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I said PID!? Extensive knowledge my white Irish ass. I may "only" be an EMT, but at least I have thirteen-plus damn years of effort behind each one. You're looking this stuff up in books and on websites.

After being married for 40 years, I took a careful look at my wife one day and said, "Forty years ago we had a cheap house, a junk car, slept on a sofa bed and watched a 10-inch black and white TV, but I got to sleep every night with a hot 23-year-old girl. Now ... I have a $500,000.00 home, a $35,000.00 car, a nice big bed and a large screen TV, but I'm sleeping with a 63-year-old woman. It seems to me that you're not holding up your side of things." My wife is a very reasonable woman. She told me to go out and find a hot 23-year-old girl and she would make sure that I would once again be living in a cheap house, driving a junk car, sleeping on a sofa bed and watching a 10-inch black and white TV. Aren't older women great? They really know how to solve an old guy's problems.

The ONLY thing the national registry does is write & administer test so that the various states don't have to spend their own limited funds to do the same. I lied: They also collect lots of money from folks forced to kowtow to their system because it's the only game in town. they are like the utility companies: A monopoly that you can't make a choice of where to take your business. As far as the adaptive CBT , it is supposed to be intelligent and sense where your strong & weak points are, & adapt the questions you see to go after your weak points until it is happy that you either don't have a clue : or really do know the material in their questions. Like anything "done by committee" , it is a compilation of what a large group of folks think you should be tested on.

I assume that I am not able to participate since I am no longer in the field, but I did pass it along to several people who are. I know what a pain in the ass research is, so I'm glad to help.

I have to agree with Wendy, although the clinical picture paints PID (and or associated complications) you say she says she is NOT being sexually active (again is she being truthful?). She needs a work up that includes labs (and an HCG cause Im still going to R/O ectopic), a pelvic, ultasound (especially if the HCG is up), etc. Does she have an IUD in place? Does she douche frequently? History of STD? As I said earlier the differential for this is long. She may even have developed a tubo-ovarian abcess secondary to salpigitis and require surgery. Bottom line she needs a hospital and a work up. I also have to agree with 1C. Kiwi I think you have a lot of knowledge and are passionate about your job. You do come across as a bit of a "clinical bully" trying to beat people up with your impressive array of knowledge and playing "I know this you don't therefore you're a poor medic" You copped an attitude with me... "a common misconception" well that's your opinion and you can certainly voice it but your bedside manner, so to speak, sucks. I don't like condecending attitudes and I would bet most other folks here don't either. Anyway like 1C Im done playing Kiwi's "Look how smart I am" changing scenario of Gyn doom. Thanks for the scenario bud have a good day!

Called to a seizure today (patient has hx of seizure) and nothing out of the ordinary with regard to the seizure. Patient was postictal upon our arrival, vitals normal minus an elevated pulse but when I put the Pulse Ox on the patient which is equipped to read CO levels as well it registered at 16%. Patient came around and was alert/oriented x 4 I called the FD to come down and test the levels at the scene which were normal. Continued to monitor the patient with our LP 15 in the hospital and it did decrease but remained above 10 throughout my shift. (I was only there about 20 minutes after dropping patient off) I apologize as I have no ABG's to report. Sinus Tach on the monitor, 12 lead showed no abnormalities minus sinus tach, Blood glucose 147, Patient was african american but mucous membranes were not red, patient denies head aches, incontinence or other S/S of CO poisoning. I placed the pulse ox on myself and it read 0% CO, I then placed it on a smoker at the hospital and it read 4% which indicates to me the machine was working appropriately. Any ideas what may have caused the elevated CO levels? Patient had been at the location where she had the seizure and the CO levels were reported to be normal for approximately 6 hours. Any ideas?

There is a huge differential on any woman who is old enough to have children (on the young ones too but some stuff can be safely ruled out). I don't know much about NZ prehospital care but in the USA what exactly is going on with the gal is not really a field medics job. Even an MD in the field without labs, ultrasound, X-ray, and limited in the scope of their exam, i.e. no pelvic/bimanual exam is going to go... hmmm. febrile, hypercapnic, dysuria.... could be this, or that, or whatever.... So in the USA we would transport to her hospital of choice where she would be worked up, figured out, and treated. If the doc/nurse/whatever asked what we thought was wrong the answer is going to be along the lines of what 1C gave as a hand off. Does she have an ectopic?? She denies...but patients have been known to lie, does she have a hot appy?? who knows, UTI?? who knows... thats what the hospital does NOT what the medics in the field do. Recognizing that the gal is sick and needs to be seen is the gold standard along with symptomatic treatment PRN. Once she hits the ED then the work up will point us to where we need to be. In your system you may do things differently so please rather then spank "us" for not trying to over think a patient*, tell how you guys would "pin point" her pathology in the field in the back of your ambulance. * Please don't take this as being anti-knowledge for EMS people but we have to recognize that difinitive differential diagnosis of complex medical problems is the job for the ED/Clinic etc. Having a good knowledge base is great and EMS eduction in the USA is lacking in many ways but I would rather have a medic in the field that says... "I don't know wtf is going on here, but this gal needs to go to the hospital." then one who says "Ooh damn this gal has hysterosalpigingiooophoritis and needs to see her PMD on Monday.." and be wrong! Cheer! Pave

Why do we care that much about scene time in this context?