Kaisu

BLS before ALS irritates the crap out of me. One of my former partners was an EMT for 7-8 years. She was hell on wheels, bossy, opinionated and domineering; also, smarter than the average bear. She finally went and got a 9 month medic mill cert and has been running for less than a year as a medic. She consistently states that being a medic is easier than being an EMT. I guess being a cookbook protocol monkey with no understanding and even less interest in pathophysiology is easier than attempting to control every scene as an EMT. What I see is someone that has painted themselves into a corner, unable to admit they were wrong because it would cause them to change the attitude and opinions they nurtured for 7 -8 years. It also irritates the hell out of her that I went directly to medic with no time as an EMT, especially as that option is not available in this ass backward EMS backwater I run in. My advice to you MetalMedic, is forget all that EMT crap and concentrate on the medicine. Good luck to you.

I did mean fake, and I thought they are the same thing. I will research. Thank you Dwayne. A few things I have noticed about the fake seizure... No one has one of those alone. There is always some weird ass family dynamic at play. The fake seizure interrupts whatever dysfunction is currently playing out and forces the focus of attention on the "patient". Some of it is drug seeking for sure, but I have run on people with full Rxs of benzos having a fake seizure. It is actually kind of interesting. I have yet to come up with a satisfactory way of dealing with these people. The last thing I want to do is educate them on why I know it's a fake. I don't want to coach up their act for the next provider. One of my favorite things to do is monitor them during the "seizure" getting a BP for sure. I tell them "I know this is hard for you, but try and keep your arm still so I can get a good number". 99/100 cooperate. I then say "Your BP stayed stable, your heart rate did not budge, and your O2 sats were not affected. Disconcerting as these episodes are for you, I will be administering no medications." Usually they go to sleep.

I am on duty today and tonight and I am not looking forward to it. Our town holds a big street party on New Years. The main drag is blocked off for approximately 10 blocks and people wander around drinking and partying. Driving our ambulance to the inevitable calls within these blocks is "challenging". We inch our way through the crowds with lights and sirens. People (drunks) seem attracted to the commotion and converge toward the vehicle staring blankly at us as they peer intently through the windshield, their stumbling trajectory taking them into the general direction of our front grill. It looks like zombie nation. There are mobile units stationed throughout but transport is often delayed. Last year, I watched the fireworks at midnight from the street party, then 1 hour later, watched them across the river in Riverside County. That part was pretty cool. My crew also ran call 1 of 2011 at a minute after midnight. In our 35,000 call/year system, I had bragging rights. I wish everybody a safe and fulfilling 2012.

So I started with the "is there anything else I can do for you" before saying goodbye with pretty remarkable results. No-one sent me on another errand, but the responses I got were extremely gratifying; along the lines of "no thank you so much - you've been so nice" and variations thereof. Left me with a lot of warm fuzzys. Thank you to the OP. A simple thing like that has added greatly to my job satisfaction.

I love this! ... now if someone would come up with advice for the pseudo seizure patient, it would make my day

Dfib.. I think he means loss of consciousness as opposed to level of consciousness

I always tell them goodbye and leave them with good wishes. I have not asked them if there is anything else I can do for them. I think with some of the ones that try my patience throughout the contact, offering to do anything else would open a Pandora's box. I can see them sending me on any number of errands, none of which in a relatively high volume system I have time for. I will need to think about it. It just may take my patient care to the next level.

OMG.. what a nightmare. The only comment I can make is possibly counteracting the hyperdynamic circulation problem with fluid. Your ETCO2 and SPO2 are pretty good (for this guy), Breathers are so often hypovolemic after at least 5 hours of increased work of breathing. Please forgive my simplistic approach... I know I don't know what you and chbare do, but this is what I would do if it was me.

Fire - the status is based on post counts. I'm not sure where each cutoff is exactly, I just know that after 1,000 posts I became an "Elite" member - whoo hooo... Don't let that encourage you to pad your posts however. Make thoughtful, informative postings, stay active and before you know it, your status will change to reflect that. ... or ... just buy a subscription....

Thank you Aussieaid. That is the kind of information I was looking for. It always upsets me when people say "you have to do so and so..." without any reason for it except what they've been told. I will continue to mix it in NS unless company protocols tell me otherwise. It is always good to have studies to back it up.

romney - how about add an option in each that says "I am not a woman" and "I am not a man". This will allow either/or to answer both questions.

My impression was that for EMS, there really is no need to worry about the NS vs. the D5. I was hoping someone had some studies. I do appreciate the comments so far.

Having been trained in a different system than the one I currently run in, it came as a shock to me that here all the medics insist that amiodarone must be diluted in D5 for intravenous administration. I had been trained to mix it in NS, and have administered it that way with great success and no adverse affect. Can someone please educate me?

that's a little like asking what Airline food is the best?

Glad you asked. I really didn't explain myself very well did ? If I have a low SPO2 reading, one of the other things I want to know is what is the end tidal CO2. The device I have to determine this (besides an inline detector) is the nasal canula that detects exhaled CO2. I would put this on the patient to monitor ETCO2. I would not necessarily administer O2. In this situation, I am using the canula as an ET detector only. Hope this clears things up. Oh wait.. just read more of your post.. Are you asking about the respiratory physiology? specifically the inability of some patients to "blow off" carbon dioxide?

I agree with you. Incorrect reading tend to be low (affected mostly by issues in the finger - cold hands, poor circulation, etc.). Sometimes, moving the sensor to an earlobe or a toe helps. I have seen patients compensating extremely well for chronically low PO2 (long term COPDrs for example) where low SPO2 readings are correct and have had these readings dismissed by providers. A low SPO2 reading is one of my indicators to absolutely put the patient on end tidal canula. If corresponding ETCO2 is low, then it is a strong impetus to give em some Os. Conversly, high ETCO2 with low SPO2 becomes a balancing act. Like every other device that assists in evaluation, the SPO2 reading is just one piece of the bigger picture.

If you can't use what you got, no point going to a bigger model....

We are toned out for 94 year old female, fall victim, facial injuries, laceration. It was one of those bad gravity days. We had run on fall victim after fall victim. I always shudder at these. Of all the indignities of old age, this is one I had never considered – the inability to negotiate your world; the dangers people face in undertaking the simplest of everyday tasks; the courage it takes to just go to the bathroom. My patient is in her bed. She lives in a nursing home; one of the good ones. The home is clean and well ordered; it actually smells good. Her room-mate lies on a floor level sleeping pad, wracked with contractures. The room-mate's face is averted: she strains to shift her eyes towards me. Her mouth opens and closes spasmodically. I turn my attention to the patient. A caregiver sits on the edge of her bed and relates the mishap. The patient had tipped from a sitting position on the edge of the bed, hitting her face on her room-mate's bed frame. The patient has the “skull pushing out of the face” appearance of the very old and the very ill. Her cheekbones jut out of her skin, eyes huge in their sunken frames, high, narrow nose, square jaw. Her face is etched with deep farrows and wrinkles; her hair is long, thick and gray. The patient suffers from dementia. My efforts to communicate are met with limited success. Assessment is quick, decisions are made, precautions taken. The patient is lifted onto the gurney and moved into the ambulance. We head for the hospital. All business taken care of, I reach for an ice pack, folding it into I towel. I explain that I would like to apply the ice pack to her forehead. She quietly turns her face towards me and trustingly waits. I gently apply the ice. Holding this ice against her face, in the dark, morning hours away, I am struck again with the “rightness” of what I am doing. This is what this job is about – not the technical skills, the flash of the procedures, the egos and infighting. It boils down to two people, one hurting and helpless, the other privileged to be able to help. The patient puts her hand against my wrist. In a quiet voice she states “too cold”. I remove the compress. I wait a few minutes, then say “lets try it again for a few minutes”. Again, she assents. I hold the ice for a few minutes, then remove it. We sit in the silence as the ambulance makes its way to the hospital, she on her gurney, me on the bench. Then it starts. From deep within her, almost a moaning, a soft, rhythmic chanting. At first I am not sure of what I am hearing. I lean closer to her and I hear a song. It is an ancient American Indian song, the cadences older than time. In her singing, I hear of tragedy and joy, life and death, inexpressible morning and the triumph of the human spirit. It raises the hair on my arms; this gift of her song. We sit in the night, heading for the hospital, she singing and I listening.

Unfamiliarity with the specific catheter was an issue with me, especially when I was first getting started. In medic school and clinicals, we used the angiocath (that's the one with the button you push that retracts the needle). I got used to it and liked it a lot. First job and we had and still have jelcos. I practiced on oranges and it still didn't help the first few times in the field. Now, I'm good. After a year with those, I did a deployment to Mississipi.. different catheters again (and different skin). Once again, first few times in the field till I got the hang of it. I would like to think that I've been doing them enough that I can be as indifferent to the cath as some of the previous posters, but I tend to doubt it. So you missed the EJ. Doesn't mean you are incompetant, but you are a beginner, and even experienced providers miss the stick from time to time. I wouldn't blame it completely on the catheter but I do believe unfamiliarity with it was one of the factors in your missed stick.

Ahhh Squint, it made me cry....

oooo... I love it when you get all manly....

I'm reading the same thing... and am about 60% into it. I want to shake the hero and say... look - Kill Oswald, take Sadie with you through the rabbit hole and fix her face already... I am totally enjoying it.

You'd have to be pretty oblivious to accidentally run into a Gay Pride Parade.... but if that's your story than you better stick to it...