crotchitymedic1986

If you are a plumber, sometimes you have to put your hands in poop, if you are a cop there are days you have to direct traffic in the rain. In our business 95% of our patients would get to the ER alive if they went by car (I didnt say in great condition, I said alive). People abuse us, it happens, get over it. But there is a big lesson here: Always treat the patient in front of you. It is not your job to worry about how many ambulances are available, how many calls or holding, or whether or not your service is profitable. It is your job to treat the patient in front of you. The drug seekers and drunks are the two patients that will bite you in the ass. Drug seekers are not healthy, they dont eat right, and they are probably on several different drugs, and taking a dose daily that would kill an elephant. There is a reason you dont see too many 90 year old drug seekers.

Thanks happiness, for your post, but now you have learned something you will never forget. As to those who question my talent, that you see as impossible, let me ask you this ? If I had been in construction for 25 years, and during those years I worked in all sides of the field, residential, commercial, industrial. If I had built everything from dog houses to skyscrapers in those 25 years, do you think I might know more than the apprentice who is just starting out. If I worked in the day when I had to build my own roof trusses versus having them premade and delivered on a truck, do you think I might know more than the guy who uses the prebuilt trusses. If I had to cut all of my wood with a handsaw instead of a machine, and if I actually hung the sheet rock instead of subbing it out, would I know more than today's rookie builder ? The same is true for me, I have been in this 25 years, I have worked rural and urban 911, private services, critical care transport, and worked in several emergency rooms (one of which was a trauma center). In the first ER i worked in, we had to call the doctor in from home. I was working when there was no glucometers, pule-oxs, 12 Lead, capnography, IV pumps or even dial-a-flows. I am not smarter than anyone in the room, I have just seen alot more, and like happiness just showed us, I learned from my mistakes. In the future, when I share wisdom, I hope it will be greeted more positively, as I am only trying to keep you from making mistakes. If you do not appreciate the wisdom then just turn away, there is no reason for all this vitreous language and name calling. Thank you. Let's be adults.

not at all, blacks are not the only oppressed race

Wow 27 pages, that has to be a record. You guys know how i feel about muslims so I do not support the mosque and ground zero, but what do you guys think about the same controversy that is going on in Murfreesboro Tennessee. There is a mosque that has been there 30 years and they want to build a huge new one, and the locals are not happy. I think 60 minutes did a story on it too. http://www.nytimes.com/2010/08/31/us/31mosque.html Is it right to allow all other churchs to build, but not let the muslim churchs build ?

No, but I can spot a dissection from a mile away (either through my xray vision, or God tells me according to you guys). That is the whole point, I have seen too many medics treat the equipment instead of the patient. The overuse of technology has made you guys weak in assessment. I can tell the difference between Dyspnea that is caused by left sided heart failure, early COPD, or Pnuemonia, or pleurisy in a patient with no history of any respiratory ailments . Most Docs can't without a chest xray and a BNP (lab test). And I can tell you most of you miss it when it is left sided heart failure, and you end of giving an albuterol/atrovent treatment, and atrovent is contraindicated in CHF. So who is practicing bad medicine now ?

very interesting.

You killed your patient because you have absolute trust in equipment, you blew a hole in your credibility

In the box, there should be no sharp corners on any of the compartments, everything should be heavily padded with rounded corners. There should be a 3-5 point restraint device for the medic, not a simple lap belt. All equipment and stretchers should have mounts that hold them in place during a 40+mph crash --- see Dr. Nadine Levick's ambulance crash videos. The box should not be spot welded together, and should not collapse in a rollover.

Happiness, to save you from reading 5 pages; The original scenario was an unconscious diaphoretic, diabetic patient who has all normal v/s including the glucometer reading of 120. My treatment scenario, after experiencing faulty glucometer readings, was to push 1/2 amp of D50 and see if there was a response (because unconscious and diaphoretic diabetics usually equates to hypoglycemia). All of the newbies said I was crazy and should have my licensed revoked. So I asked if you had a symptomatic chest pain patient but the 12 lead EKG was normal, would you withhold NTG and ASA ? Finally, some rationale voices have joined the conversation, as I have had to argue with the rookies who believe that you should treat the machine before the patient. Thank you all !

I did not say I was giving asa for pain, I said i was giving asa and NTg because it is a possible MI (I would then move to Morphine if Ntg didnt work). Someone then wrote back that ASA does nothing for chest pain, so I answered as I did to be fecicious. Wow DOC you never had your Chem-7 contradict your ER glucometer ? I can not believe you would let a known unconscious diaphortic diabetic patient die because you needed to do a head CT to rule out a CVA. So following all of you guys line of thinking, we should not push Narcan for unconscious patients when we have no evidence of an overdose ? Why would we ever push thiamine, what test do you have to prove the patient is an alcoholic, versus just being drunk today ? Same thing. And I guess we should never backboard an unconscious patient lying on the side of the road, if there is no bleeding or fractures ?

I would agree with that statement DOC, for instance we know that we have convicted several innocent people based on eyewitness testimony and later found that the person was found innocent through DNA. But this isnt that kind of case. If there was not enough evidence this case would have not made it to trial. And this is not the type of case that demands a call to action -- meaning if a child was murdered, there is a reason for a police department and jury to seek and find the killer (someone has to pay). In this type of case there are two sides disputing the facts, and I would say it would be harder to side for the plaintiffs than the defendants on this one, because the plaintifs have to prove discrimination happened. I was not there so I can not verify what the overwhelming evidence was that made one side lose and one side win, but if the test was written on a 5th grade level by a black man, how could the defendants have lost unless something else was going on ? Neither of us know everything that happened, maybe some more details will come out in the days ahead, but I am betting there is something else at work here besides some poor grades.

Well it is obvious that I will never change your mind, so all I can do is pray that your glucometer is 100% accurate, 100% of the time, otherwise there will be a very bad outcome. We have beaten this horse to death, thank you for the debate.

And to be Repedantic, ASA could improve if it is a musculoskeletal issue. And Aspirin reduces blood clotting, which can help blood flow through a narrowed artery that's caused a heart attack, which is probably what is causing the cardiac type chest pain -- but thanks for trying, and no, there is no doubt that I am right on this one. tnuigs if you cant tell the difference between hypoglycemia and CVA, that is a whole other issue. For the record I was asking for the "veterans" (meaning like more than 10 years experience in a busy 911 environment) to voice their opinion.

AMAZING !!!!!!!!!!!!!!!! I know all you old-timers hate my guts, but for the love of God, please jump in and help with these rookies.

I am not trying to sound like a jerk, but I learned this lesson a long time ago: You decide what kind of day you will have every day. You can not let others control your life, which is what you do when your blood pressure goes up over what someone else said or did. The minute you show any emotion because of what someone else did, you have given them control of your day, it is like you are a puppet on a string. Example: If I said something mean about your momma right now, it could piss you off to the point of you punching me. But on the other hand, you could say "crotch does not know my momma, he has never even met me, so therefore he is trying to piss me off and control my day". Let it roll off of your back, its not worth being upset about. I worked for a large urban system that was on 24/48s and the shifts were brutal with the normal EMS abuse you would expect. I went to work cussing and I came home cussing. Then they switched to 12-hour shifts, and I figured out I could transport 6 patients, or not transport 10 patients. Once I quit argueing with the dumb patients and just started transporting, all the stress was gone, and my smile returned. When I saw that change I realized I had been letting others control me.

Good one ruff, you almost got me lol. But I would say the difference in the two is that no one is being discriminated against in ACLS, everyone has the opportunity to study for ACLS - using the same book, and the same ACLS curriculum is used nationwide. So if I am taking ACLS in Indiana or Hawaii, and I have studied the material, I have an equal chance in both places (unless the instructors are racist and give me harder scenarios at the mega code to fail me intentionally -which i am not saying that happens). And if ACLS fails me due to that, or has a faulty test, there is a way to appeal. When applying for the job, I have no idea what the winning candidates scored or why they were chosen above me, and there is no way to appeal a bad decision (other than sueing) When applying for a job it is different in every single city, county, state. I have no idea what they will ask me or what is on the test, so I cannot "study" for it. In big cities, the testing may have been created by a testing company or university, but in most towns and counties it was written by Joe Bob who works for the department. So if you would create a national employment test that would be used by every single department (similar to the National Registry Test for certification or ACLS), then I would have no pity or arguement for the people who fail, regardless of race. You guys keep wanting to ignore the fact that the court ruled that there was discrimination here. I did not make it up like a scenario. The facts are the facts.

I would do the same, because I treat the patient, not the monitor or the glucometer

WOW I AM AMAZED ! Thank you for making my point, the younger generation is apparently all about the equipment. A half amp of D50 is hardly similar to pushing cardiac drugs. So then let me see if you are willing to kill any other patients besides diabetics ? You have a 40 year old male with crushing chest pain, SOB, pain radiating down left arm, but your 12Lead says NSR (no infarct). Are you going to withhold ASA and NTG (NTG is far more dangerous than 1/2 amp of D50)? He could be having an embolus, a AAA, it could just be gas, or pneumonia/pleurisy. Or do you give the ASA and NTG and see if it improves the patient ? Now explain to me how the diabetic scenario is different. I hear crickets ! Did it click yet ? Treat the patient, not the equipment.

Yes you should. The difference between bad medics and super medics is "Critical Thinking Skills". The crazy scenarios that will probably never happen exercises your brain so that you can treat patients properly.

While I agree with you that the "boot camp" method might not be the best teaching method, I would also point out that the "let everyone pass" method is not education at all. For the last 3 ACLS classes I took, I never bought or opened the ACLS book, which is sad. All of the written question answers were provided verbally before the test, and the megacode was a joke. Imagine if the recert for airline pilots was as easy as ACLS, would you get on a plane ?

sorry, I thought you meant the call happened to you as a medic, I would never have implied those diagnosis if I knew you were the patient. I apologize.

I am not ensenuating that anyone in this room is racist, I simply reported that the courts found that the Chicago FD had a racist test, and made them hire people they excluded. If you have a problem with that, take it up with the courts. AND TO HELP ALL OF YOU UNDERSTAND THAT RACISM DOES EXIST IN MOST WHITE PEOPLE, CHRIS ROCK SAID IT BEST, I WILL PARAPHRASE THERE IS NOT ONE WHITE PERSON IN THE U.S. THAT WOULD TRADE THEIR SKIN AND BECOME BLACK. YOU COULD BE THE POOREST WHITE TRASH, LIVING IN A BOX, EATING DOG FOOD, AND YOU WOULD NOT TRADE YOUR PLACE IN SOCIETY TO BECOME BLACK, NOT EVEN A RICH BLACK PERSON. If you speak honestly, you will agree, and that is where the hidden or institutional racism comes from. Think about it for awhile, then ask, if I would never accept being black, date a black, or kiss a black, how do i keep that subconscious bias from leaking into other areas ? Chances are if you detest obese people, you will not hire them (ever see a 300lb receptionist in an office building). Same is true of black folks. And if you remember I posed the question once before, out of everyone in this room, how many of you have a black supervisor at work ? I think 2 said they did (maybe 3, but it was single digits).

Thank you ruff for helping me make my point: 1. If most of the firefighters that are employed there can not pass the physical agility test, then why is it a requirement. That would be like making all EMT-Bs take an ACLS test to be hired as an EMT-B. The test is only there to weed people out, and they do it both ways: The either make the test so easy that everyone technically passes, so then they can choose who they want (young heterosexual white guys). Or they make it so hard that only the fittest of the fit triatheletes can pass (discriminating against most men and women over age 35). 2. No I have no documentation of test questions, but if a court ruled it was discriminatory I have to agree that it was unless you can show that the court was biased in some way. The evidence must have proved that it was. If they had slam-dunk proof that it wasn't racist, and had the experts to testify that it wasn't, they would not have lost the case. 3. Depends on which 5th grade you are at. If you are at the Obama's children's school, or most predominately white schools then yes. If you are at inner-city public school in Detroit or Compton, I say no. 4. Yes, it is well documented that minorities score far worse on tests than whites. But as suggested before, when you do not allow a whole race of people any opportunity for education for over 200 years, then put them in bad schools for 40 years, you can not expect a Harvard candidate to come out of that situation often. I will admit that over 50% of that is our race's fault for our rate of drug use and single moms, if you will agree that your race's educational genocide of our race led to where we are today.

http://www.alternet.org/story/13826/ http://www.collegebo...wsat/index.html If the test wasn't racist, why did they change it ? Note taking out analogies in both articles. The problem with all standardized test is that it is much like the "Physical Agility Test" at any Fire Department. The test is created by old fat men who can not pass the test, to keep women and minorities out. In any Fire or EMS Department you have a wide variety of backgrounds, income levels, educational levels, and developmental issues that are unique to each individual. If I grewup in NYC my whole life, I probably will not be able to answer questions about a farmlife (words like tractor, plow, and gizzards are probably not in my vocabulary). Conversely if I am the farm kid, words like Stoop, Living in a Flat, taxi cab, cannoli, or lox is probably pretty foreign to me. I offer the same solution as offered before, make the whole department take the test every year, then average the score and make that the passing bar.

Since you seem to imply this was not a usual case, I guess three possible scenarios without knowing any details other than what was presented. 1. I had a rather healthy TV executive who just flew back in from Jamaica, had similar presentation with a B/P of 40 palp, and this guy was like 6'2" 250lbs. He had mixed some drugs and a ton of alcohol on his trip (per his friend, but he would not divulge the drugs for fear of losing his job). Or 2. I say the prostitute slipped a little something in his drink to knock him out. Or 3. He is having a reaction to the cleaning chemicals used by the hotel staff.