triemal04

About the overall mortality maybe not; about whether it is harmful or not or if there are drawbacks, I'd say yes. http://www.medscape.com/viewarticle/835297

Meh...if you look at the p-values they're high, especially when looking at the 6-month mortality, though less when looking at time of discharge.

Well...there was actually. Whether or not you want to call it significant, or if it was actually due to the trial and not random is certainly open to debate, but a 1.8%/4.5% mortality rate and 3.8%/5.9% rate was still found.

Fair enough. I'm looking at this and envisioning someone in more distress though the onset of of vomiting and her history is still concerning to me.

I wouldn't go so far as to say don't treat the patient at all; I'd be comfortable in calling this hypertensive encephalopathy. The first line should have been the narcotic of your choice, both for the headache, and for any associated anxiety, but if the symptoms persisted after an appropriate dose without change and N/V still developed...I think treatement is warranted. Esmolol might be the better choice, especially prehospital, just due to it's quick onset and short duration, but as long as it was remembered that reaching a "normal" BP is not the goal (25% reduction in MAP at the most) and that it doesn't need to be instantaneous...I say treat this one. Edit: medscape has some good articles on hypertensive emergencies/encephalopathy http://emedicine.medscape.com/article/1952052-overview#showall http://emedicine.medscape.com/article/166129-overview

So when did you start modeling? Gotta say though...you could have put the pads in the right place...

The headache and photophobia could certainly be a migraine; history of the same? Maybe an infection that has spread to the sinus cavity; it's certainly odd that his temp is down, unless that's just due to the environment he's in. Maybe a nerve has gotten stimulated from the mix of the broken tooth/mouthwash combo. Chem7, cbc, CT of head/neck. Any changes with positioning or head movement? Palpation to the face?

Really, unless more findings pop up, either neurological deficits, tissue damage, increasing pain or further symptoms, probably start by treating it as muscoloskeletal. Prescription for some pain relievers and maybe a soft-collar to remind him to keep movement to a minimum. Seeing a physical therapist wouldn't hurt I suppose. If the pain persists or things change he needs to follow up on that but for now...

Clearly ebola and not herpegonsyphilitis. Run away. Contents of the vomit? First episode or have there been previous? Pulse, BP, rr, SpO2, ecg when there's time. Skin conditions; including an accurate temp. Look in his mouth; any bleeding, pus, discoloration, abscesses, swelling? Why does he think it's his wisdom teeth? Previous problem with them? Any other complaints? Recent illness? Drug use/abuse? Medical history? Medications? 39 is a bit old for it to be impacted, but I guess that could be the case. Or a dental abscess of one type or another. Or the stereotypical withdrawal from narcotics...in all seriousness that should be on the list of differentials, though you can rule it out relatively easily.

Is there a particular movement that hurts worse than others? How about moving other parts of the body; shrugging his shoulders, pushing/pulling with his arms? It really sounds more muscoloskeletal; if he is either tough enough that he didn't care that the rice pack was hot enough to burn him that badly, OR he is just losing some sensation due to his age/a previously undiagnosed neuro disorder it wouldn't be unlikely for him to over exert himself and cause some damage. If the motrin hasn't been working offer him something stronger; toradol, fentanyl, valium and such, transport him in the most comfortable position and ask that he keep his head still (shouldn't be a problem I'd guess) to the ER for some x-rays and maybe a CT down the road.

How hot was the rice pack and how long did he have it on? If he really burned himself that badly it was either very hot or he has a problem with the tissue in his neck, localized paralysis, degenerative disease of some sort or something along those line. Or...the pain is just due to the burn and this is all a red herring... Could be a spider bite as well if that's a problem in that part of the country. Hell I've had that four times now...no big deal there.

Is there a concern here? The patient had a significantly elevated BP with some mild neurologic symptoms; treatement is certainly indicated here. Nitro isn't the best for this specific type of situation, even if the ability to run a drip is present so labetalol (or esmolol) is appropriate.

Clearly ebola. Run away.

Why? What is your reasoning for this?

There really isn't a good answer for you. t's completely variable, based, among other things, on what part of the country you're in, what part of the state, the specific department's culture, how previous people of that orientation acted and were percieved...basically, like it is throughout the country. I will mention this though, if you (and this is a general "you") are someone who has a chip on their shoulder about their sexual orientation and/or is aggressively confrontational about it, you'll have a tough time. I'd go so far as to say that's a gaurentee, even at places that would otherwise be more friendly to you. If it's something that doesn't matter to you at work (which it shouldn't) it'll be less of a problem.

I suppose if that's the case and there isn't a real securing, no harm no foul. And you're right, it may help. I'd be curious though, as this is done there more and more and people get more comfortable with it (and don't have any adverse outcomes) if that part doesn't eventually go away.

You got exactly what you asked for, which was advice. If you refuse to listen, or to entertain the idea that what you thought was actually wrong, then it says more about you as a person than anything. All of this is good advice, and things that you should be thinking about and finding answers to. And most importantly: It's already been said; learn about what it is that you might do in the future and the difference between that and whatever it is you think you are doing now. And don't act like a stereotypical 14 year old anymore.

You must be deranged because it's obvious that I'm right. The sky is clearly a yellowish shade of green.

I get not using a longboard; that's great and in line with current trends and knowledge. It's this part that has me confused: Why not just use the c-collar? It's mentioned earlier in the memo that a collar and being told to lay still provides adequate protection; why add in another piece that could, if I'm reading that right and the blocks are meant to actually stabilize the head, actually create more harm?

First off, I'd like to give a shoutout to ventmedic; always nice when it comes around to show everyone the error of our ways. To be clear on a couple of points. I was the only one to use profanity. If it was shocking...good. It was meant to be. If it also caused the OP to stop reading and ignore what he had been told previously, that, while unfortunate, may indicate that he is unwilling to listen or won't listen when he is told, harshly, that he is wrong. Did I go overboard? Maybe. Given that the OP is grossly misinformed about what he is doing and had not listened when he was corrected but tried to "prove" that he was right, or is flat out lying, I see no reason to be polite. Age does play a part in this vent, but not in the way that you likely mean. For all your complaining venty, you yourself have done very little to answer the OP's original question or provide any real guidance on what he should be doing. Perhaps instead of the standard, arguementative lecture that is a hallmark of your posting, you should do something constructive, and offer a solution, and a way for him to move forward. Which, if you bother to actually read all the posts, has actually been done already. If the OP returns I'll be happy to continue. But I'm not going to waste my time argueing with venty; done that enough and it's a pointless waste of time.

To be completely honest, I'm betting that this isn't someone being malicious and intentionally trying to annoy people. I think it's probably nothing more than a stereotypical kid who thinks he's the shit because he doesn't know any better, doesn't want to know any better, and won't listen to anyone who tells him he's wrong. But on rare, rare, rare, once in a lifetime occasions...I've been wrong before.

And this is the point where I stop being polite to the little wannabe. We are not your fellow emergency medical responders. You are a little wannabe kid who doesn't have a clue what he is talking about. In fact, by your limited responses so far, you are nothing more than the stereotypical child. Believe me, that is not a compliment. Really? Shut the fuck up. The federal government has not changed any rules specifically for you, and really has not changed any requirements or regulations for federal contracting for wildland fires or emergency medical services (which is all that your po'dunk department would be good for) for awhile. The fact that you think that this level of BS response would actually be accepted as legitamite speaks volumes to your maturity and capacity to understand what you are talking about. No. You don't. There are no "federal standards" for EMT's kid. There are requirements for people who contract with the government to provide services, which is a very different thing, and...guess what...you don't meet any of them! Not to mention the fact that a 14 year old CHILD will not be allowed to be a real, recognized part of any response, contracted or otherwise, that involves the national gov't, or even the state government during a crisis. Really? Your little po'dunk town has it's own state-sanctioned levels and standards for EMT's? Bullshit. You don't have a clue what you are talking about. Billy-bob at po'dunk fahr department (motto: we ain't never done lost us a foundation boys!) might have a "standard" for the...responders...in the department, but I gaurentee you don't meet any state or county standards. You aren't eligible for anything or taught to any real level. Billy-bob may have given you a piece of paper with some made up crap that isn't worth the paper it's printed on, but that does not make you any form of real provider of anything. You really want to do this in the future? (future because you damn sure aren't doing it now) Do what I told you and actually learn about it. Really learn about it, and not about whatever shit is being done in po'dunkville, because you child, are in for a very rude awakening. (I apologize in advance to everyone else; I know I've harped on people for the harsh response to new posters...but I think it's justified in this situation.)

1A. You're 14 and are "a paid mechanic" for a fire department? Please elaborate. What qualifications do you have to work on diesel engines, gas engines, emergency vehicles, hydraulic systems, brake systems, automatic/manual transmissions, hydraulic pumps and electrical systems? 1B. Do you just do work on 2-stroke tools (chainsaws and the like)? 2. What type of class did you go through to become a "trained BLS/EMT?" At a guess I think you're confusing actually learning how to be an EMT with sitting in on some department training. 3. If you work as a mechanic, why are you going on emergency calls? 4. If you are waiting 4 years to take an official state/national EMT test, even if you did actually take a real EMT course, you're going to have to repeat it. It's highly unlikely to the point of being impossible that any state will allow that length of time to elapse before you test without making you repeat the course. And the national registry definetly won't. 5. You have not responded on any calls as an EMT. Bystander, sure. 6. You are in no way, shape, or form a nationally registered EMT. I'm sorry, but either you are trying to con people, that fire department is pulling some hinky shenanigans, or you don't understand what whatever card they issued you actually means. 7A. What type of fire department is this? All paid? (clearly not) All volunteer? Combo? Rural? Semi-rural? Suburban? Urban? 7B. Who in that departments kid are you? What I mean is, what position does one of your parents fill there? Just some random thoughts. It's nice that you have taken an interest in this; it's a great job. But don't confuse whatever it is that you are actually doing with what others do. If this is something that you might want to do in the future, I'd suggest first learning more about it. Visit your state EMS departments website (it's often under the state DHS system though not always) and then visit the national registry website. Read everything on both. Even the really boring stuff like the actual state laws. That will go a long way towards getting you informed. Keep coming back and asking questions.

That's different, and seems a little counter-intuitive. Can elaborate a little more? Gurney straps don't do a super job of stopping side to side motion, and it seems like restricting how the head can move while allowing the body to move freely (or more freely anyway) would actually increase the potential risk.

Mikey, with all due respect, and not meaning to be insulting, but I have to ask this. How old are you? From the content of your older posts I figured that 1984 was the year that you became a paramedic, or maybe started in EMS. With a lot of what you've been posting recently, I have to ask: is that actually your birthdate? Because a lot of what you've been talking about, if you'd really been involved in EMS for that long, even if you only kept up on current medical practices in a cursory way, you'd know was wrong.