msenecal

The important thing with documentation is developing a good system that you will use on the majority of your calls. I review many PCR over the week and all the providers that exceed at documentation all use the same style. I feel it goes hand in hand with patient care most providers have a technique or system on managing and assessing a patient that don’t change it for every call.

I never say always but I tend to lean towards doing a 12lead with my respiratory patients. The respiratory and the circulatory system rely on each other to compensate for any of the others short comings. I would hope you are at least putting a 4 lead on, and does it really take that much longer to add 6 more?

We have been performing selective spinal immobilzation for years in Maine with no major issues. The only issues that arises is when the providers do not do the full assessment. You do not skip any part of it. When a mistake is made medication or spinal clearance the provider ususally skipped a step. A high perdentage of the patient's immobilized are poorly packaged or poor technique is used moving the patient to the board. My opinion is that immobilizing all patients is not warranted and has the potential to cause the patient more issues. I also feel that MOI should play some part of the assessment. If I have a vehicle that has cartwheeled through a field the patient has probably bought himself a spinal immobilization trip. There are several studies out there that support either side.

The patient is dead. I would not have worked the code but I would not fault someone who did unless they let another patient die while using resources on him. I also am making that decision with 18 years experience.

Its your amygdula identified a threat and had your sympathetic nervous system ready your body to fight or flight from the threat. The amygdula percieves the information before your prefrontal cortex will process it. However the officers radar is faster.

Whats your opionion on inserting a nasopharyngeal airway on a patient with a head injury? I have just returned from a call with a unresponsive patient who had unintentionally dismounted her ATV. On our arrival decorticate posturing, blood from the nose, small amount of facial trauma (no le fort fx)x head wound, clinched jaw, noisy airway, 02 sat 92% on high flow O2. I inserted (no RSI) nasopharyngeal airway sats improved to 100% airway quiet. I have no issues with my care however it started a healthy discussion about using a nasopharyngeal airway on patients with facial trauma due to possible intracranial insertion. PHTLS pretty well states thats untrue. What do you think?

In my opinion Non fire based services need to improve on their professionalism and out perform the fire-based services. I have worked the majority of my career in non-fire based services and had a short tenure at a fire based service. In the fire service professionalism is high and EMS was not a priority. If you look at Tri-State Ambulance in La Crosse WI they recently have thwarted an attempt by the city fire department to start a transporting service by maintaining a high level of service and professionalism. The community rallied behind the service and pressured the city council and mayor to back down (for now). There are many non-fire based EMS services that lack professionalism and leave an open door for the fire service to step in. That is how we stop the fire service from taking over EMS.