Kaisu

My husband's unit. The IaDrang valley boys are referred to as the 1st shift. My husband was in the 2nd. They had the AnLoa Valley and Tet in Hue. The theme song is his ring tone. Garry Owen!

Don't have a strip mate...

The patient is an 82 year old female with a chief complaint of palpitations. Originally exertion induced, they now occur at rest. Patient is a poor historian with cognitive difficulties. She states palpitations occur daily. Patient reports feeling nausea during the episodes, denies shortness of breath and/or diaphoresis. Patient had mitral valve replacement 2 1/2 years ago, followed by implantation of an RV demand pacemaker. Patient's ejection fractions have decreased steadily since the surgery, and she is now in heart failure. EJ of 61% after surgery, now at 34%. Patient has no coronary artery disease, is normo-tensive, with normal renal and hepatic function. Medications include coumadin, lasix and various supplements (primarily K-dur and Iron). Patient's only other complaint is frequent constipation. Patient has an underlying controlled afib with a ventricular conduction delay. Her paced beats have a complex of around 120 mmsec. Native beats are also wide, around 115 mmsec. Now the question: Given the wide complex, if I am fortunate enough to capture an episode of tachycardia on the monitor, how can I tell if the tachycardia is atrial or ventricular in origin? Thank you for any help you can give me.

It happened to me. I was suspended for postings here on this site that were deemed contrary to company policy regarding internet postings. Be very careful.

Correct me if I am wrong, but I was under the impression that Ativan is the benzo of choice for seizures because it stops the seizure activity in the brain. Valium and Versed will affect muscle activity in response to the brain seizure, but the "electrical storm" in the brain continues. I carry Versed and have used it for sedation (during pacing, combative patient etc.) and RSI and I love the way the drug works. My medication of choice for seizure for the aforementioned reason is Ativan. I would love to see the studies and other smarter people please chime in.

I don't think this has anything to do with unions and the article has a tenuous connection if any to the title of this post. The fact that 911 calls are routed to the hospital and then to 1st response seems upside down. This "Bizarro World" that you appear to work in explains a lot in terms of the outlandish ideas and thinking that has appeared in your posts. Do yourself a favor and get to a place in the country where things are run a little more rationally. I think it would help develop you as a professional.

My twin brother killed himself 2 months ago. It is so painful to realize how much he was hurting and for how long and excruciating to understand that we could not help him. My 82 year old mother sat by his coffin and howled in her grief. Months later and she is still calling me and crying. It has helped all of us to realize that my brother was ill. His lifelong depression led to alcoholism. Having struggled with depression all my life, I feel so blessed that medication and self-knowledge keep me functioning and happy. It took decades to learn how to do this and I did not do it alone. I was fortunate that I had the resources to get the help I needed. My brother was unwilling to get help. He felt it made him weak. Even before this happened, I was very sympathetic to the suicidal among us. Even the 18 year old mad at her boyfriend got sympathy and counsel from me. A suicidal gesture is a cry for help. Just because it is ineffective does not mean that the patient is not suffering. They are hurting. Never stop urging these patients to get help. Empathize. Do not judge and do not dismiss them. The wreckage my brother has left behind is indescribable. Do what you can to prevent this tragedy.

First of all, thank you for posting. That took courage and honesty. Those two traits will serve you well as you learn to understand and manage your PTSD. I call it that because your symptoms are classic. I have been living with a combat vet for 13 years, as well as my own case of PTSD from my childhood and tho not a mental health professional, I feel qualified to tell you these things. Take what is helpful to you from the following and trash what isn't. The first thing to understand is that PTSD is NOT a weakness or a character deficiency. It is a normal response to traumatic experiences. As an analogy, if you put enough stress on an arm, no matter how strong the arm, it will break. PTSD is a wound to the human spirit. Part of the solution is often spiritual. Trauma changes the way your brain operates. It is a survival mechanism and extremely useful at the time of the events. It allows you to numb your emotions so that you can function. "Normal" people do not calculate drip rates and prioritize transport decisions when faced with brutally injured children. We do. The problem is that we don't know how to process the event after it is over. It stays bottled up and does it's damage. PTSD is often misdiagnosed and mistreated IF you are dealing with someone who doesn't understand it. People with PTSD often self medicate with alcohol, drugs and even food. It is often accompanied by depression, anxiety, relationship difficulties and isolation. When you try and open up to people who don't know what you are talking about, you are often met with misunderstanding, indifference and cruelty. The good news is that while it never goes away, you can learn to understand and manage it. Into every life, bad things come. Once you stop the self destructive behavior (that originally helped you cope but is now hurting you), you become one of the enlightened ones on the earth that helps others in ways that are deeper and more meaningful than any you can imagine. Get some qualified, professional help. If the person you go to see doesn't help (if you feel worse instead of better after 2 sessions), dump them and find someone else. I personally went to 18 mental health professionals over 15 years before I finally found a good one. She saved my life. (I still call her number 19,) The most important thing to remember is that you are not alone and you are not crazy or bad. Millions have dealt with this successfully and you can too, and believe it or not, it will make you better. God bless you my friend. Love Kaisu edited for a dumb mistake

No, I work for the largest private in the country, and am based in Arizona. We have the best wages in the state (better even than fire), 401K with company match, health and dental benefits, uniform allowances, free education etc. I run 911 and CCT. We transport for 8 or 9 different agencies, including urban fire, and are first and sometimes only response on about 50 % of calls. We run more calls than any of the fire agencies. We are subject to rigorous internal QA/QI, and overseen not only by our medical director, but the EMS directors in the 5 hospitals we transport 911 patients to. We are also watched by the fire agencies and as the largest private, the state makes regular inspections of our operations. I responded to this thread to counteract the perceived bias against privates. Just as there is a great variation in quality of patient care in fire and vollies, so also privates. Do not tar all providers with the same brush.

Have had this happen a couple of times when on CCT transport. I cannot leave the patient with a lower level of care, thus my nurse stays with the transport patient, my EMT partner and I go to the mobile home rollover and help the two old people. We extricate with the help of bystanders and package for the transport unit, which in this case arrived 20 minutes after us. Note that this is a remote area with 1st response quite a distance away. Our transport patient was stable, requiring CCT for the administration of pain medication not within the scope of paramedic (in our state). If the CCT patient had deteriorated during the wait, my EMT could have continued with the nurse, leaving the medic (me) on scene without an issue of abandonment of any patients. Running ALS transports, I as the medic would stay with my transport patient while my EMT partner assisted the accident scene as a first responder. All of these scenarios are impacted by the stability of the transport patient, the seriousness of the accident patents, the distance from help, the presence or absence of others on the scene, etc. etc. We are trained to think and respond appropriately and adjust our actions to the demands of the situation.

Yep, pretty stupid statement all right. I work for the evil empire in a flagship division and I am proud of it and them. We are an example of unparalleled professionalism and fiscal responsibility that is enforced by the market. Unlike fire departments who are now at the mercy of city councils, and volly squads at the mercy of vollies, we keep doing what we do. I will be the first to admit that a high degree of scrutiny by regulatory bodies and the public are absolutely necessary to keep the profit motive in check; but hey, our country is founded on a system of checks and balances, and when it works it is a beautiful thing. Transparency in operations would prevent a lot of this BS.

As an "innie" and not an "outtie" with juvenile macho male types, you will never be in the middle of it and believe me, you don't want to be. I watched dumber, less motivated, less educated young men become totally accepted within months, while I, being hired at the same time, fought for my place for years. I concentrated on what I cared about (patient care) and let that crap go over my head. If I was inclined to seek advancement within the company structure, it would be frustrating and painful, but as this is my version of the Walmart greeter job, I can ignore it. That being said, when the scariest charge nurse in the entire ED played a practical joke on me (she put a cockroach in my clipboard), I was outwardly pissed and inwardly elated. I was IN!

My husband was 1st Cav in 67-68 in the central highlands of Vietnam. He was in Hue during Tet. Also 11B. Amazing man and my hero.

Pros Reality check to force my head out of my ass amazingly supportive community when bad things happen smart smart people that collectively know waaaaay more than any 1 person different locations, job paradigms, thus expanded point of view for any one willing to listen and last but not least - administers nothing like the neo nazis on that other site. (I quit there over a year ago and I haven't been back) Cons some pretty harsh words from people that don't see the nuances (takes balls to post here) unrequited needs for face to face time with people that sometimes become close as family

I ran on a patient that had been duct taped to a chair and tortured with a box cutter. (They had tried to induce my patient to reveal the location of his meth stash). This patient had to the bone lacerations of the head, full thickness chest and back. I had to wrap kerlex around the O2 mask to keep it on his face because I could not wrap the elastic around the skull and cervical vertebrae exposed. One of his injuries was a perforation of the diaphragm with intestine in the thoracic cavity. I kept the patient upright. His vitals were good. He had more and better stimulant on board than I could legally give him and after approximately 1,800 stitches did just fine.

Ya gotta take 'em Dwayne... I had a T-bone at the intersection of an interstate and a state highway. People are supposed to slow down when they approach the ramps. There are the usual gas station/sub shop/trucker supply places and always people leaving them to go onto the state highway to access the interstate. Long story short, I took the husband and his wife. The next available rig was 40 minutes away, I was 25 minutes (lights and sirens) from an ER. The husband was stable on scene, started deteriorating during extrication. I saw the big bubble of subQ air and had just decided I wasn't needling him unless his sats started to deteriorate. No sooner was the thought in my head, when his sats deteriorated. He was also bradying down on me. I ended up sticking 2 needles into his chest. Patient's wife was on the gurney. She was stable. I didn't want to take the monitor off him, so I did manual BPs on the wife. She was talking to me and on the cel phone throughout the transport. She had a fractured pelvis. Got them to the ER. He was knocked down and I ended up taking him CCT ground (vented) 2 1/2 hours lights and sirens because choppers weren't flying. I got reamed out by the ER doc for taking two patients. My medical director backed me 100%. He said I was in the middle of nowhere and did the right thing.

Its one thing to beat a dead horse... it's another to kick the farts out of it.....

Absolutely correct. In this particular patient death, the patient was diabetic with extremely high BGL. The doc decided against the D5W for this reason. The correct thing to do would have been to use the D5W and correct the BGL with insulin.

The safety alerts regarding this also recommend education and intense training early in medical school to teach doctors to NEVER do this.

2 or 3 years ago, the VA issued an alert and contacted all patients (including my husband) that had undergone prostate biopsy. Instructions for the sterilization of the biopsy needle (that is passed through the rectum) were deficient. Thousands of veterans had been exposed to all the nasty germs. Sterilization procedures were corrected and all affected patients that had been identified and consented to the followup were tested (and still being tested). As far as I know, no instances of infection due to this issue have been identified. Thus, a problem comes to light and the health agency follows up with rigorous procedures to minimize the harm. That's as it should be.

As far as I know, there is NO reason to administer sterile water IV, and several states have issued safety alerts concerning the danger. There was a case where a diabetic patient with a primary diagnosis of congestive heart failure also had hypernatremia. The doc ordered iv sterile water. The patient died after a bolus of just over 500ml. The bulk sterile water in pharmacies is for dilution of drugs, mixes, etc. The availability of it in an infusable form has been identified as a serious safety risk in hospitals. Edited for spelling

I work for a division of AMR.. We are professional and committed. Our division has 15 ambulances active - 3 CCT rigs of which 1 is a bariatric rig - the other is specialized for pediatrics. So far, this has been sufficient to transport our morbidly obese safely.

You appear bound and determined to not change your mind or to reflect on any of the information you have been given. Do you seriously expect a medic to take any patient they feel cannot be safely transported? Where are you running this department of yours? The only thing I can think of is you are in a part of the country that is so seriously under served by professional EMS that an attitude such as yours can be developed and maintained. How much field experience do you have? Have you worked in other environments? One of the strengths of this site is the fact any half assed cherished notion is swiftly dispelled with facts and opinions of people that have seen more and know more. I know it hurts to admit that you may be wrong but trust me, that is the most useful reason for being here.

Now imagine the liability if there wasn't a deep pockets manufacturer to sue and you had transported this patient on the floor. This was a 911 situation versus a stable interfacility transport. If I take a patient that I feel I am not qualified to take, either due to equipment deficiency, my personal limitations, patient instability etc. and the transport goes wrong it is my ass. I would take the loss of a job over the loss of my livelihood in a heartbeat.

I told a trusted preceptor once that I was scared when the tones went off. She had been working in hospital based EMS for approximately 20 years. This teacher told me that the day she stops being scared is the day she finds something else to do. I am apprehensive before each call. I mentally go through treatment strategies and "worse case" scenarios, plan what we need to take in, review drug dosages, etc. Once I get in there, training and experience take over and its not an issue. This is a tough job. People that aren't strong emotionally cover up the fear and insecurity with bullshit bravado. It takes a lot of strength to remain open, to empathize with patients and deal with the uncertainty; to remain realistic (humble) in the face of the fact that you never have all the information, you will never have enough medical knowledge and you can be sandbagged on a regular basis with your weaknesses. The people that keep feeling and deal with those emotions become good providers with longevity in the field. The "I wanna crack ribs and get dirty" types remain whackers and/or wash out. Good luck to you.