Just Plain Ruff

ok more numbers for you on this Major peds department - may get 2-5 peds IO's in a month, most will be on peds arrests Trauma center - still awaiting numbers but they do say they get their fair share but it's not even close to 75% General ED - University level ED - A small percentage of patients a month but these patients with IO's are critical crashing patients. Not the run of the mill patients. More to follow. Making me suspect that original 75% number more and more.

Yeah, Scuba is precisely correct. What normally happens on scene is this ARrive, check responsiveness, ABC's and then vitals and then sugar Usually their sugar says "LO" If they are semi conscious and can maintain their own airway - give em some OJ with sugar or the glucose paste if they are unconscious - start an IV and give a syringe full of D-50 Once they come around you then give them something to eat - usually a sandwich and more OJ or something like that. Recheck their sugar - sometimes it will drop again and you might have to give a 2nd amp of d-50 but usualy not make em eat another sandwich or better yet, have their wife/husband make em a full meal IF there's no food in the house (yes some people don't have food in their homes - thus often the cause of their low sugar) you really should transport to the hospital If they are eating and their sugar is rising, then take out the IV and they can sign a refusal because most diabetics who you get called on refuse transport, but not all do. There you go, a diabetic ems call in a nutshell

Please don't think I was angry, it might have come off that way but yes, as a diabetic who still does stupid things, I have a set way of doing things and there is a specific menu. We actually have a low blood sugar box in our pantry that if I get low I jsut go to it. It has a jar of peanut butter, a jar of yummy grape jelly, a box of chocolate and glasses for the milk. I also have a diabetic medical kit in that box such as insulin, glucagon and some other items. My wife and my son are both trained in how to administer the glucagon and soon my 4 year old daughter will be trained to give the glucagon shot as well. I have never been below the number I was in my previous post and that was due to a mistake by myself, i normally go low when I don't eat and I have never been below 60 except that one time but you can never be too safe right? The diabetic box will go with us if we ever need to use our bug out bag's for a disaster as well, but I have a separate medical kit as well in the bug out kit. But I was not mad at your post.

Ok Dr Caduceus, just tell me what kind of food I need to have in my house. Are you advocating that I treat my low blood sugar with sugary stuff such as candy and the like? Wouldn't doing that cause a initial spike in blood sugar and then after the initial sugar spike there is a responding drop that can at times be even lower which is a bad thing So a peanut butter sandwich (and yes there was jelly on it - I use that wording synonymously) which was to provide long term sugar replacement and the chocolate and milk was to provide quick sugar replacement. I am one diabetic that has sugary foods in the house but I can tell you that I'm not going to dose myself on sugar to counteract my low blood sugar without having something long term to counterbalance it. Trust me, this food that I ate that night was exactly the food that my Endocrinologist recommended if I were to have this sort of problem. And my endocrinologist works at one of the top 20 Diabetes and endocrinology clinics in the country.

some people are so stubborn they don't even know they are dead, just watch the 'Walking Dead"

You did not do what any responsible parent would do for your daughter Doc, you did not call 911, request that they transport her via helicopter to the nearest trauma center and you did not demand that the best trauma surgeon be called in in the middle of their golf game so they could fix your daughters issue. You then did not do what a responsible parent would do and you didn't contact a lawyer to determine what level of compensation you were entitled to because all you got for your visit to the ED was a script for an antibiotic and a bandaid. But the other day, I gave myself a shot of insulin by mistake, The bathroom was dark, I grabbed the fast acting insulin instead of the Victoza, I turned the knob the requsite 23 clicks which is the correct amount of clicks that i turn when I give myself my victoza. Well I mistakenly gave myself 48 units of fast actin insulin and within 20 minutes I wasn't feeling too hot. So I checked my blood sugar - it was 39. I thought for a second or two to call the ambulance for some D-50 but then I said "hey, I'm a big boy who did a stupid thing" and I walked (well sort of stumbled) into the kitchen and made myself 2 peanut butter sandwiches, a big glass of milk, and 2 chocolate bars and within 15 minutes my sugar was back to normal and I felt so much better.

Mike, please don't think I was trying to make anything out of your questioning me with your questions, as I too feel that her figures were probably pulled out of her ass, If I came off as confrontational to your response to my thread, that was definately not the way it was intended. And Chris the same goes as above as well. I have started discussions with the project team members from my project this morning and they are actually going to get together in a little while and actually pull some numbers for me. I suspect that the numbers that were given yesterday were really skewed. But hey, who knows, maybe she is right. But I suspect they are just that "suspect"

Ok, I'm really not trying to make this an issue, it was a number that she was very very strongly sure of. I really pressed her. She said that if they medics don't get an iv in 90 seconds they go IO. Unfortunately, I'm not going to really get numbers for you Mike or Chris as I don't think that she has them, they may very well be anectdotal but she is the nurse manager of the ED so I'd tend to trust her and go with what she says before I say to her "I don't believe your numbers.". And honestly I was just so floored at that high number, that I really didn't think of many questions to back up my thoughts. But I do have access to her via email so maybe I can see if she will run some preliminary numbers for me. She might just do that. I could also ask one of the doctors. I also knew the response from some in this group which is also my response in my head, and that's why I refuse to elaborate on what hospital that this person works at. I think that to reveal that in this forum would be bad form. Anywho, like I said, I do have staff from 4 other ED's in my area that I can pull info from and I will tomorrow morning when I get them all in a room with me for our project meeting and ask them about this. Hopefully more info can come from this. Again, I"m not trying to make a huge deal out of it, I was just wanting to know thoughts on the prevalence of the IO usage in other areas as like I relayed from one nurse manager, it seems significantly high in my neck of the woods.

me too. I will hopefully have some numbers from at least 3 other ER's in my area once I can talk to a couple of nurses on my project team tomorrow. More info to follow.

I prefer my self powered hand drill to perform burr holes. I have a sterile center punch to provide the needed holes for a tension pneumothorax and I have a long thin knitting needle to perform the needed pericardiocentesis. I have a small dental drill for those pesky toothaches and finally what i just developed yesterday to round out my only open slot left on my bat belt is a small needle like device (proprietary beta version), that will take care of all the hang-nails on the toe's that we get called out at 3am every week or so. I have yet to test it on a willing subject but I'm sure that my next shift that I will be able to use it. I might even be able to market this as a patient refusal generating device of the 9th order that your service just cannot do without. I'll keep everyone posted on the beta versions progress.

Actually I'm pretty sure the ER you think I'm referring to isn't the one I'm referring to. PM me and I'll tell you which one but I'd like to not color the discussion here with the actual naming of the ER in this discussion. But my concern is this, 75% of all patients brought pre-hospitally to this ER make me really concerned about the providers skill level at placing IV's. But that's just me. And this number she said is 75% of ALL the EMS delivered patients.

I carry a small bandsaw to do my amputations, I also carry a flash cauterizer for anytime I need to cauterize wounds.

Got a question about the prevalence of Intraosseous usage I'm sitting here in a ED Nurse Manager's office of a local ED(pretty busy ED too) in the Greater Baltimore area. No particulars of what hospital though. She said that the number of IO's have exploded in the number of patients being brought into her ED. She said that about 75% of the patients being brought into her ED have IO's placed by EMS. Is this the numbers that you are seeing in your areas of practice? She said that the EMS systems in her area go by the "no peripheral IV success within 90 seconds, Place IO" What are the thoughts of the group? Does this show that IV skills are lacking for providers or are providers relying more on IO's than they should? Or just what do you think might be going on? But 75% of patients with IO's placed by EMS in this ER is pretty High in my opinion but I have no reason to doubt her figures. Thoughts, Discuss amongst yourselves.

Seth, you don't have to study in the morning unless you don't have any other time to study. Who says you cannot get the things you need to get done personally in the morning and then get heads down in the books in the afternoon. The beauty of being out of high school is that you have the entire day to actually do things. You will find that you don't always have to study or go to school in the morning. You just need time management skills like the rest of us have. If you need help with that type of thing, my PM is still out there.

I'm actually thinking a office stapler actually.

I was only joshin, but this provider needs to be prosecuted in my opinion

Hey, just rewrite the lyrics to this "The doc is in" "he's gonna save the day" "He's coming to the rescue" "of your sorry ass" or something to your liking. Maybe leave off the sorry ass lyric OOOOOH anything Wagner

http://wreg.com/2013/10/22/medical-helicopter-crashes-in-fayette-county/ When will this stop???? Prayers for the dead crew members and their families and co-workers. Another sad day. Here's the text of the article (Somerville, TN) Emergency crews in Fayette County are responding to a helicopter crash near Somerville. Three crew members are reported dead. there were no patients on board at the time of the crash. A source with the Memphis Fire Department says the helicopter belongs to Hospital Wing and it crashed just before 7 a.m. Tuesday along Jones Creek near Highway 64. Initial reports from the scene said the helicopter was on fire.

how bout large loudspeakers blaring out "It's the final countdown" youknow the song, with the trumpets blaring and the drums playing.

and the patient should have been given the providers address so she could go beat her ass

The first time that my partner gunned the ambulance when I was in the back tending to a patient ended up with me being treated in the same ER as the patient for two bruised ribs, soft tissue abdominal injuries and a concussion. I don't remember anything that happened after the gunning of the engine but I talked to the patient aftewards and she said she kept trying to wake me up. It didn't go well for Mr. Speedy Gonzalez.

I got into EMS in our service area on the taiil end of the transport the dead in the ambulance to the local funeral home. The funeral homes eventually figured out that they could make more money (added fee) when they transported the body themselves. I can remember being called to the local funeral home to help them move a rather large body because just one embalmer couldn't do it. Never forget the smell. I have friends who still work for services that transport the dead and they hate it, with them being the only ambulance in a 300 square mile radius, when they are transporting a dead person they are out of service and in my humble opinion, it really isn't the ambulances job to transport the dead body to the funeral home but thats just my opinion.

Good morning/afternoon/evening to all I was doing a search for another poster early today and I came across a cornucopia of online courses related to public health. 95% of them are free. Some of course cost money but I think by the time you exhaust all the free offerings there will be additional freebies out there so you won't ever end your education pursuits. Some are from Coursera, some are from the CDC and others are from other well known universities. This is really the wave of the future. I don't expect there will be any CEU's offered but you might be able to petition your EMS licensing agency to look at the course and see if they would authorize CEU's for it or if you have a training entity they could probably do it through their umbrella. So without further ado here you go http://theopenacademy.com/content/public-health-preparedness-and-emergency-response Anything on this website by the CDC - about half way down the page http://mphprogramslist.com/awesome-free-online-public-health-courses/ And everything from the university of Albany which is found directly below the CDC portion of the site. http://mphprogramslist.com/awesome-free-online-public-health-courses/ Paitent safety course as well http://www.who.int/patientsafety/research/online_course/en/index.html Scroll further down from the University of albany and find the area where the Universal Class is listed and choose a class there that peaks your interest. http://mphprogramslist.com/awesome-free-online-public-health-courses/ The website that I have mostly linked to has numerous online FREE course offerings, not nearly college level courses but courses that everyone can take and learn something. . I hope this helps. Ruff

This is a welcome change in attitude compared to some young whippersnappers we get here. Cad - no offense taken with not wanting to give your location, I simply meant geographical location, not exact address, just so we are clear. But anywho, It sounds like you have this well in hand. I have a couple of free online courses you might want to take. Nothing great and earth shattering but they might help you sooth the EMS bug in you until you turn of age to take the class. http://theopenacademy.com/content/public-health-preparedness-and-emergency-response Anything on this website by the CDC - about half way down the page http://mphprogramslist.com/awesome-free-online-public-health-courses/ And everything from the university of Albany which is found directly below the CDC portion of the site. http://mphprogramslist.com/awesome-free-online-public-health-courses/ Paitent safety course as well http://www.who.int/patientsafety/research/online_course/en/index.html Scroll further down from the University of albany and find the area where the Universal Class is listed and choose a class there that peaks your interest. http://mphprogramslist.com/awesome-free-online-public-health-courses/ The website that I have mostly linked to has numerous online FREE course offerings, not nearly college level courses but courses that everyone can take and learn something. I think that University of Albany and the CDC pieces might really be of interest to you. I hope this helps.

How bout to the tune of "What does the Fox Say" and it goes something like "What does the Doc say"