crotchitymedic1986

The one thing that I really appreciated from my Fire station experience was learning how to cook good, cheap, and filling meals for the masses. I am sure many of you have a cheap recipe for something really good to cook. If you would care to share your favorite EMS/Fire/ or homecooked meal, I would appreciate your ideas: Please include directions for prep, cooking and serving, and a list of items needed from the grocery store. I will start off with one of my favorite cheap meals --- Potatos and Roast Beef with rolls: You Need: 2 potoatos for every person (5lb bag 2.50, 10lb bag $4-5.00). one can of canned roast beef per TWO people (each can is $2.50-3.00). Dinner rolls (2-3 per person ---- $2.50 per pack) Cooking Oil ($3.00 per container) Cooking Directions: Peel (can leave peels on if you choose) potatos and cut into cubes. heat up skillet(s) of cooking oil, and fry potato cubes until done. Remove cooked potato cubes into plate of bowl lined with paper towels to drain grease. In another pan (or drain grease and use same pan), add cans of roast beef (with juice), break up chunks with fork, and heat until bubbly. Once roast beef is heated up, dump in potatos, stir, cook until potatos and beef are warm. Serve with rolls.

OK, so what was the final diagnosis ? PE, MI, or other ?

note: it says "pee question #1", that usually indicates that more questions will follow. Lighten up guys, every topic doesnt have to be about ALS versus BLS, or medic versus emt, or fire versus ems. If the questions is beneath you, or isnt your cup of tea, ignore it and move on to a question that does intrigue you.

There is no reason to lay this patient flat and drown her in her own fluids --- did you ever think that she might have lost consciousness due to the slow heart rate and poor oxygenation ? Even with the head raised a few degrees, she is still essentially flat -- You can immobilize her C-spine with KED and Collar, and let her sit up so she can breath too.

I am 43, and although it is not a serious question, it has relevance to our job. I saw a survey that said over 90% of men admitted to urinating in the shower on a weekly basis, whereas less than 10% of women do. Had I known this when i was showering at the fire department all those years, I would have sprayed the shower with bleach or wore flipflops.

You also have to realize that less than 10% of all multi-trauma patients have C-Spine fractures, so the amount of patients who get c-spine injuries from ground level falls is significantly less. Obvioulsy, you have to use common sense if the patient has any signs or symptoms, a history of osteoporosis, neuro deficits, or even just a gut feeling you should immobilize. But immobilizing every one that trips over their own feet is ridiculous. The more common problem that you should be concerned with is brain injury. The brain shrinks over your lifetime, which leaves more space between brain and bone, where blood can collect without presenting any symptoms because the brain is not being compressed. Any elderly patient who has a head injury should be transported, but not all need to be immobilized.

Do you pee in the shower ?

I agree, the amplified stethoscopes are great, but the problem is that stethoscopes are like sunglasses and good ink pens; the chance of losing them goes up proportionally with the price.

Doesnt matter what position she was found in, you can roll her on to KED just as easy as a backboard. If she has back pain, i would use a board, but I would not force her into heart failure and respiratory distress if she does not need spinal immobilization.

If you practice cookbook medicine it is the next thing to do. Maybe ntg didnt relieve his pain because it was not a cardiac event. Just because a patient has chest pain, does not mean you have to go the automatic path of cardiac treatment. I hope you dont give NTG to patients who have chest pain after striking the steering wheel with their chest during an MVC. With what little info I have so far, there is just as much pointing to a respiratory problem versus a cardiac problem (unless the pericarditis was diagnosed in recent days. I am not saying I wouldnt go the cardiac path yet, but i wouldnt until i have more information: Is the cough productive, if so, what color When did the cough start Does he have other symptoms that point you away from cardiac (one leg with pain instead of all over, fever, other flu symptoms) Is he on any pain meds now that he failed to mention or can not report on his medical record due to DOT rules. What kind of ortho injuries and surgeries has he had Does he have any other PE symptoms Does he have any left sided heart failure symptoms Remember he has all-over general body pain -- rarely cardiac. My best guess is that he is in withdrawal from a presecription narcotic.

In the absence of back pain, I would immobilize her sitting up in a KED.

morphine is the drug after ntg, if you believe this to be a cardiac event. The rhythm is not vtach.

The patient has no vital signs (I think) so this means he is in arrest. The text-book answer is that you should immobilize the c-spine and maintain the airway as you would any trauma arrest. Real life answer: cut him down, start ventilating and compressions. The c-spine fracture (that may or may not be there) is secondary to his airway issues which are there, if you want to throw him on a board and collar for cosmetic reasons, that is fine, but you have to save his life before you can worry about a possible fracture.

The best choice is to call medical control and get permission to do a C-Section in the field to save the baby. 2. Next best choice is to go to the closest ER and let them deliver the baby. Even though they do not have the NICU or even an OB doctor, any ER doc should be able to perform a delivery and care for a neonate as an emergency (just as a medic would). the child and mother can be transferred to other facilities after stabilization. Driving for 25-30 minutes will most likely result in the death of both, there is a chance to save the baby if it is delivered within 10-15 minutes of arrest.

His allergies suggest he may be a drug-seeker (prescription), as few people are really allergic to Toradol (without having an aspirin allergy), and few are allergic to ibuprophen who arent allergic to NSAIDS. So my guess is that he has a back pain, and is hooked on prescription drugs. He can not admit it, because he can not take those drugs and drive a truck. I would not administer Morphine for his pain. Without knowing if the cough is productive or not, I can not rule out cardiac at this point, but my guess is that this is a respiratory event, not cardiac. As stated previously, I would be prepared to treat it as a cardiac if further symptoms proved that I should, but at this time I would not.

Treat the patient, not the monitor. I would call it a junctional rhythm, which we can argue all day (it is not sinus, and it is not wide enough to be Vtach in my opinion). Regardless, he is A&Ox3, with a good b/p. There is no reason to treat the rhythm. Which isnt to say you shouldnt BE PREPARED to treat the rhythm when indicated. With the history of pericarditis it is not impractical to believe that any vagal stimulus might change his rhythm.

I can certainly respect those that do not wish to share. The reason I asked is that I see alot of newbies in this forum who have just begun their EMS career, and may not have experienced what the holidays bring to EMS --- my hope was to be able to give them so expectation and coping skills for the inevitable bad call that will occur in the next few weeks. If you would rather just share your agency's or personal coping mechanisms, that will suffice.

Its that time of year, when suicides go up, and patients die because they refuse to go to the hospital during the holidays. It seems like I always had a really "sad" call around every christmas (although I know it wasnt EVERY christmas). So what is your saddest call you have ever run around the holidays ?

Good point firedoc, the post was originally intended to be funny, but it has spiraled away from that, and yes i will take most of the blame for it. So to all board readers, please accept my apologies, I will have no further comment nor will I debate anyone else about this thread. Mobey, i am not sure Firedoc was backing yours or my position, rather i think he was telling both of us to grow up. We should be able to disagree without insulting each other. Thanks Firedoc.

It is not arrogance, it is common sense -- this page does not allow you to vote more than once. So to vote over and over again, you would need to have as many different screen names as your votes. And as entertaining as I have found the topic, I do not think it is worth the effort to log in over and over again to vote. Do you honestly believe that the number of medics who have had sex on the job is really a small percentage ? Do you think that it is less than the average of a normal workplace environment ? Just because you dont know about it, doesnt mean it didnt happen. Many people are smart enough to do it without getting caught, or bragging about it. And by your logic, only 27 out of thousands have said "NO" they havent, so does that mean thousands have had sex, because they havent voted no yet ?

Sorry wendy, i read your post from yesterday, but i didnt really see a specific question for me, maybe i missed it. But to answer your main point: I have not advocated for or against the activity, I just asked questions on the subject, and then asked follow up questions to the answers given. For instance, when you and I started talking about being masters of our domains, I simply asked you why one sex act was OK in your eyes, while another wasnt ? I never stated that either was right or wrong. For all you know, you and I may just be on the same page on this topic.

Read zzyzx's post about Washington medics in trouble --- bet they got that guy to sign a REFUSAL.

I bet they got him to sign a REFUSAL !!!!!!

Arizona, its been awhile since i have been in EMS, so I realize some things have changed, but I dont think ntg and morphine are the way to go. Both drugs dialate, and I would think the last thing you would want to do is dialate an artery that is already tearing apart. If I am wrong, please correct me, cause you never know when i might get back on the bus one day. Good scenario though.

You need to work in a busier urban 911 system to understand how the low acuity calls hurt the system. In a nutshell, you have more calls than you do ambulances, and ambulances get tied up on low-acuity calls, and the system runs out of ambulances for several minutes or hours of the day. You may work in a rural area where typically, the people who call 911, are atleast sick. In the urban setting, you have a much different call volume, where people abuse EMS, and the EMS has to be the back-stop for all of the nursing homes, sporting events (amatuer, child, and pro), doctor's offices/clinics, and hospitals when the convalescent ambulances are not available --- but traditionally it is the poor, the drunk, and the stupid citizens who call 911 for anything and everything.