ERDoc

Only history is asthma. When you ask about Reynauds the parents just give you a funny look and you take that as a no. Only takes albuterol prn. No allergies. Last meal was dinner at 6pm, nothing unusual (it is now 10pm). No painting. He was outside after school playing some football. No rubber bands or other form of tourniquet that you can see. No pain in the hands. The only thing they have done so far is worry and call you. We'll come back to the ohysical exam after all questions about the history have been completed.

Oops. If it weren't for alcohol and stupidity, our jobs would be a lot more boring.

I think it depends on what setting you are using it for. If you mean a personal success, then it is whatever your personal beliefs define it as. If you are looking a what the literature uses to determine success, then it is whatever the study authors define their endpoint to be.

You are called to the residence of a 12y/o male. His parents called the ambulance because he noticed his hand were turning blue just prior to their call. What else about the history do you want to know?

What exactly does that mean (especially the part about showing up 2-3 years late)?

Zippy, I'm sorry, maybe it is just me, but I am having trouble clearly understanding your specific arguements. Why is it that just because there are many products and innovations that come from the US and are used throughout the world we are seen as evil? We are not forcing it on anyone. They are choosing to use our goods. Again, if they don't like them, then don't use them. I can admit that not everything coming out of the US is high quality. The name Ford comes to mind. I would take a Japanese or European car any day and not have to think twice about reliability. I guess I have digressed off the topic, much like this entire thread has.

Timmy, did this man ask you to call the ambulance? Did you ask him if he wanted one called? As far as hypertension and epistaxis being linked, the jury is still out on that one. There is literature to support both sides of the arguement. Here's an emedicine article on it and a few absracts from the literature: http://www.emedicine.com/emerg/topic806.htm http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_DocSum http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_DocSum http://www.ncbi.nlm.nih.gov/entrez/query.f...ist_uids=339142 http://www.ncbi.nlm.nih.gov/entrez/query.f...t_uids=10650229 http://www.ncbi.nlm.nih.gov/entrez/query.f...t_uids=10401851 There are quite a few more out there if you go to pubmed.

I don't think anyone owes us anything. We are good at what we do and if the rest of the world can benefit from it, great. What bothers me is the hippocracy of the people who have no problem using our goods and sevices but will be the first to try to tear us down. I don't need someone to go around saying was are awesome, I don't need someone praising us, I don't even want a thank you. Just don't put us down because you have become dependent on us. If you don't like us, that's fine, you are entitled to your opinion, but then you shouldn't benefit from what we provide. (Note: my opinions are totally exclusive of the current administration). Italics provided to seperate my comments from the ones I was addressing (can't quite get the quote thing down).

:thumbleft:

I think that there are 2 issues here. The first is, should the basic be pushing meds. I think the answer to that is it depends on the medic. If the medic is comfortable then I see no problem with it. The medic is the one running the show and should something happen, he is the one that is accountable. If a nurse pushes a med and something bad happens to a pt, it is the doctor that will have to answer (although the nurse is not off the hook either). The second issue is the documentation. This was pure stupidity on the medics part. NEVER falsify info. You don't have to put all of the details in the report, but don't put lie in there. He could have just said that the morphine was given with no mention of who gave it. However, should an issue ever arrive from it NO ONE should lie about the details.

Why do you hate the US so much? If so many Europeans hate American commercialism, why do they eat it up? I think it is ironic how so many people say that they hate the US and everything that comes out of it, yet they consume our goods without a second thought. Look at what our troops have uncovered in the Taliban locations, and they supposedly have the greatest hatred for the US and everything that comes from it. If you don't like our products, then don't buy them. If so many people overseas don't like our products, then make your own. I'm sorry if everyone over here does not believe in socialism, but we are a country that has had to fight for everything we have gotten from the beginning. Nothing has been given to us. We believe in rewarding hard work and dedication, not just giving stuff away. We have no problems helping when someone is down (we even pride ourselves on it), but don't take advantage of it. We could sit here and go tit-for-tat on who has invented what. How many men has any other country put on the moon? We dream big and we bust our arses to get there. That's just the American way. I'm sorry if it does not agree with you.

I'm not quite sure what your arguement is here. Yes, I made a comment about billing, so what. My point is that while anyone can make a diagnosis, only certain people can bill for that diagnosis (pretty much the same there on your side of the Atlantic I would imagine, unless you let lay people bill for things). As far as my comment about legal grounds, no there is not a staute that says exactly what you said, but we do have laws that prevent people from practicing medicine without a license. Seems like a pretty good idea, but I guess you feel otherwise. Other than that, I'm not sure how to address your arguements, as I am not sure exactly what your arguement is. Some of your statement make no sense. If you'd like to have an intelligent debate, I'd be more than happy to, but you need to clean your post up so that I can rebuttal your agruements. As for socailized medicine vs US medicine, each has its good and bad. I would hate to have to wait a few months to get a CABG with a ticking timebomb in my chest in some countries that have socialized medicine. US medicine does have problems with insurance companies and drug companies that are out to make huge profits, but with all the good that goes on, I guess you have to put up with some evil. We can attempt to minimize the evil as much as we want, but there will always be some there.

Although it is not labeled as such, oxygen should be contraindicated in cases of stupidity (including the 21% that occurs naturally), though that is just my rambling opinion at 4am. Sorry, back to your regularly scheduled thread.

Let's face it, anyone that can read a book can make a diagnosis. It doesn't take an MD to be able to look at a constellation of symptoms and say that a person has X. Google the symptoms and you will likely get your answer. Simply making a dx just takes some basic reading. However, you can't bill for making the diagnosis and you will legally have no ground to stand on should you tell someone how to treat their problem. Someone who has read a book also can't treat the diagnosis, only someone with a license (usually requiring some additional knowledge) can treat diseases. Anyone in the field can make a differential diagnosis, you just don't have the tools (and in some cases the knowledge) to confirm the diagnosis and treat all of the time. Hell, there are plenty of diagnoses I cannot make in the ER. I'm sorry if this is a little confusing, it's 3am and I am quite tired.

:shock: :shock: :shock: :shock: :shock: :shock: :shock: :shock: :shock: :shock: :shock: :shock: I wouldn't even know where to begin with this one.

Good thing you explained it a little more. As I'm sure you have noticed, there are a few people on here that think EMS education, or lack thereof, sucks. The way you made it sound was that you were just forced to memorize and recite what you were told, not absorb and understand it. I was just expecting one of the few with strong opinions on here to pick that statement apart, no harm meant.

Uh oh. I feel a verbal beating coming on. Duck and cover.

One of my biggest gripes with Paramedics was that you never found out what happened to the pts. Some followup would have been nice, and I'm sure in the pre HIPAA days it would have been pretty easy.

LOL. My uncle was one of the early EMTs in NYS. In his day they taught EMTs how to do trachs and to apply traction to the cspine. Boy, have we come a long way since then.

Easy there Rid. I loved Rescue 911 (though I was a young teenager at the time so I didn't have very high standards). The best show, in my opinion, is Trauma Life in the ER. Personally it was interesting for me to see how medicine has changed from when that show was made to how it was during my residency (and there wasn't that much of a gap).

LOL, I have to agree. I enjoy watching it for the interesting cases, but the reenactments are horrible. They make all of us look like bumbling idiots. The one specific episode that stands out in my mind is the one where a neurosurgeon runs out into the parking lot screaming and jumping up and down to get the attention of a pt's family. I can think of the last time I was a neurosurgeon run, much less jump up and down. They make such drama out of the smallest things. "Bob had a splinter in his little toe. It was going to be close, but Dr. X saved his life and his toe. Bob can now see his children grow up and go to college because of the heroic actions of Dr. X and his life saving tweezers." Everyone hug now. :pukeright:

We already have such a program. It is called Press-Ganey (www.pressganey.com). They are the people that have hospital administrators bending over and taking it. Of course, it doesn't stop there, the rectal probing rolls downhill. The Press-Ganey surveys are based on real pts opinions and are very well conducted scientific studies. They compare your hospital to all other hospitals and to hospitals of similar sizes. Administration is so bent on getting high marks that patient satisfaction is often put above pt care (Dilaudid dispenser in the waiting room anyone?). There are so many things in medicine that are not regulated by doctors that they make caring for pts so much more difficult. Have a look at this thread from another forum to see what I mean (http://forums.studentdoctor.net/showthread.php?t=250169). Dwayne, I'm sorry about your experience, but I can tell you that what you saw is the exception. The guy was probably not ER residency trained. Almost anyone who has been through an ER residency is obsessed with, "moving the meat," and something like this would never fly. It bothers me when there are charts in the rack.

Sorry to hijack this thread again. There is actually a good entry in Wiki on EBM. NREMT-Basic, read the last paragraph under the OVERVIEW about the value of expert opinions. Again, if you want to have an educated discussion or have any questions, I will be more than happy to talk. Again, back to your regularly scheduled discussion on phenergan.

As I said previously, opinions are not research. I don't know what is so difficult to understand about that. So what if some group updates the way they document the source. Evidence Based Medicine is based on research, not what someone thinks. Do a little internet search and look up what evidence based medicine involves, there is nothing about opinions. I can say whatever I want, doesn't mean it's research. Research involves doing a study, interpreting the data and coming to a conclusion. Again, which part of this do you have trouble with. An opinion is just that and doesn't mean a thing, now back it up with scientific data and it has some value. If you ever have to defend something you do, I hope you won't reply with, "Well Dr. so and so said to." It will carry very little weight and in the scientific community it will get you laughed at. If you say, "The ABC study published in XYZ journal showed blah blah blah," then your statement will carry some merit. Learn the difference between fact and opinion and their significance in a scientific conversation. Sorry about hijacking the thread, I just wanted to correct your inaccuracies (it is nothing personal). If anyone else has a problem with me trying to correct errors and do a little educating in the mean time, please let me know publicly or via PM and I will not do so again.