emt322632

Any urticaria? Does she feel like her throat is closing up? Agree with the chemicals in the shower. Also, was she cleaning recently? Is this the patient's primary residence or is she visiting? Could be a severe allergic reaction to the animals. On that note, has she taken care of or otherwise been in contact with the animals recently? Did this start before or after her jog? Lung sounds? Vitals. O2, IV, monitor...

Is his bp really stable at 210/104? I really don't understand how you could say the patient is stable with that kind of a blood pressure. The BP is of great concern to me, granted this guy is having severe back pain, but I've never really seen a BP get to be that high due to severe pain. I'm thinking he has some underlying pathology. I would explain to the genteleman that his blood pressure is of great concern to me and that I would like to take him to get checked out. I would say in no certain terms that while at the ER you MAY receive an X-ray, CT, some blood work and another 12 lead ECG. If he still refuses to go, I would call ERDoc and have him speak with the patient. I would definitely not want to leave without this patient in my ambulance. There is definitely something fishy going on here.

12 Lead please? Has he ever had this type of pain before. what exactly was he doing in the yard when he "threw his back out"? Hx of alcoholism, drug use? Hx of back spasms or fractures? Take any herbal supplements/remedies? Does the pain radiate, and yeah what is it on a 0-10 scale? Any N&V? Hx of sickness recently?

In most parts of NY they are phasing out the EMT-I. There really is no need for this level of care anymore, at least that's what I've been told. Seriously, as a EMT-CC, my education left ALOT to be desired. In the class we were taught when to give the meds, not really why. Most of the things I've learned I've picked up from other providers or through reading massive amounts. Thank God I'm proactive with my education, otherwise I wouldn't know half of what I do. I plan to do Paramedic someday, but right now I'm preoccupied with school and 2 jobs. Someday though.

As was mentioned by Lone Star, if you walk into a situation where there are AK-47s around, chances are you weren't called for a medical emergency. More than likely those people have bigger plans for you.

This just goes against everything that EMS was created for. Emergency MEDICAL Service! There is nothing in that title that even remotely comes to include any form of spying on your patients. I can see this type of reporting for some incidents, such as elder/child abuse. However in those cases, the welfare and life of the patient could very well be in danger. Just as was mentioned, there are countless things in people's homes that could be mistaken as a weapon. Heck, I'm sure someone somewhere has a bottle of bleach and some ammonia lying around, must be they're trying to create a noxious cloud eh? I just don't think it would be conducive to our job if people were worried about having the authorities called on them whenever an ambulance responds.

Wow...it really IS that easy to get your hands on uranium!!

To number one....holy crap. (Pun intended) To number 2...she is a great performer!

I'm thankful first and foremost for my family, who have supported me in every decision I've made (good or bad) They've let me make my own mistakes, and in this way I've learned so much. I'm thankful for my beautiful fiancee who supports me in everything I do, even though she called me crazy for going back to school for another 2 years after finishing a BA I am thankful to be allowed the privilege to work with some of the most dedicated individuals I have ever met I am thankful to have 2 jobs that help me pay my bills I am thankful for my teachers, not just the ones that stand at the head of the classroom, but those who have taught me things outside the classroom. I am thankful for my patients, from whom I learn so much everyday, about medicine and about myself. I am thankful for education, and for learning, without it we would be nothing.

In what context? Are we talking about someone who is a patient in a long-term care facility that has stopped eating? Or a co-worker/family member/friend that has stopped eating? Yes it is a bad thing. Perhaps not immediately, but after a while malnourishment can have damaging effects on your body, one of them is known very well as death. Is this a fast? Like in the religious type of fast? Hunger strike? Are they being stubborn and not eating? Or do they suffer from an eating disorder such as anorexia? If it's the latter I would advise them that this type of behavior can lead to serious health effects. You would be wise to lead them to someone who can get them psychological help. But I'd like to hear more on the situation as well...

I have a problem with kids skipping class for something like this. I was the DO of a campus first response group and if I found out any of my members had skipped a class to go on a call, I was none too happy. It was not something we promoted at the college level, and it should certainly not be promoted at the high school level. I was a fire explorer in high school, and we were NEVER allowed to leave school, let alone carry a pager or radio to class.

I was speaking to a rep from our local EMS office about the subject of ER nurses being required to do ride along time on an ambulance prior to being hired. I was surprised when she told me that many moons ago that had been common practice. By many moons I mean maybe 10-15 years. It's a very good idea, personally I'd like to see it implemented again. I've had several encounters with nurses in the local ER that were less than pleasant.

"What kind of terrorist are you?" "A terrifying terrorist..." haha classic

We have nice pocket, alcohol fast, guides that each provider is assigned. We also carry full size protocol binders in our ambulances. I've looked at the protocols from time to time, no shame in that at all.

Was this the point in the ride where y'all hit every bump in the road? There's the simple explanation! Seriously I'm thinking trigeminy that degraded into v-tach. The v-tach just occurred so that could be the reason why his vitals remained unchanged. I'd go the same way as everyone else here, consult med control if unsure. O2, IV, continuous ECG and some amiodarone.

"Do you have oxygen on your ambulance?" No, but we do have alot of booze and drugs....want some?

Alrighty...this case had me stumped to. We transported her to the ER, very uneventful transport in and of itself. The bigeminal PVCs went away on their own, she reverted to RSR at 88. I gave 2mg of narcan just to see if it would have any effect on her mental status, when we got her to the ER she was slightly more awake, but was still unable to vocalize or follow commands. When we were leaving, one of the nurses said it looked like a possible brain bleed. However, the next day when I went to work ( I work at the hospital we transported her to) I found out the problem.... Hepatic encephalopathy. Had to look it up, but all her symptoms fit. http://www.nlm.nih.gov/medlineplus/ency/article/000302.htm Just don't really know how the liver failure came about, her husband said she had no medical history except her back surgery.

I actually had to read an article recent on the death penalty for my English class. The author was a former federal prosecutor who said that people who are accused of atrocious crimes, but are innocent, are much less likely to take a plea bargain than those who actually commit the crime. People want to prove their innocence and, unfortunately, go to trial and are convicted of crimes they did not commit. Especially in atrocious crimes such as pre-meditated murder, child murder, and the like, prosecutors are pressured to find the culprit and put a quick end to the situation. The system as it stands is flawed. Am I in favor of the death penalty? Yes and no. Yes in that I believe people should be punished accordingly for their crimes, an eye for an eye as has been stated. I am not in favor of the current system we have. On the subject of child molestation, I say put those guys with so much love to give into the general prison population. You know, with the lifers who have kids of their own on the outside that they haven't seen in years. Let's see how well they fair against them.

It's a possibility, since she did recently have surgery. They may have prescribed prescription narcotics and she became addicted. However, she wasn't able to tell us anything, and the husband was kind of useless as far as patient information goes. He said that he hadn't been home for a while, so it is possible he doesn't know EVERYTHING that's going on with her. Suboxone is also used for pain control, so it's possible she was just prescribed it for post-surgery pain relief. Any guesses on what it could be or does anyone want additional info?

125 mg/dL.... She's slightly more obtunded now, barely rousing when you provide painful stimuli. You're about 15 minutes away from the hospital. She's still letting loose with some scream/yawns, but does not grimace upon palpation of any body part.

She hasn't traveled anywhere. She is currently unemployed due to her recent back surgery. IV 20 ga started, running NS at KVO...Do we want to try narcan for possible OD with the narcotics she has? Treat the bigeminy? Or wait and see what happens?

There was no gait, she could barely stand.

Husband has absolutely no idea if she took the pills or not, though they were sitting right by the bedside. Husband also questioned on recent trauma, says he doesn't believe she did anything to herself (fall and such) Leg is warm, dry, no deformities, contusions abrasions or the like on it at all. + peripheral pulses x 4. Pupils are PERRL Husband says she has just been getting increasingly lethargic since last night, and today he couldn't rouse her at all. While you are doing your assessment she sits up and lets loose with what sounds like a scream and a yawn together, then falls back to sleep. Pill count doesn't show any more pills missing than what should be there. She has been on this prescription for about 1 month. As far as the husband knows, no other meds. He was working out of state for a while and just came back recently. Also says no history of seizures and no seizure activity today or last night. You get her up, after putting 02 on her, and manage to move her downstairs. She has urinated herself again. You put her on the monitor and see a regular sinus rhythm with unifocal bigeminal PVCs. Now what?

You scream her name and no response. You attempt to rouse by painful stimuli and her eyes flutter open briefly and she goes back to sleep. Husband brings you one pill bottle, Suboxone 8mg. Husband says that she was fine yesterday, but has been sick the past few days with nausea, vomiting, and diarrhea. Says she hasn't been able to keep anything down. He also says that she wet the bed twice tonight, which is very unusual for her. Vitals BP= 128/72 P = 88 regular R = 18 regular Airway is patent, self-maintained. Good Lung sounds bilat. No obvious bleeding. no allergies, past history of back surgery 1 month ago. no other medical problems. last ate yesterday, yogurt and nothing else. Husband says no other meds in the house and she has taken no OTC meds. He also admits that he works alot and isn't home much.... Anything else?