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benanzo

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  1. ok, was he supine when his tongue dropped out of his mouth and hung there? that might require some effort on his part.
  2. ben was killed by: the original green goblin himself a falling condor broke his neck a gang of gypsies who wanted his bright red scarf in prague nobody knows what happened to ben, he just went away
  3. I should have clarified that she did not continue seizing throughout the remainder of the transport. The seizure lasted about 30 seconds followed by extensive postictal state during which she was protecting her airway and vitals remained stable. But the point of my story was just to point out that it is common practice for this pt to be initially evaluated as BLS and during transport the situation changes and the initial presentation compounds by these kinds of complications. I have only ever complained to the queen bee about this once because my opinions and thoughts were severely discounted because I work for the private BLS ambulance which apparently doesn't have much insight to offer. Unfortunately it's going to take some codes that were cleared by medics in order to get anyone's attention.
  4. it's the same thig, sometimes refered to as athetosis. his extremities were "posturing" in a way that closely resembled dystonia (dystonic posturing.) he had neurocystercicosis seen in CT. his ct was littered with calcified lesions....don't eat the pork in mexico. This is a CT similar to his. sorry this was kind of a dumb scenario, don't know where I was going with this.
  5. I'm a basic and we're trained in the mechanics of intubation and IV start but not allowed to do it. I learned those skills in an area other than where I work currently but just the fact that we were taught but not tested shows a clear intention of eventual transition of those skills to the basic level.
  6. yeah, I should have specified that one of the guys there was his half-brother who knew that he didn't have pmh. yes posturing was dystonic
  7. I actually feel like I'm arguing with myself on this issue. This scenario is perfect for the examples that I've given in other posts as to what is fundamentally wrong with my EMS system (Seattle.) We were called to transport a 50ish lady to the hospital for sudden onset CVA symptoms (droop, unilateral deficit, a&ox3, stable vitals.) This is a BLS call here. I have taken many of these patients to all ERs in the area with no second thoughts even though I have always known the POTENTIAL for serious complications which could arise at the drop of a hat. There was a medic pulling some OT on the engine that day (so she was operating as BLS) and said: "yeah, she's good to go BLS." But even if she hadn't been a medic none of us would have thought differently because it's protocol. Anyway...the lady had a seizure half way to the ER (which was only 10 mins away total.) She never lost her airway/pulse, stable vits the whole time....we wheeled her in and transferred care....end of story. I understand that if a medic would have taken the call from the beginning, she would have had a line/monitor/advanced airway capabilities right away. But the argument I keep hearing is that those things are always imperative on all calls...which simply isn't true. I agree that King County protocol needs to reevealuate whether BLS should keep transporting people with clear CVA signs...but that doesn't change the fact that a stable CVA fares just as well for the 10 min trip in a BLS rig to the ER as they would in an ALS rig and if complications arise we simply treat what we see and wait a few minutes for the medics. Complications which require immediate ALS intervention are rare when the pt presents as stable cva. However, it must be known that deep down I believe medics should do all transports for all patients so as to minimize those risks.
  8. it's not a matter of just being able to decide sick/not sick. There are way more factors than just knowing when to call medics. I am talking about knowing and understanding the specifics of transport and destination. They only ever see the first half of a call...nothing more, whether the pt went with medics or AMR, that is all they see. There is no transfer of care which is a huge part of field experience. Personally I think seattle has begun a slow transfer from BLS fire to BLS AMR as primary response. They just started a formal contract about 3 years ago and have had AMR respond to many calls instead of fire which I think is a clear example that the fire engine is being slowly phased out of EMS all together. It's inevitable given the rising operational costs and limited willingness for taxpayers to pay for what they don't use. I think every system will be privatized eventually.
  9. I think that we've misunderstood my intentions on this. I was not bashing the medics here. They are excellent and probably the best trained in the country but that alone is not making the system here great or even good. Medic One is terrific once they get a chance to do what they do. The problem is simply that the system is overwhelmingly BLS. The fact that the ALS/BLS decision is being made by EMT-Bs (Seattle Fire) who never see a call all the way through to the ER makes their scope of experience to decide that minimal at best. It seems that the private AMB company here, AMR has more experience with pt care than fire does. Every patient they see is one on one up close and personal gathering info and exam and then transfer to ER. That kind of experience is not part what the ffs are getting because when they see a pt they're in groups of 3,4,5???? very few of them have any good experience with report writing and exams and interpreting the results because they're not always the ones doing it. If I have to tell one more FF that hmc doesn't deliver babies I'm going to scream. they never see the end result of not taking someone into the ER on a board even though the mechanism warranted it...the nurse/doc doesn't call their station, no they grill whoever brought them in. There is very little accountability involved. I usually know if I did something wrong or if there was more I should have done when the ER tells me so. FF never get that criticism. But I'm not saying that AMR should take over as primary BLS response like some people here think they shoud....I think MEDIC ONE should do all transports. The city needs to divert funding from running ALS/BLS/BS calls with engines/ladders to buying more medic rigs and training more medics.
  10. not much to do in the field.... but some seem to think we should dx cases like this so I'd like to here some people's ideas I should have said he was posturing from the get-go
  11. You are called to a busy shopping mall to see a 35 y/o male unk medical. You arrive to find a man sitting on some stairs with two men sitting by him. He went to lunch 1 h 30 m ago. They say they called because when he didn't come back from his lunch break 30 min ago they came downstairs to find him. They found him sitting in his current position but wouldn't anwer any questions and had a distraught look on his face. His body was very rigid and was not appearing to comprehend any of their questions. You find him sitting upright alert but non-verbal. He gives no indication that he's comprehending anything around him. HEENT= PERRL, wont track, no droop, no signs of trauma neck/back=no jvd, no td chest=no dyspnea, clr = bilat, =rise and fall abd=soft, non distended, no masses VS= BP 154/80, RR 22, NSR @80, BS 110, O2S 98%RA NO PMH, NO Meds, NO Allergies After you lift him to your stretch he does a big seizure arch, big sound and lauches into 1 min grand mal. followed by 5 min postictal and then more seizures. Vitals stable throughout transport.
  12. medics don't have the monopoly on doing a good pe and knowing how to interpret the results. I am merely saying that there aren't effective prehospital ALS rx that will serve to reduce the long term effects of a CVA. A fast bls tx is what is needed. I will grant that cva can quickly become very complicated by the onset of cardiac dysfunction, seizures etc, which would require als intervention, but in an urban environment with mult hosps in close proximity, a fast BLS tx does the job. I am not saying that ALS should be ignored even if the pt presents with those complications early on, far from it. Those are clear ALS indications which require medic rx. But if normal loc/vs are presented, a bls crew should begin fast tx.
  13. "It is a reality check for all those people out there who think that training is more important than education, and that only skills separate basics from medics." But there were no ALS treatments that would have been necessary for that guy. I immediately suspected intracranial bleed...not surprising. fast trans to surg was what that guy needed, not a medic. That is why cva with normal LOC and VS is BLS run.
  14. As for not basing decisions solely on protocol, I loosely disagree. But you have to understand that I am evaluating from BLS perspective which means that I am not using all the tools that the medics would. I can only treat from their vitals and what I see. We don't use glucometers or oxymeters (I use the facility's when possible.) If I see someone who is barely responsive with huge resp effort, it doesn't matter what I think is going on, I'm using protocol to base my decision to call medics. Now, if I see someone who is overly altered with diabetic history, I'm also using protocol to call medics, even if they find his BS to be fine and send him along with me. His lungs were probably clear except for all the gunk in his windpipe. I only used that example because I have seen it consistently as being an area where there are mult. ALS indicators but the patient wasn't necessarily critical. This can be a fairly complicated situation to evaluate from a BLS perspective. The fact that he is almost completely unresponsive with severely labored breathing should trigger some sort of ALS indication...right??? Another example is a CVA with decreased LOC. A CVA with a normal LOC is a BLS call here. A CVA with altered or decreased LOC is an ALS indicator here. BUT, the medics usually don't transport that. These are just examples of potentially unstable situations that should be referred to protocol given the inevitable liability if the pt were to crash, which has happened.
  15. I am more than willing to have comfortable debate about this, in fact, I wouldn't have it any other way. I can understand how atheism can be seen as fanatical. But I'm not fanatical. I prefer to mind my own business when it comes to religious issues, especially involving work. If a patient specifically asks me to pray with them I will happily go through the motions. I would not discount their efforts to make their situation better, or be perceived to be better, in any way. My beef arises when the reverse is the case. I like the example of the pharmacist not giving contraceptives because it contradicted his religious beliefs. The last time I checked, pharmacists' licenses were awarded (as a priviledge) by the state authority requiring them to abide by the terms of that authority. That authority is funded by the state's tax-payers. I assume the seeker of that medication was a state tax-payer. If I were that tax-payer, I would confidently, and happily, sue the pants off that pharmacist, after buying my meds somewhere else. If I were that pharmacist, I would either fill the script and beg for forgiveness, or just spend the rest of my life in a cave with God.
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