Cookie

Definition:

Subcutaneous emphysema occurs when air gets into tissues under the skin covering the chest wall or neck. This can happen due to stabbing, gun shot wounds, other penetrations, or blunt trauma. Air can also be found in between skin layers on the arms and legs during certain infections, including gas gangrene.

Alternative Names:

Crepitus; Subcutaneous air; Tissue emphysema

Considerations:

Subcutaneous emphysema can often be seen as a smooth bulging of the skin. When a health care provider feels (palpates) the skin, it produces an unusual crackling sensation as the gas is pushed through the tissue.

Common Causes:

This is a rare condition. When it does occur, possible causes include:

Pneumothorax (collapsed lung)

Ruptured esophagus

Ruptured bronchial tube

Tain't nuthin wrong with kittens or cats, I have 6. People grow up and shed all over so whats the diff?

I was always taught to Look, Listen and Feel. How a person assesses a patient without doing the above is beyond me, yet I have seen some try or attempt to do it. Even assisting in classes I tell them they have to look what they are assessing, listen to it and feel it.

I would certainly ask which trimester the pregancy is in.

My husband and I and his brother are all Emt's. Our Ambulance has us three relatives plus another family who are also Emt's and a Paramedic.

We like keeping it in the families so to speak.

I have just the one in mind, if I was dying they dare not touch me. Afterall what can one expect from an Ambulance crew that puts three leads on the patients clothing instead of their skin!

They shut the freaking engine off! :evil: If it will ever pick a time not to start is when you need it most. We always leave our engine running.

Remind me never to visit Philley.

A positive post for a change.

This is Iowa's EMS Scope of Practice

http://www.idph.state.ia.us/ems/common/pdf...of_practice.pdf

I was a kid in Nebraska when Charley Starkweather went on his killing spree and they fried him in the chair. I had young children when Jon Joubert kidnapped two boys and murdered them, they fried him. Now people saying the electric chair is cruel and inhumane, they are saying that about lethal injection as well. Guess Gary Gilmore had it right, 1 bullet to the head and your gone. I am for the death penalty, not for all the appeals. Currently in Nebraska two Minnesota Teens are appealing their life sentence for murder. They shot and killed a man and wife in a robbery and fled back to Minnesota. They feel their sentence is excessive since they did cooperate with the police etc.

When we went on a trip to the Bahamas we took a private tour of Nassau and we asked about the crime rate. That have very little crime there. You commit murder, you get your trial, but the guilty verdict brings a penalty of death, no appeals. Robbery, rape etc. Life in prison and they are not luxury accommodations the states have either.

Minor age children should be left at home and not ride along. Two many dangers, and or situations where the parent becomes the victim or the fatality.

Don't they teach grammar or spelling anymore, or the use of spell check?

My first call, can't remember what I did last week, let alone 20 years ago. :roll:

I used to work in a nursing home, during which time I certified as an EMT A. I worked in the kitchen and we had one elderly woman who was on soft or pureed foods, someone fed her diced beets and she began to choke. She was a glorious color of Purple and not taking in any air. I stepped in and did the heimlich maneuver on her, she was in a wheelchair and I was able to successfully dislodge the beets. By the time I got that done the charge nurse came in and ripped me a new one for not doing a finger sweep of her mouth or pound her on the back first thing. She reported me to the Director of Nursing. I told the DON that I acted when no one else did, and that the woman was cyanotic and not moving any air, and I was not going to stick my fingers in anyone's mouth especially when they have teeth and still conscious. She agreed with me, wrote up the nurse and pointed out that there was a chart in the break room on proper hiemlich maneuvers and that the nurse should study it.

There are probably more than just somedic misrepresenting themselves, and for the most part we will never know exactly what they are misrepresenting about themselves. It’s this thing called the internet that brings on a degree of anonymity. Come up with a user name, certification and history then your good to go. Who is going to know? In most cases everyone is clueless to the certifications and history of one another. It’s only when one becomes friendly with another that they divulge certain aspects of their life, not realizing that someone might just check things out, because something they said, did, just did not ring true. In which case someone did check a few things out and look what happens.

My advice is:

1. Just tell the truth about yourself always.

2. Never be something your not.

3. If you have to make yourself out to be something your not, tell it to your dog not the world wide web, because it will come back and bite you in the arse.

Cookie, Volunteer EMT B, 57 year old mother of two and grandmother of 1, and a short order cook!

Old joke, still funny. My son back when on his prom night, dressed in tux and all, was stopped at a stop light and signaled the driver next to him. and they guy rolled down his window only to be asked "Do you have any grey poupon". The kids still do it around here.

Multiple disorders I would say. I just got back from another call and transported to same hospital, and we did ask about her, pulmonary embolism was one of the diagnosis, besides problems with the diabetes.

We had a call for chest pains last night for a person on a bus. We took her to the community hospital in another state, simply because they staff the ER 24/7. They called for a critical care unit to transport her to the Heart Unit in another town and a physician rode with her.

What got all of us is the following:

Medication Allergies:

ASA, Latex, NSAIDS, Toradol, Stadol, Haldol, Nubain, Demerol, Reglan, Hydrocodone, Tigan, Kytril, Compazine, Anzemet, Darvocet, Inaspine, Ultram, Cipro, -mycins, Sulfa, Butalbital, Zofran, Tylenol, Trazadone, ***Oral Antibotics***

Current/Past Medical History:

IDDM, Cystic Fibrosis, Paroxsymal A-fib, Prolonged QT Syndrome, VTACH Cardiac Arrest, PCOS, Diabetis Gastroparesis, DVT’s x30+, PE’s x11, Seizures, Fibromyalgia, Migraines.

Surgical History from 1990 to 2006:

Tonsillectomy/Adenectomy

Tumor Removed Rt Middle Finger

Bilateral Knee Arthroscopy

Laparoscopy/ D&C

D&C/ Hysteroscopy

Stone Removal/ Renal Stent Placement

Lithotripsy/ Renal Stent Removal

Port Placement/ Central Acesses

Left Wrist Carpal Tunnel Syndrome

Lap Chole and IVC filter placement

AICD and Pacemaker placement

AICD and Pacemaker removal

Current Meds

Humalog

Lantus Insulin

Cardizem CD

Digoxin

Coumadin

Rythmol

Nirto

Albuterol MDI

Duoneb

Tobi Neb

Admari

Pancrease

Pancrease

Lamictal

Ambien

IVPhenergan

IVBenadryl

IV Dilaudid

She is 27 years old, and she carries an 8x10 paper with all of the above on it, including dosages for the meds and what she takes them for.

In reviewing what I wrote, I realize I did not put what I was thinking. You cannot say you have a DNR "Order" emphasis on order. If you do not want resuscitation that is a personal choice. But to imply you have a DNR "Order" when none exists is another story, and that is basically what I was saying, only I left out some words.

Now if you tell me you do not want to be resuscitated then I would have it documented as to your wishes, and you will sign it after I have contacted Medical Control or in our area the Medical Director under whose license I operate. But it will be documented and witnessed and the ramifications of such actions or lack of there of explained in detail. I would then, after all is documented and the Medical Control or Director notified, and all bases covered, honor your wishes, but not until then.

Cookie stated

So I cannot tell a medic crew if I am conscious that I do not want to be resuscitated. I then code and they go against my stated wishes. If a patient told me that they did not want to be resuscitated and then the patient codes, do you resuscitate them? Against their expressly stated wishes?

Is this not a refusal of care? In which case there would be a refusal form to sign and document, document, document, and be sure all the t's are crossed and i's dotted and witnessed.

Refusal of Service and or Care:

• Competent individuals have the right to refuse medical care

• “Release of Liability” or “Refusal of Transport” form should be signed

• Patient must fully understand the risk and consequences of refusal of medical care

Consent:

• Expressed Consent

• Verbal or non-verbal

• Generally the act of calling an ambulance is considered consent

• Implied Consent

• Unconscious patients are assumed to desire life-saving treatment

• Children without a responsible adult are treated by implied consent

• Involuntary Consent

• Used if the individual is a threat to the community

• Often involves law enforcement

Below is a copy of Iowa's Out of Hospital DNR Order. What people fail to realize that this has to be physician signed, that you cannot just state you do not want to be resuciatated. Many people also feel that their Living Will will take the place of the DNR Order. Not so.

They do address the fact of wearing a Medic Alert Tag for the DNR Order and that is addressed in this as well.

OOH DNR order Page 1 of 2 September, 2003

“Promoting and Protecting the Health of Iowans”

Iowa Department of Public Health

OUT-OF-HOSPITAL DO-NOT-RESUSCITATE ORDER

(Please type or print)

Date of Order: ____/_____/______

Patient Information:

Name: (Last)__________________________(First)____________________(Middle)_____________

___

Address: __________________________________(City)____________________________(Zip)______

Date of Birth: ____/_____/_____ Gender (Circle): M or F

Name of Hospice or Care Facility (if applicable): _____________________________________________

Attending Physician Order

As the attending physician for the above-named patient, I certify that this individual is over 18 years of

age and has a terminal diagnosis. After consultation with this patient (or the patient’s legal

representative), I hereby direct any and all health care providers, including qualified emergency medical

services (EMS) personnel, to withhold or withdraw the following life-sustaining procedures in accordance

with Iowa law (Iowa Code Chapter 142A):

• Cardiopulmonary Resuscitation/Cardiac Compression (Chest Compressions).

• Endotracheal Intubation/Artificial or Mechanical Ventilation (Advance Airway Management).

• Defibrillation and related procedures.

• Use of Resuscitation Drugs.

This directive does NOT apply to other medical interventions for comfort care.

______________________________________________ ______/______/______

Signature of Attending Physician (MD, DO) Date

______________________________________________ (_____)_____-_______

Printed Name of Attending Physician Physician’s Telephone (Emergency)

To the extent that it is possible, a person designated by the patient may revoke this order on the

patient’s behalf. If the patient wishes to authorize any other person(s) to revoke this order, the

p atient MUST list those persons’ names below:

Name: ___________________________________________________________________

Name: ___________________________________________________________________

Name: ___________________________________________________________________

Name: ___________________________________________________________________

Patients please note: Directions for obtaining a uniform identifier are listed on the back of this form.

The uniform identifier is the key way the health care provider and/or EMS personnel can quickly

recognize that you have an Out-Of-Hospital Do-Not-Resuscitate order. If you are not wearing an

identifier, the health care provider and/or EMS personnel may not realize that you do not want to be

resuscitated.

Physicians please note: Information regarding the completion of an Out-of-Hospital Do-Not-Resuscitate

Order is on the back of this form.

OOH DNR order Page 2 of 2 September, 2003

Directions for obtaining a uniform identifier:

The uniform identifier may be obtained through MedicAlert®1, which requires:

1. A completed MedicAlert® application, which is available in physician offices or through

MedicAlert® by phoning (800) 432-5378 or their Web site www.medicalert.org, and

a new membership fee of $35.00.

2. A copy of this completed OOH DNR order, which must accompany the MedicAlert®

application or be sent to MedicAlert® prior to the identifier’s being mailed.

1MedicAlert® is a nonprofit 501C membership organization.

Suggested Guidelines for physicians:

1. Please review the Iowa Out-of-Hospital Do-Not-Resuscitate order and related protocol with

the patient/patient’s legal representative(s). The following points may be helpful:

• Patient/patient’s legal representative(s) listed on this order must understand the significance of

this order, that in the event the patient’s heart or breathing stops or malfunctions, the anticipated

result of this order is death.

• Patient/patient’s legal representative(s) listed on this order may revoke this directive at any

time. However, the desire to revoke must be communicated to the EMS or other health care

professionals at the scene.

• It is important to emphasize that this order does not apply to medical interventions to make the

patient more comfortable.

• The importance of wearing the uniform identifier for those qualified patients who would benefit

from the mobility this offers should be stressed. It is also helpful to walk patients through the

process they must follow to acquire the identifier.

2. Provide a copy of this order to the patient/patient’s legal representative(s) listed on this order

and place the original in the patient’s medical records.

The OOH DNR Order form is available through the Iowa Department of Public Health, Bureau of EMS, Lucas State

Office Building, Des Moines, Iowa 50319-0075, or through the Bureau of EMS’s Web site www.idph.state.ia.us/ems.

Makes me wonder if they still teach spelling and grammer in school, it's just so elementary! :roll:

First off I would not have walked him to ambulance. I would have started with him right there standing C Spine and standing take down to backboard, base line vitals, rapid assessment. oxygen and spo2. His LOC is in question, I would request ALS. In any case this is significant MOI. Also repeat questions as to name, meds, location and so forth to see if that has improved or decreased, repeat vitals. If you cannot tier or meet with an ALS unit, load and go.

The other person, someone should do a quick assesment with the persons permission. Even if they say they are ok, sometimes they are not and they don't know it. If they still refuse treatment, then be sure to get them to sign refusal.

After we got home from the hospital the night my dad died. I went to bed and my husband went down to work to make arrangements for someone to cover for him. My children ages 4 and 18 months were asleep in bed and the neighbor had gone home. The phone rang, I answered it and the voice said "Don't worry everything is ok" I was half asleep and responded who was this? I didn't know and hung up the phone, it rang again and the voice said " Don't worry I am ok, I made it" It was my dad. Thinking I dreamt it I was not going to say a word. The next morning my 4 year old who was asleep at the time of the phone call, asked why Grandpa called! Then I explained to my husband what happened. My son said it was true that he told Mommy he was ok and he made it to heaven.

I think the calls involving the elderly give me a different perspective. We have a high population of folks 70 and above. They really hate calling for the ambulance, and most often or not convince a family member to take them to the hospital. They hate to bother us with their problems is a common theme. We had one yesterday, where an 88 year old fell and broke his right ring finger, it was an open fracture and the digit was dislocated behind the pinky, plus a pretty deep laceration nearly encircling the finger. We were more concerned about the injury than he was. He just wanted us to patch it up and he would go home and his wife could run him to the Doctor when she got home.

He kept saying that he sure did not want to bother us and have us go to all this trouble , after all it was just a broken finger. No big deal.

I got Slashin' Azriel Hacke