scratrat

Temperature topic...no.

Occassionally I've been curious to know what it might be. We used to get nasty GHB overdoses in AC all the time, and when the ambient temperature outside is 20 degrees, and they are pouring with sweat, I'd be curious to know what their temperature is. I've never checked because it won't alter my course of treatment. I've had the ER tell me numbers like 106 or 107 degrees with GHB, thought that was neat to know, but I'd never take the time to check it in the field being that close to definitive care. (Don't start tearing into to me about "definitive" Dusty.. ) I've used it once on a pediatric febrile seizure, but thats about it.

On the pen topic, we did the same thing up north. We used the Jelco needles for IV access. I forget the name of them, but I know when you thread te catheter off of the needle, it locks into position. You can use a ballpoint pen on the opposite end to push a small amount of blood back out of the needle to get a reading. The needle never came back out to my knowledge, but yes Dust, the possibilty of stuck exists.

On the glucose topic, I do it depending on complaint. I had a guy with an acute MI who just kept stating he felt tired and weak and required a lot of intervention to keep awake. Yes, I understand that the MI probably caused most of that. But I checked his sugar anyway, and found it to be 35 mg/dL. Am I not supposed to fix that? I want your opinion of this Dust. Because I did correct it, or in your previous post, I guess made it worse?? But if his sugar is low, and I don't correct it, isn't that going to be worse on the heart? Wouldn't that cause more problems? I understand that the dextrose wears off quickly and he needs to eat, but most likely he would have been NPO for cardiac cath. So, weigh in. And as a side note, for all cardiacs here FL, my employer requires a blood glucose on all these pts.

Minus 5 for unapproved abbreviation.

Can you tell us what MONOC stands for? It isn't even defined in the article.

Anyhow, it's amusing that this dude defends his organisations reputation by saying they are well received at public relations events.

Yeah, that's a concrete measurement of quality!

Monmouth-Ocean Hospital Service Coorperation

[web:2df020d791]http://www.app.com/apps/pbcs.dll/article?AID=/20070524/OPINION/705240423/1030[/web:2df020d791]

I don't see where the "ill-informed" part is...

seems right to me...

A few years ago I would have hunted you down for encouraging frostbacks to immigrate to Floridia. But it's a lost cause now. Florida is crap. Jersey has overtaken English and Spanish as the most commonly spoken language there now. It's disgusting. I'll never move back.

They speak English in New Jersey??

I am going to check out their website again, and see what is better, but with the looming tax cuts, I can only wonder if they will be hiring......

They do ALL 911 calls L&S?

I thought Florida was educated to a higher standard then that......

I don't know about them (Sumter) but we don't use L&S on every one. We get sent code 3 for certain things and code 2 for others, no lights.

Tax cuts aren't necessarily a problem for us. LEO, fire, and EMS still need to function. We are still hiring people here, HOWEVER, things like our new trucks and new buildings have been put on hold. You should still be able to get hired.

I dunno the last time you were at Coastal, but its issss that bad! lol

I did look at the LakeSumpter EMS system, and, it just didnt look like they paid that much. We had a guy from our station who just got picked up by R/M, and I am hoping to get the same days as him, so we can carpool out there.

Well, in AC, there was low pay, couldn't really do all that much, and we got little respect from the PD/FD guys, unless we got to know them. Sounds like fun to me!

Perhaps the move from Jersey wasn't so smart after all.... :roll:

No, it was VERY smart. Don't look back! Ever....

Funnier???

I guess I did.

That's a shame. Oh well.

People usually ring an Ambulance because they have an acute problem which may be an acute exacerbation of a chronic illness. Having chronic pain doesn't mean that they don't deserve immediate pain relief before stabilisation of their condition and a review of their treatment plan and medication.

Wow. I wish that were the case here. I can't say it doesn't happen, but rarely have I ever had someone who had an "exacerbation" of a chronic illness. I've had a few, but most people I've seen with chronic pain conditions, state "its been going on for weeks" and they "just can't take it anymore". Apparantly the scripts for vicodin, oxycodone, oxycontin, morphine patches, and so on, aren't doing the trick. See, when some one shows me their medication list, and it includes 5 or more narcotics, I'm not going to give pain control, at least 95% of the time I'm not. Call me what you want, but I'm not doing it. If something changed, or its a new injury, maybe. I'm not giving pain meds to someone with back problems (or whatever), who has already been prescribed 5 different narcotics. Not to mention the potential for side effects when mixing all those happy little pills.

Is that allowed here? :shock:

I love this article! It gives us an excuse to take one more drug away from EMT-Bs!

I know you'll probably blow up as usual, but whatever. Why is it you say we need to work together as a team, then make statements such as this? I'm confused about this. :roll:

Actually, it was Ventura Highway.

But this could just be my lack of a sense of humour coming through.

-be safe

I thought it was Ventura Blvd?

There's a freeway,

running though the valley.

Move west down Ventura Blvd.

----Tom Petty, Free Falling

There is so much more to it than just the cost of the morphine. Drug seekers have an enormous impact on the costs to society (though I cannot speak for the system in the UK, only in the US). Who do you think pays for the ER visits for all of these people? Most of them will have medicaid (which the taxpayers pay for) or no insurance (the hospital will then pass the costs on to those who can/will pay their bills). Then there is the impact they have on the ER itself. They take up a bed that could be used by a person who really needs it. They take up the time and resources of the doctors, nurses, tech, etc that take care of them. When they call an ambulance they are taking up a ambulance that could be used by someone who truly needs it (and they likely will not pay for it). The US healthcare system is busting at the seams and is ready to collapse. These people are only making the situation worse. Their impact is much more severe than just the cost of the vial of morphine.

I am not saying not to treat people for pain (read some of my previous posts and you will see I advocate just the opposite), but when you have been in the field long enough you can spot BS coming through the door. I explain to these people that the ER is an inappropriate place to treat their chronic pain problems. I also tell them that it would be inappropriate for me to treat their chronic pain with the 4mg of Dilaudid (which I feel is one of the worst drugs ever created) that they ask for. So, while it may not seem like a big deal to give a drug seeker their hit once in a while, keep in mind that there is a much larger picture than what you have to deal with in the back of the of the ambulance.

I'll step off of my soapbox now and return you to your previously scheduled thread.

Thank you.

For the love of God, thank you.

I was never taught about putting the leads on differently, but I guess that makes sense. I did treat a 15 year old for a syncopal episode who had it. No one told us until after the call. At first, it seemed BS, like he was playing. Beautiful sinus rhythm, all vitals normal.. then he suddenly went junctional then ventricular to a rate of 30. It continued for a sort time, then increased to 50 and junctional. We found out about the tranverse heart after the fact. He also had it fixed. I learned that it is the same as a heart transplant, IE atropine won't work, and so on. This was a first for me, so I learned that much about it, but the doctor was a little busy to go into more detail with me.

I worked with someone who is very openly gay and kind of queeny at times.

Dispatch : Security states to use the rear entrance.

My partner : I am intimately familiar with the back door.

I couldn't even help treat the pt because I was laughing so hard.

One of our idiot dispatchers who finally got fired (even after falling asleep on 911)

Dispatch : **** can you repeat.

Unit : Repeats whatever it was they tried to say the first time.

Dispatch : **** can you turn the volume up I can't hear you?

I run with a BLS service. we were dispatched to a drunk. we found a 30ish y/o male seated on a stoop, slumped over. pt unresponsive initially, but with some rousing, was found to be alert to pain. pt had no signs of trauma, and had a beer can in his hand, unopened. so we get he on the stretcher, and he wasnt breathing so hot. Get him in the truck, get a nasal airway in. partner starts to get vitals. i realize this guy is breathing slow, and shallow. I decide to assist ventilations with bvm. guy is tachycardiac with pinpoint pupils, to me sounds like an opiate od. heres the weird part,. we get to the ER, and upon the nurses assesment, the pt is breathing adequately, and indeed he was doing fine now on an nrb, still unconcious.the question is this, what could possibly cause such an improvement so rapidly? did we stimulate his depressed respiratory system? or was i just being overcautious with the bvm? obviously, i`d rather be not sure and assist ventilations than not bag someone who needs it, but he was definitely shallow and slow, and definetly improved in the ER. now, i left on another job, and didnt see if they hit him up with narcan or not. any input is welcome.

Lucas Simko-Bednarski

NREMT-B/NJ EMT-B

Where did you find that old patch??? They're still around???

Another reason I pack my lunch...

Hence the name "Happy" meal....

Do we need to visit this again???

We use the EZ IO on adults here. No real protocol per se, just inability to gain regular access.

JUst a question for all here....

I work for a very rural BLS service, we have no hsptl in our county, and the nearest hsptl is apx 25-35 minutes aways. If pt is in need of als care we can call the hsptl for an intercept with medic, wich i am sure is a normal thing for BLS. But here is the question. Are medics call to much in cases where they are not needed? I have found that there are cases that EMT-B's call for medics just because they are not confident in there own skill level. What is it like where you are if you work for a BLS service?

Two things.

First, and definately foremost, what the hell is that avatar? Is that two chicks? Thats hot.

Second, now that I'm past that, to answer your original questions : yes, very often!

I can't even say much more because I don't want to get involved in the pissing contest that seems to have started in this thread. But yes, I've been called, VERY frequently, for patients who did not need ALS, did not even have an ALS issue, or flat out had no complaint.

End.

I can't do anything for abdominal pain without a doctors orders.

That said, I ironically had a guy this morning with bilateral lower quadrant pain associated c/ N/V and CP from the repeated wretching. I called for orders for phenergan for the nausea. He vomited at least 5 or 6 times just with us. Instead, the doctor gave me orders for 12.5 of phenergan and 4 mg of morphine for the abdominal pain.

Someone enlighten me. I was always taught that morphine was NEVER to be given for undiagnosed abdominal pain??

It's still the same. Luckily, when I call the Doc-In-the-Box, I usually get what I want. However, I don't do pain management that often, because unfortunately, most of the time it's a seeker. However, I seem to be developing my sense of real vs. seeker.

Thankfully our doctors got to know your voice and associated it with a face when you brought your pt in. Most of the docs, once they got to know what you are capable of, will give you what you want. That said, I have had problems getting orders for pain control. They do not like us snowing pts up there for pain management. I've had isolated fractures, with nothing else going on (at least not that I had evidence of), and they still refused. Narcs for MI's and such was easy to get.

Everyone looks at me funny down here when I say "Doc-in-the-box". Like they've never heard that phrase???

25mg is a pretty low dose still but better than 12.5

I guess I'm speaking from a surgical Nurse background and not a field perspective. 50mg minimum.... frequently 100mg. Do you also automatically mix in an anti-emetic with it?

Basically every patient I ever had would have 50mg Demerol and 50mg Gravol PRN as a minimum.

Yes it is low. But thats if I want to do it immediately without talking to a doctor. I can call and ask for more, and every time I do, I get what I want. It's usually 100-200 depending on the injury and size/age of the pt. They are fairly liberal with it, but I don't use it very often, because the large population is seeking. I have been developing a way of telling the difference.

And no, we don't automatically give it with a anti-emetic. We can get orders for phenergan, but I'm not a big fan of it. Seen the article of the medic being sued because she obviously didn't realize the line was bad and gave phenergan? The women wound up getting her arm amputated. If I'm giving any pain management or phenergan, I ensure it's an 18g or better and unless contraindication, I'll run between 50-100 cc's just to sure it's a patent line.

Sux to be in Jersey! Fortunately, pain management is one of our medical directors top priorities. Fentanyl 2mcg/Kg. PRN or Morphine 2-5mg PRN, no max on either (unless they are drooling on themselves), and Nitrous Oxide PRN. I usually have happy patients upon arriving at the ER..........

Yes, it did.

Wow... that is simply unacceptable. Where in New Jersey? Is that still the rule??

Unless they changed it in the past 8 months, it's still the same. And it is statewide. You cannot administer any narcotics without doctors orders.