ERDoc

No remote is found upon inspection of the buttocks. He has a past medical history of Ultram induced seizures about 4 years ago. Otherwise, no history or meds. He smoke 0.5ppd, no alcohol use. He has a history of heroin abuse, he last shot up over 3 months ago. He smoked some marijuana a few days ago. Vitals: P 112, BP 157/99, RR 18, Temp 36.9 orally, 99% on room air Lungs are clear bilat Heart RRR, nl S1, S2, no murmur, rubs or gallops. Abd is soft, non-tender, non-distended No bowel or bladder incontinence Na 132 K4.4 Cl 96 Bicarb 24 Anion Gap 12 BUN 36 Cr 2.3 (These are the correct values, the previous ones were my incorrect recollection) Glucose 108 Ca 8.8 Mg 2.6 Phos 5.2 Total protein 8 Albumin 4 Total Bili 0.7 Alk Phos 66 AST 907 ALT 362 WBC 16.19 Hgb 16.7 Hct 46.4 Plt 225 Red denotes abnormal lab values in our system. I don't have a rhythm strip, but I'll give you the 12-lead

Nope, no recent exercise, other than getting up to grab the remote.

BUN=57 Cr=3.7

US shows no DVT. He is A&OX3 and in no resp distress. There is no visible asymmetry in the legs.

Your rectal exam reveals no foreign bodies. The d-dimer is 750 (nl<500).

Patellar and Achilles reflexes are 2+ bilat. No change in sensation. He reports that he had a cold about 1-1.5 weeks ago.

The pt is unemployed and dropped out of school about a year ago. He is unemployed and says, "I've just been sitting around watching TV." He's never had anything like this before. No family history. It hurts to move the leg or to stand on it. When you walk in he looks a little pale and sweaty. No signs of trauma, shortening or infection. Any palpation of the left buttock and posterior upper thigh causes him to scream in pain. He refuses to move it and will not let you move it. There are equal pulses and the color/temp are the same in each leg. No CVA tenderness. Urine has 75 protein, 250 blood, negative for nitrate and leuk est, 0-2 white and 0-2 red cells. No bacteria are seen.

You are called to the residence of an 18y/o male. It is a normal middle class house in a normal middle class neighborhood. You enter to find an 18y/o male sitting in a chair trying to hold himself off his left buttock and he is visibly uncomfortable. He tells you that he woke up yesterday morning with the pain. He figured it would go away but it is much worse today. What else do you want to know?

Lesson of the day: Don't be that guy whose picture is still circulating around the internet 15 years later (assuming you survive).

It might help if there was a reference. It was reported by The Onion.

Yeah, but those weren't GSWs to the chest. The OP wants to know about chest wounds.

Horrible, horrible tragedy.

I don't know if there is a right answer. Who is to say that in the moment of injury, the pt wasn't under severe duress and not thinking clearly? In an ideal world it shouldn't be a consideration but in the real world we have to worry about the court of public opinion. Imagine the headlines when a family member hears that you didn't do anything and takes it to the media. I would think that there is some legal precedence. Jehovah's Witnesses have successfully sued when given blood when it was known by the treating providers that they were Jehovah's. I think your conversation beforehand also influences your decision. "Sir, you are having a heart attack and are going to die." "That's okay, I understand but I don't want to go to the hospital." "As long as you understand, please sign here." "Sir, you are having a heart attack and are going to die." "That's okay, I understand but I don't want to go to the hospital." "OK, sign here. If your heart stops beating before we leave, do you want us to start CPR, shock you or do anything else?" I think that changes the plan. I think the same would go for a traumatic arrest. The funny thing is, the traumatic arrest has a much lower chance of survival but it is the one we are less likely to walk away from.

Yeah I know. I was trying to think of a witty comeback, but it's busy and that was the best I could do.

I found it in google images so it is public domain.

Fair enough, but that is in someone with a chronic condition. What if you had a normal, healthy person with no medical problems who was involved in some sort of accident (MVA, fall, whatever you chose).

On one of those other websites, the issue of consent came up and I thought I would bring it up here. The situation is: You are called to a pt with serious, life threatening injuries (specifics are irrelevant to this discussion). They refuse care and you determine that they have the capacity to make that decision. You reluctantly sign them off via whatever means your local protocol requires (again, specifics are irrelevant). The pt then goes unconscious. Is their right to refuse then negated by their condition or does it remain intact and you have to honor it? If it is negated, how is it any different than a DNR? On the other site, some people say it is cancelled when the pt condition changes. Others say that once the pt makes their wishes know, it should be honored. I did a quick google search and turned up one semi-useful article that says the refusal is null and void if the condition changes, but does not provide links to support it. http://www.emergencymedicaled.com/223MedicalLegalEthical.htm

Is this from Trauma, LIfe in the ER or one of those other shows? I can see the scene. EMS is standing around waiting for the FFs to cut him down. "Well, we've got 2 IVs, got the monitor on and have taken his vitals 8 times. I feel kind of stupid just standing around while everyone else is doing something. I know, let's put a collar on and hold c-spine." lol

She'll always look like that to me.

The first thing I noticed in this picture was the hottie in the back ground. My second thought was, "Wow, that EMS crew took the time to put a cervical collar on."

Only in people who are blood type AQ+. Their blood evaporates on contact with air.

Never wear scrubs on an ambulance unless it is the dress code. You will be labeled as a whacker and it will be hard to shake that image. As for getting your EMT-B, if you are looking into getting a bachelors degree in EMS, prehospital medicine, paramedicine or whatever the school calls it, check the curriculum. I have heard that getting you EMT-B and medic are a part of the degree.

Congrats!

WTF? They need to come south of the border where a Disney World level laser light show is required by policy on every POV, yet no one can seem to locate the policy.

I had a friend in med school who was completely disgusted by feet. Her months on the medicine floors were torture because everyone was a diabetic and needed foot checks. She ended up going into psychiatry.