Kaisu

I have real problems with the ethics of hospital personnel not giving thorough and professional transfer of care report. Citing a possible HIPAA violation is bullshit as you are/will be directly involved in patient care. That being said, whenever a patient leaves AMA, there are questions that need to be answered. There are patients that are impossible to care for - ones that refuse lifesaving treatment, are totally unreasonable and simply cannot be effectively treated. This is usually a symptom of a complete breakdown in patient/caregiver relationship and is normally not one sided. The hospital washing it's hands of the patient is due to liability issues. A lawyer will make the case that although the patient had signed AMA, staff involving themselves in patient care after the signature assumes resumption of care by the hospital. Sucks but there it is. If I am dispatched to this call, then I take the call and transport the patient (if appropriate). I agree with Herbie's post. Assess assess assess. If you feel that the transport requires ALS then request it. At the very least this patient appears to need ALS and, if unstable, possibly CCT. Trust your instincts and the results of your assessment. If you feel hinky about it, call for higher level of care. Supervisors over-ruling your on scene assessment is despicable, but happens all the time.

Black Friday is another prime example of the time proven effectiveness of the something for nothing principal to rend homo sapiens mindless and willing to bend over for the screwing, even to the point of fighting for the privilege. Folks - if it sounds too good to be true it is.

I can tell from your first postings that you are enthusiastic, education oriented and professionally minded. I think you will be a great asset. Welcome to the site.

When I started in the job, I was offended that lifting was deemed so important by the men, and actually went on a tirade on this very site about discrimination. I figured that as a trained clinician, my brain should outweigh my brawn. After 3,500 calls or so, I was as dismayed as the rest of them to be partnered up with one of the smaller women - not because of discrimination, but because I knew that I would be stuck pulling my own weight and hers, exposing myself, my partner and my patient to possible injury. I work out with a personal trainer twice a week. It's an investment not only in career longevity but in the quality of my life. I find that she not only keeps me motivated, but gets me results that I could not get on my own. Currently, I can outlift all of the other women and most of the men. This is more of a commentary on the sad shape of a lot of my colleagues than a comment on my fitness. I take pride in how I do the job, and am motivated to do it as well as I can. I commend the OP, and urge her to do whatever is required to meet the same benchmark as everyone else in the field. It is the fat, lazy and cleavage dependent that scream discrimination when the question of lifting comes up.

There are all kinds of cool jobs in the world; Paris Hilton's for example. We could debate the moral/ethical values of each one and get into some pretty murky waters. I had a high paying high flying job for many years - when it became too difficult to look myself in the mirror I found something else to do. A job as a personal paramedic to a celebrity would set my moral compass in gyroscope mode and imperil my immortal soul. Cowardice? Perhaps, but this is one challenge I would back down from.

So, in your TV educated common sense science hating point of view, because I am extremely responsible regarding my fitness to do my job and thus handle situations like the one described by the OP, I should get out of the job? Is that what you are barfing out now?

I honestly can't say that any patient "haunts" me. I feel for some of them for a time, and there are those that I will never forget, however, feelings like you describe seem beyond the norm. It certainly strikes me that this is not healthy or beneficial to you or your patients. Is there something about this patient that you identify with? Was she your age? If something like this ever happens to me, I will find someone to talk with.. a professional mental health provider. Good luck to you.

Yes.. but does a helper monkey have cleavage?

Your partner is unprofessional and self centered. Your management is unprofessional. Your situation, unfortunately, is fairly common in smaller, lower volume stations. If you take a stand, you can be prepared for fallout. You have tried to resolve this and have met a stone wall. The key words here are "made to feel like". I got news for you. No one can make you feel anything. You have total control over your response. Imagine the next time you are asked to go to the rink looking at him and saying "seriously? are you out of your mind? why would I want to do that? and walking away, guilt free. End of discussion. As for the family hanging out at the station for hours and hours, I have found that heavy metal blaring out of my personal music device at the table tends to send most people with small children to the solace of OUTSIDE. (porn is actually much better, but that does carry an element of risk) The point is, deal from a position of strength Whining that they make me feel bad keeps you stuck. As chbare stated, grow some cojones and stand up for yourself.

welcome.. and really, don't be afraid to post. If you have questions, ideas, by all means share them. It is refreshing to hear from students.

"If we haven't been taught to do no harm, we see no harm in doing harm. We cause harm and shrug it off. We cause harm and laugh about it. We cause harm and brag about it." http://donoharm.us/ You have been taught to do no harm. It is the primary tenet of paramedicine, indeed all medicine. If you do not admit that quantifiable, evidence based science trumps your so called "common sense" and begin to govern your professional actions under it's rigors then I will consign you to the ranks of the hopeless and stop wasting my breath. Edited to remove errant lines of the first draft.

All them falling apples gave me a seizure... I did better then

Hey I love hot chicks. They are a hoot to hang with, and not only because its so much fun to watch all the guys turn into such idiots... Here, most docs don't want to deal with the undereducated whackers that constitute EMS and would rather get the info filtered through somebody with the educational background that enables them to speak a common language.

Are you freakin' kidding me? Your anecdotal observations and half baked theories are grounded in speculation and limited by the information in your own mind. Go and read the presentation and realize that if you persist in your opinion, you are bucking not only science but people who understand it and know it a lot better than you. Everybody is entitled to an opinion, but there are informed and educated ones and there are ignorant knee jerk ones. Don't persist in wrongheadedness on this one. It will destroy the credibility you have left.

Lots of squats and lunges produces an ass that is high, round and firm. The actual size is determined by God, but what is wrong with high round and firm? ... not to mention the health benefits that accrue while in the gym. Instead, lets go to surgery and stick foreign objects in our body... or inject garbage. Instant gratification idiots.

Once again, I miss our friend Dust. He railed against these debriefings, calling them ineffective and damaging. I happen to agree. The idea that I would allow some undereducated, overconfident department stars to rummage around in my psyche is ls laughable.

Welcome Jennay... and as for us being a bunch of characters... Hey I resemble that remark

My first instinct also was outrage at the airline.. The 200$ travel voucher they offered the passenger seems an insult. Are airlines really working on such low margins? The entire question of obese passengers and other issues dealing with passenger comfort and safety seem completely unaddressed by the carriers.

edited to take out an extra line

Who's to say that the Dr. or her staff are at fault? In the VA case I mentioned, the provider was following manufacturer recommendations. The recommendations were wrong.

When I ran in the 'hood, we had a problem with house numbers. See, when the residents left, they took the numbers with them...

You might be ghetto if Your rims are worth more than your house Your wedding cake topper was bobble heads You celebrate big occasions with the KFC family bucket (extra crispy with bacon)

Furthermore, lido would only be effective IF the ectopy is ventricular. Obviously, this patient would only be treated if she was symptomatic. For the reasons articulated so effectively by chbare, cardioversion would be the way to go. Thank you so much all for your contributions. I thought I was really dumb not being able to figure this out, but I feel better knowing that it is indeed a challenging one. Oh for freaks sake Mr. Mighty Mouth - do you have to question EVERYTHING I tell you? are you sure we weren't married at some point?

You celebrate far too soon oh mighty mouth... If I wasn't relatively sure that these were in fact of longer duration than just short runs of PVCs I would have said so.... How many short runs of PVCs have you encountered that produced symptoms of nausea lasting for 10 - 15 minutes? I am an amiodarone fan myself... the other option is synchronized cardioversion. Electricity fixes any tachy dysrhythmia pretty fast. I just like to know what I am dealing with.

It helps some for sure Bieber... thanks for posting To answer your questions Dwayne... The patient's daughter had a file of pertinent reports and notes in chronological order. While the fire medics did the initial assessment I perused the file and asked questions of the daughter. The patient was a poor historian in that she could not provide consistent or reliable answers with regards to her episodes of "pounding heart", which was the current incident. The episode had passed by the time we were able to get there and get her on the monitor. A run of PVCs lasting that long is by definition, my friend, V-tach. I have no way of knowing where it's polymorphic or monomorphic but V-tach it is.. No idea why she's in failure, but three possibilities come to mind 1 - during her open heart surgery there may have been a failure of cardiac preservation (around 5 hours for that to happen) 2 - RV pacemakers in patients with existing LV failure (that as far as I could tell was not the case with this patient as the mitral valve replacement/aortic valve repair was supposed to prevent heart failure) sometimes messes with the synchronocity of the heart and can be helped with placement of an LV lead 3 - ideopathic and I love the questions. Anyone else please chime in and correct, instruct and inform.