emt322632

When I used to hear the local volly squad get toned out 2 or 3 times for a call when I was at work, I would graciously call the county dispatch and advise them that we were available and the closest mutual aid. More often than not I would get a thank you, sometimes I'd get a very rude thank you though. I've never jumped calls though. I'll extend the offer, but I'm not going to be the one to stir up a hornet's nest. Especially when I'm in uniform and on the clock.

There is very little training received by pre-hospital care providers in regards to psychological emergencies, and more specifically sexual assault. The main priority for any sexual assault victim is treatment of obvious wounds, and to maintatin a feeling of safety. Let them know that no one will harm them, and that they are safe with you. It sounds like you did the best you could. It is hard with these types of patients, wanting to be able to say one magic word that will make all the pain go away. Unfortunately we have to learn that we can't fix everything pre-hospitally.

I've pulled several expired NaCl bags off the truck that were two weeks past expiration. Had a portable O2 tank without any O2 in it on a ped arrest, and had expired reglan show up in my truck. Everything gets checked, every shift. No exceptions. It's your certification on the line if something is missing/expired, so trust no one.

There was a hat in that picture?

Passion is a moot point when we're dealing with people's lives. It's good to have someone that loves their job, and loves doing what they're doing, but it's even better if that person who loves their job also has the knowledge and skills to help my mother when her heart gives out. Volunteers for the most part have little to no accountability for their actions. From my experience, most feel that increased educational requirements are nothing but a chore and serve no purpose. If they make a mistake in patient care that could be detrimental to the patient, oh well lesson learned. Paid is the way to go.

"I'm sorry m'am, there's nothing more we can do..." ..... "By the way, do you mind if we have that kidney?"

One thing that you have to remember is that there are many subspecialties within nursing. Nursing is much like (forgive the bad word usage) doctoring, in that you are trained in certain aspects, and then can specialize in certain areas afterward if you wish. Not all nurses can handle emergencies, and many aren't trained to do more than what a doctor tells them. Some are only exposed to certain specialties in nursing school, and then leave them far behind. I just finished OB and Psych rotation, and can say that I will not step foot in either location again:-) But it's just like has been said, in every profession there are some good ones and some bad ones, it's the bad ones you hear about more often.

Yes, we've all had to deal with additional inservices for new protocols and the like. We've all had to deal with additional education that our medical directors have saw fit to bestow upon us. Perhaps your medical directors feel that your system is inadequate, and they are simply trying to bring it up to snuff. I am sure it is not a personal attack against you, or an attack on your level of care. As Emergency Medicine advances, so must we in the trenches. You either roll with the punches, or you get dragged kicking and screaming into the new age.

Agreed, I'd like to see a strip if at all possible. Was he in this ER previously? If so I want to see prior EKG if obtained at all? I'd like to bring his rate down first, knock out the most obvious candidate, then let's go from there. Labs, chest x-ray, echo? Let's think possible CHF, P.E., AMI...

Called into the ER one night with a BLS transport from a nursing home. Advised we were transporting BLS with the following vitals: BP: 134/78 Pulse: 16 regular Respirations 60 regular ER response: "Could we have those vitals again please?" My partner couldn't stop laughing...

I'm not going to beat around the bush, this appears to be negligence. As irme said, I've never seen asystole spontaneously convert to v-fib. The fact that no code summary was provided? No copies of a rhythm strip? The paramedic wrote pulseless VT in his report, then after the fact says she was in asystole? Come on... Maybe it is the media skewing facts, but this is all really fishy to me...

Actually for the new hands only CPR the AHA is incorporating it into ALL levels of CPR from Heartsaver up to Healthcare provider. Hands only CPR is meant only for witnessed out of hospital arrests, nothing else. I stressed this to my students the other night, and told them that if they had a barrier device with them, they should perform regular CPR. However if no barrier device is present, it's time to go to work with hands only. Personally, I would never do mouth to mouth on someone I didn't know, so this makes hands only CPR perfect for everyone, not just lay rescuers. Sorry to hijack the post...

Honestly there's no substitue for a good first aid kit in your car. Forego the oxygen as there is too much liability/risk involved with carrying it in your personal vehicle. Leave the O2 on the ambulance;-)

So wait...according to the subtitle of the article rigor mortis had set in, yet the paramedics treated her? I'm guessing that it wasn't really rigor, or the paramedics in question need some refreshing.

I think as healthcare providers we tend to look back on patients and wonder "Did I do the right thing?" I think given the scenario, your boss did his job to the best of his ability. Doing nothing would have been potentially worse than doing what he did, which was the right thing in my opinion. Hindsight is always 20/20.

Superfly, I don't know that MAOIs are very common in treating your "run of the mill" depression". More often than not tricyclics or SSRIs are prescribed. MAOIs are often reserved for those with severe depression, for which previous SSRI, Tricyclic, and psychiatric therapy have failed. The reason they are reserved is due to the severe hypertensive crises than can occur if too much tyramine is ingested. These drugs are only for people who want something to change in their lives, and who are willing and able to follow the strict diet that comes with the medication.

ccmedoc, Never heard of that. Here protocol is 2mg IV/IM. Only ever had to give it once, for suspected narc OD which turned out to be hepatic encephalitis. I saw it pushed once when I was in ALS class, woman had actually ODd on her vicodin, woke her right up with the 2mg. She wasn't violent, but a little confused as to how she got in the back of an ambulance.

Maybe it's just the region I was "brought up" in. I haven't really had this sort of situation arise, nor heard of this situation before. I may have to talk to a few of my local ER docs and see what their opinion would be, often times opinions around here are a tad bit conservative, this is definitely something I would consult med direction for. Maybe it's just my comfort level though.

The ONLY time we are allowed to even think about starting an EJ is during an arrest. Personally I wouldn't ever think about starting an EJ on a person who's awake. As has been noted, diabetics may tend to be a bit combative. I had a hard enough time starting a peripheral line on a combative 86 y.o. woman once, can't imagine trying for an EJ.

What does the father say when you're presented with the DNR? I don't think the scenario is that simple. In my region we're allowed to ignore the DNR if it looks as if there will be a confrontation with family members. The DNR is valid and signed by both parents, but I don't agree that it is always the "Final Answer". Once in a great while you may pull up to a scene where a DNR has been signed and is valid, but the family may want you to begin CPR and try to save them anyway. People do change their minds. Personally I would contact medical control while continuing to work the child, telling them one parent agrees, one disagrees, however there is a valid DNR. See what they say, and if they agree I should stop, I'll stop. Nice scenario.

Very nice scenario, learned alot. Didn't notice the PR depression on the EKG at first, my first thoughts were MI as well. After reading the article provided though, learned something new. Thanks everyone!

I'll go with all or nothing. Depends on the pt. and MOI though.

Why not help out a bit more by calling for an ALS intercept? I understand your thinking as far as the high blood pressure goes, but did he really NEED the oxygen? No apparent respiratory distress, L.S clear bilaterally to auscultation. From the presentation you gave to us it appears that the patient was in no obvious distress whatsoever, save for a few signs that MAY point to something larger on the horizon. Also, how can you be sure that the recent death of a close relative wasn't the primary cause of the event? Death = grieving. Grieving = depression. Depression = avolition, and substance abuse. Patient may not have cared enough anymore to take his meds, and may have started to use alcohol heavily. Did his mentation change at all during transport, you're right, the BP of 90/70 in the ER is something to note. Any pallor or decreased LOC on the way in?

Did you compare his left ankle to his right ankle? Any bruising? Warmth? Perhaps this patient is just non-compliant with his meds, that would explain the increased b/p. Did you inquire as to the death of the loved one? As in was it recent? This may explain a few things. Perhaps he is still grieving, may be depressed, could explain non-compliance issues and the alcohol use. This leads to a question of does he normally drink? If so how much? What did he drink? Any illicit drugs on board? Any OTC drugs? If ALS on board this truck, O2 IV and 12 lead EKG. Pt. seems relatively stable despite the elevated BP.

Today it's been "I'm Just a Guy" by, Brad Paisley. Yesterday it was "Don't You Think This Outlaw Thing Has Done Got Out of Hand", Waylon Jennings cover by James Hetfield.