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  1. Yesterday
  2. Bariatric Patients

    If they have no desire to take care of themselves, there isn't much that you can do for them no matter how hard you try.
  3. Old folks Still here?

    Wow. Hadn't realized that it's been almost a year since I was here. The joy of daily life getting in the way.
  4. Last week
  5. Old folks Still here?

    Well, at least some of you are still alive. I had to BUY a domain name, to get into an email, to use software.. and all of a sudden it starts populating with old email. And then I seen this place... and I was like, how the hell am I supposed to remember the password for that? Anyhoo.. Still have a pulse. Actually, every single time someone asks me how I am, I check my pulse and just stare at them.
  6. Two muffins are in the oven. One says, it's hot in here! The other says, whoa! A talking muffin!
  7. Stupid Joke

    Two muffins are in the oven. One says, it's hot in here! The other says, whoa! A talking muffin!
  8. The aggressive methamphetamine patient

    I remember being able to go to the local pharmacy, tell em you needed Novahistine with codeine and they would sell you a bottle. I could do it on a daily basis if I watned to back when but I think the last time I was able to do that was in the early 1980's if not the 1970's. My parents would tell me to go get a bottle of novahistine and bring it home. I also remember a pharmacist at the local Bruce Smith Drugs who gave me 90 days worth of all my medications instead of just the script amount. To say it was not well regulated or watch-dogged is an understatement.
  9. The aggressive methamphetamine patient

    The biggest problem was that the register for codeine based products was not compulsory. There is a good argument for some OTC Codeine to be available, either in conjunction with Paracetamol or ibuprofen. When it was initially approved for OTC sale there was supposed to be the implementation of an online register to control who, when & how much was bought. The pharmacists then lobbied through the big pharma companies to water this down & it became a voluntary register. This simply meant, like with anything, the honest people who use it for legitimate purposes, bought what they needed & when with advice from the pharmacist. Those who wanted to abuse the system simply found those pharmacies who did not participate in the register & went from shop to shop to purchase. In reality this has not really changed anything. If anything the supply & use of Codeine will actually decrease with an increase in other presciption meds such as Endone (oxycodone hydrochloride) & Tramal (Tramadol) increasing & becoming the drug of choice. They are easy to get & people will Dr shop & have other get scripts for them. Codein, in the OTC meds was safe & very low dose (15mg per tablet). The decision by our highly intelligent lawmakers to change this, while restricting the use of medical cannabis, is questionalble & could be easily resolved by reintroducing a compulsory online register. If, as a pharmacy you choose not to participate, then you are not licenced to sell it. Easy.
  10. I did a couple of stand by's at junior high and High school football games, Was asked several times if I would give the return to play authorization and I refused. I told them that I was no where near qualfied to make that level of decision. Pissed the coaches off to no end and they usually would call the parent of the player down on the field and the parent would make the decision. Needless to say, they didn't come to me after I refused the 5th time. Not putting my license in jeopardy when that type of decision is WAY the hell out of my scope. The liability is just too great and any EMS system making these types of decisions are taking a HUGE risk. I know of a ems system that was stand by at a rodeo. A young boy was hit pretty hard by a medium sized bull, the medics said he should not be riding anymore and needed to get checked out but he and his parents just took him back to the trailer and had him lay down and rest. The family left him alone and went back to the rodeo. When they returned the young boy had died and I believe it was ruled as closed head injury or maybe a bleed.
  11. Earlier
  12. Sorry I am so late to respond to this topic but I just saw it and have a unique background. My first career was as an athletic trainer and I worked at the high school, university and professional football levels and I have maintained my license to this day. I am also a paramedic, registered nurse and certified registered nurse anesthetist so I can say with complete certainty that EMS providers of any level and registered nurses are NOT qualified to make return to play decisions. Every youth sports team should make provisions for medical care during practices and games and certainly cost is a factor but isn't the safety and well being of the athletes more important? Relying on parents that are health professionals is done frequently but it is not always a wise choice. You pay the officials so why don't you pay the health care provider? Paying a local EMT or paramedic to attend games is reasonable as long as you recognize you are only getting somebody who can intervene in life threatening conditions and access EMS more readily than calling 911. My service is paid to provide one EMT or paramedic for youth football games and who ever works takes one of our response vehicles and can immediately summon a medic unit if needed. Frequently, they treat minor orthopedic injuries with a splint of some sort and the parents transport to the DEM for evaluation after signing a refusal form. Easy gig that pays OT so there is competition for the shifts. EMS folks who work sporting events should always say no when asked to make return to play decisions because as soon as the coaches realize you will always say no, they will quit asking. The best way to provide medical care for sporting events on any level is to hire a licensed athletic trainer. Yes, I am biased. Spock May the tube be with you.
  13. Paramedic vs. Firefighter/Paramedic

    I'm not going to weigh in on this topic either way because although I have worked as a paramedic and a firefighter, I never had to depend upon either profession to pay the bills. That said, I almost peed myself laughing over the comments by Van. Troll to be sure but I did find it funny in a sarcastic sort of manner. Choose a profession that allows for growth and a new challenge every day otherwise you will wither and fade into the dust. Spock May the tube be with you.
  14. Bariatric Patients

    To add a little more into the mix, there were 2 of the most respected physicians(one was the patients own physician) on scene with us, they left their offices to come help us. And let me tell you, they were really big helps. (hope you read the sarcasm) Competing orders, trying to sign papers to get him transferred directly up to the city so those big city docs could take care of him but we weren't about to transport this guy to the city on a flatbed. In the end, he spent 3 miserable days in the ICU at our facility and finally passed.
  15. Bariatric Patients

    What additional resources would have helped here?
  16. Bariatric Patients

    It’s sad to see patients suffer because of health related issues. We should be able to provide these patients with additional resources so they can improve their health.
  17. High Utilizer Care Plans

    In areas where I've worked these types of care plans have been individualized for the person in question. There was no template used as a basis for patient interactions. And honestly? Most of these care plans were "ensure patient and crew safety, transport to the ED". For some of these folks social work at the receiving hospital has had to get involved as the ER was seeing these folks as often, if not more often, than we were. If that's not a resource you've looked at yet they may be of help. Sorry this is not of more help. These are tough cases that usually don't follow a global script or fit into a neat template.
  18. High Utilizer Care Plans

    Does anyone out there have a template that they use for care plans that are disseminated to field crews on high-utilizer patients to help assist with clinical decision making? Trying to deploy a care plan template here and not super interested in reinventing the wheel if it already exists.
  19. New To Site and Thanks for Allowing Me

    Thanks for the invite. I've been doing this for so long that I look at everything on patients. Not just resp stuff. Get a big picture Look at home meds, labs, H&H, , BNP, CBC,creat, K+, Na, liver, renal panel, ammonia..it all plays the part..
  20. Bariatric Patients

    Yeah, there is that. But they said it was Sepsis that killed him but he was in no condition to fight that infection.
  21. Bariatric Patients

    I'd say he died from complications of obesity.
  22. EMS stuff..

    Bits & bobs to do with my job..! I work as a Paramedic Practitioner in and around the city of Sheffield in the UK.
  23. Paramedic BSc Education in Saudi Arabia

  24. New To Site and Thanks for Allowing Me

    Welcome! Love working with the RRT's! I'm an ER/Trauma nurse and always fascinated by the amount of knowledge you guys have, very valuable asset to the community.
  25. New To Site and Thanks for Allowing Me

    good to have you here 556Nato. I bet your user name has some pretty significant things behind it. It's good to have a RRT on board - been a while since we had one here. And we welcome most anyone with your type of experience. You can probably teach us a few tricks. Later gater
  26. Thanks for allowing me to introduce myself. I'm a BS, RRT of 26 years. Usually work ED and ICU. Intubation, trach changing, aortic balloon pump certified as well as arterial line placement, ACLS and PALS. I probably don't have much to add, but would enjoy chatting with you folks. I've been working with EMS half my life and enjoy you people and value your help. Thanks for letting me be part of your group.
  27. Intubation question.

    Hey EMS folks: new to the site. Interesting topics though. I'm a B.S., RRT-Clinical Specialist of 26 years. Cut me some slack, I'm not EMS. I enjoy working with you folks in ED. The right hand intubation method question, no idea. Never attempted it. I'm ambidextrous but always intubated left. That is until we started using the GlideScope few years ago. My strangest position with it has been intubating standing to the side of the bed and going backwards. Those instruments are amazing. As for regular larygascope, Mac or Miller, either work for me. Whatever the nurse hands me.
  28. Bariatric Patients

    We had to remove about a 10x10 part of a patients wall because not only was his family the proud owner of a bariatric patient but they were also hoarders and we had ZERO ability to get the guy out from his back room Parents enabled this guy and would go out and buy him thousands of calories per meal and not do anything about helping him address an issue that he had been educated on - overeating. He was proud of his 735 pounds and had plans of getting larger. He even had a girlfriend who was half his size. One day he didn't eat anything and his sugar bottomed out, even though he took his insulin and lantus, metformin and Victoza that morning which didn't help us in getting his sugar up. He also had a horribly infected foot caused by an ingrown toenail which thus caused him to get beginnings of sepsis. So we could not get this guy out of his room through his door, the window was a 4x5 window which didn't help. So we just cut a huge hole in his room wall, backed up a flatbed trailer to the hole and took 11 of us with a tarp to get the guy to the flatbed. Same amount at the hospital to get him off the flatbed. It was the longest 10 minute ride to the hospital I ever had. so embarassing for the patient, we tried to give him dignity during the transfer but by the time we had cut the hole in the wall it seemed like the entire town was there to watch. sadly, 3 days after admission he passed due to sepsis from the infected foot.
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