Kiwiology

That's pretty fucked up inefficient; they only have to be locked here when nobody qualified to carry them is on and then they are locked in the station safe.

Where is your morphine and midazolam?

Not here in New Zed, neither

I don't believe in carrying all that crap. Radio, phone, some pens and hip pouch and thats it

So thats how you get away with it ... The law in New Zealand is not clear on the age at which a child becomes competent to make decisions regarding their healthcare. Although an age guideline of 16 years is used (below which a child is automatically deemed to be not competent), all children should be communicated with and treated as if they are competent. If a child younger than 16 years of age is making a decision, which in the opinion of the treating personnel is not in their best interest, then that child should be deemed to be not competent. Parents or guardians, have the right to decline recommendations on behalf of the child, but personnel should insist on treatment and/or transport if they believe the parents or guardians, are placing the child at risk.

He was more fucked in the head than I am, fo realz, so um yeah, not sure I would be dong anything he does

Eh, I was going to post up some long deconstructive rant but I figured it was easier to get wasted on valiumz and various dopanergic and noradrenaline reuptake antagonists.

Technically somebody who expresses thoughts of self harm is supposedly deemed not competent to decline a recommendation of transport but I've seen times when it's not followed. Just like every patient who calls an ambulance does not require transport, not every person who says they want to off themselves needs to be immediately involuntarily admitted to the nut house ... kinda disturbing if that is the case actually, but anyway. Same goes for children and young people; they are competent until proven otherwise. Bottom line, if the patient is competent then they can refuse whatever they like, including life saving treatment.

I am not sure if my rants when I am wasted on valiumz to quell the debilitating mental illness are "professional" or "communicative" nor "quality" Mmm, Kings English valiumz

To agree with this, one must accept the findings of the Warren Commission and the single bullet theory put forth by Arlen Spector, which I for one do not. Either way, rather interesting and a good reminder I need to see Lincoln Oh and the Texas School Book Depository was a depository not a warehouse

Then what do you call me being tied up, gagged and stuffed into the trunk of your car? Shame you didn't drive across state lines, then I could have the FBI come after you because that is a federal crime. Oh and for a Consultant Physician your car kinda sucks, I disappoint ... and lets not even go near your taste in music

I'd get a couple of helpful bystanders to hold up a magic ambo drawer sheet if it was something that was going to be quite undignified for the patient, for example cardiac arrest resuscitation or where we need to significantly disrobe the patient or something Those drawer sheets are magic for things like that

I wouldn't even ask them to stop; it is a public place and the patient has given implied consent to be filmed until they communicate otherwise.

I'm fresh out of ideas here people Ugh, are we at the hospital yet? .....

I will admit it mate, your line of thoughts makes the hair in my ass crack stand up and go "hmmmmm?" You like to piss the media off? how old are you like 12? That sounds very immature. Unless the patient explicitly refuses themselves being photographed or videotaped then they have given implied consent, especially if they are in a public place. The TV crews here are specifically allowed to do their thing anywhere except inside a private residence or business without express permission of somebody there, not necessarily the patient, but it should be the patient wherever possible. Now you do have a point to a degree about patient dignity, if they have to have a rectal exam or its a cardiac arrest resuscitation or something then that might be time to whip out some of the magic ambo drawer sheets (handy them magic ambo drawer sheets) and hold a couple of them up or just move them to the ambulance. But seriously so what if somebody wants to show up and stand on the sideline and take some photos; for all we know he might be a curious citizen or more fucked in the head than I am and he is spanking off to them at night; don't know; and as long as he is not in the way or something then I don't care; if it's in a public place then unless the patient specifically says so then it is allowed and should be allowed. The actions of the person in that video are disgustingly unconscionably unprofessional and rather disturbing; if it were up to me he would have his professional registration cancelled as well as being forbidden to practice again and In jurisdictions such as the UK and SA (and when it happens in NZ) if the person complained to the appropriate registration body that is probably exactly what would happen.

OK so we have secured her airway, nice. Little morphine + midazolam to maintain sedation as required. If she has crackles then I am going to stop infusing fluid and go with just an adrenaline drip. Wheezes to me signals extrinsic bronchoconstriction from acute pulmonary edema so no salbutamol. Her BP is absolutely shit but we cannot simply keep dumping fluid into her it's not going to do any good I dno hmm .....

My somebody didn't take their morning valiumz, dopanergic meds and noradrenaline reuptake antagonists now did they ..... I do like the smoothing out properties, very handy and they also help with the severe suicidal depression which is resolving somewhat nicely but anyway my point stands.

Man what a bitch this situation is, fo realz, I reckon we need to oxygenate her without the need for intubation, now that can be either sedating her and using a bag mask with PEEP and passive ventilation or using an LMA. She is likely to be a very difficult intubation so if we do need to tube her then we need to pre oxygenate her by sedating her with some ketamine say 0.5 mg/kg, a tight fitting bag mask with PEEP of 10 or 15 and a nasal cannula set to 15 lpm then intubating her using a bougie, which we should be using as standard anyway oh and lots of anterior laryngeal pressure.

Before we begin, some premedication sounds good, of me, with valiumz, amitriptiline, prozac and these little blue pills the Doctor put me on as well I just saw this as I was out the door to work, I will have a think about it and post later from teh medicalphone ....

Apparently

I happened across this last night, its a peri-arachnoid cyst, I mean Jeebus H Fuck look at the size of that thing!! Maybe we finally found the cause of my head problems?

Morphine is good for acute pain as long as the dosing is appropriate i.e. at least 0.1 mg/kg given intravenously There are other, more suitable, medicines such as ketamine, fentanyl or tramadol depending upon the specific circumstances

He has not shown he is incompetent and every sign that he is capable of making an informed choice about his healthcare. I believe very strongly in the patients right to informed choice and right to refuse treatment, including life saving treatment. If he can confidently repeat what we are saying, display an understanding of it and why we want him to go as well as express why he does not want to consistently then I am going to be quite happy leaving him at home under the circumstances, obviously I want him to get treatment but if he does not want to then as much as I clinically disagree, morally and ethically he has made his informed, voluntary choice so be it. We might also to be able to use his GP if appropriate, give them a ring and explain the situation and see if they can convince him to going.

In the first instance I would like to sedate her a bit with some ketamine and see if she will tolerate passive oxygenation as opposed to completely anaesthetising and paralysing her because if we do that then we have to sit squeezing a bag mask for the next two hours until we get to the hospital (automated ventilators coming next year apparently) and also because it is a less invasive procedure. She could be in CHF however if this were the case I would suspect significant worsening of her respiratory status and possibly either extravascular edema or the production of a lot of pink frothy sputum or both because if we have given her four litres of fluid it would have horrendously expanded her extravascular fluid and it would either end up in the interstitium or alveoli

In New Zed St John is the major provider of emergency ambulance and non-emergency patient transfer services as well as commercial medical coverage at events. The emergency ambulance service is by no means "basic" and although it does rely heavily upon Volunteer Ambulance Officers, along with Australia, New Zed has the highest standards of education for Paramedics in the western world. the broadest and most autonomous scopes of practice for any jurisdiction still reliant upon volunteers and one of, it not the, best RSI programs in the world. I know in other places you mentioned St John is voluntary first aid only and/or provides limited backup to the emergency ambulance service but New Zed is certainly not one of them. I also know you were just rattling lists of places where St John exists and did not mean to lump New Zed into such categorisation and that this post is very self serviant and shamelessly self promoting in nature but bloody hell why not?