Arachne

It's "scotoma", not "scatoma". A "scatoma" is an accumulation of feces that appears to be a tumor (http://www.fasthealth.com/affiliates/h_ths_nm/dictionary/s/scatoma.php). To save others the trouble of looking those words up: Scotoma is a blind spot, and diplopia is double vision (from www.thefreedictionary.com) As to the patient: Vital signs? (Do I need to explain why I want to know those?) Equal grip strength? How are her pupils? Confusion? Any other signs of CVA/TIA? What was happening before all this started? Was she sick? Was there any trauma? (just ruling things out) Is she orthostatic? Dizziness, vomiting, visual disturbances and head pain are all indicators for some sort of problem in the brain. As mentioned above, the combination of smoking and BCP raises her risk for blood clots, which could occur or travel to the brain, so I would be considering that as a possibility, which is why I'd like to know about the grip and pupilary response. I'd want to know about recent trauma and what was happening when this all started because a head injury could also cause these symptoms. I'm also wondering if this is some sort of hypovolemia issue (hence the question about orthostatics) - the vomiting, dizziness and visual and aural disturbances could be related to this. Perhaps not if she has those symptoms while lying down as well, but it's something I'd want to consider. BTW - that service doesn't run dual response anymore. For a patient like this one, they'd probably just have send A52 for "the transport" - they'd be lucky if the dispatcher was motivated enough to give a CC. EDIT: Apparently a bunch of us are writing at the same time - there are some entries that already cover some of this that weren't there when I started. My apologies for the redundancy of some of this.

My first code was like that...they sent a BLS truck for a fall, and we walked in to find grey skin, no pulse, no breathing. We're dispatched by a fire department that doesn't have real dispatchers - the firefighters rotate through dispatch. I guess it's too much work to ask, "Is he conscious?" or "Is he breathing?" when you can just say, "Yup, okay, we'll send someone over for a fall".

I try to say something like "Hi, I'm ......, what's going on today?" rather than "How are you today?", for reasons that people have mentioned above. On another note: I used to take this nice, funny old lady to and from dialysis. She was a bilateral amputee. Whenever she has a new EMT taking her, she tells them that they forgot her shoes, and that she really needs her shoes. She says some EMTs start to head back to get them, and the rest can't figure out a good way to say, "but you have no feet".

Seeing that video is like hearing about some guy who dresses up as a police officer to be able to kidnap kids/girls/whomever (or worse, a real police officer who abuses his authority like that), or hearing about priests molesting kids, etc. Some symbols/uniforms you ought to be able to trust, and it's very sad when that gets violated.

his wacker belt

I think that would take a miracle. In 7 years I've never had a pair of pants in which the waistband didn't bump into my ribs (or come above them), in which the hip-to-waist ration was reasonable, and only recently found some in which the side pockets are actually at my thighs, rather than at my knees. If I may add: 2a. And everyone wears the correct size - nothing skin tight on people that shouldn't wear skin tight clothing!

1. The addition of professionalism - consistantly clean & polite partners, some semblance of respect from hospitals, employers quicker to remediate or fire those who do not meet standards of care or professional demeanor and appearance. I think if we could all act like professionals, the respect and pay would come with it. 2. Nationally recognized, standardized, across-the-board (pre-hospital, in-hospital, etc.) living wills/DNRs. This would ideally come with a system to verify the existance/validity of a DNR without having to have the original sitting in front of you - perhaps via a serial number (like MA has) and a phone number you can call with that serial number to be sure that the DNR associated with that number and that person is valid & current (like MA does not have). 3. A nationally recognized EMS organization with the goal of improvement through increasing education and standards (as opposed to the current trend increased limitations and watered down cirriculi). I'd like to see an organization that is actively involved in EMS research and improving patient care, as well as working on #1 and improving how EMS is utilized and perceived. I'd also like to see this organization work with nursing organizations to improve understanding between EMTs and nurses (and therefore patient care).

I've never heard of a cheek impalement as an exception to "never-never-never remove an impaled object unless it prevents transport or prevents chest compressions". Sure it's in a textbook, but textbooks generally also say that we must adhere to local protocol - I'd double check with that. As someone mentioned above, removing something from the cheek could cause a lot bleeding (messy) and I've never been a fan of a lot of bleeding in or near the mouth due to risk of airway compromise. This seems like an odd answer to me because I'm not sure how it could be beneficial to remove the pencil. Are they worried that leaving it in will cause further injury? Is it somehow impractical to stabilize a pencil in the cheek? I'd be concerned about how deeply the pencil was embedded, at what angle, and what else inside the mouth it may have impaled. The patient should be seen by a doctor regardless (to close the wound, etc), so I don't see how the patient is better off if we remove it prior to ER arrival.

We use PD if at all possible...If nothing else, they have more restraint training and are paid a lot more than we are, so they may as well wrestle patients if they're there. Both places I work will happily even let me take PD in my truck to the hospital, which I've found helpful. If PD is not on-scene and the patient is not actively fighting us, I'll wait for PD. I'm small, I try to stay out of fights. For transport purposes, I personally like cravats, with one arm down, one arm up. We carry soft restraints, but they are cumbersome to use and if your patient is actively fighting you, there's no way you're going to get them on. I'm also a fan of backboards - not backboard sandwiches, but just regular backboarding with straps properly cinched and hands restrained with cravats. It also makes them highly portable - you don't have to remove restraints to give them to the hospital.

An overly-helpful organization "donated" animal oxygen masks of assorted sizes to the semi-volley service I work on. We now actually have to keep them on the truck, and are expected to use them if there are pets in need of oxygen on a scene (presuming all humans have been cared for already, of course). I'm just waiting for people to start calling us for their pets...

I can't be the only one to have said something generic like "Good luck" or "Hope you feel better" to hospice patients after you leave them at a nursing home/hospice floor. And overheard on the radio: EMT with a stutter: "We're going o-o-o-off a-a-at the Amy-Amy-Amy-Amy-Amy-Amy-Amy-Amy-Amy-Amy-Jeremy* Hospital" Dispatcher: "That must be a big sign" While transporting a respiratory distress patient, the EMT driving turned up the song with the chorus "Just Breathe" (I think it's by Alanis Morsette...) when it came on the radio. The medics in back were less than impressed. *Changed for anonymity EDIT: clarity

My company recently started using "Medic Ed" (www.mediced.com). I appreciate the ease of use, being able to do con-ed on my own time, and (supposedly) it will report your hours/credits to the National Registry or the states of MA/NJ as appropriate. In the end, however, it's not the same as live education. It's a pile of slides that you read and a 10 or 15 question quiz at the end. In theory they're one or two hour "lectures", but I can usually get through a "two hour" one in about 30 minutes. Some lectures are limited to ALS, but even ones that include BLS often have ALS questions on the quiz...it's tedious to flip through slides to find a dosage that you don't need to know because you can't do IVs, never mind give the drug. It is also very general - it does not help with specific information for your district/region/state. The major disadvantage, however, is that you can't ask questions, there is no discussion. You completely lose the benefits of interacting with a good lecturer and with classmates. A multiple-choice quiz is just not the same. As an overall tool, I don't find it as helpful as live training. I am unimpressed that our clinical coordinator/education coordinator has chosen this in lieu of live con-ed. It would be great if it was being used as a supplement, but in our case it has completely replaced live education, which I find to be overall detrimental. Perhaps "Use with caution" would be appropriate.

One more: "My wife is in labor at XYZ hospital and I need a ride" Upon further inquiry, it was discovered that the wife woke up in labor several hours prior, drove herself to the hospital, and the husband decided he should be there around 5 am, then called 911. When informed that we do not transport for non-medical reasons, he decided he had "anxiety", then stated in route that "well, I have medicaid so you're paying for this anyways". (He also signed the authorization for transport that states that if his claim is rejected, he is responsible, as well as two places where it states that he understands that medicare/medicaid may not pay. Last I heard it was going to court because the company is seeking payment because ::astonishment:: medicaid rejected it.)

"They won't deliver a pizza to my house and I want pizza." - elderly lady at 10 am (the toned "nature of response" was psychiatric....she was not a psychiatric patient, she was a cranky old lady who thought that 911 would send police to enforce pizza delivery)

John's Hopkins Univeristy did a study related to this. I no longer have access to PubMed, so I can't get the full article, but the abstract is below. It was published in The New England Journal of Medicine, Volume 352:539-548, Feb 10, 2005. It stops short of explaining death from a "broken heart", but addresses MI-like symptoms following a major emotional upset. The university website press release about the study: http://www.hopkinsmedicine.org/Press_relea...5/02_10_05.html Neurohumoral Features of Myocardial Stunning Due to Sudden Emotional Stress Ilan S. Wittstein, M.D., David R. Thiemann, M.D., Joao A.C. Lima, M.D., Kenneth L. Baughman, M.D., Steven P. Schulman, M.D., Gary Gerstenblith, M.D., Katherine C. Wu, M.D., Jeffrey J. Rade, M.D., Trinity J. Bivalacqua, M.D., Ph.D., and Hunter C. Champion, M.D., Ph.D. Background: Reversible left ventricular dysfunction precipitated by emotional stress has been reported, but the mechanism remains unknown. Methods: We evaluated 19 patients who presented with left ventricular dysfunction after sudden emotional stress. All patients underwent coronary angiography and serial echocardiography; five underwent endomyocardial biopsy. Plasma catecholamine levels in 13 patients with stress-related myocardial dysfunction were compared with those in 7 patients with Killip class III myocardial infarction. Results: The median age of patients with stress-induced cardiomyopathy was 63 years, and 95 percent were women. Clinical presentations included chest pain, pulmonary edema, and cardiogenic shock. Diffuse T-wave inversion and a prolonged QT interval occurred in most patients. Seventeen patients had mildly elevated serum troponin I levels, but only 1 of 19 had angiographic evidence of clinically significant coronary disease. Severe left ventricular dysfunction was present on admission (median ejection fraction, 0.20; interquartile range, 0.15 to 0.30) and rapidly resolved in all patients (ejection fraction at two to four weeks, 0.60; interquartile range, 0.55 to 0.65; P<0.001). Endomyocardial biopsy showed mononuclear infiltrates and contraction-band necrosis. Plasma catecholamine levels at presentation were markedly higher among patients with stress-induced cardiomyopathy than among those with Killip class III myocardial infarction (median epinephrine level, 1264 pg per milliliter [interquartile range, 916 to 1374] vs. 376 pg per milliliter [interquartile range, 275 to 476]; norepinephrine level, 2284 pg per milliliter [interquartile range, 1709 to 2910] vs. 1100 pg per milliliter [interquartile range, 914 to 1320]; and dopamine level, 111 pg per milliliter [interquartile range, 106 to 146] vs. 61 pg per milliliter [interquartile range, 46 to 77]; P<0.005 for all comparisons). Conclusions: Emotional stress can precipitate severe, reversible left ventricular dysfunction in patients without coronary disease. Exaggerated sympathetic stimulation is probably central to the cause of this syndrome.