SWM_Medic

"Invisible City" - The Wallflowers

In my system we have an assisted living facility that the people living there can look at the Level I trauma center from there living room. My feeling is what does the pt need? If it's something I can help with right away. Then I do, if not I transport. Remember just because they can get to the ed if five minutes how long till there registered and actually get to see a doc? For a non-critical anyway.

Let's get away from colors "Idiot Summer" - Gin Blossoms

I am lucky enough in my system we get our supplies from the same place the hospital does. It makes life super easy!

"Black Chick, White Guy" - Kid Rock

They should really license people to have kids. If you can't figure out what to do with a foul mouth elmo you shouldn't reproduce.

I am in agreement with the don't accept tips policy. You have to be careful however cause you don't wanna insult anybody. I'll share a quick story for you. I was transporting home a hospice pt one day and when we arrived no family was there. Now the pt was very medicated and didn't know what was going on. When family finally arrived I found out that the people who delivered the hospital bed put it into the wrong room. So my partner and myself disassembled the bed moved into the correct location and reassembled it. The whole process took over an hour. When we were done the gentlemen tried to tip us what looked like a $50 bill. I refused but instead suggested I could really go for a cup of coffee. Well he obliged and the next day at work he sent coffee and bagels over. So that's my thought on it. Try to redirect, now if it's an older person and they insist on a few bucks don't insult. I like the three refusals then accept. At most of the nursing homes in my area they have birds, dogs or whatever for the residents. And if you look there's always a collection box for feeding the pets. That's where I put my tips. Remember it's all about the pt's and treat them how you wanna be treated.

I can't speak for everyone but when I make my decision as to whether I start a lock or line I consider a couple of things. First of all what is the side effects of the medication I am administering. I would never start just a lock for a chest pain pt. When giving nitro one of the side effects is hypetension. The fastest easiest way to correct that is a fluid bolus. Second, what am I treating. If a I have female pt who is pregnant I probably wanna go with a line because if she seizes I may go with a mag sulfate drip to correct it. Now your straight up seizure pt I will go with the lock. Depending on what caused the seizure of course. Overdoses I'll do a line because the ed may wanna do a naxalone drip. That is if my first dose doesn't correct the situation. Most medical stuff I really like to do a line just because you never know. But don't forget you can very easily and relatively quickly attach a line to a lock. I'll sometimes do that just so the hospital can get the person into a gown more easily by just detaching the line. Now if you have a situation where the pt might not benefit from fluids you can go with lock to prevent any kind of fluid overload. I'll admit I am not the most experienced emt-p on the site and some people may disagree with me but these are just things I try to think about. Never let the cost of supplies dictate treatment. A bag and a line are not that much more expensive than a lock set up.

I work ssm as well and we have the average 8 min response time, but we have another hiccup that I feel is stupid. The city fines us $10 a call for being late. Yep that's part of our contract with the city. I couldn't tell you the exact number of calls we do a year, but it's off subject anyway. I'm not a huge fan of ssm it tends to burn out medics even faster than normal. We work 10-14hr shifts at my company and trust me that a long time to sit in the car. Granted we have a relatively high call volume but there are those days your stuck in the truck for hours at a time. The worst part about it is when we finally get to a hospital and get to see other humans the company tries to find ways for us to get back in the truck quicker. So now we have to type reports in the truck.

That makes alot of sense. Thanks for the feedback.

We have life pak 12's and use the pads. Personally I like the pads. I don't always get someone in the back with me when I transport an arrest so I kinda need my hands free as much as possible. I will say however it's damn fun to use the paddles. It makes me feel like a real medic.

So I have a couple of questions. I had a call tonight for a pt with high BLG. I arrived to find a 63 y/o female with type I diabetes and a blg of 559. Now the standard of care for my system is to start and IV and transport. So I started a 20g IV running tko with normal saline(it's all I carry). Now has normal saline shown to be of any benefit to someone with blg this high? Now the pt told me she started taking prednisone for asthma that she was diagnosed with last week. She was under the impression that the prednisone caused to spike in her blg. Is that so? If it is, how does it do that? It's just a steriode I can't seem to figure how that effects the body on that level. Any thoughts?

The mom and baby came out okay. She wound having to get a stent and as far as I know the baby was delivered without incident. The risk benefit is defiantly something to consider here. I would like to point out that giving asa doesn't stop the clot from forming just assists it from getting any worse. So skipping the asa won't make a huge detriment with all the other factors considered. As far as where mom needs to go L&D vrs ER. I am not sure what the answer is. Since the hosp is a childrens hosp they do have excellent docs in L&D that can handle it. They never accept women over 24 wks in the ER. I am not sure if this is local policy or national. Still it's something I like to share.

Ok so this is a big one I tell all new paramedics. I got a call for a 37 y/o female with chest pain. she was in her third trimester with her 2nd child. The first one was a miscarriage. Now she had sub-sternal chest pain radiating left arm to her left jaw. 12-lead showed elevation in leads I, II, and depression in v4 and v5. With a history of cardiac problems to beat the band. So I did the standard treatment MONA. (Oxygen, Aspirin, Nitro, Morphine) When we got to the ER they wouldn't accept the pt Er dr said we had to go to L&D. When we got to L&D and gave report they wouldn't take the pt because of the Aspirin. I got yelled at by everyone who has any authority over me. From the ER doc to the my PMD to my Supervisor and ops manager down to the training officer. The PMD came in to work at 23:30 to yell at me. Apparently in the late trimesters you can't give Aspirin to a women because it will cause a disease that I can't remember the name of sorry. It basically causes the little heart valve that is supposed to shut during labor to remain open. If you ever wanna gives meds besides Albuterol, Dw50, mag sulfate and oxygen to a pregnant women. Call a Doc.

I got a small sticker on my side window. I really wasn't going to do it but when I saw the sticker I had to have it. It says "EMT-P paid to save your ass not kiss it" which I know is rude but damn it makes me laugh.

My heart really goes out to this person. I have heard of other medics having breakdowns whether on or off the job. We all have to remember one thing though. We have a duty to care for our pt's after ourselves and our co-workers. What would happen to a partner if his/her partner had a manic episode while dealing with another manic pt? This may not happen on scene, what if it was in the back of the truck traveling down the road? I would hate to be in that situation. While I don't think anybody should be fired over a disability, I also don't want to endanger anyone else. It's kinda of a catch 22. If the medic in question could demonstrate she dosen't pose a risk to anyone, by all means get back to work. Now that my tangent is over, no I don't think a suicide attempt is grounds for dismissal.

Need to get an IV established NS TKO for now. How did the sputum look when he was suctioned last? Any complications with the surgery?