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Everything posted by emt322632

  1. Ugh I hate this topic... I had a discussion similiar to this with a probie once, wanting to know why we didn't respond priority to every call because after all "Dispatch could be wrong..." After I stared blankly at him for a few seconds I responded that it all boils down to safety. The safety of me, my crew, and all other drivers on the road, for it's not just our safety that we have to worry about, but the safety of all other drivers. We must respond with due regard, and if involved in an accident with an emergency vehicle, it would most likely be the responding ambulance/fire apparatus that was held liable for the incident. I can tell you for a fact that the vast majority of calls in New York State are BLS calls, : http://www.health.state.ny.us/nysdoh/ems/stat.htm I can't attest for all other states, but I'm betting the statistics are similar. Why put yourself at risk for a basic call? So...in short...if someone has a hangnail, I'm not responding priority...I refuse to. I refuse to put the lives of myself, my crew, and the other motorists in jeopardy because someone can't afford a bottle of Motrin or use their digits unaffected by a hangnail to call a taxi.
  2. How about we ask the question, "What did you do that you didn't mean to do?" In other words, how did she attempt suicide...may clear some things up
  3. Wow I guess I have it pretty good...I actually like my mother in law...my father in law on the other hand...what a putz... Seriously though, the officer definitely should have realized something was up when 2 hospital employees told him that there really was an emergency... Common sense....
  4. I would have said CO poisoning but with your reading on the monitor I'm leaning away from that... Check out the BP and pulse, elevated BP and low pulse could indicate neurologic involvement (bleed) any s/sx of stroke? Patient favoring one arm over another which which to swing at you? :-) Do we have any other medical history besides his psych history? I could see the rationale for narcan here, while right now he's only altered with a patent airway, he could go even further under and lose the ability to maintain it on his own. Stop the drug (if there is one) from working and prevent him from possibly going further downhill.
  5. Congratulations!!! May your little girl bring you and your wife years of happiness!!
  6. If asked about a year ago what I felt about abortion, I would have said, "It's the woman's decision..." Now however, after having to deal with the issue and its potential outcomes, I'm much more on the pro-life side (save for the aforementioned instances of threat to mother and baby) Last year when my wife and I found out we were pregnant, we were so scared. The thought of abortion did cross our minds at first, until the very first ultrasound. Even though my daughter was the size of a peanut, I still had that special connection that only parents have with their children. We decided not to do it. 15 weeks later, we visited our doctor who told us our daughter had ventriculomegaly, which could mean a potentially serious complication or that she could simply need a shunt to drain CSF from her brain. We went to a specialist, and he laid out on the table that it could be 3 or 4 different things: 1) She would need a shunt, in which case there may be no inherent long term problems. 2) She could have a fatal genetic disorder. 3) She could have Down Syndrome. 4) The ventricles could return to normal and she could be fine... After saying all this, he also said we had a week to decide if we wanted to terminate the pregnancy. It all seemed unreal, here we were again at this decision. And still we couldn't do it...seeing her in the ultrasounds, she was her own person, and she was developing a personality!! Much of what I saw her do in the ultrasound, I see her do everyday now. We decided to keep her, even in the face of the unknown. Now, Olivia Marie is 5 months old, and even though she does have Down Syndrome, I wouldn't have it any other way. She has absolutely no physical health problems, and is just so damn cute and funny. She recently started smiling and laughing, and that is something that I will keep with me always, and can always brighten up my day. Looking back on all we went through, it seems like it was ages ago, and that I was a totally different person. I guess I was. As far as the thread (didn't mean to hijack I just started typing what was on my mind) this was a very sad case, and a heinous act. If they noticed the baby was breathing, they should have attempted all measures to save her. Period.
  7. If the patient denied drug use, you have nothing else to go on unless you can run a tox screen in the back of the rig. All you had to go on was the patient's report that he had not used illegal drugs. If you found paraphenalia (crack pipe, burnt tin foil, the drug itself) that would be a different story. I think you did an excellent job of managing the patient as best you could. For them to say it was a reaction to the illegal drugs...well...yeah...I guess tachycardia could be considered a reaction, but to have the non-chalant attitude that "This is just a cocaine induced MI", is just worrisome in my opinion.
  8. If you're waiting for changes in BP, HR and presentation, you're waiting too long... Back to the forum... Prior to going to nursing school I was very guilty of auscultating through clothes and not wanting patients to disrobe for an assessment. Now though, it's second nature, and really has to do with more confidence on my part. If I come across as a calm, cool and collected professional, I can gain the patient's trust and things will go alot smoother. My nursing instructor made a very good point, though it was in regard to bathing patients, never ask. I had problems with my patients saying they didn't want a bath, and she asked me how I presented it to them. I said "I ask them..." and she simply said don't ask, don't give them the option of not bathing. So now it's "When do you want to wash up?" So, instead of "Is it alright with you if I check your stomach and chest for injuries?" It's..." I need to check your stomach and chest for injuries..." I haven't had any problems since...
  9. It looks to be sinus tach with ST depression and T wave inversion, possibly indicative of ischemia. See a few PVCs in their too, but too much of a wandering baseline and can't really tell from the photo if it's regular or not, could you scan it instead of photographing it?
  10. I'm keeping that in the back of my head as well...The child definitely needs to be evaluated by a specialist, so if we don't have one at this hospital, let's get them to the nearest one. Meanwhile we can do a CT of the head, CBC, Chem Panel, Toxicology (just in case) U/A, and also double check for any signs of trauma while we're at it, expose the child if they aren't already and just take a peek to look for any bruises.
  11. Completely agree...I'd rather be in front of the 8 ball than behind it...
  12. Alright this little fella/lady could potentially be in serious trouble. Bulging fontanelle = increased ICP, and since mom had no prenatal care and baby has had no medical care, opens up a list of possibilities for complications (hydrocephaly, ventriculomegaly are tops right now...) IV access, if we can get a BP good let's do it...supplemental O2, may actually consider intubation to protect the airway if we want to get really agressive here...
  13. What did the seizure look like? Full tonic-clonic activity or something else? Has the baby been sick at all, any underlying medical conditions that we need to know about? Any signs of trauma? Any other children to these parents with any health conditions? Was the birth uneventful (thinking if vac was used to assist delivery maybe just maybe something happened, it's a stretch but hey...) As others have said, vitals, blood sugar...how is the baby responding right now? Awake? Is he/she acting normally per the parents?
  14. Well, let's get in the ambulance first When we get to the scene, how old is the patient, what exactly happened, did anyone witness the seizure, is there a history of them and how long did it last?
  15. I would opt to give the cardizem, rate control while attempting to treat the underlying condition (poss. dehydration secondary to infection, hypoxia r/t infection etc. etc.) Her rate is very concerning. She may be stable now, but there is only so much that a heart that old can take, and I'm assuming she has other comorbidities as well which weren't listed. Hypoxia and infection increase the heart rate, putting more strain on the heart in an attempt to get more oxygen to tissues deprived of it. However with a rate this high the heart isn't doing itself any good, the ventricles can't fill completely and sooner or later she will decompensate. I would have consulted with med control on this but I'm going to lean toward administering the drug, while attempting rehydration. Found a very good article on treatment of rapid a-fib: http://www2.nursingspectrum.com/articles/a...le.cfm?aid=5861 In the article it says that treatment is, "...aimed at controlling and slowing the ventricular rate, treating the underlying cause, preventing embolic stroke, and restoring normal sinus rhythm..." It doesn't say "Well we'll assume this is a respiratory problem and treat as such without worrying about the cardiovascular side effects..." Treat the rate, while treating the underlying cause...
  16. I'd immobilize based on the information I have, level of consciousness being the big thing here. I'd like more information though, there isn't really alot there to go by....
  17. 125 mv IVP for pts with suspected COPD/Asthma exacerbation. We do have a protocl for suspected spinal injury but I don't believe anyone has ever used it.
  18. The type of attitude seen on that forum seem to run rampant in NY. I ran into some problems very similar to that on a local web board. I've kind of given up on it as they banned the IP address of a friend of mine and honestly...it's not worth my time.
  19. Where I run, (the frozen tundra that is Northern NY), we don't have the type of response the OP was mentioning, where an ALS ambulance would call a BLS ambulance to transport a patient. I've never heard of such a thing and it souds kind of ridiculous. I would have transported the patient without ALS interventions in place, I would not have handed him over to a lower level of care for transport, just because the chance DID exist for him to develop a pneumo. Just a misunderstanding I guess.
  20. Negative on the probing, but if it did enter the pleural space, wouldn't we expect to see some signs of a sucking chest wound, or a potential pneumo forming? I don't have alot of experience with penetrating chest wounds, I'll admit, but to me from the OPs original post, it sounds like a laceration more than a penetrating wound.
  21. If it is a superficial slash wound (laceration), I really don't see why ALS interventions would be needed.
  22. Seems to me like the diagnostic tests support the diagnosis of commotio cordis. This was an otherwise normally healthy individual (I think, did we get an accurate history from the family? If not we should!) Who sustained a direct insult to the chest which resulted in v-fib. The emedicine article that was posted earlier, http://www.emedicine.com/ped/TOPIC3019.HTM seems to support the diagnosis here. This kid was just unlucky enough to get hit in the chest in that 15-30 millisecond window.
  23. Slash with no deep penetration, no resp. difficulty, no severe hemorrhage = BLS. Monitor v/s enroute, tell the FFs to do a better job of describing the wound to the hospital next time they send a report in and maybe they could have BLSed him.
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