scratrat

I know this probably has little to do with the original post but.... I had a dead guy we pronounced who was in his 30's. His wife did not think it was a problem that when she left for work, he was seen EATING morphine patches. Needless to say, by the time we got there, he was long dead. We calcuated he ingested over 3000 mg of morphine. Another case was an oxycodone overdose. We gave Narcan 2 mg. After several minutes, we inubated since she was still not breathing. She eventually woke up a bit and began fighting. At first the ER was pissed because we tubed her. Then they realized that since it was long acting, they would require a large narcan drip. I forget how much she ingested, but it was an enormous amount. So they left her on the vent for 24 hours to let nature run it's course.

Boy what a heated topic Almost as bad as my post...good greif! I haven't noticed this thread till now, so I'll reply to the original poster. I have had experiences where I have allowed a basic to administer NTG or ASA under my direction. If I'm doing something at the time, and I've already deemed that I would be giving it anyway, I will SOMETIMES allow them to do so. I have to know that EMT well, and trust that they will follow my directions to the t. There are others that I would never allow it. Is it wrong? Yes. I probably shouldn't do it, but I have. However, I would never allow a basic to push ANY IV medication. Granted NTG and ASA can easily be screwed up I guess. But pushing a drug is a little more dangerous in my eyes. And before everyone screams at me, yes, I know what if... But like someone else said, it's fairly easy to figure out one NTG. And again, I would have to know that they can handle that. I have never and will never allow a basic to administer IV medications, I don't care if it's a caridac arrest. I personally believe there is a much larger margain of error in IV medications. I'm sure everyone will have their feelings on that.

Why? You think ACPD is going to help you? HA! Just like they "secure" a shooting scene, and 30 people (all bystanders) still walk in and out of the complex. (Liberty School House ring a bell?) And don't blame us dude!!! There are some EMT's just as cocky with people! So there!

Our medical director is ironically the one who designed the first model. So of course we carry it. It works on normal skin, but I've found it does not work on dark skin. And if the veins are deep, and their skin is dark, no luck. I've used it once. I've had better luck with a blind stick, where a vein 'should' be.

AZCEP Thanks for that post! I just took a 12 lead class again and they never mentioned that. They basically state if it's new onset, treat it like an MI until proven otherwise.

I was not trying to be nasty and I'm still not. BUT, you cannot ask for treatment based 'solely on the machine'. You just can do it. You cannot come up with a treatment plan without knowing whats going on with pt.

ST Elevation is NOT indicative of LBB and that's is not how you figure it out. The ST segment changes are possibly caused by it, but that's not how you determine if it is a BBB. Look at the QRS complex. If it looks wide, immediately go to V1. If the QRS is greater than 0.10 (and I think AHA may have raised it to 0.12), it's a BBB. Now looking at V1, go backwards from the T wave. If the QRS complex is negatively deflected, it's a LBBB. If it's positively deflected in V1, it's a RBBB. And about your treatment modality, slow down there trigger. I may be looking for answers as to the cause, but if the pt is asymptomatic, I would most definitely NOT be arbitrarily throwing NTG and ASA his way. It could be indicative of an infarct, in which case go for it. But it may also be normal for that pt. Remember to ask the pt if they know they have it, or if they have an old ECG. I can't stress this enough (sorry for shouting) TREAT YOUR PT NOT YOUR MACHINE!!!!!

I can't agree with any treatment as of yet. Especially not fluid challenges. What if it's tachy because they are infarcting c/ normotension? Or BBB is normal but they are in CHF hence the heart rate? Or something as simple as fever? I don't think I can commit to treatment modalities without hearing some sort of patient information.

I can tell you everyone is different in the States and therein lies the problem. I know I said it before, but NJ is very strict. You need to go to the police department first, to be fingerprinted and have photo ID to do so. The state police then do, what I considered, a thorough background investigation including mental health facilities. If you have ever been seen at any facility for anything psychiatric, including depression, no permit to you. It's still a failed system, since there are obviously illegal guns in New Jersey. But they also have strict laws. Caught with a handgun thats loaded, jail time (unless at the range). Can't even transport one loaded in your trunk. Florida is nothing in comparison. Valid drivers license and a fee and you've got a gun. scary.

Next time block out the interpretation so those who are learning can investigate it on their own. Just saying. It's a BBB. So everything else is out the window. Treatment. I need a complaint first. CP? Fever? SOB? Dizziness? ????? And how did you get that 12 lead up there? Scan it and add it as JPG file? That's pretty cool.

OK. You got me. Not all doctors.....just the ones who don't work in the ER.

You disturb me....

A stethoscope and an sttitude problem. In case you haven't noticed....

ambman142 Boy, you're one to talk about appearances and how you carry yourself. Just kidding....I couldn't resist. :twisted: :twisted: You know I love ya! It's still 80 degrees. Enjoying your Nor'Easter?

You're right. But they've created a problem that there is no easy fix to. I don't think taking away those rights 100% is the answer, but I do agree that something needs to be done. I still can't believe you can't own firearms in Canada. Is that all guns or just handguns? Don't you guys hunt up there?

Go with what you are comfortable with. 911 gives you one type of experience, and transport is different. I enjoy both, but I wouldn't want to do transports all the time. I like the long distance runs we do, especially if the pt is interesting to talk to. Any reputable company shouldn't be throwing you to the wolves anyway. I started as a paid EMT with a local squad. I had to run as a third until they signed off that I knew certain things. It took a couple weeks for them to let me go out alone. I don't know if that was good or bad?? But I've seen companies so desperate they hire someone and throw right into 911 by themselves. I've seen people who have been EMT's for years (later find out it is doing transports), that could not figure out a BVM on a code. No joke. So transport doesn't really give you the experience you will need to finish out that medic goal.

Oh, and guys, why do you still respond to firefighter? He did this last time. Why not just ignore him until he eventually gets the hint and goes away?

When I took it for medic school years ago, it scared the crap out of me. CJH, I went thru the big "V" when Regina and Scott were still in charge. Him and his fake hand scared me a little. It was cold. Ew. Now I feel it's a waste of my time and energy. Why not just say, you're a paramedic, you've worked codes, here's you new card. Unless they change something, like this year, it's pointless for me to get out of bed to go. And the doctors...OMG :shock: :shock: Nothing scares me more then listening to someone with MD after their name, trying to figure out the dose for epi or atropine in an adult code setting....wow.

While I believe we should have more to say, I think you asking for a can of worms you don't want opened. That's face it. We've all done this. When they call for a stuffy nose at 3 am and the ER is still packing with an 8 hour wait, I advise them of this. "Oh, I don't get to go in the back". No, that would be for emergencies. And I inform them that stuffy nose does not qualify as an emergency, and therefore, they are still going to triage. Granted, it's more paperwork for a refusal, but at least I stay on the ER's good side. I probably shouldn't do that. But it comes down to abuse, and no one is going to get paid for a stuffy nose. Especially when they have 3 cars that run in the driveway.

I miss my Camden nights!! They were mostly fun. But I never relied on those cops. If they ever showed up in the first place.

That was pretty funny, especially the part about balancing herself on her walker. But scary too. That is a little extreme. If she was in immediate danger, sure, fire away. But to shoot someone's tires for theft is a little extreme. That's negligence. And things like that give gun owners a bad name. But thanks for the chuckle nonetheless.

MEDICNORTH... Here is my problem with your solution of cutting out guns, if that is in fact what I read. I noticed you said Canada does not allow gun ownership or at least sidearms. Here's my reasoning why I feel you should be afforded the right to bears, IF, and ONLY if you can prove you should, IE background checks, mental health facility checks like New Jersey does, and so on. Not just a safety course. My grandfather gave me a German WWII P38 that he commandeered as captured enemy equipment. The army let him keep it. Anyway, I cleaned it and took it to the range to see if it still worked, and it did. It jammed every now and again, for reasons I'm not going to delve into right now. So I had this one gun locked at home and I still had ammunition for it, but I keep the gun away, since it's worth a lot. I had to tell you all that for this. My wife woke me up and said someone was staring through our front window. I loaded the gun and went downstairs, unfortunately knowing it occasionally misfired or jammed. I checked everything out as best I could and left it at that. No, I do not have grandeurs of being a cop or being in a shoot out. I was protecting my family. So I called the non-emergency line for the police, since my wife was so freaked out. I knew the dispatcher, so I told her the story and asked to just send someone through the neighborhood for a check. Being in a small town at the time, we had one, count one, officer on duty at the time. I found out the next day, from the dispatcher, that the female officer waited for well over 2 hours before doing a driveby, because "I don't want to go alone". So she waited for another officer to come on shift. I went that day for apply to purchase a new gun. One that wouldn't misfire. So what happens when that person opens the window, and climbs in? What happens when that officer is too scared to help? I am supposed to just roll over and hope to God someone shows up to save me and my family? I've got 3 kids that are my world, and I'll be damned if I'm ever going to stand by while they are harmed. Next story, I now live in Florida outside the city limits. This means where are covered by the county sheriff. My wife called for an aggressive dog that climbed INTO our minivan and almost bite my child. She fended it off with a PVC pipe. Know how long she waited for ANYONE including animal control and the sheriff? 8 hours. 8 hours and numerous phone calls. I understand that animal control is not the sheriff's duty, however, when it threatens the public, it now becomes their job. They were too busy was the answer. This doesn't illustrate the gun point, although rest assured that if it did bite my child, I wouldn't think twice about putting a bullet in it. This is more of a 'see how long the police can take' point. And for all the cops, I'm not flaming you either. I understand your job and what comes first. But 8 hours? So, MEDICNORTH, I'm not trying to flame you or anyone else. But honestly, what am I going to do? Not protect my family? What happens when someone breaks in and threatens my family? These two cases illustrate my point. What happens when I call and "they are too busy"? Have this ever happened to you? Has anyone ever broken into your home, and you've had to wait in excess for police? Granted, my house wasn't actually broken in to, but it could have been. Or the guy could have returned or went to a different house since the police never bothered to investigate my concerns. That being said, I own a 40 caliber handgun that I use at the range, and as my home protection. I do NOT believe that ANYONE deserves the right to own things such as, AK-47, AR-15 (or at least the ones that are automatic and high capacity magazines), and so on. No one should be allowed to purchase these types of rifles. I know that in New Jersey, I believe, that maximum numbers of rounds for a rifle is 6, and 12 for a handguns. My gun holds 12 rounds. I'd be more than happy to lower that to 4 or 6 or whatever. At least 4 rounds to ensure I hit the target in question. I think some of these NRA freaks are out of control. There are certain weapons that have no place in this world, save those for police and military. The problem is the gun sales. They may check NCIC, but that shows criminal history, I don't believe it shows mental health, although I could be wrong. I know that in New Jersey, they check all hospitals and out patient clinics within X miles from your current, and previous addresses. If you have ever been admitted for a mental disease of any kind, guess what? No gun. No, that doesn't mean that they can't go acquire illegally. But something needs to be done on that aspect to. I just don't know what. I know banning sales altogether, is not the answer,.

That was my point, only you voiced it much, much, better than I did..

Thank you for pointing that out. I forgot to add your name back to it. Next time I will. And I didn't read anything that there already. I didn't ASSume. The gist of your words spoke for themselves. To everyone else, you're right. I'm sorry, this was the wrong time to ask about this little debate. I guess I'll wait until everyone forgets what happened, to again bring up my feelings about taking my rights away. Sorry, but I felt it warranted conversation. I guess not. My bad.

QUOTED FROM DIFFERENT THREAD Legal or illegal carrying a weapon is what contributed to this tragedy. Please, if you want to discuss firearm legislation and the pros and cons of gun control, start a separate thread. This is not for you to spout your beliefs on the second amendment. This thread is to acknowledge and express thoughts/condolences to those affected by this insanity. If you can't show even a modicum of respect, then please just don't say anything at all. Thanks. -be safe QUOTED FROM DIFFERENT THREAD! Legal or illegal carrying a weapon is what contributed to this tragedy?? Um, no. The fact that this guy was nucking futs is what contributed to this tragedy. I don't wanna hear it about how guns kill people. I own a pistol much like the one he used. I would never walk into a school and shoot innocent people. So carrying a weapon does not automatically make you a lunatic who wants to shoot people. I would, however, shoot someone in the chest if I had to protect my family when they break in to my house. I would never carry my gun into a building and start randomly shooting people. I don't even advertise the fact that I have it most times. (To the public eye, as in keep it hidden when in public and don't advertise). I would certainly use it in a heartbeat to protect myself or my family, and you can't take that right away from me. You can scream "guns kill' all you want. The fact remains, they do not. The idiots at the other end do. I have never heard of a story yet where a gun just gets up and shoots someone. There is always someone at the other end making that chain of events happen. I will say that I am all for gun CONTROL. It took me 6 months to get one permit for one handgun. That's not to carry, just to purchase it. I was fingerprinted and researched by the state police. This was in New Jersey. Florida is a lot more laid back, and frankly, it scares me. I like my gun, but I am by far not a fanatic. I would love to see tighter laws restricting the sales. I would also love to legislature that ensures that you do minimum jail time for possessing a weapon without a permit. Right now, in Florida at least, it's mandatory jail time when a firearm is used to commit a crime, even just to threaten. Not necessarily if you are just caught with it. You could get off light for just possession, as long as you were not committing a crime. paraloco wrote: I pro-gun, not anti. I posted this message because of the thread "Texas at it again'. It illustrated why even just one person carrying a concealed gun (legally or illegally) might have made a difference here. Sorry, the way I read it, was to mean the opposite. So now, I'm sorry. And I agree. If each teacher had been licensed for concealed carry, he wouldn't have made it very far. Again, I don't believe every single person deserves the right to carry, but with vigorous background checks like New Jersey does, there is no reason why you can't. At least the teachers anyway.