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Showing content with the highest reputation since 09/02/2009 in all areas

  1. 12 points
    Mazrin, Exceptional first post! Welcome to the City! I noticed that you're not naive about the whole 'glory and teary eyed thank yous' that is so commonly associated with entry level EMS people. Since you appear to have your feet on the ground, let's get right down to 'brass tacks': EMS can be a rewarding career. It's got its 'up sides' and its 'down sides'. A lot of people aren't burned out on the helping people aspect as much as they are on the bullshit that's associated. Depending on the service you're with, you've got: 1. Small vollie politics and ass kissing to get ahead 2. Clicques that you'll find any place you work 3. The "You're nothing more than a warm body in a uniform" mentality of some of the larger services 4. The "You're just a mere Basic, while I am a PARAGOD!" mentality of some of the levels of EMS 5. The 0300 "I've got to go to the ER for this stubbed toe!" call Then there's fighting the 'trauma junkie' mentality that is very pervasive in this field. The disappointment of not being able to 'save the world' because you've got your EMT-B, and have been turned loose with peoples lives in your hands. Depending on the call volume of the service you're on, you may or may not get breaks, you may or may not get 'sit down meals', and you may or may not be returned to quarters between calls. In GA, (and other areas of this great country) the average wage for an EMT-B is about $10.00/hr. By the time you factor in taxes and other expenses; no, you're not bringing home a lot of 'bacon' at the end of the week. Because of this, you start 'jumping open shifts' as they come available. This can lead to relationship problems because you're never around, and you're sleeping if you are. Another 'relationship hazard' is not being able to talk to your 'significant other' about the calls, because a) they won't understand a thing you're talking about or you're trying to shield them from the 'yucky stuff' we deal with in the field. EMS is demanding work, and it takes a special breed of person to be able to deal with all that we come across in the field. Many will tell you that once it 'gets in your blood', it's hard to get rid of the urge to 'jump in and take control of a bad situation'. A lot of EMT-B's get 'burned out' because they're relegated to the IFT trucks, where you're not always viewed as a health care provider, but more of a 'horizontal taxi cab'. Because of this, most people tend to lose sight of the fact that for any private service, the IFT is the 'bread and butter' of the company. They also tend to lose sight of the fact that on an IFT truck, you're getting a myriad of exposures to establish and hone your 'bedside manners' and really get your 'hands on' experience. Then there are those that go into EMS 'blind' until they are called to their first MCI and realize that this is NOTHING like they thought it would be and can't handle the patients screaming in pain. (Why does it always seem that the patients with the minor injuries scream the loudest and longest?) EMS is never a 'steady pace', it's either 'feast or famine'. The calls may be hours apart, or they may be back to back....it makes it difficult (especially with a volly or on call service) to make plans for anything. Sick and injured people don't take holidays off, and usually the 'low man on the totem pole' gets to pull all the holidays... Bottom line: EMS is a field that takes some 'tough as nails' individuals that can learn very quickly how to separate the 'business' from the private life. Many people can't do that, and they end up taking the job home with them. You have to be able to balance being compassionate to your patients, and being able to 'shut it off' at the end of the day. This ISN'T a good career choice for those that want to just do 'eight and skate', who can't leave work at work, and who are just too 'soft hearted'. It is also not a good 'fit' for those that complete EMT-B and think that they're at the top of their game. There is no 'top of your game' in EMS, because our patients rarely, if ever, read the textbooks and act accordingly.....
  2. 12 points
    Dust forwarded this video. IT IS SHEER GENIUS. What a great way to vent frustration and identify an issue. I have told everybody to boycott the trauma show and A.J at JEMS is doing the same. I have emailed the link to everybody I know and they love it. I could not resist the chance to send the link to Randolph Mantooth. He'll laugh his ass off. I'll let you know what he says (he loves this kind of stuff). Again, sheer genius lurks somewhere in the confines of this list. Thanks for letting me in on it. Bryan Bledsoe, DO, FACEP P.S. There is an "E" at the end of "Bledsoe" (e.g., Drew Bledsoe). But, it's all good.
  3. 11 points
    I sent the memo to two of the EMS agencies (fire based, as are most around here) where I work. We are attempting to effect a cultural shift for the benefit of our patients. I guess we will see if it takes hold. There is no question that spinal immobilization is painful and anxiety provoking for nearly everyone. Patients often have back pain induced solely by lying on the backboard, pain which resolves not long after removal of the board, but which may prompt imaging in the ED due to pain and tenderness caused not by the presenting injury but by the backboard. We have seen harm in other ways: the demented elderly patient with a ground level fall who becomes more agitated from the pain and restriction of the board, the patient from the MVC with anxiety disorder who panics in the straps, the monstrously obese patient who has the equivalent of another person sitting on their chest and has to fight gravity to breathe. I've summarized below some notes from a presentation I have given on myths in EMS. The bottom line up front is that spinal immobilization on a long backboard has no evidence to support its use, but substantial evidence of harm. It is predicated entirely upon theories of injury that have never been shown. It has been taught dogmatically to EMS providers, nurses, and physicians for 3 decades, though there is now a swell of thought that we should modify the practice. Using a long backboard makes sense when pulling an injured person out of the water, or moving them out of a smashed vehicle, but once on the ambulance stretcher, movement is minimal, even with jarring movements of the ambulance. Being on a hard, slippy surface of a backboard will worsen that movement rather than improve it. The National Association of EMS Physicians is working with the American College of Surgeons on a position paper regarding backboarding. The gist of it is that we should eliminate backboards for anything but extrication. There's a few things I've discovered in the literature: Backboards do a horrible job of immobilizing the spine, and movement is worse on the backboard than on a soft surface that conforms to the patient. Patients who can follow commands can typically maintain stabilization of their own spine without assistance. Backboarding increases mortality in certain trauma patients. Backboarding does nothing to prevent neurological sequelae from spinal injury. Backboarding restricts respiration, which some patients cannot tolerate. Backboarding rapidly leads to skin breakdown and pressure ulcers, even after a short period of time, and is particularly hard on the elderly. I think there are some steps we can take to eliminate some pain and suffering and reduce some unnecessary imaging. Stop transporting patients to the hospital on backboards. Utilize the long spine board only for extrication purposes. Once the patient is extricated, using log roll or lift-and-slide technique, lay the patient flat on the stretcher and leave the c-collar in place. Do not ever immobilize a patient with penetrating trauma such as a gunshot wound or stab wound. Immobilization DOUBLES the mortality rate of these patients. Even with neurologic deficits caused by transection of the spinal cord, the damage is done; additional movement will not worsen an already catastrophic injury. Emphasis should be on airway and breathing management and rapid transport to a trauma center. If patient is being intubated, and manual cervical stabilization is hampering this effort, the neck should be moved to allow securing the airway. An unsecured airway is a far greater danger to the patient than a spinal fracture. Eliminate the "standing take-down" for backboarding patients who are ambulatory after an injury. Place a collar and allow the patient to sit on the cot, then lie flat. Patients who are ambulatory and able to follow commands do a better job of preventing movement of an injured spine than rescuers do. Selectively immobilize (with a cervical collar) only those patients at high risk for spinal injury or with clinical indications of spinal injury. Remove cervical collars on conscious patients that tolerate them poorly due to dementia, anxiety, or shortness of breath. Leaving the collar on and fighting them will encourage more spinal movement rather than less. Clear patients from any spinal immobilization clinically utilizing the spinal clearance protocol. This protocol indicates those patients who may require immobilization: High risk injury (high speed MVC, axial loading injury), focal neurological deficits such as paralysis, intoxication, age <65, and presence of midline bony tenderness of the spine. Patients without these findings may be transported without spinal immobilization. Patients who are markedly agitated and confused from head injury may not be able to follow commands with regard to minimizing spinal movement, and combativeness may also be a factor. These patients should remain on a backboard if the crew deems it safer for the patient, and this will be at the discretion of the crew. The above measures will reduce pain and suffering, reduce complications, decrease on scene times, reduce injuries to crews who are attempting to carry immobilized patients, and reduce unnecessary imaging costs and radiation exposure. There is no doubt that our crews will get some push back from the staff at the hospitals. Nurses or physicians may rebuke them for having the patient off the backboard. FD crews should be reassured that hospital staff does not determine their treatment protocols or operational policy, and that any questions can be directed to command staff or to me or to the hospital EMS coordinators. 'zilla, MD Hauswald M,McNally T. Confusing extrication with immobilization: the inappropriate use of hard spine boards for interhospital transfers. Air Med J. 2000 Oct-Dec;19(4):126-7. This was a survey of inter facility transport services. 18/30 interfac transport services immobilized for transfer, even if cleared by sending ER MD Additional 4/30 immobilized unless cleared radiographically No services moved pts to softer surface if known to have injury McHugh TP,Taylor JP. Unnecessary out-of-hospital use of full spinal immobilization. Acad Emerg Med. 1998 Mar;5(3):278-80. 51% reported no neck or back pain at scene of accident before full spinal immobilization 13% not even asked about neck or back pain before full spinal immobilization Haut ER,Kalish BT,Efron DT,Haider AH,Stevens KA,Kieninger AN,Cornwell EE 3rd,Chang DC. Spine immobilization in penetrating trauma: more harm than good? J Trauma. 2010 Jan;68(1):115-20; discussion 120-1. Twice the mortality rate in penetrating trauma if immobilized (14.7 vs. 7.2%) 0.01% had incomplete neurological injury and underwent fixation Number Needed to Treat: 1032 Number Needed to Harm: 66 Davis, et al: retrospective study of 32,117 trauma patients 2.3% with c-spine injury 10 patients with delayed diagnosis of spinal injury AND permanent neurological sequelae Bottom line: "hidden" spinal injuries which lead to paralysis are extremely rare Gerrelts, et al: Review of 1331 trauma patients 5 patients with delayed diagnosis of cervical injury None with permanent deficit Bottom line: "hidden" spinal injuries which lead to paralysis are extremely rare Platzer et al: 347 with c-spine injuries Of the 18 with delayed diagnosis, 2 had permanent deficit Bottom line: "hidden" spinal injuries which lead to paralysis are extremely rare Hauswald: 5 year retrospective review New Mexico vs. Malaya Malayan medics do not use spinal immobilization The difference: Malayan patients had less frequent deterioration and less overall neuro disability Limitations: Small numbers, different mechanisms (more MVCs in the USA, more falls in Malaya) Neuro decompensation occurs in 5% anyway, despite ideal attention to spinal immobilization. Spinal immobilization raises intracranial pressure 4.5 mmHg Manual In Line Stabilization (MILS) led to failed intubation in 50% after 30 seconds of intubation attempt vs. 5.7% without MILS Gruen, et al: Trauma mortality in 44, 401 patients. 2594 deaths, errors in 64. Failure to secure an airway in 16% of those If spinal immobilization led to a failed airway, then it killed the patient. Santoni: MILS doubles force necessary for intubation Santoni BG, Hindman BJ, Puttlitz CM, Weeks JB, Johnson N, Maktabi MA, Todd MM. Manual in-line stabilization increases pressures applied by the laryngoscope blade during direct laryngoscopy and orotracheal intubation. Anesthesiology. 2009 Jan;110(1):24-31. Totten, et al: LBB or vacuum mattress restricted respiration by 15% Bauer, et al: LBB limits respiratory function Respiratory failure is COD in 6% of trauma patients Hauswald: Substantial force required to injure spinal cord Post-injury movement probably not sufficient to injure the cord, even if already partially injured Chan D,Goldberg RM,Mason J,Chan L. Backboard versus mattress splint immobilization: a comparison of symptoms generated. J Emerg Med. 1996 May-Jun;14(3):293-8. Perry SD,McLellan B,McIlroy WE,Maki BE,Schwartz M,Fernie GR. The efficacy of head immobilization techniques during simulated vehicle motion. Spine (Phila Pa 1976). 1999 Sep 1;24(17):1839-44. 3 times more likely to develop pain with LBB than vacuum mattress Trunk movement still significant; no method with a LBB eliminates motion Konstantinidis A,Plurad D,Barmparas G,Inaba K,Lam L,Bukur M,Branco BC,Demetriades D. The presence of nonthoracic distracting injuries does not affect the initial clinical examination of the cervical spine in evaluable blunt trauma patients: a prospective observational study. J Trauma. 2011 Sep;71(3):528-32. 101 blunt trauma patients with c-spine injuries 87% had “distracting” injuries: rib fractures, lower and upper extremity fractures 4% had no tenderness on c-spine All 4% had bruising and tenderness of anterior chest Bottom line: "distracting injuries" are largely a myth. Horodyski M,Conrad BP,Del Rossi G,DiPaola CP,Rechtine GR 2nd. Removing a patient from the spine board: is the lift and slide safer than the log roll? J Trauma. 2011 May;70(5):1282-5; discussion 1285. Del Rossi G,Horodyski M,Heffernan TP,Powers ME,Siders R,Brunt D,Rechtine GR. Spine-board transfer techniques and the unstable cervical spine. Spine (Phila Pa 1976). 2004 Apr 1;29(7):E134-8. Del Rossi G,Rechtine GR,Conrad BP,Horodyski M. Are scoop stretchers suitable for use on spine-injured patients? Am J Emerg Med. 2010 Sep;28(7):751-6. Epub 2010 Feb 25. Log roll creates unacceptable motion Lift and slide technique creates less motion Scoop stretcher may be better as well J Trauma. 2009 Jul;67(1):61-6. Motion of a cadaver model of cervical injury during endotracheal intubation with a Bullard laryngoscope or a Macintosh blade with and without in-line stabilization. Turner CR, Block J, Shanks A, Morris M, Lodhia KR, Gujar SK. Source Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA. turchris@med.umich.edu Abstract BACKGROUND: Endotracheal intubation in patients with potential cervical injury is a common dilemma in trauma. Although direct laryngoscopy (DL) with manual in-line stabilization (MILS) is a standard technique there is little data on the effect of MILS on cervical motion. Likewise there is little data available regarding alternative airway techniques in this setting. This study compared intubations with and without MILS in a cadaver model ofcervical instability. We also used this model to compare intubations using DL with a Macintosh blade versus a Bullard laryngoscope (BL). METHODS: Complete C4-C5 disarticulations were surgically created in 10 fresh human cadavers. The cadavers were then intubated in a random order with either BL or DL with and without MILS. The motion at the unstable interspace was measured for subluxation, angulation, and distraction. RESULTS: MILS did not significantly affect maximal motion of this model in any of the three measures using either DL or BL. There were no clinically significant differences in maximal median motion in any of the three measures when comparing the two blades. However, there was significantly more variance in the subluxation caused by DL than by BL. CONCLUSIONS: We were unable to demonstrate any significant effect of MILS on the motion of an unstable cervical spine in this cadaver model. The BL appears to be a viable alternative to DL in the setting of an unstable lower cervical spine. Ann Emerg Med. 2007 Sep;50(3):236-45. Epub 2007 Mar 6. Manual in-line stabilization for acute airway management of suspected cervical spine injury: historical review and current questions. Manoach S, Paladino L. Source Department of Emergency Medicine, State University of New York-Downstate and Kings County Hospital Center, Brooklyn, NY 11203, USA. seth.manoach@downstate.edu Abstract Direct laryngoscopy with manual in-line stabilization is standard of care for acute trauma patients with suspected cervical spine injury. Ethical and methodologic constraints preclude controlled trials of manual in-line stabilization, and recent work questions its effectiveness. We searched MEDLINE, Index Medicus, Web of Knowledge, the Cochrane Database, and article reference lists. According to this search, we present an ancestral review tracing the origins of manual in-line stabilization and an analysis of subsequent studies evaluating the risks and benefits of the procedure. Allmanual in-line stabilization data came from trials of uninjured patients, cadaveric models, and case series. The procedure was adopted because of reasonable inference from the benefits of stabilization during general care of spine-injured patients, weak empirical data, and expert opinion. More recent data indicate that direct laryngoscopy and intubation are unlikely to cause clinically significant movement and that manual in-line stabilizationmay not immobilize injured segments. In addition, manual in-line stabilization degrades laryngoscopic view, which may cause hypoxia and worsen outcomes in traumatic brain injury. Patients intubated in the emergency department with suspected cervical spine injury often have traumatic brain injury, but the incidence of unstable cervical lesions in this group is low. The limited available evidence suggests that allowing some flexion or extension of the head is unlikely to cause secondary injury and may facilitate prompt intubation in difficult cases. Despite the presumed safety and efficacy of direct laryngoscopy with manual in-line stabilization, alternative techniques that do not require direct visualization warrant investigation. Promising techniques include intubation through supraglottic airways, along with video laryngoscopes, optical stylets, and other imaging devices.
  4. 9 points
    Does anyone else find it ironic that we are telling the OP not to believe everything he reads on the internet, on an anonymous Internet forum?
  5. 9 points
    It seems like we've been seeing a lot of new faces lately, and from them gaining a lot of strong, smart new members. In the spirit of the City I thought maybe we could throw out some ideas on how to be successful here? Here are a few of mine.. 1) Welcome. We're glad to have you no matter what your certification level, experience, education or what type of service you happen to work at. The fact that we're glad to have you doesn't mean we don't argue these points, it simply means that we value thoughts, and the people brave and kind enough to share them, from every point on the compass and political spectrum. 2) You can gain very little here if you don't participate. Learn here, where it's safe, to air your ideas and encourage constructive criticism. If you can't push yourself out front here then you need to question if you'll have what it takes to push yourself to the front when people are suffering. Also, doing so causes most of us some pressure, allowing you to learn to think with that pressure and accept the consequences of those decisions. 3) No one here, regardless of how it may sometimes seem, wants to see you fail, here or in your career. Too often it seems that criticism is considered derision when in fact the exact opposite is true. We thrash each other's ideas to make each other stronger, not to try and prove our superiority. There is nothing that makes the smartest people here happier than to see those that have been mentored here succeed and even surpass the high standards most often expected here. I'm always very aware when someone has commented on one of my thoughts that this is a smart, successful person that had better things to do, yet made time to help me try and get smarter. I try and remember to be grateful for that. Nothing makes me happier than to lose an argument, because it means that I've fought with every tool in my toolbox to defend something that seemed perfectly logical and evident to me, yet...I was wrong. And now, thanks to someone smarter, that fought harder, I don't have to continue to be wrong tomorrow. 4) Do not Google your answers and then pretend that they are yours so that you don't feel stupid. Being wrong isn't stupid. Being afraid of being wrong, and so allowing yourself to remain wrong is stupid. Give answers from your head, use your own brain, create your own logic trees, that is how you grow and become stronger. Think I'm kidding? Follow my posting history and you'll see some of the most idiotic thoughts you can imagine, but many didn't remain idiotic because I was allowed to work them out with help from my friends here. And when I say friends? I'm talking about some really smart folks that left my ego bruised and bleeding at the end of some gnarly discussions. 5) Please understand that when we critique your spelling and grammar that it is not to belittle you but to help you grow as a professional and separate yourself from the significant number of your peers that everyone else is laughing at every day. Hanging out is fine, but use that time to improve yourself. We all make mistakes. We're looking not for perfection, but for the effort that says you're trying. Spelling and grammar are a practiced skill. We all make mistakes, that's why we push each other to constantly keep practicing. 6) Chat is chat and the forums are the forums though often the two overlap. Please don't bring your playful chat dialog and insert it into forum conversations. Not because 'chat is stupid' because of course it's not. It's just easy sometimes to take the fun, carefree familiar attitude of chat and allow it to distract from conversation in the forums. Besides, most of the people reading the threads won't get your references anyway. One's not better than the other necessarily, they just don't often mix well. 7) Have fun, be brave, make friends, find mentors, ask for help, help others…but most importantly, use this as a resource. This isn't a place that you come to prove how smart you are, but to prove that you want to be smarter. Almost everyone here respects that. Some of the most intelligent people I've ever met I've met here and my life will never be the same because I was gifted with their patience and advice. Use them, but as you do, remember to be grateful and give back. And in case I was somehow not clear...If you see my posts, and you find a bad idea, wrong thinking, bad attitude, poor logic, spelling, grammar, and choose to ignore it to 'be nice?' I will never thank you for that. I will never be grateful that you allowed me to be weaker today than I needed to be..Just sayin'... I'm hoping that many here will add to my silly little list…what do you think guys and gals? Dwayne Edited about a gazillion times because, for some reason, the text I see in my edit window isn't translating well when posted. I don't think I'll cut and paste from Word next time. No contextual changes made. Formating only.
  6. 8 points
    It had to happen sooner or later....................... Blonde Men! A friend told the blond man: "Christmas is on a Friday this year." The blond man then said, "Let's hope it's not the 13th." ------------------------------------ Two blond men find three grenades, and they decide to take them to a police station. One asked: "What if one explodes before we get there?" The other says: "We'll lie and say we only found two." ------------------------------------ A woman phoned her blonde neighbor man and said: "Close your curtains the next time you & your wife are having sex. The whole street was watching and laughing at you yesterday." To which the blonde man replied: "Well the joke's on all of you because I wasn't even at home yesterday." ------------------------------------ A blonde man is in the bathroom and his wife shouts: "Did you find the shampoo?" He answers, "Yes, but I'm not sure what to do... it's for dry hair, and I've just wet mine." ------------------------------ A blonde man goes to the vet with his goldfish. "I think it's got epilepsy," he tells the vet. The vet takes a look and says, "It seems calm enough to me". The blonde man says, "Wait, I haven't taken it out of the bowl yet". ------------------------------------ A blond man spies a letter lying on his doormat. It says on the envelope "DO NOT BEND ". He spends the next 2 hours trying to figure out how to pick it up. ------------------------------------ A blond man shouts frantically into the phone "My wife is pregnant and her contractions are only two minutes apart!" "Is this her first child?" asks the Doctor. "No", he shouts, "this is her husband!" ------------------------------------ A blonde man was driving home, drunk as a skunk. Suddenly he has to swerve to avoid a tree, then another, then another. A cop car pulls him over, so he tells the cop about all the trees in the road. The cop says, "That's your air freshener swinging about!" ------------------------------------ A blonde man's dog goes missing and he is frantic. His wife says "Why don't you put an ad in the paper?" He does, but two weeks later the dog is still missing. "What did you put in the paper?" his wife asks. "Here boy!" he replies. ------------------------------------ A blond man is in jail. Guard looks in his cell and sees him hanging by his feet. "Just WHAT are you doing?" he asks. "Hanging myself," the blond replies. "It should be around your neck" says the guard. "I tried that," he replies, "but then I couldn't breathe". ------------------------------------ (This one actually makes sense...sort of...lol) An Italian tourist asks a blonde man: "Why do Scuba divers always fall backwards off their boats?" To which the blonde man replies: "If they fell forward, they'd still be in the boat."
  7. 8 points
    Greetings, Comrades. Rumours of my demise have been greatly exaggerated. I can't believe some of you actually bet money I was dead. If you did, may all your children be born naked! Anyhow, I'm down, but not completely out yet. Don't pull your bets yet, because they will most likely pay off this year. I took a long hiatus to avoid creating [more] drama here and distracting from the forum. I didn't want to start a pity party, but as some of you know, I've had serious health issues since my injuries in Iraq. I certainly won't be returning to practice. Or walking. Or even wiping my own arse. My piss glows in the dark. And it takes all the strength, energy, and coordination I have just to type this. But shyte happens, so I'm cool. Nuff said. No worries. I've been devoting my attention to spending my time with family and friends, who keep my spirits up. I'm not a real fan of Walt Whitman (after all, he's from NY), but I often echo his thought that, "I no doubt deserved my enemies, but I don' t believe I deserved my friends." My thoughts exactly, Walt. And many, many of you here are my friends, so I owe it to you to keep in touch. If I have ever pissed you off or offended you, either intentionally or unintentionally, I apologise. I only hope that you recognise that it was most likely my passion for the future of this profession that drove my tendency to get carried away at times. Of course, sometimes I'm just an arsehole, but I apologise for that too. No excuses. There's not one of you here (over the age of 21) that I wouldn't happily buy a beer and get small with. Especially if you're hott. Anyhow, other than the occasional trip to the doctors at the VA, my life is pretty much spent in this bed, in front of this piece of shyte Macbook, so I hope to start spending more time here. I dropped in yesterday and read through some hot threads, and it got my juices flowing like the old days. I do miss you guys! Life is not total boredom here. Family from Japan came to visit me two days before the earthquake and stayed for a week. It was great to see them, but I sure hated to see them return home. The next week, half a dozen colleagues I served with in Iraq came to visit me. These weren't just guys I was stationed with; these are all guys who were actually patients of mine at one time or another. One had been so seriously blown up that I was certain that he died after I put him on the helicopter. Today, he's alive and well and looking great. The scar from my trach is more obvious than the rest of his many scars, lol. He's not complaining though. And getting to see him again was the greatest thing I've experienced in the last three years. I truly hope that all of you have the opportunity to experience that kind of satisfaction once in your career. Okay, getting really tired now, so I'll catch up with you soon. Kisses (no homo, not that there's anything wrong with that). And don't drink any water in Iraq, Rob
  8. 7 points
    After a very long and trying week with everything meeting me at the door each and every morning and demanding my undivided attention at once, it was nice this morning to get a phone call that I have never ever gotten before in my life~~ Ring~ Me~ "Hello" Female Voice~ "Is this Tami *****?" Me~"Ummm, yes?" Voice~ "Well, you don't know me, but you know my husband." OMGosh....little voices in my head are running in circles yelling at each other "What did YOU do? Nothing, what did YOU do? Nothing I tell you! I've been sober for twenty years and haven't touched another ladies man....are you sure?? Yes,"......(okay, well you get the picture) Me~"Okaaay?" Then the "voice" starts out with a quiet little laugh that came across with slight embarrassment and then says, "I guess I just don't know where to start but here goes...You met my husband outside of the casino a few weeks ago. He was the one laying on the ground....." The memory comes flooding back easily, I had stopped at the casino on my way home from a meeting and as I was walking towards the hallway I suddenly felt a female security guard grabbing at the back of my jacket and pleading for me to follow her back outside where they had "a medical" down on the ground. Looking around and seeing no-one else following her I reluctantly followed her as she half ran back to the front of the casino where I was confronted with the sight of an older male lying face down in a pool of blood and several people standing around watching as another older male was feeling for a pulse. When I got close he locked eyes with me and said "I'm glad your here ma'am, he doesn't have a pulse." I went thru the usual questions quickly as I felt for a pulse and gathered the important information that despite the fifty people standing around, not one of them knew him and no one knew what had happened....the gentleman kneeling next to him tho tells me that he is an EMT "from 100 years ago" so I quickly inform him that we are now partners and CPR hasn't changed much so we proceeded to flip the gentleman over and begin CPR while the casino First Responders ran and got us an AED and BVM while we waited for the ambulance (did I mention I used to work for this ambulance? awkward) arrive we performed CPR. We managed to get a pulse back after one shock and I assisted ventilations with a plain old BVM while we waited for the boo boo bus to arrive. Seemed like it was a couple of hours but turns out it was only eleven minutes.... Just as we got a c-collar on the gentleman and had him loaded unto the spine board he lost his pulse again so we quickly loaded him into the back of the rig, restarted CPR, shocked and got a pulse back again. Long story short, I rode along with the gentleman to the ED in the back of my former employers ambulance (did I say awkward before?) where they stabilized him and flew him out to a higher level of care within the hour and I went home to wonder the final outcome. I have to admit that I googled his name a few times in the following weeks thinking that I would see an obituary and finally just kind of put it out of my mind.... Then the voice started to break up and said, "I don't really know how to tell someone like you Thank you for giving me 45 more years with the love of my life. The doctors told me that if you hadn't of been there and done what you did, he would not have made it. How do I tell someone thank you for that?" With a few tears in my own voice I replied....."You just did." Turns out he had a defib/pacemaker implanted and is back to his old self again....
  9. 7 points
    Alot of threads have been headed in this direction lately, and I personally have been questioning my own career longevity lately. Since I don't blog, I decided to write out my strategies to prolong my mental health, and career, and identify the problems we face as time goes by on the forum. I feel really passionate about this topic, and hope for alot of productive responses. First to identify the challenges: Although the number of years I have been in EMS is hitting double digits, the first time I was truly affected by a call was only about a year and a half ago. I was driving to my farm after treating a post partum hemmorage on a young redhead girl, I recalled all my actions from starting large I.V.'s to performing bimanual massage (not technically in my scope, but try stop me!). Eventually the hemmorage was brought under control, and all ended well for her. As I drove down the highway, I felt like I entered another atmosphere. Suddenly the air got thicker.... I became short of breath, the temperature in the vehicle seemed to rapidly increase, and I got a huge feeling of impending doom, as if something out of my control was going to happen. I pulled over and grabbed some fresh air, and it passed quickly. I thought to myself "man, that was wierd.... I must be dehydrated". I went to work, seeding peas that evening. While driving our 4WD tractor pulling our seeding outfit I crested a hill and looked around my fields, with no neighbors for many miles I got a feeling of being too alone. Almost immediatly, my patient from earlier came screaming into the picture, I could see her freckled face clear as ever, the innocent look in her eyes as she gazed at her first born through tears and wincing in pain as I assaulted her uterus in an attempt to control the bleeding. Finally I had to shut down the outfit, and get out to regain my composure. That evening I went in for supper, and my father remarked that I seemed "distant". I told him I just had a tough call, and needed a day or two to get over it. I returned home a day later (I farm somewhere else), to my wife and kids. My wife proceded to tell me about some problem she was having... likely something about what her sister said on the phone, or how one of the kids smart-mouthed her. I quickly shut her down, telling her she should be so lucky as to have a family. She had no freaking idea what I was talking about, but could tell I was not in the mood for chit-chat. The reason I told that story was to point out 2 very important warning signs that something is going off in the ditch. Warning #1 - Panic attacks. Seem to come on unprovoked, can be anything from minor hyperventilation and anxious feeling, to an all out bawl-fest Warning #2 - Deprioritizing the needs of the ones whom count on us. The story goes on...... Another week or two goes by and I have a dream: It is an older lady that I recognize, it is the first patient to ever go from living, to dead while in my care. We are in a crowded mess-hall, and I get that same choking anxious feeling. I immediatly get up out of my chair (in my dream still) and everyone is staring at me. The lady starts to bleed profusely from under her dress as she sits at her table, she looks oer at me and cries in a helpless crackling voice: "Marc.... I'm dying, you have to help me". I awaken from my dream with severe chest pain, I can feel my heart pounding, I am sweating profusely and can't catch my breath. I have to get up out of bed, and grab a drink to calm myself. I tell my wife about the dream, laughing as if it was no big deal. The next few nights are short, as I have difficulty falling asleep with images of the elderly lady, or the young redhead, or that stupid dream, flash through my mind everytime I close my eyes. As soon as I awaken while i am still laying in my bed a slideshow plays in my mind of faces of people I have treated, I keep seeing pictures of intercostal retractions on a tiny chest, blue lips, concaved chests from CPR, blood running down a cot mattress.... ugh... I gotta get up, no sleep in day for me! I attend some more rather critical calls, being the sole Paramedic for hundreds of miles around has it's perks, and it's challenges. 2 successful neonate resucitations, 1 shakin baby case with increased ICP, a few transfers to the city (3-4hrs away) for different reasons, couple intubated transfers and of course some routine lodge type calls.... all in all exactly what I am educated to do. Please don't let me fool you either, there are many days I don't even do a call. But as I have said before 3-4hr transports makes for some pretty long days too. I'll be honest with ya, I have alot of Paramedics dream jobs. Work from home, Salary nearing an RN, being the only Paramedic in this area the Dr's respect me, and the surrounding (BLS) services look up to me. But this brings great responsibility. like the responsibility I feel as I back up a crew with a pregnant trauma victim, and they look me in the eye and say "thank god you're here" as if I am going to ensure she will surive.... she didn't. Or the responsibility I feel when I get that Difficulty breathing call wondering if this will be the tube I miss, with backup many many miles away. But this is not exclusive to me. Yes I may be in an extreme setting, however those in air medical have similar resources. Even a overworked city ambulance may not have backup available. These are the regular stresses of the job. The problem is, if you do not deal with them, one day... they sneak up, and tear you down when you least expect it, just as they have done to me. So as I sit here now, on another night shift, with my heroic Paramedic eppaulettes, and my tactical looking narc pouch on my side, I feel totally unprepared for battle. I have lost the will to prepare or seak out a good healthy meal, I am not sleeping as much as I should, and I am pretty quick to snap at my family since thier problems are not "real", not like the problems of my patients, so i have no time for them. This brings me to Warning #3,4&5 Warning #3 Failing to maintain a balanced diet & excersise Warning #4 Sleep disruption Warning #5 Flashbacks So just what do I intend to do? Well here is my plan of action to increase my longevity in EMS Find an arbitrary confidant. An EMS provider from outside this area I can bounce calls off, and discuss treatment without too much judgement. Someone without thier own agenda of always "1 upping" as we often do Make a conscious decision, starting today, that fast food is no longer a part of my life. It can and will be avoided. Fast food is a fast track to failure in this industry. Occasionally seek a professional: Periodically I will be making an appointment with a mental health professional. i go for physical checkups.... why not mental health checkups?? Make sure holidays are not EMS related. This means no popping in to staff meetings during holidays, no wearing wacker gear, no scanner, no accepting cell phone calls from co-workers, nothing! Just family, and friends. Find an outlet: I loooove being alone, but with a family of 5, it is harder and harder to do. I need to find an outlet where I can be in my "happy place" and organize my thoughts and do some filing. I think I`ll buy a vintage car to tinker on. I always think of my life as a car, I am driving, but right now all the shit that should be in the trunk is cluttering up the dashboard and making it hard to see what is ahead, and for some reason I have a HUGE rearview mirror I can't stop staring into. It's ruining my driving experience, and I know I am headed for a crash. Define the line between work and home. This has gotten to be a grey mushy mess, I spend way too much time writing work emails and work related calls from home. That is not nesessary, when I walk into my house, the uniform shirt gets hung on a hook, and THAT is my mental signal - switch - You are a husband, father, son, and brother now. Thoughts?
  10. 7 points
    I am not trying to sound like a jerk, but I learned this lesson a long time ago: You decide what kind of day you will have every day. You can not let others control your life, which is what you do when your blood pressure goes up over what someone else said or did. The minute you show any emotion because of what someone else did, you have given them control of your day, it is like you are a puppet on a string. Example: If I said something mean about your momma right now, it could piss you off to the point of you punching me. But on the other hand, you could say "crotch does not know my momma, he has never even met me, so therefore he is trying to piss me off and control my day". Let it roll off of your back, its not worth being upset about. I worked for a large urban system that was on 24/48s and the shifts were brutal with the normal EMS abuse you would expect. I went to work cussing and I came home cussing. Then they switched to 12-hour shifts, and I figured out I could transport 6 patients, or not transport 10 patients. Once I quit argueing with the dumb patients and just started transporting, all the stress was gone, and my smile returned. When I saw that change I realized I had been letting others control me.
  11. 7 points
    1. I think part of a best friend’s job should be to immediately clear your browser history if you die. 2. Nothing sucks more than that moment during an argument when you realize you’re wrong. 3. I totally take back all those times I didn’t want to nap when I was younger. 4. There is great need for a sarcasm font. 5. How the hell are you supposed to fold a fitted sheet? 6. Was learning cursive really necessary? 7. Map Quest really needs to start their directions on # 5. I’m pretty sure I know how to get out of my neighborhood. 8. Obituaries would be a lot more interesting if they told you how the person died. 9. I can’t remember the last time I wasn’t at least kind of tired. 10. Bad decisions make good stories. 11. You never know when it will strike, but there comes a moment at work when you know that you just aren’t going to do anything productive for the rest of the day. 12. Can we all just agree to ignore whatever comes after Blue Ray? I don’t want to have to restart my collection…again. 13. I’m always slightly terrified when I exit out of Word and it asks me if I want to save any changes to my ten-page technical report that I swear I did not make any changes to. 14. “Do not machine wash or tumble dry” means I will never wash this – ever. 15. I hate when I just miss a call by the last ring (Hello? Hello? **** it!), but when I immediately call back, it rings nine times and goes to voice mail. What did you do after I didn’t answer? Drop the phone and run away? 16. I hate leaving my house confident and looking good and then not seeing anyone of importance the entire day. What a waste. 17. I keep some people’s phone numbers in my phone just so I know not to answer when they call. 18. I think the freezer deserves a light as well. 19. I disagree with Kay Jewelers. I would bet on any given Friday or Saturday night more kisses begin with Miller Lite than Kay. 20. I wish Google Maps had an “Avoid Ghetto” routing option. 21. Sometimes, I’ll watch a movie that I watched when I was younger and suddenly realize I had no idea what the heck was going on when I first saw it. 22. I would rather try to carry 10 over-loaded plastic bags in each hand than take 2 trips to bring my groceries in. 23. The only time I look forward to a red light is when I’m trying to finish a text. 24. I have a hard time deciphering the fine line between boredom and hunger. 25. How many times is it appropriate to say “What?” before you just nod and smile because you still didn’t hear or understand a word they said? 26. I love the sense of camaraderie when an entire line of cars team up to prevent a jerk from cutting in at the front. Stay strong, brothers and sisters! 27. Shirts get dirty. Underwear gets dirty. Pants? Pants never get dirty, and you can wear them forever. 28. Is it just me or do high school kids get dumber & dumber every year? 29. There’s no worse feeling than that millisecond you’re sure you are going to die after leaning your chair back a little too far. 30. As a driver I hate pedestrians, and as a pedestrian I hate drivers, but no matter what the mode of transportation, I always hate bicyclists. 31. Sometimes I’ll look down at my watch 3 consecutive times and still not know what time it is. 32. Even under ideal conditions people have trouble locating their car keys in a pocket, finding their cell phone, and Pinning the Tail on the Donkey – but I’d bet my ass everyone can find and push the snooze button from 3 feet away, in about 1.7 seconds, eyes closed, first time, every time!
  12. 7 points
    Crotchity, in the original article, at the start of the second paragraph, it states “City Councilman Kenneth Stokes has threatened to reverse the contract American Medical Response has to serve in the area if the company doesn't send its workers into violent crime scenes, even before police arrive.” I think that makes the intent of Councilman Stokes’ comments very clear. As much as you want it to be, since you have brought it up in other threads, this Councilman is not basing his comments on race, and the replies from EMS are not either. It is a question of “is the scene violent? Yes or No.” End of story. Using race as an excuse, or a crutch in situations like this is just that, and excuse or a crutch. The true issue is that this idiot wants EMS to respond prior to police to violent scenes. Race is only an issue when we allow it to be, and instead of looking at the sins of the past, how about looking to the future, and trying to solve problems instead of creating problems where none exist. Let's keep this thread on topic - that this councilman has his head up his *** and needs to be educated about scene safety and the role of EMS.
  13. 7 points
    Just to add my 0.02. I don't think it is necessary for a woman to have an exam in the field under most circumstances. Obviously if she is giving birth then it might not be a bad idea to take a look. Heavy bleeding will be another reason, but should usually be obvious from the outside. In all other cases, you don't have the proper tools to do the proper exam, so why do it half assed? Does anyone carry a speculum on their ambulance? Has anyone been trained to do a bimanual exam? An exam by someone in the field will add very little (no, I do not mean that to put anyone down) to the pt's care. I would have to say in this case, keep the pt's dignity and let her go through the exam, only once, in the ER.
  14. 7 points
    How many of you carry printed Vial of Life papers to pass out to anyone who comes to your station, or stops your ambulance if you stage in different places. Theres so many people that dont know about these sheets that not only make our jobs easier but they can prevent possible mistakes from being made due to the pt being unable to speak for whatever reason, or a mother who is losing it and cant tell you what is wrong with her child. Something to think about. Get them printed and get them out there, its a free 1 page print of the vial of life website.
  15. 7 points
    Hey guys, this is Franco Colon. Found this because I decided to Google myself. I just wanted to clarify some things. I had decided not to really say anything regarding this since I had planned on fighting this with my Union but the more time that passes by, the less I feel like drawing this out. First off, I was a Full Time EMT at LICH with no prior instances of ever getting in trouble. I've never banged out of a tour and I've always been comically early. As an EMT in NYC we don't have a station that we hang out at in between calls. We sit at our assigned locations in the ambulance and respond to calls from there. We were parked at our assigned location for about 3 hours. I have my personal laptop with me when I work and so we were passing the time. Obviously we ended up going on chatroulette and since our gas masks where with us we put them on. It was stupid and a bad idea. As you know, pictures were taken an put on Flickr. Another stupid, bad idea. What did NOT happen. We didn't flirt with girls, we didn't write anything obscene or vulgar, you couldn't identify what hospital we were from, I was NOT driving and texting (a photo was taken of me while I was sitting there texting on my phone but my left hand happened to be resting on the wheel) and that photo was NOT named "Franco likes Safety". It was 10 minutes out of our 16 hour shift. We responded to our calls, pt care wasn't compromised, nobody would have even known about it. That is until the reporter from the post found the photos, came to the hospital, threatened us with a story. She was just out for blood. Because of the issues our hospital has been facing lately, we were terminated without a chance to say anything in our defense. I've never even received so much as a written warning. Technically we weren't terminated because of the article, we were terminated for a series of extremely grey policies that allows the administration to fire you for just about anything. The really ridiculous thing about this all. Nobody from the hospital except the reporter, my partner and myself has even seen the photos in question. It's all been based on the word of the reporter. I have no desire to distribute these photos but I'll say this. Friends of mine who have seen them agree when I say, it's absolutely crazy so much fuss is being made over such simple harmless boring photos. I love my job, and it pains me that something like this happened. I feel like I was struck by lightning, just in the wrong place at the wrong time. I would love nothing more than to just move on and get a job somewhere else. I just hope this doesn't hang over me like a black cloud while I try to do so. Watch out guys and gals. Big Brother is watching.
  16. 7 points
    Rookie Ease up on yourself. You'll thank yourself for it in time. EMS practitioners are by far, the worst offenders of being one's own worst enemy when it comes to looking back and wondering what could have been. After 21 yrs in EMS (17 + as an ALS practitioner and 18 as an EMS educator) this I know; trauma patients die. A lot. And mostly in spite of what we do. Five years ago on Memorial day weekend, my brother in law suffered a cardiac arrest in the driveway. He was 43. I was with him the day before when he was complaining of palpitations and like all of us would, strongly advised him to go to to the ER. Not strongly enough. I, like you, beat myself up over it, over and over until the weeks turned into months and the months to years. In the process I began to lose my faith in my abilities as an ALS practitioner, insomnia set in, then came a couple of med errors, (strangely things continued to get worse despite my avoidance of the real issue), my long term relationship failed (not related to this incident), and my desire to care took flight. I was the poster child for EMS related stress and Accumulative Stress Disorder. I existed as a shell of myself for a little over two years, until I became seriously ill. The illness was the last straw and I ended up on stress leave. Four months later I walked away from my twenty year career without blinking an eye. After a year and a half of unemployment, some menial jobs for minumum wage, and five months on welfare, I returned to prehospital health care. I kicked my arse for a long while for not getting the help I needed when I needed it. Don't make the same mistakes many of us have made, Rookie; everyone makes a mistake or two, and most of them are not life critical. Some mistakes are, but I doubt yours was. Given the chance to do the call again, knowing what you know now, the outcome would be the same. Trauma patients die. A lot. If you need to speak with someone professionally have your service provider make the arrangements. Speak with someone outside of your service / agency. And stop beating yourself up over something that would have happened regardless of what you, I, or anyone else would have done. Also keep in mind; you weren't the only one on scene; if whatever it was had been obvious, someone else would have caught it. I don't have all the answers, just a lot of experiences of things not to do again. I wish you only the best, and then some. Take care of yourself, Paul
  17. 6 points
    Sorry all, I only have a few minutes with internet so can't answer all of the questions... What I ended up doing is writing out my concerns, loss of leg, shock, loss of life, etc, etc. I had the manager on site witness while he read it out loud to his wife on the phone and then had him and the manager sign that it was read aloud and understood. Had the supervisor assign a worker to sit with him until his wife came with instructions to call if his mentation or physical condition seemed to change in any way, and left him there. I do understand that I could have forced him and later justified it with his refusal being an obvious sign of altered mentation, but as mentioned above I'm a true believer that I am a patient advocate first. This guy understood the risks, he's just had a lifetime of experience of ignoring such risks and having things work out ok for him. I wasn't able to convince him in my limited time that his experience might not work this time. I left him on scene. About an hour and a half later I got a call from the site supervisor telling me that he'd decided to go to the hospital due to increasing pain. The employee had driven him instead of calling me back, which was faster anyway...I lost track of him after that... Thanks all for the discussion. I do find these types of cases sometimes more mentally challenging than some medical patients... One thing that I have come to believe, that trying to be morally and ethically sound with these types of patients seems to be becoming less and less popular. That the, "Screw it. Take him and tell them he was altered, no one will ever question that.." is more and more prevelant...That's a shame I think...
  18. 6 points
    Hey there Mike. That's a great question, and like the others have said, much of requirement for pacing requires a substantial foundation in education related to the topics Island had mentioned. That's the reason it's an ALS skill, if you were to learn everything there is to know about pacing, well, then you'd be able to do that skill, but you'd also be in school for much, much longer. EMT school curricula simply does not have the educational basis for many paramedic level skills. I believe that the biggest difference between the EMT level skill set and the Paramedic level skill set is that if used wrongly, it could kill your patient. Without the knowledge to understand what we are doing, why we are doing it, when to do it, what should happen if we do it right, and finally, what to do if we did it wrong, we'd be killing people left and right. Pacing is just not a case of slapping on the pads and turning a knob or pushing a button, it's much more involved. To answer your questions now.... Pacing is the use of an electrical current delivered through the defib pads to the heart when pharmacological therapies do not work or the patient is too unstable to wait for meds to work. Typically, the electrical conduction is in the area of 100 - 140 milliamps (mA). slightly less than half that used in defibrillation. The indication for pacing is a symptomatic bradycardia, often a 3rd degree block or a 2nd degree type II. If the patient is conscious, alert, and has otherwise normal vital signs...just a low heart rate in the 20s or 30s, transcutaneous pacing is not indicated...but if the patient begins to decompensate, then it would be. Pacing is an extremely painful treatment, so sedation is also required. Usually midazolam. Therefore you'd also need more pharmacological training. When we pace someone we start at a low amperage setting and increase it slowly. We are looking for a change in the ECG rhythm that is known as electrical capture. Once we see this change...and it will be a drastic change, we evaluate the patient to determine if the heart is actually beating at the same rate we see on the monitor...usually it isn't, so we have to increase the amperage until we have mechanical capture, ie a pulse rate equal to that being paced. Finally we increase the power level 10 mA more to ensure mechanical capture is maintained. Following this we will continually monitor the patient and ensure that mechanical capture is being sustained. I hope this answers your question appropriately.
  19. 6 points
  20. 6 points
    When I was a third year medical student on surgery rotation, we had a patient in his late 30s-early 40s with a large pleural effusion (fluid around the lung). He was doing okay on a NRB mask as long as he remained seated upright, but each time we laid him down, he would desaturate. He needed a chest tube to drain the fluid so he could breathe. As a med stud, I was eager to do the procedure. We were on a med-surg floor. I brought the appropriate gear, gowned up, and prepped appropriately. I thought through every step of the procedure: when to put on the sterile gloves, how to position him, filling the bowl with betadine before putting my gloves on, drawing up the right amount of anesthetic and what size needle to use, getting the right scalpel, setting up the Pleurevac and filling the chamber with water, suture, foam tape, everything. The attending, a surgeon who has been cracking chests since the year I was born, stepped into the room, looked around, then out into the hall, looked around, then back into the room. "Transfer him to ICU. We'll do this later." Disappointed, I put the kit away to be resterilized, knowing that it would be done by someone else. Later, we had our daily wrap up meeting between the attending and 4 of us med students. He asked, "Do you know why we decided not to do the chest tube then?" Not really. "How many nurses were in the room helping you set up?" None. "How many nurses did you see in the hallway or at the nurses station ready to jump in if things went sour?" None. They were all in patient rooms, going about their duties, taking care of the patients on the floor. "Do you know if they are experienced running codes? Do they know where all the code equipment is on this floor? How much practice do they get? We know that the resources are available in the ICU, that the nurses there run codes all the time, and know where the equipment is. If something happens, you know there is manpower there to jump in." He meant this neither as a slight to the MS floor, nor a ringing endorsement of the ICU, but a reflection of the bigger picture of anticipating where we would be. He continued. "I'm not thinking about the procedure. I know I can put a chest tube in. I can do it with my eyes closed. I'm not worried about that. What I'm thinking about is, what happens if the patient decompensates? You always have to be thinking ahead of the procedure. Your mind has to be one or two steps ahead, preparing for that event that comes next. Otherwise, he goes down the tubes and you aren't ready to deal with it." I preach this to my residents. Don't get lost in the procedure. Intubation is a physical skill of muscle memory, not a mental exercise. Your practice has taught your hands how to intubate. You know how to intubate, and if you are thinking only of this, you will miss the big picture. When you are in the ER, the OR, the ambulance, or on the street, take it all in. Think beyond the immediate, and wrap your mind around what comes next. Don't think, "I'm going to intubate." Think, "this is what I will do if I can't intubate. These are the parameters that will tell me if I need to intubate, or just give oxygen. This pulse ox level is when I will quit attempting to intubate and bag the patient. This ETA will determine if I need to tube now, or use other methods to support the patient until I get to the hospital." Concentrate on where you are going, rather than how you get there. The little things, like the procedures, will flow. 'zilla
  21. 6 points
    You would be surprised at the amount of people that believe that God is in control of all things in their life.This is a very complicated theology for most Christians and most definitely for non believers to understand. It is rooted in a Biblical teaching that God is all powerful and sovereign in all things. We believe that His perfect will work all things together for the good of those who love Him. Therefore, nothing is impossible for God. I believe this theology. I have seen definite miracles but most often see circumstances develop through the normal administration of science and natural law.. I understand that miracles are extraordinary and have a adequate balance in my beliefs and their expressions. I mention this so that you can understand where your classmate is coming from. I think that she is sure and confident in her religious beliefs but has very little experience with society at large. Many times people like your classmate say things like what you describe to demonstrate their faith, but more often than not it is simply the way they normally talk to their family and circle of friends. They do not realize that people with different socio-religious backgrounds might think their behavior is odd or weird. I think you can help her by talking to her from a clinical perspective and say that although we all believe different things we have to respect the patients beliefs as well as avoid the dangers of inducing the patient into unhealthy theocratic projections stemed from their psychopathology. It is gonna be up to you to decide if you want to help her understand limits and boundaries. I would explain the situation to her because of the commonality of beliefs and because I bet she is a really good and caring person that can help many as a provider.
  22. 6 points
    I am very dedicated to my work. I wear Paramedic/EMS shirts every day, even when I'm not on duty. The EMS station is my second home, and my second family. It often seems as if my life revolves around the EMS department, but it means nothing compared to my little girl. I am normally a very friendly person, but if you hurt my little girl you will make me mad. I know my little girl is growing up, even if I don't like it. She seems to like you, so I'll tolerate you dating her, but here are a few things for you to think about while you're with her: First of all, I go into hostile situations to save people that I've never even seen before, you can't imagine how protective I am of my little girl. I once broke a man's sternum by accident while doing CPR to save his life. If that's how I help people what do you think I do when I'm pissed off? I know who investigates arson fires. They know exactly what clues to look for to prove it was arson, so they also know what not to look for should I mention anything... and I know where you live. I've worked more car accidents than you'll ever see, the sight of blood doesn't bother me one little bit. It's normal for me to IV catheters, Syringes, paralytics and extremely strong sedatives in my car.. Touch my little girl and me and you take a little ride. When my firefighter friends burn down a house for training, nobody ever looks in the closets. I use the jaws of life to tear doors off wrecked cars. They cut though solid metal like a hot knife through butter. So watch your paws or get the jaws. Sirens and air horns can really muffle the sounds of someone screaming. Most of my friends are cops, paramedics, or firefighters. WE ARE 911. If you make me mad who do you think you're going to call for help? I have access to explosives. I am well trained in emergency medicine. I know exactly which arteries are the easiest to sever and which ones bleed the most. (Remember the Medical training, IV catheters, Syringes and drugs!?!) Even though my little girl insists that you are a "nice guy" and not like most other guys, I know better. I was once your age, I know EXACTLY what you're thinking. Because of that I already have plenty of reasons to not like you. It wouldn't take much at all to push me over the edge, and I just stocked my med kit. So if you want to date my little girl you better keep these things in mind. Medics are protective by nature, and there is nothing we are more protective of than our little girls. Whenever you're alone with her, you better remember that someday you may be alone with me! (I modified this from "Dating a Firefighter's Daughter" I am having this printed on a nice paper and framed for both of my girls ) Race
  23. 6 points
    Signs and symptoms of PTSD have been documented in ancient literature from several hundred to several thousand years BC. Nothing new about it. However, the pejorative statements people make about PTSD patients are quite harmful and do little to describe the facts about this problem. Attached, is a link to a study on PTSD documentation in ancient literature, and this study was done outside of the United States, because I would not want to use anything from the "pharmaceutically" tainted literature in the States... http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990839/ Take care, chbare. On a side note, I am not sure I would say I suffer from PTSD; however, I have had a few nightmares relating to experiences I've had in both the United States and Afghanistan. Also, I remember being out walking and had a minor incident shortly after returning from Afghanistan. Apparently, there was a foot ball game and when one team won, a massive fire works show started (Homecoming I believe). There was a sudden, large boom and for an instant I though it was an IDE/VBIED and went to the ground. Had I been a little more aware of the fact that the game was going on, I do not think it would have taken me by surprise. I have had no other incidents since and generally think I am doing just fine. However, I can appreciate what some of these people who experienced "real" action may be dealing with. Take care, chbare.
  24. 6 points
    Crotchity, you truly are an asshole. I guess my father-in-law (Navy corpsman stationed in Vietnam with the USMC) was just pretending when he would hide under the covers every 4th of July because the fireworks made the flashbacks uncontrollable. It was even funnier when he couldn't take it any longer and overdosed, leaving behind a wife, 8 year old daughter and 5 year old son. Yup, must have been the pharmaceutical industry's fault, especially since he was on no meds. So how long until you make this thread about yourself and turn it into a racism thread? You truly are a worthless piece of shit.
  25. 6 points
    Don't you EVER ask for a discount. EVER. If it's freely given, you may accept, circumstances depending (thanks for your story Squinty). To ask, or to be offended because one previously given is not extended, is churlish in the extreme, and reflects poorly on our profession. Just what is it that makes you so god damn special that somewhere you ate is OBLIGED to give away part of their profits to you? We get prodeals through my SAR team. If they stop being offered, which companies occasionally do, we don't say a word except thanks for the previous years of prodeals. Do we *ever* go into a shop and ask for discounts? Absolutely not. That's actually grounds for dismissal from the team. In the rare instance that something is offered to us, we ask that the business make a tax deductible donation instead (which I know has happened). That way, it benefits the whole team and not just one or two of us who happened to be in uniform. Man, this kind of stuff REALLY chaps my ass. It's so stupid. Really. Just don't do it. Wendy CO EMT-B
  26. 6 points
    What is it with people and the internet? You, "flaming", are not real. Here. You're a virtual name, a number. What is the forum judging? Your words and thoughts. I'm just gonna shoot from the hip here, and speak from my own mind. Although, I haven't given any "negative ratings", I could see why some would. Having never met you in person, we have a "screen name", and a character in words. So, if this were a book, you would just be like a character. Like, say, The Boxcar Children. AK would be Henry, you would be Benny. That was just for visual. If another user is judging someone, they're not judging your personality, your human character.. They're judging your words in print. You're not speaking from your mouth. You're typing, you're not face to face, so you're probably typing in some instances with a smidge of rage or intense inner anger. That's okay, let it out big boy. ha ha. It's not because you're different, alone. We're all different. Nobody is alike, each individual on the face of this earth is unique in their own way. So what, you're gay, that's who you are. But that doesn't define you. I'm gay, it doesn't define who I am. I'm damn good at what I do, and at the end of the day, that is all that matters.. As an EMT. I don't tell people who I've slept with, what I'm into, porn, sex, etc.. I may tell my friends, who respect me for who I am, but would I tell a co-worker that may or may not be a true to heart friend? No. If you want to let being gay define your entire personality, then you open yourself up to hearing what other people have to say. Back to your statement, because if it doesn't have a "?", it isn't a question. Are you being judged for being Gay. Yes, your screen name is. You're being "difficult", not different. You're taking your view, plastering it on a wall per se; and when people give their opinion, instead of accepting it and moving on, you're resisting it, and pushing their head closer to your views. At this point, I don't think your cause is really to get opinions, I think your only goal here is to get attention. In fact, I really don't believe that you're "representing" homosexuals. I believe you're a past user, that has returned in order to stir up trouble. All I see is, a little boy, stomping his feet, jumping up and down, crying, because nobody wants to see life his way. Get yourself a tootsie pop, and go watch cartoons.
  27. 6 points
    Man, Lone Star just killed your thread brother, as that is nearly a perfect post in my experience. There is no way to describe here what the job means and entails to everyone, but if you choose this path you will instantly recognize each and every point that he made. I'm going to highlight a few simply so that I can feel superior and believe if I've added something pertinent to the conversation... I never get tired of pts.in general. There are moments, but they are incredibly rare. My coworkers sometimes make fun of me, mostly in a good way, because I tell them that my theory is to 'love all of my patients. If I love them then I talk to them right and all of the other decisions become easy.' And I believe this, that I share my life with each and every pt that I encounter. (Understand that I have never worked a high volume system with the exception of being overseas, so others may feel differently, and justifiably so) I forget most of them almost immediately when I leave the ER, or in my current gig send them off to the hospital or clinic. But for the few minutes/hours/days that I am with them I try and open myself up and truly see them... I love that. Some here will tell you that that is just a bunch of wanker bullshit. And they will also be right..for them. But sometimes we all get tired of the bullshit we work around. I recently came into contact with a medic that was telling me that the only use he had for Hydrogen Peroxide in his ambulance was convincing the drug addicts that it is an HIV/AIDS test. You bring it into contact with blood, and if it foams, that that is a positive test. I completely destroyed him in front of God and everyone. I forced him to try and explain in front of about 15 people how convincing someone that has almost nothing to live for that they now have absolutely nothing to live for was proper care? I asked him to define the role of a paramedic in healthcare, to define the word compassion. It's wasn't pretty, but I'll bet he's more careful about talking idiotic macho TV crap around people he doesn't know in the future. He doesn't like me much now, and that's ok, because I don't like him at all. Unfortunately he will tell that story to many, many of his coworkers that will think that it's hilarious and will use it on their trucks. Of course the flip side is that you will also run with many providers that will almost take your breath away with their kindness and competence. And for me, that keeps me working, and thinking and studying every day, so that I can try and throw my hat into their ring. But the truth is, if you truly want to be a rockstar provider you will always be in the minority. You will always make others at least a little bit uncomfortable. But fuck em...This isn't a popularity contest. Akflightmedic, chbare, billygoatpete, Mobey, hell...there are probably 30 more here that I could name if I took the time..Being in a profession that allows me the priveledge of having folks like that to council and guide me? Priceless. Yeah, I'm not sure where you're at, but these wages sound well above the national average. I do pretty well now, by my standards, but I work a min of 14/12s in a row in some pretty cool, but weird places. Yeah, this is the down side of having a career that is dominated mostly by kids. They are willing to go crazy, burning themselves out working a gazillion shifts a week. It's not healthy, but it pays the bills they would say. I'm thinking that if you have a family, a house, a boat, a motorcycle and a jetski, that you need to redefine your priorities and what it actually means to pay the bills. Another great point. Plus, if you have a hard time keeping your dick in your pants there is plenty of opportunity to cheat on your spouse or sleep with someone else's. Judging from the quality of your first post though, you don't strike me as someone that has trouble with logic and focus. As far as stories...yeah, mostly they are best left at work unless you have something that hurt your heart, and then of course you should share that with your mate. My wife could not possibly care less about EMS. She's proud of me for being a medic but has no interested in the blood and gore stories, etc. Once, early on I had 6 patients in one day and three of them died. After the last pt was delivered dead to the ER (two were end stage pathologies that died during transit and one arrest.) I swore I was going to duck calls for the rest of the day. As I was walking back to my ambulance, another pulled in so I reached out and opened the doors for them and they had a pt in arrest. My partner was waiting at the truck and saw me riding in on the cot doing compression and almost died laughing at the coincidence of me getting stuck on another dead person. I was laughing my ass off telling this story to my wife who said, "Honey, that story is very funny, I'm sure it is, but please don't tell that to any of our friends or family." Heh.. It's a crazy world... I wish if firemen really needed to get whacker hero tattoos that they would replace the 911 nonsense, (unless of course you were actually there) with some of the words in bold. Ok, not the IFT part, but you know what I mean. Lone Star has pretty much created an EMS primer for you as it relates to your questions. I've got almost nothing to do in the clinic at my current job, which is why I feel the need to chime in and give long winded answers where there often weren't really any questions. But you know what? One of the things I love about being a paramedic? Is that those here get that I'm bored out of my mind, they will allow me my drivel, even support me if I need it, until enough is enough, and then one will be kind enough to say, "Ok man, it's way past time to stop being an asshole. you've had your time, now suck it up princess and go do something productive!" Heh...I love my job.... Dwayne
  28. 6 points
    Of course it was me that gave you the negative. Normally you're whining and whatever nonsense you spout in the chat room keeps others feeling sorry for you and prevents them from doing so. But why do you assume that I'm a jerk for giving you a negative? Why can't you, like an adult, assume that I thought that your arguments were shallow, one dimensional, self serving, cookbook Basic level medicine and simply not good educational material on the board? Isn't that what the votes are for? To show others my opinion of your thoughts, either exceptionally good, or exceptionally bad? You continue to espouse 'proper' exam. And I couldn't agree with you more. You simply go so far out into left field that your opinion loses my support. Wasn't it you, months back, that said that if we let a speeding car pass, or one drive through a yellow light without calling the police that we may have just allowed a kidnapper to escape with his victim and that we should be ashamed? That's what I'm talking about. Your thinking is so one dimensional. It's too shallow. You sound as if you're constantly doing scared medicine. "What will the ER complain about? What can I claim that I do that everyone with think is very unusual and heroic?" I'm hoping that I misunderstood you when you asked why we take blood pressures when it won't change my treatment as I can't raise or lower blood pressure? I can do both...did I misunderstand? If so, then I apologize, if not, then they should shred your medic ticket today, right now. I hope that you're a good provider, but I don't believe that you are, and I'll tell you why. You are too inflexible. You take the first thing that pokes itself in front of your nose and makes sense to you and you commit to it, fully unwilling to change your mind. The very best educational moments in my short career have come from exposing my own process to others, having them say, "But what about X?" At which point I often said, "Holy shit...I don't know how I missed that..I screwed the pooch on that one." Also, your skin is so thin as to be near transparent. No one simply disagrees with you because they don't respect your opinion. They "don't like you" or "have it out for you" or some other such nonsense. I've been watching for the shout out, if we still have them, saying something that resolves in, "Oh poor me, everyone is so mean!" Ive not known a provider, and I've known a few really good ones now, that are so easily offended, nor so quick to discount a valid opinion as simply mean spirited harassment. I've gone to the friggin' mat with Dust, ak, an many others here much smarter than myself and at times left feeling pretty good, at other times bloody and beaten, but still I count each here that has intellectually bashed my head in amongst some of my closest friends. When Wendy used to correct my grammar and spelling I wanted to choke the shit out of her! But I know present myself, though not as well as I'd like, much, much better than I did before she took me to task. (Watch, now she's going to shred this post...and I'll say thank you, though perhaps it will be hard to understand through my gritted teeth.) Do I like you? No idea. I've not given you enough thought to develop an opinion. Why do I care then if you give opinions that I disagree with? For two reasons. First, I believe that there is great power in strong debate. If I confront your best argument with my very best argument, perhaps we'll both leave with some wholly unexpected piece of knowledge that neither of us would have gleaned on our own. Secondly, and much more importantly, there are many, many young, and/or new providers here that come with the belief that we are here to help them, as well as learn from them. You are willing to take an argument that you believe Dustdevil would have made, only he was most often right, and present it simply to feed your ego, to have the young/new come to you and say, "My God! You are so brave!! I would never ask a woman to expose her vagina and use her hands to spread her labia! You're a rockstar!" You plant the seeds that will send them into the ER glowing only to have the ER physician say, "What were you thinking? Where did you go to school? Are you an idiot!?!" Do I believe that you would always employ those interventions? I don't. I believe that often you simply present them, and then swear by them, for effect. What is a proper exam? Initial impression, good sets of serial vitals, an in depth current/past history to include current medications whether compliant or not, an attempt to get a decent feel for my pts frame of mind, and depending on their chief complaint exposure up to the point that I believe it is necessary to support or retard my working diagnosis. SPO2, monitor, etc? Sure, if indicated, but they are mostly toys and I can't really think of a time that I couldn't guess what they were going to say before I read their fancy little screens. And as expected, you ignored my questions, which I'd presented carefully to make them relatively easy. Do you spread the cheeks of your 70 y/o hemorrhoid pt? Palpate? Do you expose your kidney stone pt that has radiating pain into her groin? Ask her to spread her labia for a peek inside just in case your working diagnosis is incorrect? I worked with a new medic that wanted to put 15L NRB on every pt that she believed needed O2. I suggested that she use more appropriate amounts when required. She said, "Why? It's not going to hurt them, and it's better too much than too little." I told her that in the vast majority of cases that she was right, the pt was not going to be hurt, but she was. That the people that view her treatments, or take transfer of care of her pts are going to expect her to know how to determine, and then use, appropriate interventions. She thought I was silly and is now little respected around her peers, and worse, her betters. That seems to be what you're suggesting here. I will expose the genitals and ask an already damaged pt to spread her labia so that I can best examine her whether or not my thorough exam reveals that this is a prudent step. A vagina is an amazing and wondrous thing, but I promise you this. No matter how macho you think you are, how many "babes you've bagged", nor how many books you've read or videos you've watched, you will never know more about the inner workings of that freaky little machine than it's owner. Peds and trauma excluded of course. Is it leaking icky stuff? Sure, and it smells nasty! I can't justify being down there under the guise of alerting the ER to this fact. Is it swollen? Yeppers! How come? Beats me, and I can't justify collecting that information under the guise of alerting the ER. Is she tachy, diaphoretic, appearing to be trying to smuggle a giant watermelon under her shirt while she screams "I think it's coming!!!" Ah, see, this might dictate not only a peek, but a good hard look. But my physical exam already told me what to expect before I dropped her drawers, right? I once exposed a rape victim and examined her genitals because she claimed that her attackers had stabbed her multiple times in the rectum and vagina with an ice pick. And the area was a mess. It was ugly, disturbing, but it turned out that she had inflicted the wounds herself. Did I need to expose her? I believe that I did, as I could see blood through her clothing at the vagina and rectum and believed that bleeding control might be necessary. Would I have exposed her if I hadn't seen blood? Absolutely, as she told me that she had been stabbed in that manner and I'd want to look for signs that she had compartmentalized bleeding or that it had perhaps been tamponaded (? Not sure that that is a proper word) in some way. I also checked femoral/pedal pulses, checked cap refill, and did a lower extremity neuro exam on the way to the ER (as well as prudent, associated interventions) in case there was hidden vascular/nerve damage. Those are things that I believe the ER might benefit from knowing at, or prior to my arrival. A lot of people here have tried to express their views of your opinions and you've narrowed it down to "everyone thinks I'm right except those that don't like me" again. You need to let that go brother. Many here, such as Wendy, Matty, Dust, akflightmedic, Kaisu, etc, etc, have told me that at times I'm an arrogant, ignorant asshole. And you know what? In each case I went back, reread the posts that caused them to draw those conclusions, and I can't think of a time that they were wrong. Despite my best efforts, sometimes I simply go off into the ditch. And I thank the powers that be that there are people here willing to say, "I know you think that you're right here, but you need to trust me when I tell you that you are thinking and behaving in a way that you wouldn't like if you could see it from the outside looking in." Step back from the self pity man. Stop making an argument simply because you believe you will look ignorant if you reverse your position once chosen. There is not a single person here that I respect that doesn't say, on a regular basis, "I don't know" or "ooops, I see your point." It won't kill you...trust me. Dwayne
  29. 6 points
    Ok, I guess it's 'confession time' here.... As an EMT, I looked at a lot of the medics I came in contact with as 'pompous asses' because of their attitudes toward the lower license levels. This thread has forced me to re-evaluate my position. As I climb through the license level ranks, I find more and more that there’s so much I DON’T know. I’m not the first EMT to come to this stark realization, and I know I won’t be the last to ‘figure it out’. Working my way through EMT, then EMT-I and eventually onto EMT-P, I find that when I was a ‘mere EMT’ I thought I knew it all. This feeling was great to hold onto, and gave me confidence to do my job. Then I went on to the EMT-I portion, and realized that I didn’t ‘know it all’ like I thought I did. But I learned more, and still felt good about it all. I was still confident, but looked at things differently. When I started my medic class, I quickly learned that what I really knew nothing more than oxygen, stop bleeding; and keep broken body parts from moving. Those that know my story know that I had to drop my medic class for reasons beyond my control. I haven’t given up, and will be working toward getting into the next class. As I wait for the next class to start, I realize how painfully inadequate my education has been, and how much I still have to learn just to be able to call myself ‘competent’. Terms like ‘good, great and exceptional’ will just have to wait. I do not deserve them … yet. As with every ‘confession’ comes the opportunity to eat a little crow. I think I’ll have mine with a generous dose of A-1, to make it more palatable. To all the medics that I call ‘friend’: I offer each and every one of you a sincere apology. While I thought that many of you were ‘harsh’ in how you dealt with the lower license levels, I’ve come to realize that it wasn’t out of ‘meanness’. You were challenging me to not only prove you wrong, but also push me into learning more. For that, I owe each of you a great deal of thanks and appreciation. This confession serves as a warning to all of those medics (and the Doc’s too!): Since you all have pushed me into going further than I thought I could, each and every one of you will be ‘hit up’ as an information source with even more questions than I’ve already hit you with! To everyone else: This site is a great place to ask questions, debate theories and ultimately LEARN. These ‘grouchy old medics’ may seem harsh and ‘mean’, but they’re only want you to push to be the best that you can be. We’re taking people’s lives into our hands, and the patient’s deserve more! When the ‘old hands’ around here challenge your posts; whether for content or spelling/grammar, they aren’t being ‘meanie-heads’, they’re pushing you to correct the ‘little mistakes’ before they snowball into ‘big ones’. One misspelled word on a PCR can change the entire meaning. It’s been said that those that have successfully completed the medic course (especially with a degree), have ‘forgotten where they came from’. Some have gotten ‘arrogant’ because they’ve completed the course; but most appear to be coming from the same position that the previously addressed medics are. In the United States, our EMS education is very lacking in content. The cliché “You don’t know what you don’t know’ is so very true. The ONLY way to get a glimpse of this is to pursue your education above and beyond the minimal course called ‘Emergency Medical Technician – Basic’! When I finish my degree, I hope to remain the same person that some of you have come to know and at least ‘like’. I’m going to push you as I always have to get more education. I’ve had to re-evaluate what I thought I knew and now have to look at things much differently than I did from the ‘safety’ of my EMT-B world. I hope that many of you will find yourselves in the same position! ER Doc, Thanks for reviving this thread!
  30. 6 points
    I was with your train of thought, bro (because I know Airborne thinking patterns) until this last bit. Here, I think you dropped the ball, and you're going to catch a LOT of flack for it(not just from me, either I bet.) OK, I get the whole "balls to the walls" hero mentality... and I understand that combat medicine involves treating while under fire. WTF is wrong with you that you don't take the 15 seconds to protect yourself? How about popping a pair of nitriles on under your tactical gloves, so that you don't increase your chances of exposure to bloodborne pathogens? I know there's not always time to stop, put on gloves, etc... but you can prep yourself as your unit's medic. Lead by example, dude... you're smart enough to wear a condom, right? This is no different. You wanna die of hepatitis? Nasty way to go... and the thought of going to the VA for care for that for the rest of whatever life you've got is scary indeed. Way to disrespect the SISTERS AND MOTHERS AND DAUGHTERS who are fighting just as hard as you are. I dig that there's no chicks in the Airborne, and there's not as many women on the front... but there are women in intelligence and support and medical who are just as vital to the operation of the military as you are. One of my acquaintances just graduated boot and is on contract to be in an aeromedical drop unit. Your first phrase, "it's about a soldier's life" is absolutely spot on. The rest is realllly narrow thinking. Get your head out of your ass. Just because your unit is a bunch of hopped up male adrenaline plane-jumpers doesn't mean that you wholly represent the entirety of the armed forces. No, it's not, from our perspective. We're looking at your education and understanding of medicine, not your setting. I understand that "medic" is a near and dear term to you where you are. It's a badge of honor. Medic means something different in the military- it means "the nearest dude who can maybe plug my bullet holes" and I get that this is different from civvy EMS. But you're on a civilian forum, discussing *medicine* with a group of people who are mostly civilian with some former military and reserve mixed in. We appreciate YOU for what YOU do... don't piss on us and get all touchy because we refer to your actual civilian EMT level. You are indeed a separate breed of EMS, but when it comes down to it you're an EMT-B with some EMT-I skills and less education than nearly any paramedic on this forum. Have some respect for yourself. Step back and try to think outside your military box for a little bit. If you don't protect yourself with something as simple as gloves and don't recognize that you are speaking from a viewpoint that many of us will never be able to fully understand, you're just going to piss people off here. Have you ever stopped to wonder WHY 101st Airborne has such high suicide and mental illness rates? Couldn't have anything to do with the mentality and culture of the unit, could it? Sure, you're getting exposed to gnarly shit... but I bet the special ops folks have a lot more skeletons than you, and for some reason they don't seem to have as many issues proportionally speaking when they get out of the service. Just food for thought. Stay safe out there. Wendy CO EMT-B
  31. 6 points
    If you cut someone's property without an imminent medical need, you're really not thinking clearly and just being a douche. Sorry. You can dislike the "emo kid" and all his jelly bracelets... but unless you can't get them off without cutting, you have no right to destroy his property. What's wrong with you? If there's a medical need, you do as little damage as possible but do what needs to be done. If there's no medical need, and the original post doesn't really indicate whether or not there was, then keep your scissors to yourself. I'm actually really disgusted by this... is it OK to cut off someone's coat because you don't like the designer? Because you think it makes them stuck up? Where do you draw the line here? Wendy CO EMT-B
  32. 6 points
    I take no credit for writing this. I found it at: www.medicmadness.com If Chuck Norris was a Paramedic March 20, 2010 Posted by Sean If you have never heard of Chuck Norris, then you have been living under a rock with no daytime cable. From the “Delta Force” to “Walker Texas Ranger”, he has shown the world that he is one certified badass. Now today we are going to talk about what happens when you take Chuck Norris from the role of kicking ass to saving lives. So now the big question…… What kind of Paramedic would Chuck Norris be? Shifts Chuck Norris doesn’t work shifts. He tells people when they are allowed to have emergencies. This is done around his busy schedule. At no time will he be tied down to scheduled hours. Scene Safety We all know the “Texas Ranger” doesn’t need to cleared to a scene. As a matter of fact, he prefers to live life on the edge. The more dangerous the scene, the better. My guess is law enforcement wouldn’t be dispatched to any of his calls. Response Chuck Norris doesn’t respond to calls. The calls respond to him. When he gives the OK to have an emergency, patients will make their way to his location. He can’t be bothered with driving and trying to find peoples homes. Vehicle Chuck Norris doesn’t need a vehicle to respond in, as he doesn’t respond. Patient’s seeking his services must provide their own form of transportation. Partner Come on now…..we all know Chuck Norris works alone! Equipment Chuck Norris doesn’t need medical gear, tools or medications. Disease processes quiver at the very sight of Chuck Norris and have no choice but to immediately comply to his demands. Patients suffering from trauma usually got their injuries as a result of a Chuck Norris beating. There isn’t much treatment that can be done to improve their condition anyway. You can’t end a post about Chuck Norris without including some old Chuck Norris facts….. Here are some health/medical related Chuck Norris facts that I found for your reading pleasure! The leading causes of death in the United States are 1. Heart disease 2. Chuck Norris 3. Cancer TNT was originally developed by Chuck Norris to cure indigestion Chuck Norris will never have a heart attack. His heart isn’t foolish enough to attack him. Chuck Norris doesn’t get frost bite. Chuck Norris bites frost. Chuck Norris’ tears can cure cancer. The only problem is, Chuck Norris doesn’t cry.
  33. 6 points
    Actually hyperglycemia has been shown to contribute to morbidity and mortality in many acute conditions, MI and CVAs being 2 of them. Multiple studies have shown that it can reduce hospital survival rates and glucose levels are often looked at as predictors of outcomes. Pt's are started on insulin drips to strictly control the glucose levels even when they are only slightly elevated no matter what the cause of the hyperglycemia. There are plenty of studies out there and it the adverse effects of hyperglycemia with head injuries and sepsis is also well documented. Here are just a couple of article to get you started: Controlling hyperglycemia in the hospital. hyperglycemia and MI Just learn from this mistake and remember that none of the treatments we administer are completely benign and all have some degree of risk associated with them. Cheers!
  34. 6 points
    Ive seen some local fire trucks around here at Subways, KFC, and the such. I wonder just how wrong, i.e. funny, it would be if one of these trucks pulled up at KFC with the PETA ad on the side...lol And I just have to say that meat is muder.................... Tastey, tastey murder. Yummmm *I wonder if I will start getting negative votes now lol
  35. 6 points
    Wow. Just.... wow. It seems that there are at least three different questions here: Should abdominal palpation be done on this patient? Should it be done by an EMT or EMT student? Should it be taught to EMTs at all? Was the situation handled correctly by the OP? 1. Yes. Abd palpation is indeed indicated in the general examination of abd pain. However, it should be done at the proper time, by the proper person, utilising proper technique. And, of course, it should be deferred if the clinician determines a potential for exacerbation of the situation by the manoeuvre, or if it causes too much discomfort for the patient. Remember, it's going to happen again, probably at least twice, in the ER, whether yo9u do it or not, so there is little to be risked by deferring it in the field. 2. I'm a little mixed on this. There are instances where I would say this may be indicated. However, none of those instances would involve an acute abdomen, as in this case. And even then, it should be done only under the close supervision and guidance of an advanced clinician who has confidence in the EMT or student. 3. As already well stated by VentMedic, with the current state of EMT training in the U.S., I have to say 'no', abd palpation probably should not be taught in the basic EMT curriculum. Hell, for that matter, there are a lot of paramedic schools that shouldn't be teaching it either, because their students are neither the anatomical or physiological foundation necessary to properly implement and interpret the results. Most of them are wholly incapable of even identifying where organs and structures are located within the abdomen (and yes, my students get verbally quizzed on that within the first hour of showing up to my ambulance for a ride). And I am not for just doing shyte that looks cool, just to look busy, when it offers no benefit to the patient. 4. Should the OP have stopped the student from palpation as he did? Yes. No doubt about that. However, the reason he had to do so is because he FAILED to establish the ground rules and a clear line of communications with his student at the beginning of the shift (this, of course, is an assumption. He may have, and the student may have just been an idiot.). Before you ever make it to your first patient with a student, EXACTLY how things will work should be discussed, understood, and agreed upon by all parties involved. As an educator, I encourage my students to be assertive and pro-active, using initiative to be a part of the team. This should be tempered by the student's knowledge of his/her own limitations, of course. If a preceptor wants to play 'mother may I', then such problems are obviously going to arise quickly. For this reason, I also counsel my students to establish the communications and ground rules mentioned above, whether the preceptor brings it up or not. In this case, it appears that both student and preceptor FAILED in this, and both need to learn a valuable lesson from it. Ideally, the student would have known the limitations placed upon him by the preceptor ahead of time, preventing him from overstepping his role. This would have prevented the embarrassing incident in front of the patient. And it would have given the student a good question to write down and remember to ask the preceptor and instructors about after the run. I do believe I would like to have seen the verbal intervention handled a little more diplomatically, if for no other reason than to avoid worrying the patient. Instead of the old, "DON'T YOU EVER..." line, perhaps a gentle, "Uhhh... I think we're going to just defer the palpation to the ER, okay?" Yeah, I know that when you see something wrong about to happen, it is sometimes difficult to remain calm and diplomatic. However, that is what is expected out of a preceptor. You are, after all, a professional educator. Try to sound like it.
  36. 6 points
    Everybody should make their own decision about the vaccine. I don't believe that any vaccine should be mandatory UNLESS failure to vaccinate puts the rest of the population at risk. I remember, as a grade schooler, going to my elementary school and getting the flu vaccine in the 1960s (it was mandatory). I am taking the shot as soon as I get to Las Vegas early next week. As a group of emergency physicians (at UNSOM), we decided not to take the nasal vaccine because it is a weakened (attenuated) form of the H1N1 virus and we were afraid that we would shed some of the virus which might adversely affect some of our patents who may be immunocompromised. But, we are taking the injection. I am making sure my two kids (in their 20s) and my son's pregnant wife (also in her 20s) get the injection vaccine. I intubated two people last shift at UMC who had H1N1. I had one patient, a male in his 20s, who was in the hospital for 7 weeks, spent 5 weeks on the vent, had bilateral chest tubes, a DVT, and ARDS. He was low sick. This H1N1 is scary and if you are in your early adult years or pregnant, you should be concerned. The Obama administration has done a horrible job of providing information about the H1N1. While in Texas last Friday (I am in San Jose now), the TDSHS web site showed that two pharmacies near my Texas house was supposed to have the vaccine. I went by both to try and get the vaccine for me and my family. Neither pharmacy had the vaccine and neither knew when they would get it. It is available in Clark County, Nevada. Go figure. I was in Mexico when this H1N1 emerged several months ago. The way it affected children in the Mexico City area was scary. Although the predominant strain in the US appears to be less virulent than the one on Mexico City, it is still a bad deal. Vaccines save lives. If you give people enough of a substance, be it vaccine, drug or placebo, a few will have an adverse effect. This does not mean that the vaccine is dangerous. The links between childhood vaccines and autism are pseudoscience. Far more kids will die from not being vaccinated than will suffer ill effects from the vaccine itself. Look at the evidence and make your own decision. I, for one, will get my vaccine next Monday.
  37. 6 points
    This isn't about being careful with what you say, it's a valuable lesson in identifying pathological issues in someone who's supposed to be a patient advocate. I'm glad this guy's license has been revoked, at the very least. I'm surprised that it got this far, with allegations of roughness throughout his past... if that is the case, someone screwed up somewhere along the line and this guy should have been identified and yanked a long time ago. Scary stuff to be sure. Wendy CO EMT-B
  38. 5 points
    Hey everyone! Glad I found you all, from what I've gathered from some brief browsing, this seems like a good place to get advice on the world of EMS! So, I'd thought I'd just directly ask this community some on my questions, as I'm a little on the fence about pursuing EMT and Paramedic Should I become an EMS student and eventually an EMT? Also, will my age hinder me greatly? What are the challenges of studying to be an EMT that I should be aware of? If you're concerned about the emotional and mental strain of the job, but know it is a challenge you want to try and overcome, should you think twice? Sorry for all the big questions, any answers or advice you could give me would really be appreciated! Thanks in advance!
  39. 5 points
    Hi Caduceus, nice to meet you I'm going to be the one irresponsible adult in this bunch who walks over, shakes your hand, and hands you the code to access my ambulance shed door..... Then we are going to sit down together and have an in depth visit. In some of your previous posts you've alluded to having witnessed or possibly having been a part of some traumatic events, or maybe some medical events. I'm going to ask you further about them, what they were, what your part of them consisted of, how it affected you in the following days, weeks, etc. During our chat, I'm also going to give it to you straight. We see things in EMS that most people can't even begin to imagine. Things that we carry with us for the rest of our lives. I only have three decades in this business and I'm sure I haven't seen it all and there are probably more things I have yet to see, but honestly, I still have a few accident scenes and traumatically abused young patients come and visit me in my dreams.........but I also have some wonderful memories of being the first person to hold a newborn baby in my hands and can still feel the arms of a mother who's son we revived after he plunged into an ice cold lake hugging me and thanking me for not giving up on him. So we are going to talk about those things together. We are going to talk about the good, the bad, and the boring. We are going to talk about how a profession in EMS can either make or break a person. Then I'm going to ask you to go home and take 24 hours to really think about whether or not you want to come along with me in my ambulance. 24 hrs later...............you show up at my bay and say "I thought about it and I still want to do it." And then I'm going to give you a pager which you will carry with you at all times. He probably will be quiet for the first few days that you carry him and you'll probably push down on the little protruding button on the on/off knob a couple of times a day "just to be sure" it hasn't gone off and you've missed it...... And then finally, when we least expect it, (most likely at 0600 hours) Mr. Pager is going to scream/beep/tone at the top of his lungs to tell you that "Old Mr. Creeky Hips down the road has fallen and can't get up." and your going to jump out of your nice warm bed, throw on that set of clothing that you have had nicely laid out for just this occasion for three days now, wipe the sleep out of your eyes and try to calm your shaking hands while waiting for me to swing by and pick you up for the ride to the ambulance bay. I'm going to pick you up outside your house and on the way to the ambulance bay I'm going to coach you to slow down your breathing and shake out the tremors running thru your body and just relax. I'm going to calmly remind you that this is Mr. Creeky Hips emergency and not ours. And we're going to talk about what we might be heading into as we get to the bay and transfer into the ambulance with the rest of the crew. I'm also going to remind you that this is the time of day that heart attacks happen and that we can't always rely on what "Mr. Pager" tells us so we need to be mentally prepared for the "worst case" scenario as well as a simple fall. As we pull up to the front door of Mr. Creeky Hip's house I'm going to ask you again if you are ready and if you want to come in. If you don't, that's fine with me and I really won't mind if you decide to sit this one out in the front seat of the rig and just wait for my partner and I. I will not hold it against you either, so don't be afraid to tell me that you've changed your mind. I'd rather know now than have you come in against your better self judgement. But if you do decide to go in, then you need to know that I can't hold your hand. I can keep an eye on you and guide you if needed, but once we step foot into Mr. Creeky Hip's house, my focus and my attention need to be on him and what is happening with him. If we get in the house and it is a simple fall, great! We can do a rapid trauma assessment while we question Mr. Creeky Hip and try to find out what caused him to fall and get him all packaged up and ready to transport (if needed) or if he doesn't want to go in, do a thorough assessment both medical and trauma, call medical control then help him up off the floor and be on our merry way. Most likely the entire time I am going to be observing you and how you handle yourself, how you interact with Mr. Creeky Hips and his family, and how you interact with myself and my crew and hopefully you will be wonderful at it. But if we walk in the door and Mr. Creeky Hip is exhibiting agonal respirations and his family is hysterically screaming at us to "do something" then I may even forget for a few minutes that we brought you along because we will be in full "code" mode and you may have to fend for yourself for a few minutes until we get CPR started, the AED on, get IV's going, etc....so I hope you are okay with that and secretly I am probably hoping that you jump right in and ask if you can help with CPR. Whether I need you to help or not doesn't matter, but your offer to help will be immeasurable in the amount of faith I put into helping you continue along your chosen path should you choose it after this call. And when it is all said and done, and the call is over, we are going to talk about it. And we are going to talk about you. And should you decide you want to continue on this path I will urge you to first get your Emergency Medical Responder patch.... And I will probably give you my personal cell phone number and tell you that any time you want to talk about it to call me. Any time. I will be honest with you and tell you that I would much rather you get your EMR patch before your EMT patch because of your age. I'm not trying to downgrade you or say that you aren't ready for an EMT patch but rather just saying that "at your age" the logical step is to get an EMR patch which will allow you to ride on the rig but the ultimate responsibility for a patient's life will never lay in your hands. That's a huge responsibility to have at 15. As a side note, my son, who is 12, has his EMR patch and it might be a shock to some, but he is allowed to ride on the ambulance with me on certain calls. Granted he has grown up in EMS and has practically lived in an EMS classroom since he was about five years old, not to mention been witness to several car accidents that we have come upon while traveling and watched from afar as I've treated the patients. The last class that I taught he decided he wanted to take the State final and practicals..........and he passed......he passed all the skill stations and the written so "legally" he can practice as an EMR but legally and mentally are not always the same. I am fortunate that I work full time for a small service and I can pick and choose which calls I allow him to go on, but I always know in the back of my mind that at some point we could be called to something I know he shouldn't be involved in because it will be totally different on scene than what the call came out as. Thankfully my town is small enough that if he isn't able to stay in the rig, there will most likely be two or three extra people on scene that can take him home again and I can talk to him later about the call and why he wasn't allowed on scene. But in your case, it will be a totally different deal and I worry a little bit that you may get in over your head by mistake.....especially if you are running with a bunch of guys who maybe won't think twice about how something may or may not affect you....but on the other hand, I applaud you on the research that you have been doing and how you found this site. Your maturity level speaks to me of far older than 15 and I may be worrying for naught... Please keep us posted and let us know how you are doing....and never be afraid to talk to us about stuff..........good luck!!
  40. 5 points
    I actually shelled out the $6.00 in order to be able to give a fair critique of this piece, and in the suspicion that in doing so I might be able to write a review for your work on Amazon that would save others their money in the future. 1. The name of your book is "A Professional Rescuers(sic) Guide to Behavioral First Aid Crisis Response". In spite of the title, there is an addendum at the end stating you make no claims to this book, and there are no credentials to be found anywhere in the book. At the end the author is listed as Steve J. Stevenson Jr. A quick google search turns up little to nothing, though on LinkedIn I found a Steve Stevenson who is a Fire Safety Supervisor at Oklahoma State University. Don't know if this is you, but if it is, I see no credentials on your page that demonstrate your competency in either emergency medical services, medical care, behavioral health, or any related fields. 2. Brevity of content... Reading your piece from my Kindle, Chapter one took up all of 5 pages. One chapter was only a single paragraph long! 3. Unscientific. The content seems to be purely derived from anecdote and what I can only surmise is your own poor understanding of the topic. There are no references, citations, or evidence of any kind that any of your analyses or suggestions have any scientific basis whatsoever. Finally, the explanations appear simplistic for the depth of the topics being discussed. 4. Grammar/Spelling Errors. Numerous grammatical errors and misspellings throughout the text. 5. Plagiarism? It appears you've taken some of your content from other sources without either adapting them to EMS and rephrasing them or citing them. I thought it was kind of fishy when you began recommending EMS providers use such phrases to patients as "would you like to continue our discussion calmly or would you prefer to stop now and talk tomorrow when things can be more relaxed?" A quick google search shows that this phrase is not novel... 6. Same as above... this book is increasingly starting to look like a copy and paste of other texts. 7. Unprofessional. Why does the font size change every chapter or so?! 8. Logo. Is that the 2011 National EMS Week logo?! Do you have permission by the American College of Emergency Physicians for its use? Anyway, your book took me all of 20 minutes to read... It was in my own personal, humble opinion, not worth the pixels that made it up (and I'm not even sure how much a pixel costs?). I would NOT recommend it to anyone, and I will be happy to share this review on Amazon and anywhere else it is sold. I hope this review has been helpful. Enjoy my six dollars.
  41. 5 points
    UPDATE: We have implemented new policy on immobilizing patients, and I have copied the policy below. There is substantial room for EMT judgment. It went into effect about a month ago, so I thought I'd share the experience thus far. The director and AD of Trauma thought it looked good. Our trauma team is pretty good about getting patients off of the backboard during the secondary survey and before any CT scans. The medical director for our ER group liked it as well. We've had an internal ER policy in place for a year not where the medics and nurse get the patient off the board upon arrival at the hospital and before being seen by a physician. The competing hospital system has had such an ER policy for at least 2 years with very good success. Acceptance of this internal policy has been mixed. Some nurses are in favor, others nervous about it and unwilling to take the patient off the board, so they will just let the attending know that there is a patient on a board and to see them quickly so they can be removed from the board (easier at some times than others). The EMS response has been interesting. The 2 agencies where we implemented it seem to like it quite a bit, but they tend to be fairly progressive services. There are some who have been teaching in the area, and response has been all over the map. Some medics think it's great. One chief stormed out of the room and said it would never be implemented at his service as long as he was there. Over his dead body, or something to that effect. It seems to be the younger medics who like the policy more. A snide comment by one of the other local EMS medical directors: "The chance of endorsing this policy is inversely proportionate to the size of your prostate." One hospital, a level III trauma center, initially pushed back very hard. As one doc said to the crew, "dumbest f&%#ing thing he'd ever heard." They initially said they would purchase backboards and reimmobilize any of our patients until the scans were done, but subsequently reversed their stance on it and are supportive. Another doc, from the same hospital, said it was "long overdue". Another local agency (with which I have no involvement) has reviewed and adopted the policy. We've had to tweak the policy a couple of times: - The flight service has very strong feelings on immobilizing any patients they transport, and insist that it be done. I think this is not huge, partly because we hardly ever call them due to ground transport times of <30 min, and if we did, it would be for a critically ill trauma patient that is likely to remain on the board anyway. - We had to put stronger emphasis on the multi system blunt trauma patient who cannot follow commands that should remain on the board. - Initially the memo referred to use of the board for extrication, which to my mind meant "movement from point of injury", but was interpreted by some to mean only vehicle extrication. So this was clarified. The medics have been very understanding of it as we adjust the policy and training based on their feedback. Nothing new is perfect the first time out, and they have been very patient. 'zilla To: All Bigredtruck Fire Division Personnel From: Doczilla, MD Re: Change in spinal immobilization protocol The following policy combines policy memo from July 6, 2012 and subsequent clarification from July 14, 2012 memo. Substantial evidence now exists to show that long back boards may cause harm to patients, and no literature has yet shown a benefit of their use. Back boards do a horrible job of immobilizing the spine, and movement is worse on the backboard than on a soft surface that conforms to the patient. Patients who are alert enough to follow commands can typically maintain stabilization of their own spine without assistance. Backboarding increases mortality in certain trauma patients. Backboarding does nothing to prevent neurological complications from spinal injury. Backboarding restricts respiration, which some patients cannot tolerate. Backboarding rapidly leads to skin breakdown and pressure ulcers, even after a short period of time, and is particularly hard on the elderly. Effective immediately, the following changes are to take place in our practices of spinal immobilization: These patients may require immobilization with a cervical collar: High risk injury (high speed MVC, axial loading injury) Focal neurological deficits such as paralysis Intoxication or altered mental status Age >65 Presence of midline bony tenderness of the spine Midline spinal pain with movement of the neck Patients without any of the above findings may be transported without a cervical collar. Selectively immobilize (with a cervical collar) only those patients at high risk for spinal injury as above or with clinical indications of spinal injury. Use the long spine board, scoop stretcher, vacuum mattress, short board, or Kendrick Extrication Device (KED) to minimize movement of the patient when moving them from the point of injury to the stretcher. Once the patient is moved to the stretcher, using log roll or lift-and-slide technique, lay the patient flat on the stretcher and leave the c-collar in place. Elevate the back of the stretcher as needed for patient comfort. Do not transport a patient to the hospital on a backboard, short board, KED, or vacuum mattress unless it is necessary for patient safety. Patients who are markedly agitated and confused from head injury may not be able to follow commands with regard to minimizing spinal movement, and combativeness may also be a factor. Patients may remain on a backboard if the crew deems it safer for the patient, and this will be at the discretion of the crew. A multi system blunt trauma patient, such as from a high velocity crash or significant fall, who is unable to follow commands due to combativeness, intoxication, or decreased mental status, should remain on the backboard for their safety until handoff to the ED. Never immobilize a patient with penetrating trauma such as a gunshot wound or stab wound. Even with neurologic deficits caused by transection of the spinal cord, the damage is done; additional movement will not worsen an already catastrophic injury. Emphasis should be on airway and breathing management, treatment of shock, and rapid transport to a Level 1 or 2 trauma center. If manual cervical stabilization is hampering effort to intubate the patient, the neck should be moved to allow securing the airway. An unsecured airway is a far greater danger to the patient than a spinal fracture. Eliminate the "standing take-down" for backboarding patients who are ambulatory after an injury. Place a collar and allow the patient to sit on the cot, then lie flat. Patients who are ambulatory and able to follow commands do a better job of preventing movement of an injured spine than rescuers do. Remove cervical collars on conscious patients that tolerate them poorly due to anxiety or shortness of breath. Patients who are markedly agitated and confused from head injury may not be able to follow commands with regard to minimizing spinal movement, and combativeness may also be a factor. Patients should remain on a backboard if the crew deems it safer for the patient, and this will be at the discretion of the crew. [The Helicopter Service] has requested that we fully immobilize on a backboard all blunt trauma patients transported by them, regardless of complaint. This is so they may remain consistent with their own policies on spinal immobilization. The new protocol will: reduce pain and suffering reduce complications decrease on scene times reduce injuries to crews who are attempting to carry immobilized patients reduce unnecessary imaging costs and radiation exposure Any questions about protocols or medical treatment may be directed to myself or Capt. Awesome. Very respectfully, Doczilla, MD FACEP Medical Director Bigredtruck Fire Division Cc: Chief
  42. 5 points
    It's come to my attention that we on the City are often very inconsistent as to what biases we will accept, and what kinds of "stereotyping" we take for granted. For example... the shit storm of a thread prompted by a single joke about hysterical black woman syndrome. Wow! Just looked at that this morning... and I gotta say... holy Jesus (hey, zeus!) what a mess. On the one hand, you have the ethical provider, with a no-tolerance policy... (but nobody likes someone who likes to point out the rules...) On the other, you have folks saying "well, we've seen it... and no, we don't treat patients differently..." But I challenge you.... how can a stereotype NOT influence how you view someone? The second you know they are (let's keep the original group here) a black woman, you're going to have that little joke pop up in your head... and consciously or unconsciously, the way you interact will be influenced. Doubly so if you happen to be a different race than said black woman. We could get into comparative racial psychology, if anyone wishes... that's a tangled web all unto itself, my friends. But wait! There are those who purport that just knowing someone is in a certain group won't change how they interact with that person... and then turn around and DO THE VERY THING THEY SAY THEY WOULDN'T. Want to know what group I'm referring to? Fire personnel. The second some of our illustrious posters hear that someone is a member of the fire services, or a person steps up to defend their group, whom they perceive as being unjustly attacked, some of us jump both feet forward and go so far as to cast PERSONAL ASPERSIONS on that individual. Wait! I thought we said we didn't make broad assumptions, just because someone was a member of a particular culture? Hmm.... it appears that we do. I know a lot of us have an axe to grind and feel that the fire system in the US is holding back some of the development of EMS. This is true. The system is rigged. There are injustices. But to point fingers and play the blame game with individual peons who are within that power system, who really have no influence over how it all works? That's just plain stupid. It's like those of us who become frustrated because minorities cry "unfair!" with regard to academic opportunities and job opportunities... yea, there are some institutionalized biases that most of us don't even see, and boy, don't you feel attacked when someone points the finger and says "You have all this privilege because you're white, so YOU (as an individual) suck!" Sure. There may be some advantages conferred by being a member of a certain race or culture. But is it MY fault that the school systems in the ghetto suck? Well, my friends... simply insert "firefighter" for "white" and "EMS" for "minority".... take a good hard look at this parallel, OK? Recognize your biases. Own them. Illuminate where they are influencing your arguments. But don't pretend you don't have them, as that's hypocrisy at its finest. Wendy CO EMT-B
  43. 5 points
    *Back story to this post* We were dispatched for a 0.2 mile Inter-facility transfer from one ICU to another because this pt had a type of pneumonia that couldnt be handled at his existing location. We arrive there and we have the following 0.2 mile? 3 blocks? Was it downhill? Could you push him there? Just kidding. approx 65 yo male who is sedated running 3 infusions controlled by a pump norephinephrine fentanyl and a antibiotic which I cant think of at this moment Ok, so he has a pressor (norepinephrine) to maintain his pressure because he's septic, got all sorts of inflammatory mediators and bacterial toxins floating around that are dilating everything inappropriately, and possibly if he's been sick for a while, his adrenal glands aren't putting out enough epinephrine, and the endothelium is all dysfunctional, and the vessels aren't responding appropriately in any case. If there's not enough arterial pressure, the organs don't get perfused, and badness ensues. The norepinephrine is to treat/prevent this. The fentanyl is for ongoing sedation. The antibiotic is to treat the pneumonia and/or any secondary infections. I realise you're an EMT, but it's a good practice here to work out what sort of lines the patient has for access before leaving, work out where everything is running in, especially if you've got multi-lumen central lines, and get some sort of idea why each medication is being used. You want to know the drip rates, even if they're on pumps (hopefully the norepi is), in case you have a power/equipment failure. Before leaving, you should have an idea of which can be turned off if there's a power failure, or a problem with one of the pumps. In this case, the critical med to be on a pump is the norepinephrine. The antibiotic could be discontinued, if absolutely necessary, and the fentanyl could be given as a bolus dose. But the norepinephrine is the highest priority. Turn if off for any length of time and the patient becomes hypotensive, and probably dies. If it runs away on you, they probably stroke or infarct, or go into VT or VF arrest. You don't absolutely need to know this stuff as an EMT, but if you can ask a bunch of questions, and try to learn, it will help you later on. A lot of people treat transfers as a glorified taxi ride. They're not, as your call clearly illustrates. A lot of these patients, the difference between a ground transport and rotary/fixed wing is weather conditions, availability, or the fact that you're moving them between two ICUs or an ER and ICU that are in the same city. His vitals at the time of arrival Pulse 77 BP: 105/58 Spo2: 98% via 100% O2 delivered by a vent GCS: 3 (patient was sedated) Weight: approx 250 lbs. or 113.6 kg A little hypotensive, but ok. We have an auto-vent 3000 Zoll M series cardiac monitor (ETCo2 not equipped) This is a problem. Not your fault, but really, no one should be running around as an ALS truck without waveform capnography. It's a system issue if it's not there. If all you've got is quantitative cap, or a simple yellow/purple detector, this should be on the trach/in the vent system. It would make managing situations like this easier. Short after switching it the medic and myself hear this high pitch squeak come from the vent (more specifically the part where it connects to the trach or ET tub) I see there's a clear window on top of that piece and every time it delivers a respiration the sound comes back and a little green piece inside the window goes red. (sorry I dont know my terminology of the equipment) This is a problem. You should try and find a copy of the manual and read it. Whenever you get a competent partner, ask them about it. You shouldn't be altering vent settings yourself, but if you're going to be present on these calls, you should educate yourself about the equipment being used as much as possible. Any decent paramedic should also be more than willing to help you learn --- and should be proactively encouraging you to learn more about it, whether you want to or not. That's part of building a decent team environment / organisational culture. Being an EMT may limit your scope of practice, but doesn't need to limit your knowlege. I'm not familiar with this particular vent. We checked the monitor and SP02 normal with the 3 lead showing a NSR. About 2 minutes this bloody squeaking is still present and driving me and my partner nuts. I start getting this gut feeling that something is really wrong and shit is about to hit the fan. So I start checking and re-checking that monitor and I begin to see a negative trend. His spo2 is falling rapidly and his heart rate is steadily increasing. So there's a lesson here. Pulse oximetry is a poor indicator of acute changes in the patient condition. It can lag the change, e.g. apnea, by several minutes, as probably happened here. This is why we preoxygenate patients before doing an RSI, whenever possible. The first clue that something bad was happening was the warning indicator on the vent, and the squeaking sound. The story you're telling suggests this is some sort of peak pressure alarm / blowoff device. But I'm not certain. What I am certain about, is that ignoring this for two minutes was a bad idea. This was 2 minutes you had to act before the patient desaturated. This is mostly on your partner -- he's the paramedic, and most responsible. He should know much much better than to do this. But you do have a responsibility to speak up when you beleive the patient is in life-threatening danger. I have always encouraged the EMTs I work with to do this. I ask them, don't do it in front of the family, unless you're convinced I'm doing something boneheadedly stupid, but whatever you do, don't be quiet and watch me do something you know is absolutely wrong. Speak up. At this point I tell the medic somethings not right here. He looks at the monitor and yells up to the driver to go. "Yells at the driver to go?" --- were you still at the sending facility? Or is he telling the driver to drive stat now? Good on you for voicing your concerns, even if it's quite late now, but better late than never. The medic should have a better set of corrective actions than this. That moment I suggested a possible displacement of the trach. This is a possibility, especially if the trach tube is particularly long or is improvised from a cut-down ETT (unlikely in an ER transfer). It's probably more likely to be obstructed with a mucus plug (or one of the bronchi are), or a pneumothorax has occurred. There's an outside chance the tip has ended up outside of the trachea, but this isn't too likely either. This is something any competent medic should be all over. Obvious trouble-shooting steps: * As chbare, (who knows way more about this than me) already said, remove the vent from the circuit and use a BVM with a PEEP valve. This eliminates problems with the vent, and if it doesn't have a decent display, you get some sense of the compliance from the bagger. * At the danger of making the heads of chbare and other RRTs the world over explode --- run the mnemonic. This is a situation where time is critical. What's the mnemonic? DOPE. It covers immediate management in these situations. Displacement? - has the tube displaced? Capnography would probably have answered this right away. If the waveform disappears, it's probably obstructed. If the ETCO2 has shot up suddenly, there's a chance it's gone mainstem, although this is hard to do with a commercial trach. - lung sounds? epigastric sounds? Obstruction? Run a french cath down the ETT/trach. If it runs the length of the tube, it's not obstructed. If it doesn't, you either need to suction the tube to remove the obstruction, or it's time to exchange / replace the tube. Pneumothorax? If there's no air entry on one side, and the tube's at the same depth, and not obstructed, either there's a deeper mucus plug that you can't remove without a bronchoscope, or you have a pneumo / hemo. He's getting decompressed. Equipment failure? We remove the vent, and if we're not using one, we check our bagger and PEEP valve, make sure we haven't overtightened it by accident, etc. This guys vitals still deteriorating and Im thinking of pulling out my stethoscope to check but something kept me from doing it. You were probably expecting the medic to take charge, like they should have, probably afraid of doing something wrong, and probably just a little scared / surprised by a situation you hadn't encountered before. It will be easier next time. You should have. It would have given you valuable information. It might have spurred the medic into action, as well. My medic was quiet and said nothing he just was occupying himself with tasks and I didnt know what. We had no further communication. Sounds like the medic got trapped on spin cycle and shat the bed, if I may mix my metaphors. Again, this is more on him than you. I can only say that panic is infectious, and spreads rapidly. If the senior medic on a scene loses control, it becomes much harder for junior staff to regain control of the situation. That being said, when things start getting excited, sometimes it just takes one person to take the stress level down a notch and get everyone thinking again, and that can sometimes be the junior person. In this sort of situation, "Hey do you think the tube's obstructed?", "Do you think there could be a pneumo?", and "What do you think that red thing means"(about 2 minutes ago), are all good options. I have seen quite a few scenes spinning out of control, only to be rescued by someone saying, "Ok, let's sit on our hands, take a couple of deep breaths, count to five, and jump back in again". Sometimes a couple of seconds of collecting yourself enables rapid focused action. The chances are if you feel the necessity to do this, you're not being effective at that point, anyway, so you're not losing anything by taking 5 seconds to regain your cool. Remember slow is smooth, smooth is fast. If you can develop the ability to talk slowly and calmly, but move deliberately, it will serve you well in almost every situation. See something simple, like a cardiac arrest run by a good crew, and you'll see what I mean. The patient began to cough and gasp and appeared to struggle for air and at this point Im about to press the internal oh shit button cause im in the captain chair watching this guy spin down the drain before my eyes and im just sitting here. I didnt want to get in the way of my medic but at the same time I was frustrated because I keep feeling their must've been something I can do. We arrived to the hospital and I was thinking we were going to hit the ER with the way things are going with this guy. But no, we head to the elevators and begin to take this guy up. My eyes were set on that monitor fearing he was going to code right in that elevator. By now his pulse was 140 spiking at 170 and his SPo2 leveled out at 80. His skin showing it too. I don't think he likes being hypoxic. Running to the hospital because there's an airway problem, and deciding to take your time to go up to the ICU are illogical and contradictory actions. Either there's an airway issue, and you need to be in the first place that can fix the airway problem, or there's not an issue, and you're going to the ICU. This mostly isn't your fault either. Although you should, hopefully, have recognised the situation as being serious, and suggested the ER to your partner. Once up to the ICU he was transferred over. And it was clear with the amount of staff in the room he didnt fair too well on the way over to their facility. After he was on their bed I removed myself from the room and went back to the truck. Hands trembling. Adrenaline dump. Happens to everyone, becomes less of a problem over time. How do you ladies and gentlemen manage to maintain composure when a perfectly uneventful transfer spirals into a oh shit run. It's a learned behaviour, that comes from prior experience, and an understanding of the pathophysiology of the patient, the tools at your disposal, and how they apply to the situation. And even then, sometimes calls still get messed up. Talk to some ER or ICU docs and ask them about times they screwed up. It'll open your eyes. There's a lot of weird presentations and crazy situations out there that can catch you, sometimes even when you're on your A game. Do enough decent calls, and you learn that when it gets exciting, you need to slow down. This takes time, and it gets a little harder as a medic, because you can't show any fear / concern you might be feeling, because it will spread to your crew, or encourage other medics to start intervening, which is only helpful when everyone's working together. Save this experience, learn from it. Once you collect enough experiences like this, go to medic school. ------------------- Edit: Sorry for the long length and messed up formatting.
  44. 5 points
    First, do you think his death has impacted me any less than the others here because I lack belief? Second, are you stating my coping mechanism has no relevance here since it is not religious in nature? The topic is how we cope, I shared, others shared. I knew Rob personally, I also knew his beliefs or should I say non-beliefs. It is entirely relevant and entirely appropriate place to share...unless you have a different copy of a rule book somewhere?? Dust, still able to stir up a thread without actively contributing...awesome!
  45. 5 points
    Fixed that for ya mate. Don't worry, I make the occasional typo as well.
  46. 5 points
    SD, who the hell gave you a job? I don't even mean an EMT job, I mean who the hell hired you? What person would interview you and say that you're acceptable to hold any type of job, yet alone an EMT job. I don't think I'd hire you to clean the bathrooms for fear that you'd go crazy and insist on bringing your own "tactical" cleaning supplies. You're clearly a whacker (with your OC and cuffs), and now you're demanding discounts? The establishment determines the discount, if they want to give one. Sit back, let your bill come, and see if they give you one. Never ask. I don't care if you only had ten bucks on you, you should have gotten more. Use a credit card or something. Ask your partner to cover you. If I were your partner, I'd much rather have you mooch a few bucks off of me instead of making a scene an embarrassing the shit out of me.
  47. 5 points
    For coral snakes native to the US it's "red on black, venom lack..." There are coral snake species from central and south America that do not follow this pattern. It's a misnomer that there is no available antivenom - the FDA extended the expiration date on the remaining stock until the fall of this year and there is available supply. Without antivenom, a severely envemomated patient might need prolonged ventilatory support. I caught this thread very late and am glad that the original poster did not have any problems, but I thought I'd comment about some of the practices some of the respondents seem to be supporting for bites by pit vipers (subfamily Crotalinae), which includes rattlesnakes, copperheads, and water moccasins. Tcripp, you asked about "what to expect" - it depends on the species, location of bite, patient comorbidities, and other factors. Many patients early on will have pain and local tissue swelling. Some develop signs and symptoms of systemic toxicity (e.g. nausea, parasthesias, etc) early on. Shock is usually from third spacing of platelets and plasma volume. Very rarely, someone who has been sensitized to proteins in the venom (e.g. someone who has handled snakes or venom or been previously bitten) may have a true anaphylactic reaction. We sometimes see anaphylactoid reactions with rapid onset shock and airway edema. Many patients develop coagulopathy, which can range from isolated thrombocytopenia or a syndrome of defibrination or a combination of the two that is DIC-like. Neurotropic findings, which can include neuromuscular blockade, can occur after bite by several species of rattlesnake, not just Mohave rattlesnakes. In terms of first aid, do not apply tourniquets or lympathic constricting bands, or ice packs. Maintain the bite in a neutral position (some medical toxicologists think elevation is reasonable - others thing neutral until antivenom is started and then elevate. Do not apply any kind of suction. If a tourniquet, pressure bandage, or constricting band has been applied, do not remove it in the field. In general, when this is done, we get big lines in the patient, give them volume, and start antivenom before releasing this. At least one IV should be started. Give fluids for hypoperfusion (obviously), but patients with intact perfusion and extremity swelling also need fluid boluses. Extremity swelling early after a bite is usually from the effect of polypeptides in the venom, and these cause tiny cracks in vessels that are large enough to allow platelets to leak out, but not large enough for red cells to leak out. This third spacing can be significant very early and cause significant hypovolemia and hemoconcentration. Very often, we see patients with rattlesnake bites who don't get enough IV fluid in the field. Give antiemetics for nausea, and treat pain (if you have fentanyl, I think it's preferred over morphine as the histamine release from the morphine can cloud close monitoring for development of allergic response to antivenom). The destination hospital may not necessarily be the closest hospital, or even the closest hospital with antivenom, but this would obviously be region-specific. I have seen horrible outcomes when patients are taken to hospitals where arrogant physicians refuse to consult a toxicologist - we've seen patients diagnosed with compartment syndrome who get unnecessary fasciotomy and even amputations that were likely totally unnecessary. Where I work most hospitals have antivenom but we have centers available to us that have onsite toxicologsist and very large supplies of antivenom and we fly our patients to these centers. The 2010 guidelines from AHA and ARC actually mention snakebite first aid, and they advocate using a pressure immobilization bandage for Crotalid envenomations. This recommendation is based on no evidence of any quality - in fact, one of the studies they cite as supporting the practice actually demonstrated worse limb outcomes when pressure bandages were applied (in a pig model). This practice turns what is very rarely a life threatening event into a limb-threatening one. This should be addressed locally, and hopefully administrators and medical directors will consult a medical toxicologist with snakebite expertise when establishing local or regional protocols. Pressure bandages seem reasonable for eastern and texas coral snake bites, and are standard for bites by neurotoxic snakes that cause rapid development of symptoms in Australia, but they will likely worsen injury when applied to victims of Crotalid snakebite. Finally, you can not diagnose a dry bite (fang puncture mark without envenomation) in the field. This requires observation for at least 8 hours (and labs). Especially after Mohave Rattlesnake bite, patient can have a life-threatening, potentially fatal envenomation event with minimal local tissue injury, sometimes without significant pain. Patients with probable Mohave bites are admitted and watched for 24 hours at the tertiary center we work with.
  48. 5 points
    Why would you bother with gloves for an IV if you're not going to bother with them when they *really* count? And sure, you're not supposed to deploy with known HIV/Hepatitis, etc... so, it's totally unheard of for someone to catch it after they're screened, right? Ignorant... Mm. You had potential here... shame. I'm done... Wendy CO EMT-B
  49. 5 points
    Not a popularity contest. I earned some points because I tried to do something interactive, positive and educational. You took a tiny little beating because you simply whined, tried to do something negative, and then whined again, which is why you'll get negative points again. Your experience here is not normal. Very few of the new members stay and whine. They either need to whine, and eventually leave, or they step up to the plate and try and be productive and intelligent. You've done neither. You don't leave, yet you continue to whine. I hope better for you...I'm just waiting to see if you'll ever want better for yourself. I'm grateful for your posts though as this is an excellent example for the new members that want to do better for themselves. Thanks for participating. Dwayne
  50. 5 points
    I will probably get negatives for this, but whatever. I though it was hilarious.
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