scratrat

ALWAYS write what they tell you in quotes. I had a little old lady fall in a parking lot breaking her hip, wrist and ankle. The store covered her bills completely. When asked what happened she replied and I quoted "I tripped over the orange parking bump thingy". Then she tried to sue for millions claiming she tripped in a pot hole. The case was thrown out based on my report. Given the example of chest pain, this is how I was taught by a physician and I prefer it over the SOAP format. I just never liked it for some reason. CC : CP HPI : Pt sts he woke up at 0745 this morning with a sudden onset of mid-sternal non-radiating CP. He describes pain as "someone sitting on my chest". Rates pain 8/10. Neg aggravating or alleviating factors. He denies any PMH. He c/o associated nausea and SOB. Pt speaking in full sentences. Neg accessory muscle use. (+)Diaphoresis. PE: LOC : CAO x 4. Skin : N/W/Diaphoretic. HEENT : Pearl. Neck : Neg JVD. Trachea midline. Chest : Equal expansion. Lungs : CTA c/ adequate air exchange. SpO2 96% on room air. Rhythm : NSR s/ ectopy. 12 lead shows definitive ST segment elevation in Leads V1-V3 of 10mm. Abd : Soft ; non-tender. Ext : Neg edema. Full equal pulses. Tx : HFO2 via NRB @ 15 lpm. NTG 1/150 SL x 1. ASA 324 mg PO. IV NSS (L) ACF 18g KVO. Pt reports pain down to 7/10. NTG 1/150 SL. Reporting pain unchanged. NTG SL 1/150 c/ slight relief to 6/10. CMC. Orders for morhpine in 4 mg increments repeated up to twice as necessary. MSO4 4mg IVP with significant relief to 2/10. Arrived at ED and transferred care to ER RN Mary in bed 4.

1./ Not funny at all. 2./ If I'm not mistaken, Macon is in GA where citizens can carry. 3./ I would have returned fire. How funny would that have been then?? Because I can bet I'm a better shot. 4./ Everyone who was involved and/or had knowledge of, requires immediate dismissal. No questions asked, no union involvement. 5./ The person brandishing the "weapon"; charged with terrorist threats, (No acutal weapon is required for this) and kidnapping. Maybe more if I can think of the correct statute.

I can tell you first hand, Crotch. As much as it pains me to admit it, I did a VERY short stint there. Bunch of backwoods..blah blah. Believe me when I tell you, when you see the population of Marrianna, you'd understand and your argument becomes mute. In this area, women don't WANT to be firefighters. You're surrounded by southern bells and/or farm girls. With an appropriate teeth to tattoo ratio. And they drink beer from a (gasp!) can. This town is BEYOND rural. And NO ONE wants to leave Panama City in favor of Marianna. And the previous fire chief was also black. Dumb as a box of hair, yet he was promoted. I don't even think he was capable of forming a complete sentence in English. It is over. Again, this is why it's the first question of federal applications and a lot of private ones. You get "points" for being anything other than white. You are rewarded in fact. So kiss my ass if you think it still continues. It's reverse now.

We had a guy sitting calmly in the chair with the family reporting SOB. Guy speaks no English. They claim he was started on an antibiotic but can't remember what and it wasn't filled yet. NO DISTRESS WHATSOEVER!! We load him up and go. We operate chase vehicles, so I was following behind the BLS ambulance. All of the sudden it vears of the road to a halt. Turns out, the guy started bradying down and coded. Couldn't get him tubed, but had a line, so we did some drugs and took him in. At the hospital, they were able to intubate. Turns out, he was given a shot of PCN that we didn't know about and had an acute reaction, slamming his airway closed. Since my partner gave epi, it opened him up enough to allow intubation, but it was still too late. They pronounced him. He had NO SIGNS other than the complaint of SOB although he appeared in no distress, with clear lungs. Another one, was an unresposive casino patron. Unresposiive, no gag. Judging from the characters in the room, we went with overdose. Gave narcan and nothing. Looked at his arms and they looked "weird" but I wouldn't say hives. We were able to intubate easily. Figured it couldn't hurt so we gave diphenhydramine. About 10 minutes later he magically woke up and tried to extubate himself. Turns out he ate shrimp and is allergic to shellfish. Then he ate a hamburger which he choked on after his throat suddenly closed. My point is that neither one of these patients had any signs or indications of allergic reaction. Your guy was reportedly stung. From these past experiences, I would have given Benadryl and maybe some epi as well as a trial an error. It may not be the best medicine, but sometimes you have to try.

Flip a trick coin and make it your partners' turn to treat...

What's wrong with the dirty versions?

1. ABC's? Is that what you're looking for? I'm going with PE and/or embolus to the heart itself. 2. Allergies, PMH, present medications, previous episodes 3. Oxygen 4. That depends....did I give a medication? Is the rhythm unchanged? If I've done nothing so far, he's getting cardioverted. If I've given a medication AND the rhythm remains unchaged, I'm cardioverting.

Again, how is this my problem?

So, an article from the 90's is your basis for your comment? Intersting...especially given the fact that WE are now the minority. And how is it MY problem that more blacks are unemployed?? I'll say it again....get off your ass. There are PLENTY of free rides to college just for being anything but white. Jobs and education are out there for the taking, people are just too lazy to GET said jobs/education. I'd also like to know why, when applying for federal jobs, you automatically get "points" for being anything but white and you score a better chance of getting a job even if your less qualified, based on the color of your skin. There is reverse racism these days, so you can kiss my ass if you think I owe you anything. Go tell those unemployed to do something about it and stop trying to blame me for your races' issues. The 60's are long gone.

Not when you're a public servant and you are spewing hate rhetoric towards a specific group of people. Would you say the same thing if I posted hateful things about blacks on my Facebook page while off duty? I bet you'd call for punishment. This is no different. Where did you get your data from that states that predominately white people are on welfare? Or is this another one of your blanket statements with no merit? I for one am all for getting rid of ALL social programs to ALL people, white, black or indifferent. You get what you breed and social programs breed laziness from all sides.

You truly fit the description of racist Mr. Crotch. I find it comical that it’s okay for you to do, probably because you think it’s okay. Why do you feel the need to turn every thread into racism? That says “insecure” to me…

CHBARE....has anyone ever told you that you look suspicously close to someone named Lebowski... I just happened to notice the resemblance..

That's awesome. All I get is an EMT....can't really do IV infusions... Besides, there's a nice little cheat sheet laminated card on the back of the IV pump usually. But I'm thinking I can't bring that into the testing center with me. When I first got my cert back in 2000, I walk in the room and she gives me lidocaine 2mg/min. Beautiful!! Go through the whole think like clockwork. When I get all done she asks, "Anything you would have done differently?" I looked around and said, "Yes, I would have taken the syringe with the lidocaine in it and actually injected it into the bag..." She passed me. LOL. I felt like such an ass...but I thought it was funny ONLY after I knew she passed me..

LOL. Well, I found a review test book on Amazon for about $15 that has really been testing me. I've forgotten some of the information since I took it last. Drug calculations were always my pitfall too, so I'm brushing up on those before I test again.

I knew you'd have the answers doc! I found this online for something like $10-2 and figured I'd take a peak. Money wasted.....

I found this review test by id44 something or another. And for money, I say it sucks. So many grammatical errors and such. This was SO not helpful. Anyway, I disagree with the answer he/she has to this question. In a third degree heart block the P-R interval is : a. None of the above. b. Longer than .20 seconds. c. Contains more than one P wave d. Normal, but is not consistent with the QRS complex e. Progressively increases until a beat is skipped. Okay, I choose A. none of the above and he/she thinks the correct answer is d. normal.... I don't agree. It can't be "normal" if it's a third degree heart block. I see what he was getting at, but I don't agree with the way he worded the question. I already know the P waves and QRS complexes have no correlation. I;ve been doing this long enough...but how is the P-R interval "normal"????? It always changing theoretically in a 3rd degree block. What say you? If this were a REAL national question, how would you answer? Let me see what else I can find.... I think this one was a misprint. Either that or I really AM borderline tarded... The period of the cardiac cycle when stimulation may produce depolarization is: a. the refractory period b. the absolute refractory period c. the decompensation period d. the relative refractory period. I could have sworn there was only absolute and relative refractory periods, obviously the correct one being D. But he/she thinks it's A. Am I missing something here??? Maybe I do need to open up a book again.....

I don't remember hearing that it is contraindicated with atrial fib. It is contraindicated in SSS and high degree blocks, which I never understood anyway since a 3rd degree heart block is not going to be at a rate of 200 bpm. Or at least it is highly unlikely anyway. I can remember giving it to someone with no known history whatsoever only to find that when the rhythm breaks, you can see obvious A-fib. When it returns to SVT (or more appropriately A-Fib with RVR) then the doctor ordered Cardizem. Doczilla said where I was going with it - I have heard of that with WPW and SSS. I could have sworn adenosine was contraindicated for WPW as well, but I can't recall exactly on that one.

RUFFEMS - You said it all for me, thanks.. I refuse. I don't give it to EMS providers and I never give it to the hospital staff. Like Ruff said, how many times have we seen in the news where an EMS or hospital provider steals someone identity and goes on a shopping spree?? Although with my credit, you won't get much! Be that as it may, I still don't. And when they've asked for my kids socials, I tell them I don't know it. I don't care if where're in private or not. Over the years, information has become increasingly vulnerable to cyber attacks and I'm just not willing to take the risk.

The QRS complexes appear wide to me and the R-R interval is actually regular, so A-fib is out. I'm going with 3rd degree heart block. I would have absolutely paced her, just based on the fact that I can Admit it, that was funny... But I would have done it seriously. She's confused, maybe new onset. However, she's also pretty darn old. That could definitely be her norm. I wouldn't touch the atropine only because it was ingrained in me not to. It can cause reflex worsened bradycardia. Pacing would be the way to go, but also being only 15 minutes to the heart center and being relatively stable, I may have saved that for them.

I got KED my first go round years ago. I failed it the first time most likely because I was afraid to really tighten it down on the poor girl. But they allowed me to redo it the same day so I did everything the same but tightened that crap out of it and I passed. I saw the sheets on their website site so I'm reviewing now so I can get ready!! lol. Scene safety, BSI....recall all other apparatus...this one's dead. I'm guessing that would be an inappropriate response to the trauma session...

I have already taken both the written and pratical tests almost or just at 11 years ago. I have to retake EVERYTHING in order to move back to New Jersey (damn bass ackwards state....) I can say that I'm not nervous about the written exam. Obviously, with my experience, I would hope I can pass that. I'm more concerned about the pratical stations. Not only do I have experience, but I'm sure I've got bad habits that I must overcome in order to pass those! lol Any insight into the stations?? Which ones are paramedics required to do in BLS?? The oral stations are new and were implemented the test right after mine. I've seen the checkoff sheets from NREMT website, but what are they looking for?? I can memorize the check off sheets but if anyone can offer a little more, I appreciate it!!!!

Yes, Virtua Health Systems covers Camden city. But you rotate through all different trucks. It wouldn't always be in Camden. That's Medic 43 and 45 is in Pennsauken as the second due in. If you are out of state, it appears you will have to have NREMT first. Then Virtua would have to "sponser" you, which basically means they will hire you temporarily for 6 months and then apply for your full certification. Once you have that certification, you move to any other projects without a problem. Every MICU in the state has it's own set of problems. I had no problems at Virtua because I made it what I could. It can be a miserable experience if you let it. And since you are relatively new, I'm guessing you want Philly/Camden because of the call volume and the glory. Allow me to inform you that BLS there in Camden is no joke. They don't care if the patient is bleeding to death. They will load and go and leave your ass behind in a heart beat. You don't really make it to very many calls within the city itself. They will cancel you and just drive to Cooper without you. The city is relatively small, so transport times are less than 5 minutes usually.

engine173351 - sounds like a small town or something. The ER should have had plenty of staff ready and willing to take over for you. I don't think I've ever run into a situation where the techs didn't jump right in. So this guy was off duty, what was he doing in the ER? I'll be perfectly honest, I am SOOO over the glory part of this job and I'm the first one to not get involved when it doesn't pertain to me. I'm not going to "jump" calls or show up on scene just to "see" if you need help. HOWEVER, if help is needed, I'll jump right in, duty status aside. I can't just sit idly by when you are asking for help. I think that was a shitty attitude to have on his part. But like someone else said, he's not covered by malpractice, but more importantly he's not covered by workers compensation. If he's got mouths to feed, that could be VERY important to him. I work be thinking of that. I've got four other mouths to feed and I don't need an injury that's not going to be covered. Oh, and P.S.....you with IN A HOSPITAL!!!!! How hard is it to find a pair of gloves?????

Dwayne, Thanks! I'm making my guest appearance!! lol.. I'm still torn about the nitro. I guess I just have this "thing" about an EMT-B administering a medication. Understand that back in NJ where I've spent most of life, EMT school is a 3 month long crash course. There is also an extremely high rate of volunteers there. So the education, training and experience of an EMT up there varied greatly. Down here in Florida, the one at the local college is a year long and they were required to take college level A&P and Pharmacology (which I didn't even have to do in medic school). I guess that's something that I might have to get used. Be that as it may, I was agreeing with you on the IWMI which is where my other hesitance came from. If there's right ventricular involvement, you can kiss her B/P good bye post nitro administration, which did make a hasty retreat. He can't fix that with Trendelenburg secondary to the SOB, unless you say screw it and lay her flat and start ventilating. Boy, I miss these discussions!! I wonder if I can access this page at work???? lol.

I'm guessing you're a basic? Coming from a paramedic stand point, the only thing I disagree with is giving Nitro. That has nothing to do with you or this case, I just don't feel nitro should be given at a Basic level without having an EKG readily available first. She may have had an inferior wall MI with right ventricular involvement, which is why her blood pressure tanked. Or she may have taken sexual dysfunction medications (yes, women do this too). Or her chest pain was caused by an arrythmia. I noticed her heart rate jumped up to 150 and you were initially sent for an unresponsive person - leading me to believe she may have had a syncopal episode. With her current complaint of chest pain, I'm venturing to say there's an arrythmia under there somewhere. The only thing I would have mentioned would be maybe assisting ventilations. The theory being that her respirations are now increasingly labored despite high flow O2, she shows signs of hypoxia and her heart rate skyrocketed....she's impending failure..