scratrat

So without ridiculing, I'm really curious.

Case:

90 something from a nursing home. Get limited info from staff for obvious reasons. Pt presents in bed very obviously tachypneic and using accessory muscles. Pt obviously severely dyspneic. Pt CAO x 3. Just states she can't breath. Unknown onset. Pt on O2 @ 5 lpm via NC with SaO2 96%. Normally on 2 lpm per staff. Pt has PMH of HTN, NIDDM, and pulmonary fibrosis. Possibly has part of a lung removed but it is unknown which or how much was removed. BP was around 98/60. Weight 80lbs soaking wet. Lungs were actually clear as est I could hear. And they were present throughout just slightly diminished on the right, so they probably removed the right base. Any other pertinent info that I'm missing here, just ask.

Anyway, she's a DNR, definitely no tubes. Pt put on HF O2. Blood sugar 212 mg/dL. ETA of only 2 minutes from local nursing home to hospital, it's right around the corner.

Another medic saw me and immediately inquired why I didn't use CPAP.

Couple questions here.

1./ What exactly is Pulmonary Fibrosis?

I was under the impression it was a disease that basically caused the lungs to harden and have difficulty expanding.

2./ If I used CPAP (not BiPAP), wouldn't that just cause a build up of pressure? This, in my mind, would have led to a probable pneumothorax.

I don't think, short of bagging her or intubating her, I could've done much else. But she was a DNR so I couldn't do that. Plus being such a short transport, I opted to just run. But if it was longer, would CPAP have been a good idea to use?

Any help is greatly appreciated. I'm still learning, I admit it!! lol

First, it's called SUPRA not super.

And carotid massage is a vagal manuvuer kind of. Same thing as telling them to 'bear down' like they are to deficate, which is a Valsalva Maneuver.These maneuvers stimulate the vagus nerve, which can slow conduction of electrical impulses that control your heart rate. Some systems allow for the bearing down but not carotid massage. It's different everywhere you go though. Carotid sinus massage has a lot of contraindications and some badddd juju associated with it.

May I steal a few of these to put on a coffee mug???

Thanks guys.....rub it in just a little more...

Finish your other degree first. If thats what makes you happy. Your mother is paying your tuition, use it while you can. You can go places with that degree. If you go into paramedicine, you're not going much further. Unless you do med school or something. Wait till you're done with EMT school to see if you even like it first.

REALLY.??? be careful with the "always and never" statements,, Oral Glucose for "unconscious or Altered Mental Status patients" with known diabetic history, is in a lot of protocols.

Even if the patient is unconscious.

I know for a fact that it is in the MD Protocol for 10-15 Grams paste between gum and cheek.

So, don't tell him "your teacher should know better." That may be directly out of the protocol book from the state or county they they are in.

Now you may not agree with it, and being an ALS provider you may have a better way of doing it, and it can be a airway problem if you are not careful, but Glucose paste is protocol for Unc. Pt's.

Thank you

If someone is stupid enough to follow that protocol and administer a sticky gel to an unconscious person, then shame on them. And shame on that medical director. Someone should be speaking to that medical director to change their protocols. It's all fun and games until someone aspirates on this and it will come back to haunt the EMT. The medical director may have written the protocols, but it still falls back on the person administering the medication. If someone chokes and dies, I GUARENTEE you the lawyers will eat the person alive who gave it. The medical director may get into trouble too, but he/she probably will not stick up for you in that case. You should NEVER give oral glucose to someone who cannot follow your commands to eat it themselves, or you're just asking for trouble.

I just moved to Florida from NJ. I know that as a medic, all I had to do was take Florida's medic exam and once I passed I could practice in FL. I don't know if they would allow the same for a RN or not. If you are interested in a particular state, jus google up State DOH EMS, and you can usually find answers and/or links.

They are already RN's. They must be employed by an MICU project who is willing to allow them to challenge the state paramedic test. They must complete, I believe, 100 hours as a third person on the MICU vehicle as a "student" before they can test. After being certified, they can function as a paramedic while working with another paramedic. HOWEVER, when responding as an MICU vehicle, they can only function as a paramedic, nothing more. When working as an MICN on an SCTU (Specialty Care Transport Unit), they function as a nurse.

Since you are in the Atlantic City area, the MICN's you see are from AtlantiCare. They function first as a nurse on the SCTU. They can provide backup paramedic services, last I knew, only in the city of Atlantic City.

AS a brand new EMT I was forced into attending a CISD after a child related date. I was told at the time that this was mandatory. Had I known it wasn't, I never would have attended. The call didn't necessarily bother me to point where I needed to talk about it. But here I was around 15 people, at least 13 of whom I've never met, and I'm supposed to just pour out my feelings. It doesn't work.

My advice, seek out a professional counseler. And you're only human for continuing to remember this call. I've got a few I think of periodically.

Nothing a little friendly nasal intubation with a BAM device attached can't solve.

With most employers, I won't pretend to know anything about AMR, if you got an offer letter of employment, that means you are in like Flynn!

Congrats!

Don't let it bug you that much. If the doctor didn't catch it at first, then you probably would never have noticed. Stuff happens. Just try to be thourough each time, and if you miss something, as long as its minute, don't fret.

TAKEN FROM PRESS OF ATLANTIC CITY

Sadness, frustration at vigil for sisters killed in crash with trooper

By MICHAEL MILLER Staff Writer, (609) 463-6712

Published: Friday, January 26, 2007

Staff photo by Edward Lea

Family members and friends hold a candlelight vigil Thursday for Christina Becker, 19, and Jacqueline Becker, 17, two sisters from Upper Township, Cape May COunty, who were killed in a crash Sept. 27 with State Police Trooper Robert Higbee. Christina would have been 20 on Thursday.

UPPER TOWNSHIP — Neighbors, family and friends gathered Thursday at the Church of the Resurrection to remember two teenage sisters who died last year in a crash with a State Police cruiser.

“They were bright lights to us in the all-too-brief time they were with us,” the Rev. Robert Gregorio told the more than 100 people who attended.

The sisters' aunt, Laura Caiafa, read from the Bible.

“And these three remain: faith, hope and love, but the greatest of these is love,” she said.

The Cape May County Prosecutor's Office is still investigating the Sept. 27 crash that killed Jacqueline Becker, 17, and her only sister, Christina, 19.

Prosecutor Robert Taylor had no comment on the investigation Thursday.

Some of those who attended Thursday's vigil expressed frustration with the duration of the investigation.

“I'm upset as a parent,” Tuckahoe resident Ken Thompson said. “I'm not confident at all in the system.”

State Trooper Robert Higbee was not using a siren or flashing lights when he ran through a stop sign on Stagecoach Road. Some witnesses have said he was speeding. The prosecutor has said Higbee was pursuing a speeder.

Higbee faces traffic citations for careless driving and failure to yield. The Becker sisters' family also filed a citation in Upper Township Municipal Court accusing Higbee of reckless driving. Those tickets are being held in abeyance until the conclusion of the prosecutor's investigation.

Higbee faces a fine of $50 to $200 and as many as 15 days in jail for each of the traffic violations.

“I think they've been dragging their feet too long,” Dennis Township resident Dan Nees said. “The Attorney General's Office should get involved. It's taken way too long.”

The Prosecutor's Office recently obtained data taken from air bags in the police cruiser.

Once the memorial service began, people wanted only to remember Christina and Jacqueline.

“It's very, very sad for everyone,” said Linda Ellison, who lives near the teenagers' mother, Maria Caiafa.

“I saw their grandmother in the store. She was so heartbroken and so sad. I pray for her.”

In the months since the accident, those who loved the Becker sisters erected a roadside shrine with a small white garden fence. On Thursday night, it was bathed in alternating pools of flashing red and yellow from the new light signal Cape May County installed after the accident. The Township Committee had asked county freeholders repeatedly to install a flashing signal here as early as 2005.

The shrine also had a flier for the Natalie Portman movie “V for Vendetta,” which was one of Jacqueline's favorite movies. A helium birthday balloon floated from a string tied to the shrine, which was covered in flecks of snow.

Christina would have been 20 Thursday.

This was taken from the Press of NJ where I just left.

This illustarates the point I was talking about. Although he didn't have lights on, he is still responsible. If he did have lights on, would he still be charged? I think so.

I'm not saying I don't do it, I'm was only pointing out that emergency or not we are still held responsible.

Amen brother!

This actually came to an argument with the newbie, he keeps trying to tell me that you cannot under any circumstances take custody of a pt without the police permission. Honestly what are they teaching people in school? He was the senior medic calling the shots, and the junior had to say no, im not taking this anymore.

Tell the newbie he's wrong and right. There is one time you can't do it. When they are awake, alert, and oriented x 4, and they are a compotent adult, with NO alcohol or drugs on board, and they are not considering suicide/homicide, then you can't take them without LEO intervention. Otherwise, if they are drunk (or sorry, intoxicated), under the influence of drugs, suicidal, or otherwise a threat to themselves or others, you can certainly transport without intervention by LEO.

But this thread still goes back to scene safety. I still can't fathom the fact that they did that.

All I can say is wow......

They thought this was ok? Why would one partner abandon the other to gather history when the pt already had been violent once? That was a stupid mistake. You should impress on both of them that, that could have ended their lives.

In response to whether or not to transport, absolutely. Intoxicated people can't sign a refusal. At least not in the states. I don't know about where you're from. Judging from the limited information (LOL) I would say this person was definitely not capable of making decisions for himself. They should have transported with or without consent. Get the police to go with if need be. I know that here in Florida, they have different Acts that basically state a police officer may, if he feels the person is a danger to himself or others, force him to go to the hospital whether they like it or not. They don't get the choice in that case.

This whole call sounds like a SNAFU from the beginning. That crew made several grave mistakes that they need to understand.

I'm still trying to figure out why/how people aren't getting that I posted several times about due regard. The question has never been about due regard, but about passing through an intersection against a solid red light. :? :? :roll:

And passing through a red light is WITHOUT due regard. I'm not saying you shouldn't do it. We do it all the time. My point was that if you hit someone in the process, you are at fault. Every person I've ever heard of that has done this, has been cited. Didn't matter that it was emergent or that it was an ambulance.

I'll see your post and raise you one.

I just got to this state from NJ, and NJ does have that same provision. HOWEVER, if you go thru a light even with lights on, and you hit someone, that still makes it your fault. Thats due regard. If you cross the center line while passing another vehicle, and you hit someone, I guarentee you the officer will cite you for careless driving. Provision or not.

And no, you didn't "fix" my post...

I hope I just fixed your post for you. If not, I can drag up a source saying (at least locally for California) that any emergency vehicle displaying a forward facing burning red light is exempt from traffic control devices (except for intersections under manual direction or the flashing reds of a school bus).

Maybe in CA, from every other state you are by no means exempt. If we run a red light, it's our fault no matter what the circumstances. You are not exempt in any other states that I've ever heard of.

Welcome aboard Jester!!

I learned a lot, just not spelling.....

LOL

Thats not true. NorthSTAR takes about 20 minutes from the time they get the call till the time they're on the ground. They still operate... well, I don't know about right now with this going on. They're good for extrications because you can't get the pt. out right away anyway. Other then that, A Level II trauma center is 10 minutes from my house. A level I trauma center is about 20 minutes away. And the nearest hospital is about <10 minutes away. So there's not too much need.

Well, Southstar tells you 15 minutes and 25 minutes later, they still can't figure out how many times to circle the scene before they land. That's assuming the moon is aligned and they're even flying.

That's great that you're so close to a trauma center. What about those of us who worked where a trauma center was 45 minutes to an hour? and Southstar doesn't feel like flying since there's a cloud in Ohio?

Thank God they finally opened up the certificate so Medevac and Pennstar can now take calls even if southstar refuses to fly! Now you can actually take care of a pt!!! WOW.

I have a question.....

how do I become a FDNY EMT??

I think we need to be careful using words like "running emergent" in this case. Should we even be running "emergent" with our families in the vehcile? If he was in his POV, I'm assuming his flashers (as described in the article) to be his standard four way flashers. This is in no way an emergent response. Even if he was running an emergency light in his POV, they are deemed courtesy lights (at least in CT) and don't give the driver of a vehicle any authority to violate a single traffic law. If he was doing 85 in a 55, that is reckless driving and if a trooper was trying to initiate a traffic stop and he failed to stop then he was evading the officer. The officer did go to extreme measures to end the pursuit and that issue should be addressed as well. The officer may or may not have known who else the guy had in the vehicle with him.

80-85 MPH becomes to fast (legally) when the speed limit on most interstates is 65 (maybe 70) in some areas. Assuming a speed limit of 65, he is traveling +/- 15% over the speed limit. In Connecticut, anything over 20 MPH over the limit and you may be charged with wreckless driving which involves a mandatory loss of license.

I don't condone the actions of either of these guys, but the officer at least had a reason to try to initiate a stop.

Shane

NREMT-P

That was my point as well, the fact that the kids were in the car.

I think the officer got a little carried away, however, if you run, you're done. He didn't know if it was a felon or something, so I can't fault him too much.

But this FF was being an absolute idiot. It sounds like he only had his four ways on not any other lights. And it is that way everywhere else with regards to lights. Did you know that legally the only person allowed to run a red light is the post office if delivering mail, and the military? Cops, ambulance, firetrucks, none of them are allowed to go through a light. Especially not with just a whacker light (blue or red depending on the state). If a cop blows a light on the way to a call, it's his fault. Usually the person he hits happens to be some smuck who doesn't have insurance or something so they get into trouble rather than the cop. Go figure.