ERDoc

But isn't that the way it is with any career that requires a degree or schooling? You don't really know if you like the field until you are done and doing the job. You can like numbers, but once you are an accountant you may hate the job.

I've been involved in medicine since 1991 (but didn't get my first call until Jan 1992), so I have 24 years experience. I hope you crazies haven't scared off the OP. "strictly part time basis," famous last words.

Welcome, despite the fact that you have been welcomed by our resident psych cases, we are a pretty normal bunch around here. You did the right thing by going right to medic school and don't let anyone tell you different.

The veinlites are fun, but you can't beat an US for getting a good look at the vein.

They are great for getting peripheral IVs.

That was a "hypothetical" statement made by a "hypothetical" patient to a "hypothetical" EMS crew that PD refused to help. The pt was "hypothetically" intoxicated with a "hypothetically" significant head wound that needed evaluation.

But if LE isn't willing to help you get the pt on your stretcher, are you going to risk being hurt by a violent pt? "If that ambulance driver touches me, I will kill him."

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Law enforcement, at least locally, is getting out of the medicine business. They have decided that they cannot make a person go to the hospital, even if the person does not have the capacity to refuse and needs to go. They are putting the burden on EMS, who is not equipped or trained to properly take someone who is violent. It's pretty shitty of LE to do that. They don't want any responsibility. I had an officer get pissy with me on a busy Saturday night once. Guy was arrested for DWI (no accident or any complaints) and was taken to the jail where the jail nurse said he was too drunk to be there so he had to go to the ER. He blew a 300+ but was fully coherent and not altered other than a little swagger when he walked (he probably lived in the 300-400 range on a daily basis). I asked him if anything hurt or if he had any other complaints. He denied everything and had a normal exam. The officer was a little angry when I said we were going to discharge and told me that the guy couldn't go back to jail. He didn't seem to understand it when I said that being drunk is not an acute medical issue and there was no need for the pt to be in the ER, taking up a very needed bed. The charge nurse offered to let the office and pt sit in the waiting room.

Would that be considered a case of...BLS before ALS?

I have never cardioverted a conscious person. Most of the time they are unstable enough to be unconscious or stable enough to wait for the nurse to grab the propofol (we tend to skip the consent form and JHACO required time-out).

I'm not sure what your concern is here. You are working within the scope allowed by the hospital (the license you are working under).

Looking at it from the other side (sending facility and receiving facility), this guy should be tubed prior to transfer by the most skilled person (probably the ER doc, but I may be biased). This pt will be spending at least an hour in non-ideal intubation conditions. Let's tube him in a controlled environment with back up devices at the ready (I'm grabbing the Glideoscope). I'm a little concerned about the pt's vitals. He needs fluid resuscitation/blood products going. As for the other guy, at least here in the US, he isn't going anywhere until he has been accepted and the forms have been filled out (seriously, had a tubed head trauma pt that the helicopter was initially responding to the scene for (2 miles from hospital, but got worse so EMS transported to local hospital) and they wouldn't leave the ground until the EMTALA form was completed and they had their copy). Not enough info on the other guy to really make any calls at this point.

Welcome, from another former NYer. We might be able to take this place back from those Cannukistanians soon, if we get more of us.

Yeah I know, but we can all dream. Can't we?

Why can't there be any normal, straight forward patients tonight?

I don't think the OP was thinking he/she is a medic. I think he/she is just concerned about not screwing up at a new job, which I think is a pretty legitimate concern. Yeah, some of it sounded wackerish I think it came from true concern.

I'm pretty sure AEDs fall under first aid now days. I wonder if we have lost the OP.

In reality, all anyone in that situation is going to be providing is first aid. You could have a physician there and all he/she will be doing is providing first aid until the ambulance shows up and takes over. There really isn't any issues here for you. I would advise to skip the mouth to mouth though.

Out of curioisty, is there anyone here who would not have treated hypoglycemia in the field? I accidentally forgot to say that she was a known diabetic. She did have a bit of a UTI and doesn't think she ate before bed so that seemed to be the cause of the hypoglycemia.

You arrive at the local ER where they repeat the finger stick and get 19 (1.06 mmol/L). They push D50 and with 3 minutes the pt wakes up and asks where she is and what is going on. Her neuro exam fully improves. Head CT shows a small scalp hematoma with no intracranial pathology. She recalls all events from the night before. She is watched in the ER for several hours and is sent home when her sugar and temp stabilize. All other workup is negative.

This has nothing to do with the money. The decision to accept the pt was made by the ERDoc, who gets paid the same either way but the decision was left up to the crew since they were the ones who had eyes on the pt. Sorry about leaving off the units on the glucose. It is in mg/dL so for those not in the US it is a level of 1.28 mmol/L. 12 lead shows a NSR without any concerning findings. Sat was 99% on room air. Lungs are clear bilat.

No recent med changes. There is nothing at the scene or with the family that concerns you for elder abuse. Rectal temp is 35.8, other vitals and EKG as previously stated. Finger stick is 23. The family reports no seizure like activity and you do not see anything that you would call seizure like activity. The local ER says they can handle her and transfer her if needed.

GCS 3, 1, 6 Airway patent and pt is breathing. Palpable pulse with a rate in the 90s. Monitor shows a sinus rhythm. She is full code. The husband reports that the pt got her feet caught on a rug around 9pm. She has a pubic rami fx from a fall 3 months ago and has times where she has a shuffling gait. Hit her head on the door but not the ground. No loss of consciousness. She went to bed at 11pm not complaining of anything. Her husband went to wake her up the next morning and she wouldn't respond. Only other history is hypertension for which she takes atenolol. Nothing unusual found on the scene other than too many FFs standing around doing nothing. ABC as previously stated. D-no collar applied, E-no other injuries noted. She was walking around after the fall last night. Currently she will squeeze weakly with her right hand. No movement in right leg or left leg/arm. Questionable unequal pupils. FFs state the left pupil was constricted as does one of the medics on the ambulance. Other medic thinks they look equal. Palpation of the scalp demonstrates the firm swollen area, it is difficult to say with certainty if there is any underlying abnormality. H&P normal, except for what is stated. The ER is staffed with a board certified ERDoc and a CT scanner. No seurosurg services. She is breathing and supporting her airway. Pulse is 90s and regular The husband and 2 other family members witnessed the fall

You are an ALS crew who is called to a house that is 5-10 min away from a small community hospital that is the equivalent of a level 3 trauma center. The call comes in as an 88y/o female, unresponsive. En route, FD on the scene tells you that they have a female with a depressed skull fx who is unresponsive and fell last night. You contact the local hospital to see if you should bring the pt there, go to the level 1 trauma center that is 45 min by ground or call for the helicopter. You are told to get to the scene and assess the pt, then make the decision from there. You arrive on scene and find an unresponsive female who is breathing with a scalp that looks like this (only the injury was over the left parietal scalp): Discuss.