ERDoc

I don't know many folks in our industry who are without worry when it comes to financial stability.

At my age while we don't owe any large mortgages ,but still don't have enough to just walk away and retire without working some to pay the never ending property taxes and excise taxes and normal things like taking a trip down to see a red sox game at Fenway.

You could save some money by not wasting it on Red Sox tickets.

I think the issue with the chat room is just the general downturn in membership. Less members means less people to go to chat. I tried it a few times and luckily managed to avoid the drama but when I went in there I didn't know anyone. It seemed like the people that posted didn't go in chat and the people in chat didn't post. Ruff, maybe if you threw on some pasties and danced for us it would get more people to come out.

I think your number is too high. I'm just not convinced there is any utility to the whole rushed process of working up strokes.

Personally, this seems like a huge waste of resources that will serve a very small pt population. I'm sure it would be more financially prudent to put another normal ambulance or two on the street for the same price.

Their station is always staffed, you just have to call them at 911. You will get a whole bunch to come to your house. Talk about personal service. OK, don't actually do that (I know I don't have to tell you that). Call and leave a message, they recruit people somehow. Whether or not they will take you, it is impossible for any of us to say. That is entirely up to them. I can't hurt to try. Worse case, you wait until you turn 18.

I'd be more than happy to chat with you.

Well, then monkey on.

Just understand that with a bachelors, you will pretty much be a lab scut monkey.

Depending on where in the US you live you may be able to join an ambulance company or fire department and ride on calls. It's frowned up here, but if it is available, why not take advantage of it?

I also read anything medically wikipedia based!!!!!

but seriously, I just got done reading some really good End of the world Virus killed us all books. Based in facts but scary as hell.

Read Biohazard by Ken Alibek.

Personally, I like Annals of EM, AEM Journal and Prehospital Emergency Care. There are a few throwaway magazines that have interesting articles. Don't read too many "medical books" any more since by the time they are published, they are usually outdated.

Interesting case and not that uncommon.

Congrats Scuba!!

I almost did my residency in Rochester at UofR but decided to stay south.

Now that we have a decent physical down we can launch a bird and start driving for a meet. Lab values?

What labs do you want?

Ebola with a side of gastroherpagonosyphiltusis

Has she been running any fevers? Yes How high, when did it start

Any vomiting? Yes Diarrhea? Did it start before or after the headache?

Has she c/o any pain in the last few days? Yes - headache Where in the head? What does it feel like? When did she first notice it? Is it worse any certain time of day?

Have they noticed any bruising or unusual rashes? Milid rash What does it look like?

Any bleeding? None

Has she been around anyone else that has been sick? None

Is she on any medications? Vitamin for low iron Is she taking the right amount? Have they changed the dose recently?

Has she been exposed to any new foods? No

Has she ever been vaccinated? Full series of vaccines and she didn't catch the autism not YET!!!

Is there any family history? Yes brother died of sids SIDS according to who?

What part of Africa is she from? Kenya

Vitals? Previous post

Pupils? Unequal on left Unequal how?

Do you feel any masses in her abdomen? soft non tender

Is she protecting her airway? Yes

Does she resist any of your exam maneuvers? Yes somewh

Now is the time you might want to think about where you want to transport her to.

Nah, you'll just pimp out for more.

Has she been running any fevers? Any vomiting? Has she c/o any pain in the last few days? Have they noticed any bruising or unusual rashes? Any bleeding? Has she been around anyone else that has been sick? Is she on any medications? Has she been exposed to any new foods? Has she ever been vaccinated? Is there any family history? What part of Africa is she from?

Vitals? Pupils? Do you feel any masses in her abdomen? Is she protecting her airway? Does she resist any of your exam maneuvers?

EDIT: I went back and read a few posts after posting this and found the answers to some of my questions.

Whatever Ruff. You are just jealous because I have more reputation points than you. You can borrow some if you want.

welcome to the City

We won't hold it against you that you're from New Yawk

Right Doc ????

At least he's not from Jersey. Welcome MC, as you have found out already, we have a very opinionated bunch of ambulance drivers here that enjoy lively debate. What part of NYS are you from?

Except when that picture causes the pt to receive an invasive procedure that they didn't need in the first place. There are very few emergency indications for bedside US, even in the ER. I will agree that a FAST exam can change pt care in the field. In the proper setting (ie trauma), fluid in the belly means go to the trauma center. There are not very many services that allow pericardiocentesis. OB, eh. If they are pregnant and have anything that might be OB related you should be going to a properly equipped hospital anyway. Anything else is to reduce length of stay in the ER and not really necessary in the field (gallbladder, DVT, retina, etc).

"Common features in patients who are awake include universal symptoms of chest pain and respiratory distress, with tachycardia and ipsilateral decreased air entry found in 50–75% of cases."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660039/

How comfortable are you with diagnosing a tension pnemo? Location to hospital doesn't matter if your patient requires decompression, but what if you are wrong?

Your US will not make a diagnosis of a tension pneumothorax. It will only identify a pneumothorax. This will quickly turn into one of those situations where someone has a new toy and overuses it. Not all pneumos need a needle or a chest tube. You can bet your ass that if this were introduced, there would be medics putting a needle into every pneumo, regardless of whether it is needed or not. Anyone that gets a needle ends up with a chest tube. You have now given a chest tube to someone who never needed one in the first place. Not to mention that the number of tensions are very small.

I think that is more a failure of the system than the medic. Prehospital education in this country sucks. This is why we have so many tests, boards and societies in medicine. It is a way to make sure providers are well educated and prepared.

The pediatric facility is 190 miles away and it's top notch or you can use a level 1 adult facility that's even top notcher (if that's a word) because they do peds as well and they are 240 miles away.

It's notchier but that's okay.

Aneurysm, embolism? NRBFM @ 12 (15?) lpm w/suction ready to go, if needed. I'm an EMT-B, but an anti-nausea med w/fluids IV.

If I'm a BLS rig, I'd first figure if an ALS meetup/transfer or helicopter would be the better bet. With a possible hour+ travel time in the BLS rig, it'd be pushing the boundaries of that golden hour. I'm leaning towards the helicopter, especially if there is a Paramedic & Nurse. I suppose it all depends on the fastest arrival time at the general hospital vs. pediatric facility.

Constructive criticism appreciated. Plain ol' high & mighty attitudes need not reply.

We should probably get a good history and physical before we start jumping to diagnosis. What are some questions we would want to ask the pt and the parents? What do you want to know about the physical exam? What is the indication for high-flow oxygen (or any oxygen) in this case? The golden hour is a reference to trauma and is really a work of fiction.

Just because the community hospital isn't an ivory tower of medicine doesn't mean it would not be able to handle this pt. They may end up needing to transfer her, but don't count them out.