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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. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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.
  13. 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!
  14. 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
  15. 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.
  16. 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.
  17. 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
  18. 5 points
    Wow, I have gotten a few discounted coffees while on duty, have gotten a few take-n-bake pizzas on duty, and gone to the local theme park on "heros weekend" with free admission. But seriously! To talk to a manager because you didn't get you discount is utter BS. We had a thread not long ago about professional courtesy and what it was but wow man, I rarely am suprised by the selfishness of human nature, but to pull a stunt like that is unforgiveable. I certainly hope that your local "discount program" ends soon because of entitlement issues. Fireman1037
  19. 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.
  20. 5 points
    What you are describing is extremely common. Almost universal, I would venture to say. Applicable rule from The House of God (essential reading, by the way): 3. AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE. I dismissed that as a joke when I first read it (before I was a paramedic). Now I see the genius, and I honestly remind myself of that phrase whenever I feel things starting to get out of control. I would advise you to always remember: -Our job is simple, and often becomes more so as the "crazyness" of a call increases. -Do the same things on every call ALL of the time. Even the BS ones. Cannot stress this enough. -Reassess mental status, check lung sounds and vital signs often. -IV, monitor, O2. If you find yourself "stuck" on a call, give yourself time to regroup by reassessing or doing one of those tasks. -For the VAST, VAST majority of the time (read: pretty much all of the time), seconds do not count. Take your time to do things right and relax. You'll get things done quicker than if you had tried to rush. This is why we walk onto the scene and do not run. Carry that mindset with you for the rest of the call as well. -Embrace the phrase "it is not my emergency," not out of callousness, but out out of respect for a job well done. On a scene where everyone is freaking out, it is your responsibility to calm things down-- even if only by example. -Don't be afraid of mistakes. Be very afraid of repeating mistakes. -Always remember that we are here to provide comfort and reduce suffering, and are placed in a position of trust that enables us to do so. Some of that may be helpful and some not. Just some lessons I've learned along the way and would like to pass on... Things will get much better with time and experience, but don't expect it to happen overnight. Good luck!
  21. 5 points
    Can't really say that's my typical day. I don't argue with dispatch, that's like shooting the messenger. It's not their fault a nursing home sits on a patient that ill. It's also not the patient's fault that they are ill. It may not even be the nurse's fault that they sat on the patient all day. They have protocols, and they often state that they can't send a patient out until labs are reviewed by the physician. He may not have gotten the lab work until 11 pm that night. Do you know how serious abnormal labs can actually become for a person? Very serious, and very dangerous. Besides, running calls doesn't bother me like it seems to bother a lot of other people in EMS. It's my job. If people didn't call 911, they wouldn't have a reason to keep me employed. Just so no one has their feelers hurt, this post is NOT directed at the OP. It's just a statement on the video itself. Let them get their bearings here in the city before they get their butt jumped on. Plenty have posted those text to talk videos so it's only natural to think others here may find them funny. I don't, but I guess some people do.
  22. 5 points
    Doctor Dave had slept with one of his patients and felt guilty all day long. No matter how much he tried to forget about it, he couldn't. The guilt and sense of betrayal were overwhelming. But every now and then he'd hear an internal reassuring voice in his head that said: "Dave, don't worry about it. You aren't the first medical practitioner to sleep with one of their patients and you won't be the last. And you're single. Just let it go." But invariably another voice in his head would bring him back to reality. Whispering...... Dave.......... Dave ............. Dave........ Dave......... ..........you're a vet.
  23. 5 points
    I will probably get negatives for this, but whatever. I though it was hilarious.
  24. 5 points
    Miss Beatrice, The church organist, Was in her eighties And had never been married. She was admired for her sweetness And kindness to all. One afternoon the pastor Came to call on her and she showed him into her quaint sitting room. She invited him to have a seat while she prepared tea. As he sat facing her old Hammond organ, The young minister Noticed a cute glass bowl Sitting on top of it. The bowl was filled With water, and in the water Floated, of all things, a condom! When she returned With tea and scones, They began to chat. The pastor tried to stifle his curiosity About the bowl of water and its strange floater, but soon it got the better of him and he could no longer resist. 'Miss Beatrice', he said, 'I wonder if you would tell me about this?' Pointing to the bowl. 'Oh, yes,' she replied, 'Isn't it wonderful? I was walking through The Park a few months ago And I found this little package on the ground. The directions said To place it on the organ, Keep it wet and that it would prevent the spread of disease. Do you know I haven't had the flu all winter.. '
  25. 5 points
    Dude, I do truly hope your joking? You want to do Pediatric Critical Care Transport having JUST finished Paramedic SCHOOL? Short Answer = ABSOLUTELY NOT! I will tell you what, if you can tell me the pathophysiology of Tetralogy of Fallot without having to use GOOGLE, then I might be willing to listen to your argument. I really hate to sound like an A$$ here, BUT, there is NO way on this earth, any brand new paramedic is ready to do ANY type of CC transport. That included myself back in the day.....In fact, I have tons of CC experience, education, and when I took PNCCT last year ( Pediatric Neonatal Critical Care Transport Course) ( 10 Days, 8 hours day) i only scored an 86 on the final exam........This stuff is NO joke, and will truly be beyond the mental capacity of 99% new paramedics. So, Unless you are the statistical outlier, the answer is NO..... I suggest, go work the streets for 3 years, start taking CC courses, PNCCT, read some ICU nursing books, do ride alongs with a CC crew. Send me a PM, I can point you in the right direction for books and classes to get you started. There is an old saying, You don't know, what you don't know, ( Until it is too late)! Respectfullly, JW