimes regardless how hard you try, you can't save everyone.
A & P has got to be the most difficult class to get a handle on it's just hard core memorization of the body systems and how they work. I can't offer you any real memory tips and tricks but I can provide this bit of advice. When you're learning about each system, think about how the body systems respond and are affected by variations down the line. Here's an example. Hypernatremia. How does the body respond? What the receptors detect is too much salt, so, to fix it, the brain tells the digestive system to drink more water. Does this decrease the salt content? No, but it dilutes it to the point of reduced risk to the body. In truth, hypernatremia is typically caused by dehydration. The salt content in the body is usually normal, but it's the water content that is reduced, resulting in higher serum levels. Hyper and Hypoglycemia are similar, Hyperglycemics have a loss of appetite, nausea, vomitting, frequent urination and excessive thirst. Why? The body is trying to prevent food (sugar) intake by getting the digestive tract to remove as much as possible, urinate as much as it can to remove the glucose from the body, and thirst to get fluid into the body that would dilute the glucose as well as feed the kidneys. Hypoglycemics are the opposite, they get hungry, wanna eat, not urinate, and try to get those glucose levels back up. A&P is likely the most important class you will take because you will learn to think about how things work in the body and more importantly, how they affect other parts of the body when they don't work properly. Once you get the hang of it, the rest of class will be a breeze because you'll be able to look at a patient's condition and with a reasonably high index of suspicion be able to identify the root cause of the problem. On another note, if I may ask; why is your user name the symbol for commerce and banking?
My understanding is that the pain is not associated with the injection site but more that the high pressures required for infusion result in discomfort beyond the site. Think of it like this, when we give an IM injection the patient is left with discomfort for some time afterwards. This is because we've created an artificial hematoma with that 1 cc of fluid and it is putting pressure on the surrounding tissue. The situation is similar in IO. the tissues are being forced to deal with increased pressures that they are unaccustomed to. So it hurts.
There's not a lot of medicolegal stuff in the EMT course Ruff, and if I recall correctly, there wasn't any mention of incompetent adults. It was just assumed that an incompetent adult would fall under the same criteria as a child. In essence, any treatments that would immediately reverse a life threatening condition are okay, but beyond that we need the permission of a guardian.
Our vehicles have a swivel airway seat. I'd flip it all the way around so it faces forward and have the kid ride there. He may turn his head around to see what's going on with dad and that's fine. Face it, if dad is really in that bad shape that the child may be traumatised, the damage is already done. He was with dad, alone, waiting for you to arrive. If he's going to be, the child has already been damaged by what he witnessed. I would think it might be therapeutic for him in the long run to be able to witness dad's demise rather than be sheltered from it. Here's a story, like you asked for in your intro thread. I got called to a scene by a husband whose wife has been suffering from depression and is threatening suicide. As we pulled up and my partner walked to the house and the husband answered the door. He told my partner what's going on and so on and so forth. Partner walked in and as I entered the room the husband lost his mind. He started screaming at me and yelling to "GET THE F___ OUT!!!" , "I HATE YOU!!! GET OUT!!!!" He's perfectly fine with my partner, it's me he's enraged with and I couldn't fathom why. My partner and I both left to discuss what's going on when the husband came outside. He's incredibly distraught and very remorseful for his conduct, and that's when I recognised him. Two years earlier I responded to a different house for what was eventually diagnosed as a SIDS baby. THEIR baby. My partner went in to talk to mom and I talked to dad. This was the first time I had seen him since they lost their daughter, and as we sat on the front step of their house, he shared what happened over the past couple years. When his wife couldn't wake their daughter he called for an ambulance. When we arrived I swooped in, grabbed his lifeless daughter away from his wife, and rushed out the door. The next time he saw his little girl she was dead. (Remember, it doesn't matter how dead someone is, when we leave the house actively working on a body, the family holds out some hope for survival.) I took away his chance for reconciliation. For years he harboured the envy that I got to spend his daughter's last moments with her and he did not, and he was jealous that I had taken that away from him. Even though she was long dead. His wife got depressed from the loss of their only child, their marriage began to suffer, their love life was non-existent, they became withdrawn, had to move in hopes of burying the memories and continued to spiral. Eventually she became suicidal and when I was called in, it was her third attempt. I was stunned, I didn't know what I should do. Here I was, a young EMT with only a few years under my belt and this guy is pouring his most private and intimate life details out for me. I hadn't learned the coping mechanisms that I have now. I had no advice I could give him. He was older and wiser than I, what could I do that could console him and start their healing. I tried to apologise, I tried to explain my point of view when we were called to his daughter. I didn't have the experience to be able to empathise with his pain. 6 months later they both committed suicide. 30 years ago there was a mantra, work every dead body, even if it's useless, it gives the family hope and time to prepare to grieve. After this call I changed my entire outlook when it comes to dealing properly with loved ones. I am entirely open, honest, and forthright regarding the care they are receiving. I would take a free moment during a cardiac arrest while my partners continued CPR and speak with the family about what we are doing and what to expect. I also invite family to come with us if we are transporting, regardless of how gruesome the call is. They don't see the blood and gore...they see their little girl or little boy. Just as your scenario, the child sees daddy, not daddy's intestines on the floor or blood squirting from an arterial bleed. Regardless the choice you make, the child will likely need some form of therapy, but the current thinking in many sectors is that being shut away from a family member in this way usually does more harm than good.
Welcome, you must be from Alberta. (edit, Oh yeah, I see that in your location now)
Ahh the exuberance of the NFG paramedic. I remember 30 years ago when I reveled in sharing war stories, competing with my co-workers to win the most bloody/smelly/disgusting/grossest, call competition.
Then I got old, and remembered that that bloody mess was once a child before he ran in front of a speeding train, or that smelly corpse was a rape and murder victim, or that disgusting oozing body was an abused elder, the memories from those stories have become the nightmares that wake me from my sleep.
I found this poem posted on a friend’s blog. He could not give me the name of the author, who I wish I could thank. It was titled For My Paramedic Friends Who Have Passed On. The medic stood and faced God. Which must always come to pass. He hoped his uniform was clean, He’d gotten dressed kind of fast. "Step forward now, paramedic. How shall I deal with you? Have you always turned the other cheek? To my church have you been true?" The medic squared his shoulders and said, "No Lord I guess I ain’t, cause those of us who wade in blood, can’t always be a saint. I’ve had to work most Sundays, and at times my talk was tough. And at times I’ve been violent, cause the streets are awful rough. But I never took a penny that wasn’t mine to keep… although I worked a lot of overtime, when the bills got far too steep. And I never passed a cry for help, though at times I shook with fear. And sometimes, God forgive me, I wept unmanly tears. I know I don’t deserve a place among the people here. They never wanted me around, except to calm their fears. If you have a place for me, Lord, It needn’t be so grand. I never expected or had too much, But if you don’t I understand." There was silence all around the throne, where saints had often trod. As there medic waited quietly for the judgment of his God. "Step forward now, paramedic. You’ve borne your burdens well. Walk peacefully on heavens streets. You’ve done your time in hell."
When blood sugar levels are low there is a potential for spontaneous glycogen release from the liver in diabetic patients. It's similar to what happens when glucagon IM is administered. Basically, what happens is that the patient is hypoglycemic and loses consciousness. Someone calls 911 and before the ambulance arrives, the liver releases the stored glycogen which converts to glucose. When the ambulance arrives the patient is alert and oriented, seems completely normal, and has a normal or near normal glucose reading. However, the glycogen is still a short tern solution and gets used up pretty quickly, so the patient bottoms out again.
I've simplified it tremendously here, but here are some links: https://en.wikipedia.org/wiki/Glycogen http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442155/ http://www.diabetes.co.uk/body/glycogen.html
Thanks Rock, my staff has all been trained in CAMATA and it's a requirement for employment. I'm thinking of targeting the student paramedics. More or less an aviation primer so they have a chance to actually witness how physiology is affected by flight as well as the safety and patient handling aspects that many of them may only see infrequently from a ground perspective.