scratrat

And let us not forget "Never underestimate stupid people in large groups"

Guess what, If you see a supraventricular rhythm, and you cant tell if it is SVT or AFib, I don't think you would give a CCB before you would give adenosine!!! Adenosine is a natural occuring agent that will chemically convert PSVT to NSR. In the event that it doesn't, it will slow the Afib down so you can see it. Then you will treat accordingly!!!

How about a 12 lead ECG instead of blindly administering a medication and HOPING it works?

1. You should NOT let them decide, that is what you are there for. You are the professional, and are the one that is supposed to know what to do. 2. Make a decision and go with it. Just hope it is the right one. 3. This pt sounds like they are unstable. I would cardiovert, if vitals and and pt impression indicate. Blue lips, resp distress with rapid A fib would get electricity.

Well, lets see here.

1./ So what you are saying is the pt cannot decide what treatments they want? You do know what assault and battery is right? I hope so, because if you ever touched my family member in the manner in which you speak, rest assured you'll be doing jail time. When my pt's tell me no to a procedure, I rationally EXPLAIN it to them, including pros and cons, if they still refuse, it is their RIGHT to do so.

2./ Make a decision and HOPE it's the right one?

Are you retarded? I hope you never say that in court.

3./ That may be unstable, but that still doesn't give you implied consent.

Finally, please tell me that, judging from your screen name, you are only a firefighter and not a paramedic? Please tell me you only play with hose and not with pt's lives????

Personally, if given a choice of Versed or Etomidate, I'm taking Etomidate. Versed bottoms your BP, and I've seen too many patients where 10 mg wouldn't even slightly sedate them. Etomidate works faster, and doesn't cause the hypotension that versed does. It doesn't last very long, but once they're intubated I would use valium to keep them that way. But to facilitate the tube, I'd rather have Etomidate.

I guess more of you would find this comical if you knew Monoc or have ever worked there, as some of us unfortunates have......

This is because they have closed down over 10 ALS rigs in a year..

I can't take credit for this, but it is funny as hell!!

To be sung (roughly) to the tune of "Walking in a Winter Wonderland" one anda two anda....

9-1-1 rings

are you listening,

At MONOC

no one's listening...

Having chest pain tonight?

Oh what a fright!

Living there in Vince's Wonderland

Gone away are the medics

What's to say,

it's pathetic.

No medics tonight,

The budgets too tight.

Living there in Vince's Wonderland.

In the ghetto while you're having chest pain,

the medics are on the unemployment line.

You'll say I need Nitro,we'll say "no man",

But you can have Bayer Aspirin anytime...

Later on while you have rales,

Call 9-1-1,

you'll get voicemail.

No CPAP for you,

You'll have to turn blue.

Living there in Vince's Wonderland.

Terri,

Wanna hear something funny?

That's the place I used to work for! There's my old director.....hahahahaha.

I've done it plenty of times. Sometimes, it's the only way you get through. But I only do it below 30 mph. And I use the siren sometimes, but if it confuses them, I'll trun it off.

I never stop unless it's a crew I know and it looks like they need help.

I hate when people stop at my scenes. "I'm a nurse, I can help!" Please god, don't. It never fails. They are ALWAYS either a nursing home "nurse" or the ICU nurse. Neither of which is helpful on an MVC.

You refer to yourself in the third person? :shock:

Hmmm, interesting. If he has similar conduct issues and seriously did this against the patients will, then he will get whats coming to him. But on the other hand, how many times have you been on a trauma call that when you start cuting clothes off of people that they object? Depending on mechanism, I'd want to cover my ass about things, and make a full assessment. Maybe they could have gone about it differently.

Me too.

HOWEVER, I would never cut off someones underwear or a womens bra unless it was restricting the airway. Or if I absolutely knew an injury was underneath that I just had to see. Other than that, I would have stopped there. No need to cut off underwear and bras.

Not to mention the fact that he falsified legal documents by not documenting the third morphine dose. That's also a federal offense I would think.

I have to agree with the previous poster about telling the truth. It is probably gone from his record since he was 17 at the time UNLESS he was convicted after his 18th birthday.

If I were you, as a friend, I'd have a LONG talk about how bad he may have screwed up, and enforce that this CANNOT and WILL NOT happen again. If he seriously wants to pursue this career, he needs to smarten up if he hasn't already. If he gets a job, and this happens again, not only will he get fired, but most states will permanetly revoke his EMT license/certification.

HAHAHAHAHAHA!

My bad!! :oops:

Could I steal this if I give you credit for it?

That is so awesome!!!! I think I snotted coffee right out of my nose!

I guess coming from up North to the South, I should be leary about this huh? y'all....

Paramedicmike thank you for the alternate perspective... being fresh out of school I still have faith that our protocols are whats always best for the patient. I never considered the aspiration perspective, but it makes perfect sense. Appreciate the eye opening,

Mobey

Please tell me you are joking? You honestly believe that your protocols are ALWAYS the best? Wow. Just wow....

HAHAHA.

That's funny...

First of all, get some good sleep the night before. Second, show up to work AT LEAST 20 minutes early to show some enthusiasm. Third, if it's a good FTO, and good EMT/Medic (whichever), they will understand that you are new. My advice, pay attention to what you are doing. If they ask a question, give the simple answer. Don't try to impress them with extras, cause you'll only end up screwing it up. And finally, just learn something. That includes asking questions. If you're unsure, ask. I would be inclined to pass the person or doesn't know and asks so they can learn from it, rather than the person who thinks they know it all, and needs no direction.

Oh, and have fun!!! It's a rewarding career if you let it be!!!!

No offense, but if in Ohio EMT-I's are running around playing with benzos and opiates in their pajama bottoms, I am staying the hell out of your state. Up until this point I thought that Ohio adhered to National Registry standards. Thank you for educating and scaring the crap out of me at the same time.

Asys,

I gotta tell ya.......you're a hoot!!!

I love reading your posts. How long do you actually sit on it before you reply? Piss myself laughing everytime.....

And thanks, I'll stay out of Ohio too....

Okay, shira, here's my question. You hopped out of bed in your PJ's, dashed off in the middle of the night to the woman who ran into a tree, and did exactly what for her? Took her blood pressure? Held her hand? What was the immediate attention that this woman required that was so critical and crucial that you couldn't even put pants on? And if the MVA was that critical, how were you going to even get near the patient with all the jagged metal and broken glass in your PJ's? To answer your question, if my mother was having an MI, and people showed up in their pajamas to take care of her, yeah, I really would care, and I'm not sure if I'd let them in the damn house.

I dunno, I'd wager that a paid professional service would have showed up appropriately dressed, maybe.

No, you really don't. You don't fully comprehend EMS in all its full function. Tell me, even less so than the MVA, what are you, as an EMT-I responding in your pajamas, going to really do for the MI patient? Sure, you can wait around for them to code and then defibrillate them, but in the grand scheme of things the O2 and the line you started is not going to make a difference in the patient's outcome. When people are alone, sick, and scared, they want someone who is knowledgable and professional to show up at their door, not someone in their pajamas. And just for the record, just for all you wonderful superhero volunteers out there who do this for the sake of helping others, just a friendly reminder, I could be doing a whole HOST of other jobs right now with a lot less aggravation and a lot more pay out there, so you had better bet your next issue of Galls that the reason I do my job is to help others when they are in need. I do this job by assuring that people get the best quality prehospital care they can, and to me, someone showing up in their pajamas with the delusion that their mere presence is going to somehow make a difference is not good quality patient care. Sorry, it isn't.

-25 points for being a typical volunteer and making me repost stuff I have already said many different times in many different forums. My suggestion: Get the jump suits back.

OMG! Dude.......a little over the top, but wow. My point exactly. When I was still a volunteer EMT, before I knew better, I always took the time to throw on my jumpsuit. At least I looked somewhat presentable.

And while we are on that topic, let's not forget to mention the professionals who show up half dressed too. There have been plenty of times that I've been working with someone , as a full time paid paramedic, where they couldn't tie their shoes, polish their boots once in awhile, tuck their shirts in for God's sake, etc, etc.

I do have to agree you Asys, I wouldn't want someone in pajamas treating my family either. Even before I was a provider, I would notice things like that. If someone showed up in pajamas, my first thought would be, "wow, what a joke. Are these people serious?"

I'm sorry, but if you can't take the time to look somewhat presentable, please don't come. Even if it's me laying there, I don't want to look up and see pajamas.

Shouldn't take any longer than 2-3 minutes start to finish. The ones' I've dealt with anyway. You basically have the power device that plugs directly into the wall of the ambulance, the tube goingfrom the device to the pt, the mask, a PEEP valve that goes on the mask, or some don't have that valve if it's an adjustable machine, and then the strap. That's all there is to it.

I recently moved down south and have been presented with a new device. I have never used it yet in the field, but I have put in together in training. The one I had up where I used to work, I could put that together in under 2 minutes.

VENTMEDIC :

Again, thanks for the great posts.

I am not sure how many different devices there are for pre-hospital use. I can tell you I've used two different types. Both were CPAP though and not BiPAP.

1./ Had a set valve to deliver 10 mmHg PEEP and always delivered 100% FiO2.

2./ Can set anywhere from 0-?? mmHG PEEP. We are instructed not to exceed 10. Also, you can adjust the FiO2 from 0-100%.

I guess it's all medical director dependant.

Does amio cause it or they're usually on it?? Never took notice to that before, although this one was not on it.

I've long felt that the difference in FiO2 between 10L/min and 15L/min is not clinically significant but does empty the tank one third faster.

Spock

As EMS providers, I think we're talking more about the difference between 4-6 lpm on a nasal and 10 to 15 on NRB, not the difference between 10 and 15 lpm. I never go above 10 unless they are draining the resevoir, but still, you can't treat everyone with a nasal @ 4-6 LPM.

HAHA. Great ending.

Thank you for the in depth reply. I appreciate.

So, judging from your post, it is safe to assume CPAP would have probably caused more harm than good which was why I avoided it. Even if I was questioned, I would still stand by my decision. But thank you, it seems to clear it up for me a little.

Thanks guys/gals.

Vent - I did exchange the nasal for a NRB @ 15 lpm, thought I said that. Sorry if I missed that. And we did attempt IV sticks enroute but between the prednisone skin, and veins, they were unsuccessful. I have also had pt's bottom out after CPAP use, so I was leary in this case. We don't have the option of BiPAP so it was CPAP or nothing, I chose the later. Thanks again for your imput.