MedicRN

What is his mental status? oto/rhinorrehea? Neuro check? Stroke s/s?

Dental abscess that has "migrated" to the brain. Mouthwash followed the tract and is now in the brain. My $0.02.

Flown by EagleMed. Second chopper in 4 months (in Oklahoma), third aircraft (at least) in 3 years.

IMHO....... The details provided do not violate HIPAA. HOWEVER..... since this is a "wide spot in the road community," everyone generally knows everybody's business in very short order or at least is able to deduce quickly/easily with minimal information (I grew up in one of those. I couldn't sneeze without my parents finding out).

Was it a direct violation of HIPAA? Probably not. An indirect/inadvertent violation of HIPAA? Probably so.

That's the bad thing about small communities and social media. You're probably better off not posting anything about calls.

If you are truely going into EMS, make the investment into some good black work boots. Black dickies should be ok. If you want to be taken seriously by the crew, dress professionally. If you have any questions, ask your instructor. They will have the best answers.

This patient needs emergent intubation for airway protection. Why the ICU hasn't done it is beyond me (also wondering what idiot doctor ordered >10mg of Valium q1hr PRN [600mg/48hr=12.5mg per hr] without a secured airway instead of seroquel and Haldol). Depending on local policy (and after consultation with my shift supervisor), I would refuse the hospital-to-hospital transfer of an unstable patient.

Question for the nursing staff... Have they given any Romazicon? Results?

Treatment for patient:

Suction and secure airway

Provide for adequate oxygenation

Consider Romazicon if not already attempted in ICU

Have defibrillator standing by

There was a reply on the Basics Doing ALS stuff thread that got resurrected here two days ago.

I have a question.

When is it ok for basics to perform ALS procedures.

There are a few scenarios where this might occur

1. EMT in medic School - they have learned ALS Stuff like IV's, Intubations, Defibrillations, Medications. Do you allow them to perform those skills while you are watching and there. They are not performing in a student capacity but as an employee of the company. Do you let them do this?

They are not licensed by any state to perform anything ALS.

2. EMT just waiting on his medic license - doesn't know if he passed but is sure he did. Do you allow them to perform ALS skills

They are not licensed by any state to perform anything ALS (as far as anyone knows at that particular moment).

3. EMT just starting medic school - do you teach him yourself?

They are not licensed by any state to perform anything ALS. You may or may not be authorized by any state or employer to teach ALS.

4. EMT not in medic school but says he knows how to do it.

They are not licensed by any state to perform anything ALS.

You're right. SOME hospitals pay extra for a BS. Not were I live. Locally, there are 3 or 4 universities (within an hours' drive) and about twice that of community colleges which offer ADN. I will take an ADN over a BSN any day. I have precepted both. The ADN is much more prepared for BEDSIDE nursing vs the BSN who can research you right out the door.

I've found that ADNs have more MEANINGFUL clinical time at bedside vs the BSN thus more comfortable with the fundamentals. The incident which stands out most in my head is having to step by step tell a newly minted BSN grad how to put in a foley (I was a nurse tech at the time and could do it blindfolded)! I've never had to walk an ADN through a fundamental task.

Aside from the apparent advancement possibilities (which I have no interest in), there is nothing a bedside BSN does better than an ADN.

:::: off my soapbox ::::

More ADNs might go for their BSN is they were "paid" for it. Not only for the employer to pay for the education, but also in wages. Currently where I work, ADNs and BSNs make the exact same money! I have no desire for management and therefore have no incentive to go for my BSN (Bull S**it in Nursing).

I absolutely LOVE IT!!!!!!!!!!!

Nothing quite like the smell of a GI bleed. Too bad we can't do a rapid hematocrit test sometimes- we'd at least know what we are dealing with and how anemic/hypovolemic they are.

Just curious..... How would that information direct/change your treatment in the field??

Now that they're televising the funeral 'celebration gala event', it's time to 'fess up and publicly admit:

1) How many of you out there in forum land tried to get tickets to attend in person?

2) How many of you out there in forum land sat glued to the 'boob tube' and watched it?

For the record, I didn't try to get any tickets and I didn't watch it on TV......

1) Nope

2) Nope

I can't wait for this circus to be done and over with. The family apparently wants to wait until the media 'frenzy' has calmed down before they bury the body. I hope they have a good fridge or smell-proof room, 'cause that ain't going to happen for a while!! And when it does, there will be another media feeding frenzy!

I can back better than that blindfolded without a spotter!!

Only 40 cameras?

What is the average acuity levels of your ICU(s)? Is your ICU more med-surg? More 1:1 patient:RN ratio? 2:1? 3:1? Centralized or Pods?

You are listed as central USA. You definitely can not speak for all eICUs in this country and especially not at the hospitals I work at.

Our hospitals are open 24/7 and so are the eICUs. We don't get lax on patient observation just because the sun sets or it is after 5 pm.

You may just have a general monitoring system and not one that provides much in the way of patient observation.

I know the difference between a "general monitoring system" in an ICU and a virtual ICU. I think you are confusing general camera monitoring/observation done at the nurses station (regardless of station configuration and/or patient acuity) with true off-site remote monitoring (eICU).

I work both sides of the camera. As an eICU RN in a remote location, I'm responsible for monitoring only 40-50 of the few hundred beds we monitor (everyone in the remote eICU location has their own assignment of 40-50 beds). We have the same alarms as the RN at bedside has. We camera in and out of the patient rooms throughout the shift, checking on various things. We rarely have a camera on a patient longer than a few minutes. We also have an MD in the remote location making camera rounds a well. They generally do not directly manage patient care, but rather are there for consultation with the RNs and on-site MDs (should they chose to use it that way).

Check out these links (Via Christi Regional Medical Center, VISICU, St Lukes Health System). This what I do and what I am referring to at eICU.

The acuity in the ICUs we monitor are 1:1 and 2:1 (primarily). The ICUs are a variety of specialities.... MICU, SICU, Burn ICU, Neuro ICU, CCU, CVICU (all in our Level I Trauma Center) and outlaying community facilities with "lower" acuity ICUs. The configuration of the nurses station has not bearing on our system as we physically are not in the building with them.

Now back to our regularly schedule topic.............................

Which is why we now the "eICU" in many hospitals. Physicians and nurses sit in a control room monitoring by video all of the patients when the nurses are not in the rooms. They make their own record of CR monitor numbers, meds, and ventilator settings.

As an eICU nurse, I can tell you eICUs do not have eyes on (cameras on) the patients 24/7. Yes, we have access to various monitors/alarms, we do not sit with 40+ cameras tuned into every patient 24/7.

Now for your question about the iodine being a problem with infiltration. My guess would be that it could cause some damage since it is a cleaning solution and has chemicals to kill bacteria.

He's not referring to "cleaning" iodine. It's actually IV contrast.

But why waste the resources on someone who will obviously not survive (or is not meant to survive)? At that moment, your skills/resources could be needed across town for someone who will survive - but only if you are available with intact resources.

I frequently work with patients who are 'survivers' of some massive blunt force multisystem trauma accident. In order for them to 'continue' in life, they now breath through a hole in their neck, 'eat' baby formula through a tube in their stomach wall, pee and poop like babies, have open sores on their butts because of peeing and pooping like babies, are dependent on others to clean their pee and poop, to put Desitin on their open sores caused by the pee and poop and must have the the drool wiped off their chin. And this is the result of someone giving them a 'fighting chance.' Some injuries are meant to be survived.

Remember, a bed sore killed Superman (Christopher Reeves).

Poorly photoshopped

http://blog.ksstorm.info/2009/05/h1n1-is-b...y-britches.html

H1N1 is a Bug in My ... (Britches)

I'm more than a little peeved that everyone pooh-poohed Isreali Jews and Muslims offended by the name "swine" flu on Monday, but now that US pork producers are worried that the TV ratings-induced hype is scaring people off the other white meat, we have to DO SOMETHING about it...

Never mind the fact that more people have died in the (pick any two days between Jan1 and April 1) from *regular* flu than have died worldwide so far from H1N1. Regular flu deaths so far this year in the US alone: 13,000. Typical flu deaths from the regular flu each year worldwide: 40,000. Total worldwide deaths from this stuff so far -- what, a couple hundred?

I'm more concerned about the winter flu season than now....there won't be a vaccine for it -- takes too long to develop one. And we won't have the benefit of the ratings period and the end of the first 100 days to have the media pay attention to it....not until a celebrity comes down with it, of course.....

Well said!!!

I dont remember but does that 5k survival whacker pack contain any measures to protect us from this?

It's got everything but the kitchen sink and flu vaccinations. I don't recall seeing any face masks.

This newest strain can be controlled/contained by the same precautions used to control/contain the 'regular flu' and the common cold. I'm not going to get all bent out of shape until it's proven that these precautions are no longer effective.

Help me!! Help me!!

The SKY IS FALLING!! The SKY IS FALLING!!!

probably.. seems like propaganda to me

If it's true, he better have an attorney with him at the arraignment!!

Can you beat me?? I dare you to try!!!!!

http://ultranosepicker.mybrute.com

I have some ocean-front property in Colorado as well. It also has a wonderful view of Mt Rainier.

If you are a single, male flight medic or know someone who is, contact itku2er/Terri immediately. Her sanity (and ours) could depend on it!!!