fireflymedic

If you know this patient REALLY well and have a pretty decent idea of how she will react, perhaps ask if she has seen someone in pain management and if not suggest she try someone. Pain management specialists are trained to detect addictive behaviors and also provide non medication relief such as bio feedback, relaxation, etc which work just as well in some cases. If pain meds are needed, they can prescribe something that works longer or doesn't require such a high dose. They really are a beneficial resource to patients. As far as addressing her otherwise, it's not really your place to do so. The only thing you can do is prevent additional addiction by providing her with further pain meds (ie she calls you to obtain narcotics). However, keep in mind that pain is difficult to rate and what may be tolerable to you, may be intolerable to someone else. Everyone's pain threshold is different. It's frustrating indeed because you never want to see someone in pain, yet you don't want to feed an addiction. Since the ER is so familiar with her, you may suggest they try coordinating with her regular physician to find alternatives to having to go to the ER. Also, it never hurts to go ahead and contact med control or your supervisor regarding taking someone out of county. The one excuse I have used for patients that request going out of town EVERY time is that if they are severe enough to request an ambulance via 911, that I will take them to the local hospital, let them get stabilized and then transfer them if needed. After doing that a few times, I have found that reduced the amount of times I was called. Perhaps give this a try and see how it goes. She may not be happy with you, but it will reduce the time spent on the road and wasted resources.

I am quite familiar with the service which is the "whiners" in kentucky. It was Henderson, KY and their truck was not fit to be on the road any longer. It was undependable and frequently quit on them mid run, wouldn't start, and the county refused to do appropriate maintenance on it. If you think this is "whining" by refusing to make runs in equipment which is not dependable, then you need to have some things re evaluated ! The area is quite rural, and it may take a while to get another truck there if that one breaks down - something that happened multiple times. They were a volunteer service, not a paid service, so they were providing a service for FREE - there was no requirement for them to even provide service in the first place ! I don't feel they were out of line, and sometimes it takes a strong stand like that to achieve change that is needed to get the appropriate equipment !

I think the decision is it worth it is up to each individual. What is acceptable risk to me may not be to others. On the flip side, what is acceptable to them may not be to me. I ask myself this question frequently as I am often in unsafe situations long before it is realized and we are blindly dispatched to unsafe scenes and not told they are such. I've been shot at, nearly beat up, had multiple other things happen. I know of more close friends which have died or were injured on the ground due to ambulance wrecks or assaults in the last three years than the last three years of friends I had that were flying. Do I still want to fly? Yes I do because it is something I know I want for multiple reasons (and I know I'd look really cool in that big helmet lol !) but on the flip side, if at any time I felt the risk was too great I'd walk away or push for change just as I am with the ground services. Our safety is our responsibility, no one else's and the companies will only push as hard as we will let them. As far as salary, the ground CCT medics here and the flight guys make roughly around the same a year approx 40 - 50 thousand. Average medic in this area makes between 28-36 thousand and basics around 20-24 thousand. That's for the average service (fire based being at higher end of the spectrum). Be safe !

I'd start off with albuterol neb see where that gets us. If no improvement with that, if still have wheezing, we could try a little sub q epi and benadryl see how that does. If airway continues to close off or significant swelling is present, intubation is a possibility, but I'd prefer to stay away from that if possible. I believe this patient could be managed with simpler measures. Let's hear some more on this.

Tell dust I hope he gets to feelin better. He needs to stop breaking himself dang it !

Anthony - how sharply the decline happens after D 50 administration really depends on a few things. First is it just a simple they didn't eat and it went low or did they take their insulin and not eat? If they have insulin working against the D 50, you may see a sharp spike with BGL up to 300, but then drop dramatically within 10-15 minutes afterwards. If they just haven't eaten, it seems the drop occurs much more slowly. Also, are they on oral diabetic meds which work with the little insulin their body already produces? If so, you give the D 50, their body processes that like it would food producing insulin and utilizing the medication as well to supplement their existing insulin. If you have someone on both, you will definitely see the upward spike, then a significant drop quickly. So to answer your question, yes and no, it just depends on the surrounding circumstances.

D 50 is a pure simple sugar meant to immediately increase BGL in a short period of time. It must be followed with additional carbohydrates to provide long term maintenance otherwise you will have a scenario similar to what you stated. Thiamine is given basically as a facilitator in absorbtion of glucose to allow the body to process it better in alcoholics as they have liver damage (and remember the liver is where glycogen stores are which convert to glucose). As doczilla stated, that is the basic benefit to thiamine, otherwise, there isn't much benefit to thiamine administration to the average diabetic patient. D 50 does the job of a quick boost the same as gel glucose or orange juice would do, but the patient must follow up with something longer term as a regular meal otherwise their body goes nuts with processing the sugar actually causing them to go hypo again (similar to if they eat something very sugary sometimes they will experience an immediate surge then the body over comepensates causing hypoglycemia later on). Hope this helped.

Rest in Peace my brother in EMS ! You were one in a million. Chris Hall a paramedic from Mount Vernon, KY died in a single car crash Saturday morning after getting off duty at Garrard County EMS. He leaves behind a wife and two daughters.

Can someone please clarify the difference in rhabdomylosis and compartment syndrome. Everything I've found and read seems to use the two terms interchangeably, though I know they are two separate conditions. Does one neccesarily lead to the other? I am familiar with compartment syndrome, but not as familiar with rhabdo. Thanks for the info in advance. Be safe.

BINGO ! You are the winner fire doc - tubal pregnancy !

Have EMS personnel across the country forgotten that ambulances are to be driven with DUE REGARD to other vehicles/people even in emergency situations? Virginia seems to be one of the biggest states to crack down on this as they don't care what the situation is, if you are showing excessive speed, you get a ticket, period, end of story. We frequently transport into virginia, and my driver has been told more than once, "you speed you will get a ticket, and you will no longer have a job !" They don't play with this either. More than one has been fired. Now do I feel there are certain situations which warrant going a bit faster than the speed limit - yes. However, in truth very little time is saved by going like a bat out of hell driving crazy, and NO time is saved if you get into a wreck. There are too many risks taken across the board driving and too many workers are dying or getting seriously injured due to mistakes. Enough things go wrong if you take all the safety precaustions we don't need to add to that list. Be safe.

In KY, most services are dispatched via state police post, but there are a few that aren't. However, if they know we are headed to a 'rough' area, they automatically send PD with us. Once we get on scene, code 12 - everything's okay - you better say that or someone start's coming to look for you we also have the pretty red button and ours does link directly to dispatch. Hit that and you get your sup, another crew and every available trooper in the area. You hit that and you better have a good reason. If accidentally hit, immediately state your unit number and code 12 ! As far as if I need help now, I'm pressing that button and waiting for the pretty blue lights to show up ! Also, I'll be yelling something to dispatch along the lines of COP NOW ! I've only been in that situation once and that was what I told them when I hit the button. Had a guy aiming a shotgun at me and my partner - not cool. I'm going home at the end of each shift and so is he ! I seemed to get their attention quite nicely when I said, "COP NOW !" Anything else for minor stuff, just pick up the phone and call dispatch to request pd to be at the scene or for truck breakdown. No big deal.

It depends on what capacity I am functioning in. If it is 911, then roughly 10,000 at any given time. If I am functioning CCT, around 50,000. Just depends on the day and where I am placed. Gotta love rural medicine !

Pt states she has been urinating more frequently than normal. Also, she has temp of 99.4. No history of STD's - is currently married and is only contact ever (or at least that is what claims). No bleeding noted. Other than pain in lower abdomen, pt does not complain of any pain. As previously mentioned, pt had syncopal episode earlier. Doc - I like your thinking lol. You are knocking on the door but haven't opened it yet.

You are called to a well kept home of a twenty two year old female complaining of severe pain in the LLQ. Pt states it has a cramping quality and is intense at times rating it up to a 9 out of 10. She states she has not had any nausea or vomiting, and denies breast tenderness. Pt states she is sexually active, though is currently on the pill (seasonique so she only has 4 periods a year). Pt stated earlier in the day she had a syncopal episode and still feels lightheaded. Vitals: BP : 90/62 pulse: 104, regular, strong resp: 18 pt AxOx3 able to answer all questions appropriately, speech is clear and fluid What would you like to do or know?

sorry to take a while to update this, I actually forgot about it lol. Anyhow, firedoc is right on with the medical - guy was hypoglycemic and had seizure behind wheel. Long time diabetic. Did send the guy by air as he came around significantly after some D 50. Did fine and rehabbed those injuries. All's well that ended well.

My bucket list (not that I plan on croakin in the near future, but ya never know) 1. Get to fly in a chopper as the medic, not the patient ! 2. Go to belmont racetrack in new york 3. See the 9-11 memorial site 4. See if you really can bounce off the padded walls in a psych unit 5. Go see a real rainforest before they're all gone 6. Take the time to stop and smell the roses 7. Teach a kid to read 8. Sky dive (yeah I'm a bit of a daredevil) 9. Swim with dolphins 10. Hear someone say I love you and really mean it

Please excuse the ignorance here, but Recently I transported a patient who had been on propofol infusion for several days and his urine was literally green. I had heard of this phenomenon, but I have never heard an explanation as to why this discoloration happens. I am wondering if this is part of the so called "propofol infusion syndrome". All research I have found states it to be benign, but I would still like to know why the urine has the discoloration is does. Is it part of the metabolization of the drug in the body through the liver or what? Thanks for the info

There is no longer a place for unconscious/unknown protocol because with the medications you are administering, there should be no question as to being unknown. Check your pupils - pinpoint along with other s/s of narcotic od, then give narcan, check blood sugar - at 205 do you really want to be giving this guy an amp of D 50 it's obvious he's not hypoglycemic ! Thiamine, well is he an alcoholic? If so, perhaps an alcohol induced seizure, but thiamine is given to help with absorbtion of D 50 in alcoholics....it scares me that you still maintain these protocols. My suggestion to your med director would be let's update these puppies !

I'm not going to put anyone at fault here, because I don't know the whole story. However, most defensive driving/driver's training tell you that if you believe you may hit something, keep both hands on the wheel and hit it straight on. I've been involved in "accidents" where something was hit (not the driver though !) including a 2000 lb elk, drove through a plate glass window which fell off a truck in front of us, MULTIPLE deer, a dog or two and even a turtle. Every time when we were about to hit my partner told me hang on, kept both hands on wheel, and that was that. We never turned an ambulance, though we've been splattered with more than a few animal parts. But we were safe. The one accident I've been in that we turned the truck was due to bad weather in a run that never should have been taken (I was too young and naive at that time to realize this though). Keep both hands on the wheel, and be safe out there.

Okay, first things first, I would like this gentleman boarded and collared. While we are doing this I am going to ask the wife to bring me his meds so I can see them. Also, determine whether he is insulin dependent or not and if so what type and how much. Next, what type of reaction am I seeing to painful stimuli? Is he opening his eyes, attempting to talk, just moaning, posturing, etc? Do I see any blood or obvious injuries? As this is an unwitnessed seizure - who is stating it is such? Are pupils dilated? Reactive? Signs of bladder/bowel incontinence? Is the guy improving with time typical of post ictal? Does he tolerate an airway adjunct? NPA or preferably OPA? Intact gag reflex indicating he can protect his own airway? Okay, now let's get a glucose courtesy of a finger stick as most machines are set up to evaluate capillary not venous blood. What do I get? I want a line and if glucose less than 80, I'll give an amp of D 50. If glucose is high, I want fluids. What is his skin condition? Color, temp, turgor? Does he look like typical insulin shock? What is his normal glucose range and does he have reasonable control over his diabetes? I'll leave him on the 15 NRB for now provided he can protect his own airway. If he can't, we'll escalate, but it sounds like he can hold his own for now. Oh BTW, all the above is being done enroute. I'm not gonna stay and play with this gentleman.

Drug me but don't cut my boots ! Lol, them suckers are expensive ! That being said, a real concern for development of compartment syndrome is there with injury. If vitals are stable, and MS is normal, go for giving him a little pain killer. MS is an option, but you have the option of fentanyl I'd prefer it as you don't have the vital signs effects that you do with morphine as great, plus it'll make him care less that you're cutting off his boot ! Be safe.

I'll tell you this much - you ever show up to my station drunk, stoned, or otherwise impaired, I'll send you home and if there isn't a legal reason for it you'll be without a job. Period, end of story. Yes, we drug test. Without notice. You're positive, you're gone. No working on pain meds - if you're on 'em for a legit reason, you're temp reassigned. We have a good safety record for a reason. I don't want to work with an impaired partner. That's my life and my patient's life at risk. I think you are asking for trouble by 1 admitting on a public forum that you use weed (it's not that hard to find out someone's identity, especially if someone in your area gets on here to see it) and 2 working at any point after using it. That's nothing but stupidity and irresponsible. If you want to do drugs of any sort, please do us all a favor and get off the stuff or find a new profession !

I like having music in the buggy especially if a long distance transfer. If it's gonna be on in the back with the patient though, I'll ask the patient what they like. Hey, they gonna be listening to. I've done transfers with everything from bluegrass to heavy metal. My partner and I are both contemporary country people, so the radio tends to stay on that the majority of the time. If I tell ya shut it off though and I'm in back, shut the window and kill the back and have fun. With previous partners though, I've had fun even as far as going into a particularly ghetto section of town and we were playin some rap station (don't ask why). Guy walked up and was like, "hey let me hear that" so we put it on PA and piped it to their basketball game. Was cool with them and us. Bottom line, be considerate but have fun. Be safe !

no etoh bg is 70 can't remember when last ate insulin 1 hour ago VS - 140 pulse, cap refill 4, bp 80/60, RR 12 shallow, total GCS 10