whit72

4cm6 wrote: I use Salvia leaves for a tea, to dismiss per se, my back pain. Only before bed, b/c going from a sitting posture to laying, hurts like an SOB. If I take a pain pill, then I relax into a position that will, again, hurt like an SOB when I wake up. I grow the plant myself, in the flower bed. Press the leaves and keep a small bottle of the oil from them, and then dry the leaves. Well recognizing you have a problem is the first step

Gurty wrote: I am wondering if anybody can tell me what can be the possible cause for an 82 y/o male to have a BP of 142/36 and a hr of 56. Too many birthdays Ticker is getting old. Could be 100 things. If he wasn't symptomatic, I wouldn't be too concerned. Christ everything effects blood pressure, maybe he just rocked a deuce. I concern my self with, if the patient is symptomatic and his systolic is over 200 or under 100 consistently or any narrowing pulse pressures.

We had a couple of kids who were drunk admitted to smoking it earlier in the night, I had never heard of it, they said they get a couple minute high from it. I guess you can buy it at smoke shops its completely legal. I think its used by landscapers also. I haven't had any time to read up on it yet though. Was just wondering if anyone had any experiences with it. I haven't had any experience with anyone actually in the hallucinogenic process of it, just wondering if it mirrored the typical acid or shroons type effect. There was a kid in the next city over that supposedly was high on it wigged out and through himself out a window. I guess its growing in popularity.

Anyone have any experience with people high on Salvia or flowering sage.

Quick question. How definitive are the findings with the Hepatojugular reflux. Could you base your treatment on its findings?

KateB wrote: The reason for the ambulance personnel taking them is to ensure proper handling and to expedite transport as time is of the essence. Time is of the essence, how do you figure? Racing around town isn't going to change the fact that he was stuck, the damage has been done (in this case I think the damage is very low risk) nor will the 30 seconds you save by speeding around have any impact on the outcome of the person being stuck. He was stuck by a needle, he wasn't bitten by a rattlesnake. I hope everything is going well Anthony.

Yeah these scenarios seem to run much smoother on the internet, and you don't even sweat It is good to refresh, keep things in the front of your mind, in case the need arises. (I am knocking on wood right now.)

Ship the one patient in the ER to the ICU with a nurse. Now you have two nurses and three patients. Send the other three nurses to the ER to open the clinic, gather equipment and call in neccesary help such as the doctors. Now you have 13 beds to play with. Close to all traffic except from the crash site. Send the 4 citicals with the best chance of survival in the helicopters, two to each trauma center. If you have four doctors at the community hospital they can take four critical and nine non lifethreatning. Load the available units with one patient an ambulance with signifigant injury, and two an ambulance that are less likey to decompensate enroute. Send the four ambulances with the single critical patients to the community hospital, and four of the double stacked ambulance to the community hospital, that leaves one bed for a critical not related to the crash. Send 5 of the double stacked ambulances to the 18 bed er Have the walking wounded put in a bus, with any extra techs or EMTs you have and driven to the most available hospital, have an ALS ambulance and a crusier escort them so if any decompensate in route they can offload to the ALS truck. Send them to the 18 bed ER to the south. So thats 24 patients by ambulance 6 with one 9 with two, 4 in a helicopter. Thats 28 patients by ambulance or helicopter. Nine on the bus. You have five dead out side. So four patients by helicopter Twenty-four by ambulance nine on the bus and five dead Thats 42 how did I do Only if it ran that smooth.

I would quit After the beers and donuts got their of course. Has the bus already exploded? No ones on standby, get the birds in the air and get the rescues rolling, trust me you are going to need them. Call a private ambulance company if possible they can mobilize quicker, they have much more resources at their disposal such as equipment and manpower. Dont strip the surrounding areas if you don't have to, that just creates another problem.

Anthony wrote: Advanced DAT (I have to find out what this means) Its advanced dementia of the an Alzheimer's patient. Good luck

Yes sounds low risk. I haven't had any needle sticks but I have had multiple exposures to the usual suspects. I am not sure but people I have come in contact with that have had needle sticks, don't usually take the meds unless it medium to high risk. That however is a decision you have to make. Couldn't they contact a family member of the patient for consent on testing her? It sounds very low risk, but if you need to know for piece of mind, thats fine too. The needles are als providers use now are the protective caths, when they withdraw them the needle locks inside. We also use the protective lancets.

It takes time, repetition will make him comfortable. Have him practice on you if you have a long transport time, or later back at the station. If you make a huge issue out of it, it might make him more nervous. He will be fine with practice. I remember the first couple of times I had to give a report in a trauma room, with 10 nurses and doctors around I almost shit my pants. Now I am like is everyone here who needs to be here or should I wait. Talk loud and clearly, if they ask you a question you dont know, tell them you dont know. Dont make up answers.

Tkstorm wrote: Saying what you would do or think should be done is irrelevant, if you choose to disregard a protocol/policy you would lose your certification. So for everyone here who has said they should not get out and start treatment would all lose your certifications, in NY, and thats that. Protocols and policies are written in controlled environments. I don't work in those same environments My patient is of my utmost concern. I am driven by their needs, if that means a protocol or policy is broken so be it, thats fine, you want to put me on the carpet for it, go ahead. As you progress in your career you will understand that not everything is black and white, sometimes rules policies, protocols get disregarded for the benefit of your patient. It happens.

Ok I tried, I made my point and I was done with it. Well I thought I was done with it. Until someone made a comment about urban EMS. I worked a busy city truck for a long time, six thousand calls a year. I have since moved on to a rural truck, still around 10 calls a twenty-four, but thats quiet for me. If this was a rural setting where the next ambulance was an hour or two away, I would have less of a problem with it. Being an urban system, with ambulances on every corner. I don't agree, notify dispatch carry on. You have hardly exhausted your resources with a hospital every mile I would assume that there are plenty of private ambulances to call if your backed up. As far as the two scenarios flight brought up. If I could responsibly leave my asthma patient in the care of another crew sure. If there are no beds available thats tough to do. I guess you could leave them on your stretcher, as long as you have your equipment and respond to provide care until a transporting unit arrived. Sounds fair enough. As far as the medical helo landing at the bus accident. I don't have any experience working a helicopter, but I am guessing if their flying the patient, their critical enough to need your total attention and landing at a bus engulfed in flames without hoses or extrication equipment would be a breech in care. Just my opinion. Can you even initiate care as helicopter personnel without being requested. I wouldn't think you would have the necessary equipment, and if your already occupied I would assume your equipment was already busy. Just a thought.

Dust Wrote: You'd think that people would have learned by now that, when Whit and I agree on an issue, there is nothing else to be said about that issue. It is settled. I couldnt have said it any better myself.

Anthony wrote: If you follow your protocols, which you said you would've disregarded, then the liability falls on the agency or county (whoever's protocols it is). But if the accident victim is passed up and you failed to follow protocol and stop, I'd say he has a case and it falls on you. My protocols don't cover an issue that should be common sense. I don't stop nor will I stop if I am occupied. If that was my kid I would sue everyone involved for delaying treatment and transportation thats abandonment. Then I would sue for putting me and my family in jeopardy. Thats negligence, and I would win, protocols or no protocols.

Anthony Wrote: Well, that opens you up to a lawsuit... No. It opens you up to litigation by delaying transport of the patient you already have. Are protocols wouldn't and don't cover an issue that should be common sense. The decisions I make are not based on whether I will be sued or not. They are based on the best interest of my patients. End of story. Come on we encounter difficult decisions on a daily basis, this isn't one of them.

mediccgh wrote: If he has an extremity fracture, why the f#@! does he need the pulse ox? Amen. Because a fragment of bone could have broken off and traveled to his lung. Because they have nothing better to do on the way in. What els do you do with two hour transport times.

The fact is once your occupied the patient or any other patient for that matter is of no concern to you. This isn't Iraq, call 911 and wait your 5 minutes like everyone else has too. Whats the problem here. I don't care what your protocols say. How many people you think we can take care of? Your responsibility lies with the pt you have stable or un-stable. I don't have bunk beds, and someone needs to drive. Alert another unit or dispatch to the needs of the crash victim. I wouldn't of stopped, Its not my responsibility. It may sound harsh, whatever you can be assured when you call 911 in my area I wont abandon you on the side ofthe road because I think someone else's complaint supersedes yours. If you want throw the student out with a jump kit and a vest, if he makes it back to the hospital without any holes in him sign him off.

I am guessing if someone intentionally hurt a family member of mine. I wouldn't be expected to render care, as you probably wouldn't want me anywhere near this person. No one would expect you too or hold you liable for not rendering care. There are plenty of people on my scene where this wouldn't be an issue. In some remote areas where your the only game in town, this could be an issue.

Maybe dispatchers shouldn't be given out the complaint en-route. Then you can eliminate the emotional side of it, for those who cant respond to a call arbitrarily. When you arrive on scene they can update you. How much help will you be to that officer or child if your ambulance is wrapped around a tree? Weigh the benefits opposed to the risks. If I arrive 1 minute later that pt has a much better opportunity then if I don't arrive at all.

dalhio wrote: (a) All pronouncements of death shall be made in accordance with rules promulgated by the State Board of Medical Examiners and with the physician's medical judgment And the rules are?

If the contents of this article are true, this would be my stance on the situation. This is exactly why you don't allow occupied ambulances to stop and render care. You never know what circumstances will arise. This guy had to evacuate his ambulance and hide his F'n patient in a deli. Not good, especially since I am assuming he didn't bring any equipment with him in his hasty retreat. Then the kid seizes again loses his airway and he is stuck underneath a table with no equipment and his thumb up his ass. I guess you can spin a story anyway you want for the public. Those of us on the inside know the truth. His actions could have resulted in severe consequences for the people that entrusted him with their care. You want to be a cowboy do it on your own time.

brentoli wrote: Because dispatch makes up everything and doesn't listen to the caller, right? Easy there buddy. I wasn't commenting on the competency of dispatchers. Anthony wrote: Is any life-threatening call really more important than any other life-threatening call? Probably not, but to those "people" (remember, I said "people around here"...not "me"), though, it's more emotionally important (which isn't usually a good way to make decisions in medicine). I don't consider any call more important then another, life-threatening or non-life threatening. Emotionally I try not to involve myself. Everyone pt. has their needs assessed and treatments provided that coincide with that, from a ride to the hospital to full resuscitation. Yes it may be more important to the families involved, however to me they are no different. Sounds harsh but that is how I keep my sanity. Thats how I stay focused. Yes it sucks that kids die, it sucks that police officers die, you see some pretty F'ked up shit in this profession but emotionally you have to detach yourself, or you wont last very long.

Anthony wrote: The only types of calls people say they'd really jam all out for here are officers down or pediatric arrests, in which cases PD has every intersection blocked for you all the way to the hospital Are those calls somehow more important the rest? I drive the same way, no matter the complaint. Those 30 seconds you save are not with the risk or the damage you could do by driving recklessly. Most callers can not adequately determine the severity of the injury or illness anyway. I don't even really listen to the complaint from dispatch just the address. They are correct maybe 10 percent of the time so why bother.