ERDoc

It is hilarious, but I love low class humor. Realistic, not a chance. I thought it was going to be like Scrubs but it doesn't have that hidden serious side to it that has a lesson or meaning behind it. It is definitely not to be viewed with the under 18 crowd.

Putting the costs aside, I think in the field is where the most benefit would come from. There is article after article that says EMS providers cannot reliably intubate (let's not debate that here). Video scopes make some of the most difficult tubes real easy. I've used the glidescope and the McGrath. Both work well, though the early McGraths had some issues that they have fixed.

Which is worse, those side effects or death? The idea with public access narcan is that it is a temporizing measure until 911 gets there and can properly manage the other issues. It's not an ideal situation but it is better than letting these people die.

And today, that would not be me!

Oh sure, single me out. There is actually a push now to increase the peds readiness nationwide. I've had to fill out several surveys recently to see where my hospital stands.

We all admit that there are risks involved with having EMTs/medics/FFs/cops/homeboy EMS give narcan. Given the benefits (preventing death) I think we can say that the benefits outweigh the risks in this case, even when given by street pharmacists and well meaning family members.

In my old stomping grounds they did a trial where the county police were trained to give narcan (I believe they are all required to be EMTs). It was pretty successful and was continued. It has been expanded to allow BLS providers (including CFRs) to use it. I find it interesting that they were letting the cops play with it before the EMS providers but that was because the cops were always on scene before EMS and sometimes by a significant amount of time.

Yeah, as if they pay their bills. Alcohol, testosterone and stupidity are job security and they are usually bundled together.

You say such sweet things Ruff.

Calling them fucktards is the only exception, correct?

I don't think you are offending anyone (at least in this thread) but we are what we are and we are trying to show you that. Every job has their important role in society so why we glamorize one over the other is beyond me (with the exception of the military, they deserve all the glory and then some). Granted, Bill Johnson CPA wouldn't make as good a TV show as Trauma, Life in the ER does but CPAs are just as important as MDs, EMTs and FFs.

No one here knows your situation but we all know how medicine and paramedicine work so you would be wise to listen. If you think you can realistically practice medicine (yes, paramedicine is still medicine) without having a good foundation in math, chemistry and physics you are in for a rude awakening. There is this pesky thing in medicine called medications. When they are given to a person they have an effect on this other pesky thing called physiology (that's how the body works). You need to understand how the body works before you can understand what happens when things go wrong. You also have to know how it works before you do things that alter the way it works. The body is nothing more that millions of chemical reactions working together. You MUST understand math, chemistry and physics if you ever want to be a competent provider. EDIT: If the school you are looking at do not require these things, RUN! They are a useless school that will not turn you into a quality provider and are just looking to take your money.

I was that 16y/o once so I have a soft spot for him. It would be different if this guy were 20+. MD, it's great that you are so enthusiastic about the field but I worry. People who has such high expectations usually burn out once they realize what it is really about. None of us are heroes. A hero is someone that goes above and beyond. We are just here doing a job and that job involves all of those things mentioned in the pic. We all made the choice to do this, it wasn't forced on us and we weren't involuntarily put into this position. I enjoy taking care of people and still get that little adrenaline rush on difficult cases but I have no sense of heroism. I don't want to be a hero, I just want to do my job and do it well. I don't mind a thank you, but even that is asking a lot in this field. You will find this attitude more on the fire side, but don't be fooled by them. Yes, FFs die in fires sometimes, but most morbidity and mortality comes from responding to calls like a bat out of hell with the lights and sirens going. Stay enthusiastic and go for the education. EDIT: I have not read his other posts that island talked about so I may not have the full story.

There was no compartment syndrome, just the rhabdo. As for the 'how', that is hard to say. There are no purity guidelines so who knows what it was really mixed with. http://www.ncbi.nlm.nih.gov/pubmed/23518784 I guess I might have seen the second case in the US.

You were right on!! It was the K2 that caused the rhabdo, which led to all of the other bad things.

Yes, this guy is in rhabdo, which was mentioned by scuba. His initial CPK was 64,000. The MJ he smoked a few days ago was actually K2. He was admitted and had several rounds of dialysis. His renal function improved thankfully, and he no longer need dialysis.

Your astute NP looks at the labs and hears the story and asks you what the CPK is.

Mesenteric ischemia comes from arterial occlusion. We have pretty much ruled that out with a normal CT and lactate. The pain will be abdominal and not buttock and thigh (although not everyone reads the textbook). We did an US that showed no clots. Troponin elevations can be caused by anything that causes damage/stress to the heart. It can also be elevated in renal failure/insufficiency because it is cleared by the kidneys. D-dimers can be elevated due to anything that causes an inflammatory response in the body. They are very non-specific. No bites. Yes, I hired nurse Jamie but we had to let her go due to reasons we are not allowed to discuss.

The patient does not drink. We also know he does not have hyperkalemia based on the labs. No injecting anywhere. How does CES cause the lab abnormalities we are seeing? No cancer history. We haven't ruled out lupus yet, Dr. House but he does not have a history of it. Your ambulance has a CT/MRI suite and there is no evidence of AAA, CES or spinal abscess. No riding of any sort other than the couch you find him on. I thought we agreed not to mention that FB page. I know you are the number one fan but if you keep it up, I may have to shut it down. http://www.dailymail.co.uk/femail/article-2335902/How-George-Clooney-inspired-cosmetic-craze-ball-ironing--sees-wrinkles-removed-know-.html You guys are doing good so far with this scenario. It was a tough one that was almost missed. It took 2 people at different times to say something that made me put all of the clues together. I will tell you, this is not sciatica. That is what I was initially thinking and was about ready to give this kid some toradol and norflex and send him home. Luckily the triage nurse didn't like the way he looked and the high heart rate so she did the EKG. The initial computer read on the EKG said STEMI. So I was stuck having to justify why the computer was wrong so I ordered a cardiac screen while I waited for the cardiologist to call back. His Troponin-I came back at 6.64 (normal is less than 0.5). So, now you have a young guy with pain out of proportion to exam and signs of multi-system injuries. How do we explain this??? Hint, the answer has already been mentioned.

LOL, as a big NASCAR fan who has attended a race, I can just visualize the ethanol induced redneck hilarity that ensued. What is it with these kinds of people? There are some awesome CNAs out there (I know because I work with them). But then there are these freak shows. The only ones worse than them are medical assistants. These MAs truly think they are doctors. I had one bring in her 1y/o with a 103 fever once. She was the kids vitals and freaked out. His heart rate was 170. She said something like, "Oh my god!! That is dangerous. I'm an MA and I know all about vitals. His heart rate is too dangerous. You need to do something right now so he doesn't have a heart attack." "Yes ma'am, we will get him some tylenol and some motrin. A heart rate like this isn't unexpected with a fever in a kid this age...blah blah blah." "Well, can't you give him some labetalol or something?" This story made me think of a joke/warning I was given early on in my EMT class: A brand new EMT is driving down the road one day and sees a car accident. It looks pretty bad and he is ready to try out his new skills. He grabs his 50 pound jump bag out of the back of his car and runs to the scene. He sees one person on the ground who looks to be in bad shape. There is another person standing over the injured person just looking down. The EMT runs over and pushed the other person out of the way, saying, "Out of the way please. I'm an EMT and I'm going to help this man." The guy he pushes giggles a little, leans down to the EMT and says, "When you want to know where the doctor is who pronounced this guy, I'll be standing over there."

Here is the NEXUS study: http://www.nejm.org/doi/full/10.1056/NEJM200007133430203 And here is the CCSR study: http://www.ncbi.nlm.nih.gov/pubmed/11597285 The NEXUS had an N=34069 and CCSR N=8924, I'll let you have a look through the rest of the stats so we don't clog up the thread. You are correct, there are stable cervical spine fxs. Pts in the NEXUS study ranged from <1y/o to 101y/o while CCSR uses an age over 65y/o as a high risk criteria. You are also correct about how cumbersome something is. The whole reason for designing clinical decision tools such as these is so that they are easy to use in the real world. If you have some monstrosity of an algorithm it is a useless tool.

I will give you a hint. You aren't going to get anything else out of your physical exam. You have a young, sedentary guy with severe buttock/posterior thigh pain. The pain is out of proportion to exam. He is afebrile. No one has discussed his EKG. He has elevated LFTs and acute renal failure. How can we tie all of these things together?

Liver is soft, non tender and not enlarged. He has a history of IV drug use but has not used anything in 3 months.

Cultures drawn and sent. Lactate 1.3 (normal is less than 1.8)

No he didn't, but to go off topic, I heard on the radio this morning that scrotal de-wrinkling is an up and coming trend. Who's made their appointment?