EMS_Cadet

You got the 02... BP is 134/86. Pulse rate is 175. RR is 24. Pulse ox is 99% on o2. No dyspnea. Skin color/temp is normal. No diaphoresis. Lung sounds are clear and equal B/L. Apples are fine and dandy...Nothing that would suspect anything...And don't worry, a careful inspection was completed. Rhythm strips (including 12 lead) are as follows: Click here for the rhythm strips

You and your ignorant EMT partner are restocking the truck when you get toned out for a cardiac call. You mark enroute. Dispatch advises you that you will be dealing with a 70 year old female. You have a 7 minute ETA. You arrive on scene. No hazards present. You are at a residential home. You load everything onto the stretcher and knock on the door. And elderly man opens the door and greets you. He directs you into the living room. You and your partner enter the living room where you see a 70 year old female sitting on a piano bench. She is alert and oriented. Pt. states that she called EMS because she had a, "funny feeling" in her chest. FD reports that a patient has a BP of 90 palp. For some reason, they didn't obtain anything else. :? Before you know it, the FD is back in their response vehicle and is driving away... Nearest ED is 14 minutes non-emergent. Begin the scenario kiddies!

Just a hint....This has nothing to do with anything venomous

Sorry.....Nothing in site. Tell me what you want examined...I don't do it for you You find nothing....No ID or anything....

You are siting at the dinner table with your partner when the pagers go off. You are dispatched to a country road for an unconscious person of a delta response. Caller advises unknown age male laying in the ditch. Dispatch advises first responders are also enroute. You mark enroute to the call. You have an ETA of 11 minutes. You arrive on scene. Scene is secure. No hazards present, except some occasional light traffic. First responders are handling the traffic. You get all the expensive equipment out of the truck and walk down the ditch. You see an older male laying in the ditch. You walk up to him. You idenify yourself and gently shake him (taking in mind c-spine). You get no response. You preform a sternal rub. No response. The patient is cyanotic. You do a jaw-thrust and determine the patient is not breathing. The patient does have a pulse. You are on a fully stocked ALS ambulance. The nearest ER (which is also a level I trauma center) is 16 minutes away. Lifelight is grounded due to weather conditions. Go get it kiddies!

Just to make this show suck a$$ even more, I noticed something major. Remember when the OD guy stood up and started running around? The medic got an IV and pushed Narcan through it. Interesting enough however, when the guy came around, he was running around with NO IV and NO bleeding present around the IV site. I'm afraid this was a MAJOR failure...I much would rather ride along and listen to a gay crossdresser talk about why he didn't wear a "bra" to the ER. (That was an actual call I ride along on Monday). EMS is so random, but so interesting. Later, EMS_Cadet

Poisonous mushrooms contain muscarine. Muscarine is a cholinergic agent, which mimics structure of acetylcholine. Excess acetylcholine is what causes the organophosphate poisons to produce their clinical signs and symptoms. A great article on Cholinergic Syndrome can be found at: http://www.intox.org/databank/documents/tr...ate/trt15_e.htm Great replies guys and gals! EMS_Cadet

Dr. of pimpin': The boyfriend does not know what these mushrooms look like. She made the dish before he arrived. Everything is normal with the people. Police have never been out there before.

She has seasonal allergies. That was a typo on my part. She has no allergies to food, animals or meds. They went "all over" according to the boyfriend. No nuts in the dish. A description of the dish was already posted.

You are on to something......

She has made this dish before, but without this new type of mushrooms. She found these on her cross country trip. Pupils are pinpoint. No indication of a bleed. No head trauma during the trip. Monitor shows Sinus Brady @ 50 with no ectopy.

John ate a steak, while the girlfriend had the vegetarian dish. The dish contained: Green Peppers. Tomatoes. Squash. Mushrooms (assorted). Brockley. Yellow peppers. It was all on top of steamed rice.

The male who answered the door explains to you that he's her boyfriend. They have been going out for almost 4 years now. They recently went on a cross county trip as a vacation. John (the boyfriend's fake name) explains that they has just got done eating dinner. The girlfriend is a vegetarian, so she made herself a vegetarian dish. John says she is in perfect health. No medical problems. She only takes Zyrtec for allergies. She has no allergies. John explains that the two had already finished eating and were just sitting and talking at the table when his girlfriend become suddenly ill. She had a very upset stomach, blurred vision, profuse sweating and even started coughing. She started to stand up and she fell on the floor. John says that she "went on herself". John explains that he doesn't think she contracted anything during the cross country trip because she was just seen by her regular doctor for a physical. Upon assessment, you note audible wheezing, dyspnoea, bronchial secretions and excessive lacrimation. The seizure lasted only 10-15 seconds. Patient is no longer seizing. BP: 102/60. RR is 17. HR is 52. Temp is 98.1.

You are dispatched to a private residence for an unknown medical. Dispatch advises the patient is a 33 year old female. Upon arrival you find a private residence. Scene appears to be secure from the outside. No hazards spotted. You walk to the front door. You knock on it. A older male answers the door. He says, "she's in the kitchen". You follow this man to the kitchen. You enter the kitchen and see a 33 year old female laying on the floor. She is alert, but not very oriented. You smell feces and note the presence of fecal matter on the floor. Your patient is extremely sweaty and is drooling out of her mouth. The patient states that she has "blurry vision". All the sudden, your patient begins to have a grand mal seizure. Let the GAMES begin! :twisted:

I just recently heard of an EMS service utilizing retrograde intubation. Is this common? Is this usually something that is medical command or protocol?

Alright guys.... Let me tell you what the outcome was.... We transported this guy non-emergent to the closest ER which happens to be the level II trauma center. In our county, this guy did meet the trauma alert criteria due to he being over 65 and involved in a MVC with a approx. speed above 45mph. He was set in stretcher triage. We got him transferred over and started the report. We got done and left the station. Got back to the station when a nurse from the ER called and asked for the PCR. We told her that we already gave them a copy. She told us that the guy was transferred to the trauma bay after we left. The trauma team had to be called in. The guy ended up having a pnemo. They did a chest tube and that's the last we heard.... I thought it was kinda funny....The ONE time you don't trauma alert someone, they turn into a trauma.

He is maintaining his own airway fine. The blood is coming out into the gauze, not draining in his airway. No odors of alcohol. He can answer our questions fine. He remembers the incident perfectly and the events preceding it.

This *almost* gives me the impression that this patient has a history of seizures...

The patient starts asking if he can sit up. You ask the patient why, but you get no reasonable response. The patient keeps asking if he can sit up. You finally are able to "prop" the LSB up with some folded sheets and a pillow. The patient states, "That's better." Wanna change/add anything based on that?

The patient was restrained. The damage to the interior of the vehicle was moderate. Steering wheel was intact. Windshield was not intact. The patient did not take any meds. No medic alert tags. No signs of past trauma/surgeries. Blood sugar is 142. NSR on the monitor. No neruo deficits. Pupils are equal and reactive.

Alright guys.... You are just getting ready to eat when you are dispatched to an MVC. ETA is about 6 minutes. You mark enroute. Enroute, the FD advises that you have one minor patient with a possible broken nose. You arrive on scene. Scene is secure. No obvious hazards except some light traffic which is being handled by PD and FD. No gas leaking etc. You put on safety vests and take BSI precautions. You note one elderly patient sitting upright in his vehicle. There is extreme damage to the front end of the patient's truck. Bystanders estimate the patient was going approx. 50mph when the patient ran into a stopped car. (Go figure!) You approach the vehicle. Upon further assessment, you have an elderly male patient. He is bleeding from his nose. You are unable to see the nose injury due to FD holding compression with gauze. You note some minor lacerations on his left and right elbow area. The patient is A/O x 3. He denies any LOC. He denies any head, neck or back pain. In fact, the patient is only experiencing pain in his nose. You take the gauze off the patient's nose and see a large laceration all the way up the bridge of the nose. The laceration is quite deep. No other obvious signs of trauma to the facial area except for the nose laceration. No respiratory distress. Patient does not want c-spine precautions taken. He states, "I'm fine. Just need some sutures on my nose." You ask the patient how fast he was going. "I was going about 30mph." After talking the patient into c-spine precautions, you board and collar the guy. You get in the back of the truck. You expose the body for a full trauma assessment. You can find no signs of trauma (except for the nose issue). You ask the patient if he has any medical problems. He denies, but does say, "I have a neck issue." Patient cannot explain any better then that. The patient does donate blood, but hasn't donated within the past 48 hours. Patient appears to be in no distress. Vitals are as follows: Pulse: 72. BP: 142/94. RR: 22 and non labored. o2 sats: 100% on RA. You establish an IV (18g.) with NS for KVO. Here comes the question....Do you classify this as a trauma and run emergent to the ER?

Ditto!

Hello everyone, I'm in a high school debate class (yes, I'm still in high school! :shock:) and my teacher chose medical malpractice as the topic we will be debating. I have built a complete affirmative case (with my debate partner) and I think it's a great case for tort reform, but I would like to ask the medical professionals their opinions on several issues relating to medical malpractice............ My debate partner keeps saying, "medical professionals need to improve patient care because medical malpractice is harming people." I have several problems with that statement: 1). How do medical professionals (primarily speaking about physicians) improve patient care? (longer residencies?) 2). Will that improvement in patient care cost money? What do you think about defensive medicine? Good or bad? What do you think of creating "mixed" juries for medical malpractice cases? The mixed jury would be comprised of half medical professionals and half regular citizens. My debate partner is also adamant on, "if a doctor is convicted of medical malpractice through the new mixed jury, his/her medical license will be permanently revoked. Personally, I think that's absurd! If defensive medicine is an issue, then would not that make medical professionals MORE likely to practice it in fear of losing their license? What happens if "too many" doctors get their license revoked? Wouldn't that create a national shortage? Besides those questions, I don't have anything else to ask. If you would like to throw in your own opinion on medical malpractice, then that would be greatly appreciated. Thanks in advance! EMS_Cadet

Ditto!

Ditto!