triemal04

So, do you get a bonus for every new paramedic you bring to Ada County or what?

If it is an allergy to latex I'd guess it'd be from the sport's bra she was wearing, or some part of her clothes. Probably the bra since I think you said all the welts were on the chest and back. Either it's something that she's never worn before, or the rubbing against the skin and sweating during her run set it off. Or it's got nothing to do with her run and is the shampoo bottle. Is anything that she's done today different than what she normally does?

Could have a latex allergy as well. Which will make the next hour of your life real fun. Has this every happened before? Is she taking any pills for her trip to Mongolia? If so, what, for how long, ever taken any of them before?

Fookin' Californian's moving to Oregon...you're gonna ruin it for the rest of us. [-X First off, just remember that it's pronounced Origun, not Or-E-gone, there is such a thing as good beer on tap here, and you're definitely going to need to update your wardrobe. Aside from the state setting certification levels, educational requirements, and the scope, there is no real statewide EMS system for transports; each area does there own thing, so you've got private, hospital based, third service, and fire based. Depending on where you work you can easily provide for a family as a paramedic. Let me say it again, DEPENDING on WHERE you work, you can easily provide for a family as a paramedic. This isn't southern california sonny, it's a big state, and a lot is rural, so there's lot's of fire departments that transport, and lot's that don't. Same goes with how fire departments feel about privates, and privates about fire. Thing to keep in mind is that if you became a medic after 1999, then you will NOT be able to work as a paramedic in Oregon without getting an Associate's Degree in Paramedicine. http://www.oregon.gov/DHS/ph/ems/certific/recip.shtml Which is as it should be. Like I said, Oregon is pretty big and has almost every type of transport out there, and almost every type of pay too. It's going to depend on what you are looking for, and if you have a specific part of Oregon that you're looking at moving to.

Well someone already got to LOLFDGB, but don't ever forget LOL^2 (LOL squared): little old lady landed on linoleum. And if anyone ever worked around a college campus you probably met many drunk Ken dolls and drunk Barbie dolls.

Nice. The "I'm going to ignore this because it's not exactly what I do so thus must be completely unrelated and not matter" mindset. I like it. Good on ya mate. Also known as the "I can't think of an accurate response" mindset. Dwayne, I definitely agree with enforcing some standards while people are still learning how to be an EMT or medic, but going so far as to mandate that they be in uniform for a lecture is going a bit far. Enforce a "no tardiness" policy, and if it's violated, give them the boot. Same for missing classes. For a dress code...I don't know that it would be completely wrong to enforce some type of one, but in all honesty, how many people do you know that one their days off can look like crap, but when it comes time to go back to work look like an advertisement for their company/service? Professionalism should be taught to students from the beginning, but I'm not sure that making them wear uniforms is going to do it. May have the opposite effect, especially if you are dealing with a bunch of 18-20 year olds. Different story entirely when students are doing their clinicals and internship; if they aren't in either scrubs, the schools uniform (if they have one) or whatever is required to be worn for their internship, they should be getting the boot. That may be a better time to start showing them how to act as a professional and why appearances can matter. Probably be easier to get the point across then as well. Richard- I agree, when someone has been hired and is being put through their initial training with that company, or department or service, then definitely they should be in uniform, for all the reasons you gave and more. But when they're still in school? They aren't dealing with the public, most people probably won't end up working together, and when you're done with medic school, you don't come back afterwards, so there wouldn't be another type of uniform to wear. So what would be the point?

Better late than never I guess. 1. No, I would definitely not be comfortable turfing this guy. No, someone with non-traumatic back shouldn't ALWAY'S go by ambulance. But sometimes yes. Same for the ER. 2. X-ray, CT, ultrasound, definitive diagnosis of what the root cause it. 3. Yes, if he was normotensive I'd be a bit more comfortable, though the numbness to the lower extremities is still bad. Yes, could be symptomatic of an aortic aneuryism. (think that's been covered already). If he was asymptomatic then why would I be there in the first place? Going to the ER because of the HTN...yeah. I'd guess he get a full workup and then probably get started on meds to lower it. 4. Maybe, maybe not. 2 PVC's aren't a big deal. If he was starting to bleed out then it's a bit more significant. I'll just say I'm not that worried about it right now. 5. Changes in back pn, other symptoms (dizzy, N/V, abd pn, abd masses, other pain, HA, how he feels normally and if he is able to function without a problem on a day to day basis), pedal pulses, cap refill in lower extremities, how long ago this started? I'll call this a AAA until proven otherwise. IV TKO, O2, vitals, transport. I had a patient several years ago who was pretty similar. Called for back pn. Turns out this guy had injured his back years ago (40+) and has chronic back pn, today it feels just like it always does when he has a bad episode, and he is unable to walk to his wife's car to get to his doc unaided. No other significant hx, vitals were all stable, physical was unremarkable. During the assessment his son arrived, offered to help him get to the car and into the hospital. Make a long story shorter, I turfed him, at the hospital he was dx'd with an abdominal aortic aneuryism and died on the operating table.

Why is there such a trend in EMS these days to make yourself into something more than what you are? Why do people feel the need to add a bunch of gibberish to their job title in order to make it sound more spectacular? People who take a cheesy 2-day critical care course and are now "critical care paramedics." Or an equally crappy flight medicine course and are now (even though they've never worked on a helicopter/fixed wing transport) "flight medics." Same for the 5 day TEMS courses and people who don't work as part of a SWAT team and never will. Be happy with what you are doing and proud of it. Or get out and do it now. Don't do everyone else in EMS a disservice by pretending to be a superhighlytrainedspecialtytacticalcriticialcare paramedic and further confuse (and disgust those in the business) the public. If you are doing this job soley to stroke your own ego then the only place you are welcome is standing out in the street. I applaud those people who are willing to go the extra step and become a more advanced provider because they want to provide better care for their patients. For those people who do it halfassed because all they want is a way to make themselves look good/feel better all I have is contempt and utter disgust. (to stop some comments now, I know their are plenty of places that do a good job at teaching someone to be a CC-EMT-P; but there are plenty of bad ones too)

I'll take a stab at it. For left heart failure anyway. In both systolic and diastolic CHF stroke volume has decreased; a bolus of saline would increase cardiac preload, which should in turn increase cardiac output, and possible raise the BP. I think. With systolic failure the left ventricle has problems contracting, while diastolic has problems relaxing after contracting preventing proper filling of the ventricle; either way, if the preload get's increased and myocardium stretched, I'd think that the output would increase. The problem with that is that the goal to treating CHF as I learned it is reducing preload and eventually reducing afterload; decreasing preload will decrease the pressure in the pulmonary capillaries and slow the amount of fluid leaking, reducing afterload should help to increase cardiac output, which should then also decrease the pressure in the capillaries. Giving nitro (and lasix, though the effect is delayed) helps to decrease preload on the heart through dilation; lasix does it through getting fluids out of the body and a bit of venous dilation as well. So giving saline, while it should increase output due to the increased preload, it'd also possible increase the pressure within the pulmonary capillaries and push more fluid into the lungs. Don't know, but I'd think that giving a small bolus to a pt who was hypotensive to raise their pressure high enough to give nitro would help overall; initially I don't think it would, but as the nitro took effect it should help more. As an aside, I do know one paramedic that gave a hypotensive CHF'er (on a doc's orders) a dose of SL nitro. And then after the pt's pressure increased, another dose. And another... Which makes some sense, but definitely doesn't sound right when you hear about it.

After reading this thread, it is something to think about if you get someone who just had an MI a week ago. Go through your full assessment. Question the pt about any pn, SOB, N/V, recent illness, etc etc. Look for any abnormal vitals, ekg changes. Then go with what your assessment tells you is going on. Gotta say I'd treat it like the real thing, even without a complaint from the pt. Looking at the 12lead, there's no reciprocal depression, but there is plenty of elevation and an elevated troponin level. For me, treat it like an MI, I'd definitely try and contact the ER doc ASAP to give him a heads up and get some advice, but barring them pulling the records there and losing interest...that's an MI.

If an ALS ambulance is automatically dispatched for the listed types of calls that's at least a bit of an improvement. If they're not and have to be called once someone gets on scene...that's pretty disturbing, to say nothing of negligent. But, if all they are responding to on their own is a pure BLS call, that's a little better than it sounded in the news clip. It's all well and good that this program has been around for so long, but maybe it's time to trash it and move on to an appropriate level of care. It can still function in some form or another with 1 or 2 kids riding as the third/fourth members of an ALS crew, but today, and with the call volume that's listed, there's no reason for this other than making people feel good about themselves.

Actually, I'm pretty sure that you did show some disrespect for whackers people who spent way to much time watching the ambulance sceens on ER. But that is all they deserve, so... :mrgreen:

Absolutely not. The scoop either. Or KED, or almost anything else that is routinely carried on the average ambulance. The longboard is in no way, shape or form rated for any type of rescue. Hell, it's not even really rated for half the lard asses we normally carry on it. It's not designed to be used in a high-angle rescue; be hard to rig, and depending on how you decided to rig it, it might not even stand up to the strain. There's also no buffer between the pt and cliff-face, no way to protect the pt's face from any falling debris. To make it real simple: you're trusting a piece of plastic that's maybe 2 inches thick to lift someone 100 feet up a cliff. Bad idea. Unless you're unit happens to carry a Stokes or SKED, you're out of luck.

Well hell, at that point you can just go back and grab a cup of coffee from the store. Although, if the helicopter is set up for rescue (cross your fingers that they have a hoist) that's really not that far off. Let them now the specifics of the situation, and have them lower their medic (cross your fingers for that one too) down. At that point the one guy at the edge should be able to rappel down to assist with loading the pt into a stokes. From there hoist the patient, the army medic, and maybe the other guy into the helicopter. Or leave the other guy behind and let the rest deal with getting him out using a technical system. Now is the only sticky part, and it'll depend on how trained the personnel on the helicopter are, how bad off the guy is (probably pretty damn bad) and how far the nearest trauma hospital is. If it really is a trained Army medic on board, send them directly to the nearest hospital, unless it'll be an extended trip. If it is, then either land the helicopter at a location for the paramedic to get on, or hoist him as well. (course, if that would take more time than just flying to the hospital, don't do it.) If it's not a fully trained medic, there's no choice; pick up the paramedic and get out of there. If for some reason the helicopter doesn't have a hoist, thank them for wanting to play but let them know they came without the right equipment. Then have them find a suitable LZ and wait. If that was the case and it was me, I'd rappel down to the pt. And given the lack of trained personnel (and personnel period) it'll still be faster to wait for a hoist-equipped helicopter to lift the pt than to set up a technical system. Assuming they can beat the weather. If not, start looking for another way to get the pt out; more people can rappel down with a Stokes litter is there is a way to take him out overland.

It's not an emergency in and of itself. (though we'll still be responding code 3 to it due to the wonderful dispatch system...) Giving Zofran, or phenergan or any other anti-emetic isn't an emergency treatment either. It's just doing what is appropriate for your pt. And if you don't it's the same thing that's going to happen after they insist on being taken to the ER. So why not treat them appropriately? Just because you don't see N/V as a big deal does not mean that the pt see's it that way either; I wasn't kidding about someone vomiting for 10 straight minutes with little to no let up. Treat your patient appropriately. Now, an emergency treatment would be RSI'ing them...gotta prevent aspiration don'tcha know. (and listening to someone gagging is really annoying)

Yeah...nothing wrong with letting someone vomit into a bag for 10 minutes or so...not like we should bother to try and take care of that or anything...after all, the patient doesn't care.

Well...the local branch of AMR is getting the teamsters as their union, so maybe that'll change...

Actually, there's ER and floor nurses out there that this needs to be explained to.

Nah. I prefer to actually work for a living.

Gol-durn boys, we sum damn good ol' fahrfighters! We've never lost us a foundation! Not once never!

'Bout the most important part of the article. I'm not advocating blame the victim by any means, but the question "how did they end up there and why?" does need to be asked before the finger pointing get's out of control. Also like to know how deep the "pond" was...how far out the car was...if the people were in/out of the car...you know, minor stuff like that that could maybe explain some of what happened. Not that it's important or anything... :evil:

Don't worry about that; you'll get used to the great disaster specialist at some point. I agree on the rest though; non-emergency transports really aren't part of EMS. They may at some point come across a medical emergency, but given that they aren't normally used to respond to one and often can't due to lack of equipment...nope. Not the same. Regardless of what level you are certified at, running people between a doc's office and there nursing home does not qualify as emergency medical services. Non-emergency (NETS) yes. Lights really don't matter; it's what your job will be. Some of my more memorable calls have happened after I went code 1 to one nursing home or another for a "fall" or "person feeling sick." The difference between an ambulance and somebody there to take them to an appointment is that I may be able to make a difference, and can at the very minimum try. Not so with a handi-cabs van. And banning ambulance services from running transports would be great; no more privates, no more putting the cash-cow (transports) before the black hole for money (emergency calls) and make the city/county/state put money into a decent EMS system.

No, but it is damn funny. Come on, it may not be the most professional thing to put in a report, but in case you didn't realize it yet, there are parts of this job that you're going to end up laughing about when the average person would gasp in horror. Finding humor in dark situations is a good thing to be able to do. Regarding the quote that started this...no, it wasn't a good idea to put that in the spot for a chief complaint, but it is still a direct quote from the patient, and if the medic decided to add that in the report, long as it was clear that it was a DIRECT QUOTE FROM THE PATIENT...why the fuss? Abbreviating n@@@er wouldn't be a bad idea to be nice, but still... Honestly, why is everyone upset over that? Is it because you view it as unprofessional? Ok, I can buy that, and to some extent agree. (still funny though) Or is it because you think it's racist to add into a report? If it's the latter, hate to say it, but you're proving the guy's other point.

It's going to depend on the services really. Just because people work for 2 different types of services does not automatically mean that they will be butting heads on calls all the time. Though that does happen. A lot. It'll depend on a lot though; how each organization views EMS, what each's history with EMS is, how each is run, and what they want to get out of EMS. Far as the original question, I work as a firefighter/paramedic, but a county run third service, or city I suppose, is probably the best way for a transporting EMS agency to be run. If it's not based on a private service model that is.

Since it's open to everybody... Based on what's here, I'll take her up to the ER code 3 with a working assessment of DKA and possible PE. Treatment will be NRB, IV with fluids running, ekg, vitals. I'd like to reassess for chest pain, mentation, lung sounds before I started fluid, dehydration, run a full neuro check, and get more on her recent history and sugar levels. Assuming that her heartrate stays at 128 and her BP doesn't drop to much, that part isn't getting treated yet. That being said, I'd also want to see the 4-lead and 12-lead of the sinus brady to check for any signs of hypo/hyperkalemia. Given that it looks like she is now an insulin dependant diabetic, and may have been one for awhile, it's possible that she's in renal failure and that caused the rhythm changes and SOB. Given my own experiences with nursing homes and "skilled" nursing homes, I'm not to worried that there was such a difference in the cbg that they got and what I got; their equipment is probably either broken or not being used right. I doubt there was a sudden increase in her cbg; more than likely she's been high for quite awhile. Or I could be all wet and making a fool out of myself.