MedicRN

Well, the bus I rode seated 12 if that's what you are talking about.......... TPBM.... insisted on sleeping in the treehouse on a rainy night..

If it's a long distance/non-critical transfer, I generally sit in the Captain's chair (don't do well riding sideways) with the seatbelt on. When I'm in active patient care, I'm on the bench with no restraint. If we have an orienting BLS person, I'm in the Captain's chair with the seatbelt on. In the cab, the belt is always on. I feel naked without one. [Testimony] As a teenager, a seatbelt saved me (driver - no passengers) from being the fatality in a rollover (severe enough the Chief of Police took it upon himself to talk to by parents and indicated that if it weren't for the belt, I would have been killed). Overnight observation in the hospital and sent home - no injuries. Also as a teenager, a seatbelt again prevented severe facial and chest trauma from the steering wheel when I slammed head-on into an embankment. [/Testimony]

The only time there is a diversion here, it's ICU diversion - meaning no ICU beds are available and they don't foresee an openings in the next several hours. We have two Level I Trauma Centers within 3 miles of each other so it's not a very big deal. The third receiving facility in town is not a trauma center, but will occasionally go on ICU diversion. If the an ER is packed with a 6-8+ hour walk-in wait, the facility might REQUEST ambulance patients go somewhere else, but they very, very, very rarely go on ER diversion.

Level I is all my little wide spot in the road has - two of them to be exact. We don't have the luxury of a Level II or III or even IV. What I gave was LOCAL and STATE protocol. Gotta remember, my dear Rid, not every systems functions as Oklahoma does.

I would call this a Level II trauma and transport accordingly (no RLS) Well.... obviously, he hit something with his nose. Was he restrained? What is the damage to the interior of the vehicle? Steering wheel intact? Windshield intact? I would most definitely do spinal immobilization. What meds does he take? Medic Alert tags? Any evidence of old surgical scars on chest or abdomen? Blood sugar level? What does the monitor show? Are there any motor/sensory deficits? Pupils? A Level II trauma patient here gets a minimum high-flow O2, large bore IV X1 with LR at TKO, cardiac monitor and a trip to the local Trauma Center.

Lung sounds at this point?? ::::: pulls out intubation equipment and sets up :::::

He's taking a few meds which don't play well together :shock: Dig + Atenolnol = increased bradycardia Dig + Lasix = kypokalemia/increased risk of dig tox Atenolnol + Lasix = possible hypotension Is the heart rhythm a sinus rhythm (are there p-waves for every QRS??) Is the R-R equal?

Foxglove = Digitalis purpurea I'd speculate he has some sort of cardiac event (3rd degree HB maybe) causing syncopy. Since he is also on Lasix, I'd love to know what is potassium level is (especially if he's not taking potassium replacements). PR norms are 0.16-0.20sec 1 degree = PR > 0.20sec (one big box on the monitor paper) About the only thing to do is treat symptomatically as an ambulance typically does not carry Digibind.

Yellow vision = dig toxic. What does the EKG show (prob. a-fib <50)? What is BP? Consider fluid bolus. Consider TCP. Oh yea..... and all the other spinal/extremity immobilization stuff mentioned as well as high flow O2 and lg bore IV NS or LR TKO for now.

A cot never saved a life.

Was he National Registry certified? If so, check with them for re-entry needs. How long has the lapse been? Check with the state(s) he was certified in. They may have a re-entry program.

Thank you for the wonderful birthday wishes!! You guys are so great.... who could ask for better friends!! For my birthday, we (the family went out to Outback) and today, hubby and I are going storm chasing!!! Love to all of you :love5: Roxan 'MedicRN'

RRiiggghhhttt........................... AK you are so funny.... :roll:

I've worked for the outfit in Mississippi (8 years ago). I thought they were a good company to work for.... progressive protocols amongst other stuff (been too long to remember much else).

Then why document the existence of snow in an arrest found outside in the dead of winter (did they arrest while outside or arrest because they were outside too long - I don't know, I didn't observe it) or the bent steering wheel in a code red trauma with a flail chest (I don't know, I didn't see the the person's chest slam the steering wheel).............

PCR = 'Patient found in postictial state. White powder in baggies and a green leafy substance in bags noted near patient. Syringes also noted. Several large stacks of cash noted on table.' No determination as to the contents of anything is made or asserted with the above statement. It is an objective observation of the surrounds when you found the patient.

First and foremost, make the stick quickly - that is, puncture the skin quickly. Then stop and reassess where the vessel is and go from there. To help with the pain issue, I've found if you rub the area briskly with an alcohol swab or 2x2 for about 10 seconds then immediately stick, it lessens the discomfort. All the nerve endings are 'on fire' from the rubbing and have difficulty telling one stimulus from another.

The parents of a 2-year-old boy who nearly drowned won a temporary reprieve Wednesday in their battle to keep Wesley Medical Center from pulling the plug on their son's life support. District Judge Timothy Lahey ordered Wesley to provide medical care and barred doctors from removing life support until at least March 21, when he will revisit the case. Lahey also refused a request by the hospital and doctors to order -- against the parents' wishes -- a brain viability study and other tests to determine whether Brett Shively Jr. is brain dead, as his doctors believe. The boy has been in the hospital since he nearly drowned in the family bathtub Feb. 4. Lahey called the situation tragic and said he has found no other case in law quite like it to guide him. He said the boy's health would not be jeopardized by his rulings. Brett and Yvonne Shively took the case to court after hospital officials wanted to do more tests, even against their wishes, when an electroencephalograph, or EEG, as well as magnetic resonance imaging showed no brain activity. Neurologists and other doctors want to do more extensive testing, such as injecting isotopes to see whether the brain is getting any blood, before they declare him brain dead. "The reason we don't want the test is their intentions for wanting the test -- so they can say it is a done deal," Yvonne Shively said after the hearing. "We refuse as parents to give up that right to say what is best for our child." Neither doctors nor hospital officials have directly asked the court to order the life support removed, and the hospital is gathering home life support equipment and doing medical care procedures to send the unresponsive boy home, where his parents will care for him. But three doctors who treated the boy testified Wednesday that he shows no electrical activity in the brain. Asked what he would do if additional test results indicated Brett was brain dead, physician Lindell Smith replied: "We don't treat dead patients, so there is no further care. If he is dead, I don't continue caring for him." The boy's parents are praying for a miracle. "I believe he is alive and I believe he will recover completely," his mother, 26, said. "All we are asking for is time, the opportunity for his body to heal." His 25-year-old father added, "We are standing by our faith, and believing God is bigger than man." The court hearing was the first time the hospital could comment publicly on the case. The hospital's attorney, John Gibson, told the judge that the hospital and doctors are not on different sides from the family -- they only have different ideas on how they should proceed. "No one wants this to be adversarial. Everyone wants to do what is right," said Holly Dyer, the attorney representing the doctors named in the suit. They are trying hard to find a balance between the parents' rights and the ethical concerns of doctors about keeping a brain-dead patient on life support, she said. But Bradley Sylvester, who represents the parents, told the court that Brett Jr. was getting the medical care he needed without the testing that his parents have refused. "Right now there is a rush to judgment to get the test done so doctors will be free of responsibility," he said. http://www.kansas.com/mld/kansas/news/loca...ontent=kan_news

This goes along the same lines of each service/state/country does things differently. From my past experience, if I have an unstable patient (from ANYWHERE) without a DNR readily in the hand of the next of kin/nurse/President of the United States of America, then I have to treat my patient accordingly. I don't have time to wait around while they dig through a pile of paper where they THINK the form may be. DNR does not mean do no treat. By waiting on them, my treatment of a critically ill patient is delayed considerable.

How can you do something without experience in the base knowledge. Work as an EMT-B until you are comfortable with the skills. These are the skills that will make or break you as a paramedic.

http://info.jems.com/jems/2004resources/bach.html

Agreed!!!

Start some pressors - dop or levo, maybe neo (or all three) - to try and get pressure up. Send for stat head CT - looking for increase in brain mets which could be causing the problems (brainstem issues).

And what does the last dozen or so posts have to do with 'Young people in EMS and evidence against it'? I think it is time to close this derailed thread.

I agree with Doc..... just like in EMS, the patient is yours until you turn them over to the next care provider. Personally, I would have looked cross-eyed at the 'ambulance driver' :tongue2: ](*,) , taken a deep breath and said something to the effect of 'I didn't know I needed your permission to follow my doctor's orders.' And then point them down the hall to the patient's room. Since they seem to know so much about what has already transpired, they can continue to use their ESP (tongue planted firmly in cheek). :pottytrain2: