letmesleep

LOL Mike, guess I can't argue with that at all, but I did admit it before I made the judgement. I enjoy pushing the limits too when I play, but there has to be something said about a guy strapping a Kite to his body and going out in to a massive "wind" storm to play, he kinda asked for it. Just my opinion!

I'm in the same boat with the others as far as not making the switch. I can't say that I will always work in EMS, but in some type of medicine. I enjoy the science way to much to leave. I too don't have the personality to be a "copper", and in this area the police don't seem to make any thing comparable to what medics make. With that said, I wish you all the best in your endeavor, and I say you should do what makes you happy! Good Luck!

This is going to sound very judgmental on my behalf, but THANK GOD FOR STUPID PEOPLE, STUPID PEOPLE ARE OUR JOB SECURITY........................................ sorry if I ruined the thread, just had to throw it out there!

Although most of us here (at my district, myself excluded due to recent research for posting in the "city") don't know what the pricing scale is, we do inform the Pts of a price range, and also explain to them not to quote those prices due to the fact that we are NOT involved in the actual billing process. It is standard practice here to inform the residents that there is a cost for transport (when a non emergent transport is warranted, and we have the time), but before we go any further with transporting, we will suggest other options. My personal opinion in this matter is that in EMS we are forced to wear many different hats out in the street. When it is allowed we need to inform our Pts about everything that they may experience in the next hours/days of their lives. We need to be as up front with our Pts as possible about cost, not just because Medicaid states that we HAVE too, but because that is part of our job. At the point that a non-emergent transport in recognized our Social worker hats should be put on to figure out what is going to be the best means of transport for our Pts. Like it or not it our responsibility to educate (as professionals) the public about OUR different systems as best we can. I have found in my time in the street that honesty, no matter how harsh it may be, is the best policy, and the level of respect that WE all demand will rise from this. I once told a boss that it is NOT my job to make the residents of this district poorer than they may already be by NOT educating them and allowing them to make an informed decision. BTW, Ruff, what the hell happened to the dog?

Is it ok that I am laughing my ass off at you right now? I hope so! Anyways, been there done that. My partner did the same thing about 4 years ago to me. She set up the EKG and we got nothing, she put the RED lead on the prosthetic leg and couldn't figure it out. The pt lost it when I found it and moved it.....quite humorous! I think my biggest on going issue is there always seems to be some wrong with my pants......heres just one of many "I looked stupid" stories for ya. I was new at this district (where I work currently). We got a MVC call (years before we had turnout gear), so I grabbed my uniform shirt, put it on, tucked it in, and went to the call. Got the Pt to the ED, gave a verbal report, wrote my PCR, and left to return for a board meeting. Get to the meeting, stood up and introduced myself to the BOD (because I was new), and left to return to my station. En route back I realized that my fly was down and had been since I tucked in my shirt. I sat on the bench seat during transport with all my "junk" right at eye level of the Pt. Standing in a crowded room giving report, and writing my PCR. Stood up in front of the BOD for all to see my Bart Simpson Boxers. Then my partner says to me "Oh yeah, I saw that on the scene, in the ED, and at the BOD meeting, I meant to say something, but could stop chuckling at ya"! Thanks ass! was my reply. We have all done something dumb.............

I would have to say that I agree with all the above advice so far, but the biggest issue with disciplining your dog is consistency. You really need to stay on top of it, and render the same punishment every time. I would also advise that you educate your DD as well. Find out what behavior your DD is doing to provoke the puppy, and teach her that it will get her nipped. Make it an educational game so that she can learn to live with the pup long term. "Putting down" the dog, in my opinion, isn't needed just yet. Give it some time. I have a 10 month old St Bernard that still gets wound up and forgets, sometimes me or my fiance get bitten by him, but he is still a 110lb pup, and just needs that extra attention that all pups need.

That was an awesome display that there is no getting through to your head. Ridryder 911 has eaten me alive here before for things that I have said due to the education and experience. The good thing about the "city" that I have found since I have been on here is to maintain your cool, and have a discussion. Just because you don't agree with whats being said doesn't mean you throw your hands in the air and give up, but check the attitude at the door. It seemed as if you understood why I was disappointed by you initial post, and had humbled yourself to continue on the topic at hand, but from your last two posts it doesn't seem to be the case. Nobody is "newbie Bashing"! You have been given the same level of respect that any one of us would be given here in the "city". The opinions shared by us in regards to your behavior during a clinical were brought forth by your OP (we reacted to your words). The problem now is that your continuing to debate by trying to "slam" those of us that have an opinion about something you wrote. I, for one have no desire for you to "stop" posting here, but with that said, try to understand that you are talking to people from around the world with a TON more experience than 3 years of service and have had a direct hand in building the career choice that you have chosen, as well as, those with less than 3 years of service trying to learn. Like I said, Rid and I have gone head to head here before and I'm sure with all due respect for Rid's opinion, it will happen again. This isn't the last time that your going to get rattled either, feel free to fight your fight, but maintain the level of respect that you expect us to give. I know that you stated that you recognized that you may not have posted correctly in your OP, but continuing to argue with those of us who share our opinion about something you wrote only shows us that you didn't and that your not willing to learn because you keep trying to divert what is being said.

JW, your last post could start at least 3 different threads, or add to about 9 I'm sure....(not actual numbers, but you get the hint). Anyways, as far as the spouse deal.....it can be tough and does take strong women (and men for that matter) to hold up the home life end of the lifestyle. I am all EMS, and work 24hr shifts. My current situation is that I am engaged to another paramedic from another district who works a different shift than I do (same type schedule, opposite days). At this point we deal with it, and only get 10 days a month together, it will have to change when kids get in the mix. I would have to say (without any stats to back it up) that Fire and EMS have a very high divorce rate, and the causes range from any 1 thing to multiple things. You may want to research this topic yourself in order to get the info your needing to make a decision about your future. Good newbie questions in my opinion, but don't be shy about skimming thru the city for this info, it is out there! Good luck with your decision making, and remember what was said here about being a medic 100%.

Hey Doc, did he play for the "BULLS" as well? sorry had too.

this is what I found so far. I have highlighted some areas of the articles, as well as, provided the link. http://www.emedicine.com/emerg/topic490.htm Massive PE causes hypotension due to acute cor pulmonale, but the physical examination findings early in submassive PE may be completely normal. Initially, abnormal physical findings are absent in most patients with PE. After 24-72 hours, loss of pulmonary surfactant often causes atelectasis and alveolar infiltrates that are indistinguishable from pneumonia on clinical examination and by x-ray. New wheezing may be appreciated. If pleural lung surfaces are affected, a pulmonary rub may be heard. The spontaneous onset of chest wall tenderness without a good history of trauma is always worrisome, because patients with PE may have chest wall tenderness as the only physical finding. In patients with recognized massive PE, the incidence of physical signs has been reported as follows: 96% have tachypnea (respiratory rate >16/min) 58% develop rales 53% have an accentuated second heart sound 44% have tachycardia (heart rate >100/min) 43% have fever (temperature >37.8°C) 36% have diaphoresis 34% have an S3 or S4 gallop 32% have clinical signs and symptoms suggesting thrombophlebitis 24% have lower extremity edema 23% have a cardiac murmur 19% have cyanosis here is what I was able to find so far on traumatic asphyxia: http://www.bradylabit.com/classes/forensic...71,18,Traumatic Asphyxia Everything that I have seen so far about traumatic asphyxia, has not touched on "nipple line" cyanosis, but with the reading I have had you can certainly see where this idea came from.

Actually, I'm going to have to side with the Docs here as well. I will also do some further research, and post it at a later time. With that said, I do agree that there is noted central cyanosis with PE, but I think (as I said I will research this) that the "nipple line" cyanosis that is being described here is related to "traumatic asphyxia" as a "classic sign". You can also see this develope in a cardiac arrest after compressions have been on going for some time, due to the injury caused by said compressions. I will do some looking around to qualify my statements here, please be patient.

Go figure, I get started on this scenario yesterday, only to run my a** off and return to it being over!!!! We would have worked him as well depending on obvious signs of death being present such as pooling, skin temp, rigger, yada yada. Obviously, I know! Interesting call Ruff...........

Thought I'd breath some air in to this post. It seems to be an ongoing issue here at work, and we just happened to find the article this am. It's an interesting read from EMS magazine: http://www.emsresponder.com/print/Emergenc...tion-Gap/1$8073

Lets see, I have used the heat pack trick.....works good, also the loose tourniquet...........works good, no tourniquet.......does the job. I have heard of nitro paste being lightly rubbed on the site prior to cleaning.......wouldn't suggest it, It's a very old trick, and can get your a** in a sling real quick.....bad idea all around!!!! My favorite is humming, don't ask, It's my thing, and it works for me. Pts ask me all the time what I am singing, I just tell them that the veins enjoy the entertainment......ok, it is a weird habit, but it's my cross to bare.......

Welcome back, glad to hear all is well, and that the baby is getting better. Let the hubby know that even tho I didn't respond, I was keeping up on the situation with the thread. AWESOME job done with that!

What was he doing prior to being slumped? Medical Hx, meds, allergies? Environmental situation? Obvious injuries? Get him supine using c-spine precautions, open his airway and ventilate, EKG, D-stick, access the situation (is he viable or not?)

I learned from St John's Mercy Med Center to keep things as clean as possible, but to remember that aseptic technique is about all we can do in the field. The biggest thing that stuck in my head about burns (besides fluid replacement and airway management) is DO NOT put anything on a burn that is going to have to be removed by the Burn Unit. The process of cleaning a burn in the Unit is very painful for the Pt, and the less they have to PICK and SCRAPE off of them, the better. Put the fire out, manage the airway as needed, O2 therapy (always), IV where you can get it and secure with dressings instead of tape or the such, cool the burn with water, but maintain their core temp (tricky), and continue to access throughout transport to a Burn Center. Burns = pain control.

Yes, I have heard of this, and in my 15 years of sticking have never once had to do this. As far as the "pissing contest" during a clinical I think it would be wise to listen to your preceptor in their house and follow their rules. If the RN who I'm sure has at least as much "sticking experience" as you, might just want things done a certain way to HER Pts. The reason I am have a bigger issue with your "pissing contest" during a clinical over your IV starting technique is due to the bad taste you will leave in the mouth of said RN. You are there to learn, and not there to "show up" your preceptors. When you get an attitude with the ER staff, well, can you guess who it is that is going to pay for it after you leave their house? The rest of us, because now we are all cocky know-it-alls. I'm not going to sit here at my computer and tell you that you should or shouldn't do this, and by all means when you get your license feel free to use this technique to your advantage if you want, but keep in mind that your 3 years of experience are not the know all to end all, and your in somebody else house during a clinical. This particular RN may not have handled you in the most appropriate way (by ripping of your testicles in front of a Pt), but on the other hand it is NOT your place to get mouthy in your clinical sites. Ask questions, take in the info, and find another place to research the TRUE answer. By the way Rural EMS is a job, in fact it's MY career, and welcome to the city.............

tiedyedbeth, I went to I.O.P. back in the late 70's early 80's.....do you know if that school is still open?

LMAO.......would that be BARNES/ JEWISH SOUTH now a days Doc? I remember hearing some thing like that before. I also heard of a time that GATEWAY ambulance got a LP-5 stolen, and the sick SOB was using it to discipline his kids.......bastard!

Ok, Ok, so this may come off as bitching or complaining, but don't look at it like that. In my situation we have learned to deal with things and are well adapted to our life-style. Just for s**ts and giggles I just was wondering how often it is that EMS workers get together, and share "LIFE" with each other outside the job? It seems to happen quite a bit from what I can tell, but just how does it work for those who live this way? What are the ups and downs that you experience together? As I have posted before, I am engaged to a paramedic, I am a paramedic, we work opposite shifts (24hr), we work at different districts. Obviously the "normal" relationship stuff is in play such as being considerate of each others needs, trusting each other, yada, yada, but how do you deal with only seeing each other 10 days a month? How do you spend that time together? What do you do to stretch it out? We (me and the fiance) visit each other at the station during lunch and/or dinner, and do take in to consideration everybody elses needs during down time in house. This practice is very common in our area, dinner is known as family time. We both get up in the am and spend time drinking some morning coffee together before sending the other off to the job. The phone......good gawd the phone!!!! How do you handle the good old "shop talk"? Come on, if its a good relationship you share everything, don't you? So how do you talk shop with your sig other? Is there just "sitting back and listening" going on, or do you two QI each other? Is there any training with each other......outside the bedroom that is.......that you share? The chick and I talk shop, and share details of the calls we run, keeping within HIPPA guidelines of course, We share the experience of a "good" call, and the ones that make us laugh. There is plenty of respect for each other to say "I would have done it this way" keeping in mind that we were NOT both there. Training isn't always together, but we try like hell to bring the information back to the other for reading material, which really is piled up next to the toilet here at home......LOL! So how do you do things? It doesn't even have to be the fact that your sig other is in EMS. What if they are a cop? A nurse? Doctor? or just a very interested spouse? We all know how hard our shifts can be, so how is it done in your household?

Well, if we are at the hospital, then get your butt inside and transfer care to an ER doc, hang out and get the answer to our question......."WHAT THE HELL IS WRONG WITH THE BABY?" Then write your report, jump through all your billing hoops, signature from the nurse, and hang out till your next partner and truck show up.

boeingb13, I agree with your thought process, but the reality is way different! First if I may, tattoos were the OP, but body modification is body modification (tattoos or piercings). I have NEVER been instructed in class to conform either, but getting back to common sense. If you have done something to your body such as getting a tattoo, or not (being the big guy who looks scary), it is truly up to you to put your Pt at ease when you show up. As I stated above using common sense to get your Pt past your short comings (as the Pt sees you) is going to be your first step in building that confidence. How can you say that you don't conform? You admit that your scary looking, and that at first your viewed as such, but as soon as you start to speak everything changes. Guess what, you conformed to what the Pt needs to get the job done. This is where I stop addressing boe, and address the rest of us........... Listen, we don't carry our licences, certs, and other credentials around for presentation prior to care being given (your collar brass doesn't always mean crap to a Pt that doesn't understand what the letters stand for). We are not going to be interviewed by Pt that is entangled in a car following a nasty MVC. We don't need to qualify for the position durning grandma's major MI. We did all that when we got the job, but when you come through that door and you have a Body modification of any kind then YES, you are going to have to conform to the needs of that Pt. Why is this the case? Because every Pt you run in to out on the street is their own individual, and will see what it is that they want to see. They may see you as a professional, thug, biker, or even just some dumb kid that has got to be to young for them to trust with their life. It is up to you to conform to their needs by using common sense, and building that confidence so that you can improve their lives from 15mins ago. Tattoos don't make you the medic (EMT) that you are in any why shape or form other than killing the public perception of your person. Tattoos don't make you an idiot, but if a Pt can't get past your ink, you will have one hell of a time refocusing a Pt's image of you in order to benefit their needs. There is nothing different (in regards to body modification) than the medic that shows up with jelly doughnut stains on their white untucked uniform shirt. Your Pts don't typically understand the difference between EMT and EMT-P, so why would any of us think they would know the difference between those who have visible tats, and those who don't. It's all about public perception, and that first impression. Use your god given common sense is all I'm saying.......................

Arizonaffcep, +5 for the reference to "My Cousin Vinny"