mshow00

HEAR! HEAR! Now more on to reply to the OPs questions: I work for a company bought out by AMR last year, and we have had a couple of transferes already. One came from the East Coast with a bit of history he tried to keep quite. He apparently had a DUI (I don't know how old) but he was not allowed to drive for x amount of time. I say X because he did not fit in(peronality differences) and went back home.

Please don't take offense itk, I have had some of the best nurses I have ever seen or had the pleasure to work with at the SNFs. Hell, I went to EMT school because of my old boss who was an LPN. When I told her my wife was pregnet with our first, she sat me down and made me fill out the papers needed. She then went on to help me when ever I needed it. She was good, damn good. We were under orders to call her anytime one of residents "were not 'normal'", no matter the time. After I got my Basic license (and towards the end of class) she put full stock when what I told her, once she knew she could count on my assessment. I have read your post and have had minimal (thru the city here) contact with you, and from what I have seen you are a good one, but like you said "The bad ones give us all a bad name". I agree those people are everywhere. There are a hand full of employees at my work that I have no clue how they still have a job let alone a license.

With all things possible, I can not say 100% that what you ask is not possible, however the pts presentation, along with the nurse's account of what his "normal" was, I can not see this being rapid onset upon or arrival. It just dose not fit... As for the whole O2 thing it is so customary here, it sadly dose not even bother me anymore... I just fix it, and move on. I know not every nurse in ever nursing home is this incompetent, but I fail to see how they keep their licence. If I pulled even half of the crap they get away with I would be sued and looking for a new career. Kind of goes along with taking a CHF pt into the ER out here, if we put give them albuterol we get disciplined, but the first thing half the ER docs do is: order a breathing Tx du du dun! Or even having us work so hard to "bring back" a pulse, and BP in a code, only to have the Dr. blame it all on the meds and let the pt die on his table. Somethings are just so far beyond my understanding.

LOL very true! As for the time between her V/S and ours I can not say, however we saw her leaving the pts room with a pulse ox. She did say his hands were "smurf blue" prior to our arrival and that they put him on 3 LPM via simple mask, "just" prior to us (the crew) walking in. When I saw his hand they were pale and cold. The pt only had psych hx nothing cardiac, nothing resp. I doubt very much that this was new immeditate onset, it just did not fit.

I don't want to stand here and slam SNF (skilled nursing facility) nurses; I do have the utmost respect for those nurses who go to that job day in and day out and honestly try to make a difference, but what is the point of lying to the responding to EMS crews when they call for them? We had a pt today that we were called for that was increasingly lethargic. We arrived on scene to have 8 various levels of staff in the room, my partner (the medic) asked why we were called to which all 8 said the nurse is out there (pointing to the desk in the hall way). I went to talk to her, and she told me that he was usually up walking around without assistance, but was in bed all day just laying there; were unable to obtain a BP due to the pts tremors, and his SpO2 was reading 58% with a pulse of 60. When we got him out to the truck and placed him on the moniter he showed PSVT @ 170+ bpm with no radial pulse, and extremities so cold (a long with the SVT) that the pulse ox would not read. I just don't understand why she would make up those V/S and call us non-urgent for such a serious pt. Is it lack of caring? knowledge? policy of the SNF? I am just at a loss here.

I disagree with the above stated, she is A&Ox3(argument sake) why can't she make her own decisions? Obtaining some level of mental status on her would not be all that hard, blink once for yes twice for no: Are you _______"; "Have you _______" (etc); until satisfied there is some level of coherentcy(sp?) then ask "Do you understand what will happen when I turn off this vent? (asked many different ways and explaining in your questioning what will happen). If you can reasonably assume this is her wish, thats when you get the ethics board impute. At the end of the day (in my book at least): "Did I do what was best for my pt, or follow their wishes to the letter"; "Can I look myself in the mirror and know I did right by them?"

Just my opinion here, but who are we to say "No, you are 'alive' and will have to suffer as a vegetable for the rest of your natural days be it 1 or 1,826" (5 years plus 1 for leap) . I know regardless of my mental status I do not want to live like that, nor does my wife. We have both talked about this to great lengths and all of our families know our wishes. The loss of life at any stage is sad, but I believe it would be a greater injustice to make her "live" (use that term loosely here) out the rest of her life in that state. Call is suicide, assisted suicide, murder, or mercy in the end she had to suffer a whole lot less this way. You have the right to refuse any treatment at any time as long as you understand the risk, why should this be any different?

I kinda know what you mean; I had crisis of conscience a couple of months ago over a call my company did. We (as in my company) ran mutual aid for a local city for an assault victim. When the responding crew arrived on scene, they found their "victim/pt" to be a younger-middle aged man who was beaten quite severally. He was literally covered in his own blood from head to toe. Why was he in such bad shape? Well allegedly (court has not convicted yet) this man was in the middle of raping a 70 something y/o woman when her husband and son walked in.... you can figure the rest out. Needless to say, when I heard about this on the news, then found out "other" details when going to work the next day; I tried to place myself in that medics shoes. I know that I would have a very deep urge to be very heavy handed in my "RTA" of him: Does it hurt here when I push (with a closed fist)? As for irony that medic was very professional and treated his pt with some level of respect. The ironic part: this "victim" only had a broken jaw. I think I would have made sure he was far worse off. BTW he did admitt to police what he was doing and was already on the sex offender list for "other such crimes"

Lets face it, "good" almost never makes the news, "bad" "wrong" "evil" sells so much more. So AMR has a dozen or so employees that are less than shiny examples, that does not make AMR a "bad" company. Do you refuse to eat at different fast food restaurants due to some of the bad publicity of a few.

I am not defending what the man did. I totally agree that this guy made a huge mistake, but why slam someone we dont even know. Does he deserve punishment: I don't know. Does AMR? I don't think so. That was my point. This came from a news article that did not explain how much of what was posted was used to find the victim.

I don't understand why everyone here is so ready to throw AMR under the bus. AMR is no different than any other company out there. So AMR had employed an idiot or two, that makes them a bad company? Why is AMR to blame for a stupid mistake made by one on their pay-roll. It is not like AMR can control what it's staff does off the clock, or hell, even on the clock. They can only respond to the actions made, after they are made. One last thing: This guy made one mistake we know of... tell me what is it like to walk on water; to be so perfect and never to have made a mistake.

I work SSM and it happens. Get over it or move on. If you have this much anger over something so stupid, maybe its time to turn your keys in and find an ER or a completely different career. Before you come after me know that on more than one occasion I have spent over 18 hours on the rig on a suppose to be 8 hour shift. I know how much it can suck. As for the dispatchers, if I were them, I would rake you over the coals every chance I get, especially if you gave me that kind of attitude.

So would/could/should you turn off the internal pacer and place your external pacer on the pt? And would you call this rhythm: tachypaced wide complex or just paced wide complex. Pacer or not technically it is still tachy correct?

If this is confirmed to work, it will be an excellent additional tool. It is, however, a tool, with that I agree with spenac. I also fear that in a pinch the doctor will rely too heavily on this, missing/skipping another test to result in a sad ending. I do hope that this can help confirm/nullify the thoughts/suspicions.

I am a current student and my advice is pre-read and study up on your A&P and pathophys. My school hit very very hard on them, telling us the the NR test was heavily laced with those type of questions. If you can study acid-base balance, having a grasp on that will help. Be prepared to study then study and study some more. Then when you're tired study just a little bit more. Then go to work for 40+ hrs. Then on your off days when you are not studying you will be busy with clinicals. Just remember your ultimate goal, and you will be good.

Sorry about that I meant to take the word caustic out... but the point remains the same... poison control gods decide and I do.... as for the two pts I miss read that I thought he was saying the babysitter was distracted by her sick looking child; upon a second read I see my mistake. Again I apologize.

Did he take a blow to the chest? I am kinda re thinking this.... maybe cardiac tamponade what does his heart sound like?

I agree with Windy here... the girls(both) got into a caustic liquid and drank it... talking to the babysitter is important have to find out what they drank... after obtaining V/S and talking with babysitter call poison control and inform them of S/S, V/S and suspitions... possible NG/OG tube( pump the stomach?)... activated charcoal or other neutralizer (per poison control)... grow wings on the side of the rig transport to the nearest childern's hospital (or have bird in the air to transport to nearest childern's hospital) consider sending additional unit to babysitters house for her child (after talking to her of course)

I think the bitches comment earns him some silver or green anaestesia just kidding... treat with ACLS/SOGs... take an officer a long for the ride(unless they are just gonna issue a warrant for his arrest later)... beat feet to the ER

I have to agree with Ruff here... only I would add ETOH to the equation.

yeah thats it

Thanks chbare.

Im not sure if I'm posting this in the right place, so I applogize if you all have to move this: That said I have a question about EKGs, one of the medics I work with had a strip off a 3 lead that showed a wide complex with a pacer spike right before (absolutly no space between them) no "P" or "T" waves present. I regretably do not have a copy of the strip, so you kinda have to take my word for it. It was paced at over 100 bpm (i believe) and I know nothing of the pts c/c or presentation. Is this a paced V-tach or some kind of block after the pacer?

So he got a virus that ended up making his body attack the myelinated nerves of the lower extremities and (or could have) worked its way up, I understand that, but what about the virus? Can any virus do this or is it a particular one (or strain)?

r/o meningitis vs electrolyte inbalance my best guesses did he eat any chicken lately.... bird flu? (at the risk of sounding incredibly ignorant here)