Dooger

I'm with djdudley on this.

When I was younger and more cavalier in my "hero" mentality, and before I had a family, we routinely entered scenes that we should have staged for, and for all kinds of reasons/rationale. While some here have said they may risk their own lif,e they hesitate risking their partner or other responders. I suppose that is a basic rule of thumb to go by if you're single or don't have family who would miss you if you made a bad decision. I have a wife, three kids and an extended family who would feel the loss for a cavalier approach gone wrong.

OD, assault, domestic... I didn't put them in their bad situation, I'm certainly not going to risk my life to give them another chance. I'll stay out until I have the properly trained & equipped personnel there to provide that added measure of safety for everyone. Could someone die because i decided to be safe? Of course. As long as its not me or my colleagues. Remember, we dont have to make their emergency or bad decision our emergency or bad decision too.

Stage & wait. I want to go home to hug my kids at the end of a shift.

Hey Mobey... Longevity in this industry is almost an oxymoron. I had a couple minor meltdowns before I learned what you did. I wish that I could have learned those lessons a lot earlier and also wish I could engrain it in the rookies before the crash & burn.

Thanks for sharing your personal story, I think it will make a difference in someone's life & career.

And hang in there, you're not alone.

This is hilarious... you all want to lynch a man based on a magazine article, not in inquiry or an investigation... but a dang magazine article!

What facts are missing? What additional information would you like to see? What do you think based on what's presented?

We know nothing about the seizure patient... beyond the fact it was a seizure patient. Was s/he postictal? Was s/he stable? If s/he was stable is there immediate concern of recurrent seizures? Was s/he still seizing? What was being done to stabilize him/her? Was anything necessary to stabilize him/her? Was transport strictly for observation/investigation or for intervention?

There is no way of conveying how the scene presented to the crew that stopped... it seems apparent that it appeared serious enough to warrant investigation based on the seriousness (or lack thereof) of their seizure patient. If that is the case I'd have to assume they made the right choice (and subsequent decisions) based on the information they had.

Like I said before, I wasn't there to know what they knew or see what they saw so I cannot judge whether it was right or wrong. I need to assume they would use sound judgement based on all the information they have available... until it is proven otherwise; to draw conclusions or pass judgement without all their information is unfair speculation.

There are too few details included in the "report" to judge what is right & wrong. I wasn't there, I can't say what I would have done, each case is unique and must be judged based on ALL the FACTS. It is foolish (unless you are a whacker) to try and draw any conclusions/judgements based on what is presented.

I wonder if my vet could fit me in for shoulder surgery. :?

And I can argue that several cities have already tried it here. While eating establishments rebounded, some bars did not. Several ended up closing due to a steep decline in revenue. With a much higher tax on alchohol than on food, it would not be wise to impose this ban on bars. The revenue to the state alone could be detrimential during a time when our state is already struggling.

It looks like there's a fundamental difference between Canadians & Americans & their tolerance/loyalties in this particular set of circumstances.

...Some businesses are going to be hurt by the ban. I know several bars in my hometown will be. You don't find very many non-smokers who just sit in a bar all night and drink. They stop for one and go home...

Sorry... going to have to call foul on that one.

Our city, and others before and after, believed the same misconception prior to enforcing a public smoking ban. What actually happened was the opposite. Although there was a brief decline in revenue (and I mean brief), business after the ban actually increased... without exception.

These are fun because when they are still 20 minutes apart and they say it hurts so bad and ask is this the worst. Me being the compassionate sort I am look at them and say with warmth and feeling you ain't felt nothing yet.

My favorites too! I had one a few months back... 19y/o her first term-pregnancy, labor pain 20 min apart etc, screaming in the rig because of the "pain". I casually asked her if she thought this was bad how was she was going to cope when the contractions started. Her eyes blasted wide open and she said "you mean it's going to get worse?" She dummied up in a hurry. I giggled.

I don't think anyone would be dumb enough to bash Dust... most of what he says is truth, we just don't always like to hear it, or hear it put so blunt.

Why beat around the bush when you can mow it down in a hail of gunfire! :wink:

So you think Americans are special... Canadians are even more "special":

Canadians... stand in "line-ups" at the movie, not lines.

Canadians... are not offended by the term, "Homo Milk".

Canadians... understand the sentence, "Could you please pass me a serviette, I just spilled my POUTINE" !

Canadians... eat chocolate bars instead of candy bars.

Canadians... drink pop, not soda.

Canadians... had a Prime Minister who wasn't fluent in either of the official languages (English & French).

Canadians... know what it means to be 'on pogey'.

Canadians... know that a mickey and 2-4's mean "Party at thecamp, eh?!"

Canadians... can drink legally while still a teen in some provinces.

Canadians... don't know or care about the fuss with Cuba, it's just a cheap place to travel with very good cigars.

Canadians... when there is a social problem, we turn to their government to fix it, instead of telling them to stay out of it.

Canadians... are not sure if the leader of their nation has EVER had sex and don't WANT to know if he has!

Canadians... get milk in bags as well as cartons and plastic jugs.

Canadians... know Pike is a type of fish, not some part of a highway.

Canadians... drive on a highway, not a freeway.

Canadians... know what a Robertson screwdriver is.

Canadians... have Canadian Tire money in their kitchen drawers.

Canadians... know that Mounties "don't always look like that."

Canadians... dismiss all beers under 6% as "for children and the elderly."

Canadians... know that the Friendly Giant isn't a vegetable product line.

Canadians... know that Casey and Finnegan are not a Celtic musical group.

Canadians... drive with their headlights on during the day (since 1989, all new cars have been fitted with "daytime running lights").

Canadians... participated in "Participaction."

Canadians... have an Inuit carving by their bedside with the rationale, "What's good enough protection for the Prime Minister is good enough for me."

Canadians... wonder why there isn't a 5 dollar coin yet.

Canadians... like any international assasin/terrorist/spy in the world, possess a Canadian Passport.

Canadians... know the French equivalents of "free", "prize", and "no sugar added", thanks to our extensive education in bilingual cereal packaging.

Canadians... are excited whenever an American television show mentions Canada.

Canadians... make a mental note to talk about it at work the next day.

Canadians... can eat more than one maple sugar candy without feeling nauseous.

Canadians... were mad at the CBC when "The Beachcombers" were taken off the air.

Canadians... know who "Relic" is/was.

Canadians... know what a touque is, own one and often wear it.

Canadians... have heard of ... and have some cherished momento of Bob and Doug McKenzie.

Canadians... know Toronto is NOT a province.

Canadians... never miss "Coach's Corner" during Hockey Night in Canada.

Canadians... recognize that back bacon and Kraft Dinner are food groups.

Canadians... have a cord and plug sticking out of the grill of their car ... it's a block heater for those sub-zero (in Celsius) days.

Canadians... cook on a BBQ (Bar-B-Que) not a grill

Canadians... only know three spices: salt, pepper and ketchup.

Canadians... design their Halloween costume to fit over a snowsuit.

Canadians... mosquitoes have landing lights.

Canadians... have more kilometres on their snow blower than their car.

Canadians... have favourite recipes for moose meat.

Canadian Tire Store on any Saturday is busier than most toy stores at Christmas.

Canadians... take their kids trick-or-treating in a blizzard.

Canadians... like driving better in the winter because the potholes are filled in with frozen snow and slush.

Canadians... think sexy lingerie is tube-socks and a flannel nightie with only 8 buttons.

Canadians... owe more money on their snowmobile than their car.

Canadians... newspapers covers national and international headlines on 2 pages, but requires 6 pages for hockey.

Canadians... the kitchens double as a meat processing plant.

Canadians... most effective mosquito repellent is a shotgun.

Canadian... snowblowers get stuck on the roof.

Canadians... think the start of deer season is a national holiday.

Canadians... head South to go to your cottage.

Canadians... frequently clean grease off their barbecue so the bears won't prowl on your deck.

Canadians... know which leaves make good toilet paper now that there are no more dollar bills.

Canadians... find -40C a little chilly.

Canadians... attend a formal event in their best clothes, their finest jewellery and their Sorels.

Canadians... can play road hockey on skates.

Canadians... know 4 seasons: Winter, Still Winter, almost Winter and Construction.

Canadians... pronounce the last letter of the alphabet "zed" instead of "zee."

Canadians... end most sentences with "eh."

[align=center:699f1c7a21] So there... EH! [/align:699f1c7a21]

I'd be careful buying that Cherokee Spenac, the ignition only worked once... and it still needed a lighter to fire it up; besides that i hear Sinjed & Bashia stole the SUV... so it's still hot.

Dorkey Cootie-Brain doesn't sound as intimidating as I had hoped. I think I need therapy... about 24oz worth.

5%

-One 3" decal on the back window.

Isn't that pretty much what an interatrial block is?

BTW: You better slow down on your education... you get many more letters after your name & you'll have to get your own alphabet!

I can't remember when I laughed so hard at a thread... you guys are getting way 2 cheeky!

Sorry gang, got sidelined in the E/R for a couple days. Still recovering so replies could be slow.

sledogg1:

Neuro checks were all good, no hx of CVA :wink: , no predisposition except for smoking (<1 pk/day) and social drinker. No meds, rec or rx. If memory serves me correct she possibly had a vagal response after having a BM, but details are getting a little foggy though and my partner couldn't shed any more light on it. I also checked the LP-12 archives and it appears to have been bumped already (sorry).

I'm wonderin if we just stumbled on an interatrial block and it had us befuddled... until Shane & ERDoc pointed me in the right direction. On top of that I learned a thing or two about biphasic P-waves and p-mitrale while I was at it!

I think I'll file the PID dx for something anatomically lower, maybe cranial-rectal inversion syndrome, and a slightly modified treatment plan (we don't have the luxury of helo evac).

However, does your PID protocol not mention narcan? you neglected it in your post.

I read that drinking an amp of D50 (preferably with pizza) might be benificial... as long as it doesn't go interstitial on ya!

...Is it possibly a biphasic p-wave which would be indicative of atrial enlargement? There are biphasic p-waves that appear to be two p-waves side by side without breaking the isoelectric line.

Shane

NREMT-P

I'm checking into this and the p-mitrale route again... now that I have done a bit of research (thanks to you & ERDoc) I definately need to check the ECG (assuming I still have it) to see exactly what we're dealing with. I'm planning on doing a lot of digging tomorrow to find the strip for you, sorry, I should have done that before posting. It was one of those things that hit me while I was reading other posts & I wanted a bit of direction from your minds!

I have found a bit of information on interarterial blocks, which I wasn't sure was possible. Based on Dr. David H. Spodick's commentary it would seem that it is possible for completely seperate P-waves if the interatrial block is significant:

LA “strength,” as represented by LA kinetic energy (LAKE), progressively worsens as the interatrial conduction time increases (over a range of interatrial block from 120 to >200 ms), with an inverse linear correlation to LAKE. With a definitely split P wave (which is usually the case; relatively few are not clearly split) in interatrial block, an interpeak distance of ≥40 ms is an extremely specific sign of LA enlargement. [align=center:af4c4f2fc2]Italics added[/align:af4c4f2fc2]

...why are you doing cardiac monitoring if you don't know some of the basic rythems that can be determined by a three lead EKG? The flutters and heart blocks are common entry level cardiac rythems to determine and have been taught in every cardiology class I've ever taken?

Shane

NREMT-P

Come on Shane, who wouldn't take offence? What you wrote is very condescending no matter how you want to "phrase" it - question or statement (that last "question" is just a statement with a question mark).

Just say sorry and be a little more considerate how you "phrase" your comments. And I'll promise not to call you a smart a**, fair enough?

I agree that it's hard to speculate with what little information has been posted. My initial thoughts are an a-flutter with 2:1 conduction or a second degree type II (mobitz) block. Or quite possibly, maybe even a third degree heart block?

I'm curious without knowing too much about your system, but why are you doing cardiac monitoring if you don't know some of the basic rythems that can be determined by a three lead EKG? The flutters and heart blocks are common entry level cardiac rythems to determine and have been taught in every cardiology class I've ever taken? I'm not bashing here, just looking for the rationale.

Shane

NREMT-P

Careful Shane, your making some pretty brash assumptions and are being quite offensive. Maybe inquiry would be prudent before making assumptions?

We are a larger (~20,000 calls/yr) urban ALS system, most of our basic EMT's are also trained (and reasonably proficient) in ECG interpretation, our medics teach ACLS to the doctors. Our organization is quite up to date and progressive when it comes to cardiology, so don't be a smart a**, we know what a block looks like!

How far apart were the P-Waves?? What was the rate? Maybe a rapid Classic type 2, Maybe Flutter waves? It could be an Atrial focused ectopic with a 2:1 Block

Do you have anymore specifics?

Mobey

P-waves are uniform & tight against each other with 2 P's immediately preceding each QRS. They are distinct p-waves, definatley not flutter waves. On our arrival the patient's vital signs were all within normal limits, no known hx of SVT.

Interesting article, although there could be a possibility based on the article that she had been in a tachy arrythmia PTA, the P-waves in that particular instance seem to be buried in the previous T-waves which would be consistant with the block theory. These P's were together. We considered every type of block but because the P-waves were so close we had rule a block out. Because they were so distinct (no notching) P-mitrale was also ruled out.

I'm working again tomorrow and think I may have a copy of the ECG in my locker (ya, I collect strange things). I'll try to get it scanned and posted for ya ASAP.

We had a bit of a head scratcher last week I thought I would throw out for insight...

For the sake of this discussion (or at least until I can recall all the details :roll: ) we'll assume the patient was a post-syncopal, asymptomatic, normotensive and otherwise stable middle-aged female. Routine 3 lead ECG showed distinct, prominent dual 'P' waves of differing morphology immediately preceding each QRS complex, otherwise it was a normal ECG (no blocks, ectopic beats, rate changes or irregularities). Sorry, I don't have a graphic to post.

We were considerably puzzled by the dual 'P'waves with the absence of additional QRS complexes. Only logical explanation we could muster was some sort of genetic sinus anomaly.

Thoughts? Ideas?

I had a drunk with a sore ankle all day call 911 for a ride to the ER. No swelling or deformity, so I walked (ungainly limp would be more accurate) her out to the rig and drove her the 2 blocks to the ER. Later saw her films... turns out it was a fracture. Oops! :oops:

Although; I dunno how this qualifies as funny stuff, unless you've got a f**ked up sense of humor.

I prefer to call it a "unique" sense of humor, one that helps us cope in our own twisted way. :bom: