crotchitymedic1986

yes a tampon test is in order--- if it tastes sour, definitely toxic shock --- and are you saying you wouldnt narcan this patient. I have been around long enough to see what works and what doesnt, and how treatment protocols change every 2 years so a new book can be printed and purchased. For instance, Calcium Chloride converted more cardiac arrest patients than mega dose epi, vasopressin, or AEDs ever has combined --- but the PHDs seem to think otherwise.

No problem explaining at all: I would not trust a thing the little ones said, but is all you have to go on. The patient is hypotensive and tachycardic. Being 14, you can pretty much rule out a cardiac event, especially since the kid isnt on meds. The OP said no signs of trauma, so we know it is probably not a trauma event, but i immobilized anyway. The patient has been to the doctor recently and got a zebra, whatever that is to a 5 year old. Most kids in the hood only go to the doctor when they are sick -- they dont get wellness exams. So, why would a 14 year old with no history be at the doctor -- for an illness or a pregnancy in my humble opinion. When children in the hood get sick, sometimes they can not afford the expensive antibiotic or the follow-up visit, so the child could have worsened and became septic, or the more critical infectious diagnosis was missed by the doctor and the doctor thought he was treating a virus or an ear infection, when the child really had menengitis or a severe pneumonia. Narcan is part of the coma cocktail along with D50 that can/should be administered to anyone of altered LOC, when you do not know the cause (it wont hurt the patient -- I give it almost daily to altered nursing home patients who i suspect have been overmedicated to shut them up). This has nothing to do with the hood, lots of teenagers in the burbs are getting high on mommy's pain prescription. In all probability, this is probably an OD, because it was a fairly sudden onset. The child was fine earlier and is now near death. Yes anything is possible, she could have a SA or an undiagnosed heart condition, or even a AAA --- but that would be rare in an otherwise healthy pediatric patient.

Let me sarcastically respond with this question, do response times really matter (remember this is slightly tongue in cheek) especially in a rural environment ? 1. In most rural environments, you also have a rural hospital that is likely to not be a trauma center, a stroke center, or have cardiac cath/CABG. So lets say you get there in 6 minutes, and then transport to your local rural hospital/nursing home/Tire and Lube Center, what have you accomplished ? They still have to be transported to the city hospital. But then you say, we can fly them -- Ok, you get there in 6 minutes, and 40 minutes later the helicopter is patient loaded and lifting off -- so what ? 2. What about cardiac arrest, surely you want to get there quickly and save them, dont you ? What percentage of your calls are cardiac arrests -- 1%, and of that group of patients how many walk out of the hospital -- maybe 10-20% of that 1% (remember going to closest rural hospital). So is it responsible to spend millions to save less than 1/2 of 1% of your patients ? 3. I would argue that probably 90-95% of your patients would survive a 30 minute response time. So again, if only a small percentage would benefit, is it worth all the money. It would kind of be like building a dialysis center in your rural community because you had "1" CRF patient in your town. 4. What about the golden hour --- how many multisystem, critical trauma patients survive to walk out of the hospital -- especially with the trauma center being so far away ? Get me a hot pizza delivered in 10 minutes, as that is important. Most people who call 911 can wait 20-30 minutes (just look at any urban 911 system on friday night).

Well since she is 14 and has been to the doctor, she is either pregnant or was ill. Since she is not on any medications, most chronic ailments can probably be ruled out (Sickle Cell, Asthma, Congenital Heart Problems). Since the other kids are fine, can probably rule out CO poisoning. Regardless of cause, treatment is the same --- A-B-C- Immobilize, Intubate --- D-Stick, Narcan, 10-20 cc/kg fluid bolus (followed by Doapamine if no improvement -- not for cardiac, but because i believe she is severely septic). Best Guesses: 1. Infectious Illness / Sepsis / Menengitis 2. Pregnancy related issues 3. Drug OD / Poisoning 4. Brain illness or injury -- Spinal Trauma or other internal trauma

Ashley, here is a street medic axiom that you should get familiar with --- "It is better to be tried by 12 (meaning a jury), than to be carried by 6 (pallbearers). Never let an out of control patient put your's or their life in jeopardy. Sounds like your company needs to take a new look at their protocols for cardiac arrest and combative patients. Even if you dont have a protocol to stop CPR, you can always call the ER, paint the picture for the physician, and get an order to stop CPR. It is a waste of resources to tie up an ambulance performing CPR on a corpse (not to mention a safety issue for driving the corpse to the ER lights and sirens).

Actually what i enjoyed most about my old EMS job was precepting baby medics. You should have seen the look on their faces when i told them that they have to assess their patients without the use of a B/P cuff, cardiac monitor, pulse ox, or glucometer -- give me their diagnosis and probable treatment plan, and only then would they be allowed to play with the toys (especially the cocky ones who thought they knew a thing or two cause they passed their registry on the first go around).

all three were fighting over the crack rocks they found under mom's mattress. Three year old put a cap in her sista's ass with baby daddy's 9mm -- 5 year old shoved her down the steps to make it look like an accident (they have watched CSI before)

I agree, trauma doesnt do it for me -- no challenge there --- backboard, ccollar, one IV or two -- the only question is helicopter or not ? I like a good challenge -- the elderly patient on the grocery sack full of meds -- the dig toxic patient at the nursing home. But what I really enjoy is being able to tell the new nurse or doctor what the patient's diagnosis is, or when i tell them that patient's gonna code in about 30 minutes, and they give you the deer in the headlight look, or the look of "yeah right, what have you been smoking", and then you are proven right -- with no lab, no xray. Or when you start the IV on the patient they stuck 20 times already. Priceless ...

John Denver -- Country Road, take me home, to the place I belong ....................

I hear you -- i dont need a watch/clock to count a pulse and i can usually guess a pulse ox reading within 2% points by just assessing the patient. Which reminds me do any of you play the "guess" the patient while enroute to the call game --- we had it down to a science as to what kind of clothing they would be in, whether they would be amputee or not, time of onset of symptoms, which hospital they went to -- we could even guess how many teeth they had based on the trailer park we were responding too.

Fiznat gave you some great info, but even with that information, many abdominal pain signs and symptoms are shared by many ailments. I have seen to many critical pancreatitis or ileus patients who were not transported by EMS. The good news is that most of these ailments are not life-threatening, so as long as you have your AAA signs and symptoms down pat, and you do transport all of them, you will probably not get burned by sending them via BLS unit. It is when you choose not to transport them that they will get burned (this assumes you mean EMTI, where the BLS unit can start an IV). But even in the event of a AAA, it may be better to do a rapid BLS transport (with maybe an ALS intercept) versus waiting on the scene for an ALS transport -- there is little that ALS can fix once the AAA ruptures.

IN my humble opinion, any penetrating stab wound to the torso is a load and go, regardless of how stable the vital signs are. So if the first transport unit on the scene was EMTI, then they should have immediately transported and asked for an medic intercept if they felt they needed one. I know that we can argue all day about whether or not this was a cut or a stab wound, and it would be nice to know the size and length of the blade, but as anyone who has been doing this more than 10 years knows (and by the stories that have already been stated here) this is the kind of patient that crashes on you and makes you look like an idiot. If I am reading this right, the ALS fire transport unit deemed it OK, to wait on the scene for a BLS transport unit ? I wouldnt want to be in those medic's shoes if this patient did crash.

My immediate answer would be no, just because of the experience factor, especially in a small or rural department where critical calls are not an everyday event. I am sure the young lad is very talented, and may be very book smart, but there are some calls you only get every 5-10 years in EMS, and I doubt he has seen "everything" yet. To be in a position of command, he has to be able to handle every situation that could occur. With that being said, I see no problem with a department having a leadership training program that allows the under 21 crowd to train for that future position. But if he has had leadership training, and is the best the department has to offer, then so be it.

If it comes to a lawsuit, everyone on the scene will be named in the suit, regardless of rank/certification. Then you will have to defend your actions/inactions through your documentation of the call and your company's policies and procedures manual. Two ways to handle this are: 1. As mentioned above, your department can create a POLICY that states, once someone of higher training arrives on the scene, and they want to provide patient care, they will have to ride to the hospital with the patient, and assume responsibility for their actions. 2. Have a written policy that states that whenever there is a conflict on the scene, medical control will be contacted for advice (medical control could be the closest ER or a specific ER for your service). Just as you could have a podiatrist show up, who thinks he needs to crack a chest. You could have a Paramedic on the scene who doesnt have a clue or EMTs that dont have a clue. Get a supervisor or medical control involved, and document what happened and at who's direction.

Thats not a bad idea. At one of the private services I worked at, everyone had to walk in the others shoes - disptachers, medics, billing staff. It made for a better work environment and patience among all staffers. I have also seen it work when we were having a problem with one ER, we invited their manager to come ride with us, and after 6 hours of getting diverted and hearing the attitude of her staff on the radio, things changed in that ER. I think it is a great trade off if you can get nurses and medics to swap shoes for a few hours.

It would never work. To be a fireman you have to have a "real" job in construction, electrical, or plumbing, and use the Fire Department for benefits only. Paramedics work at their full-time profession, and then freelance at their part-time EMS job. If paramedics took over the fired department, it would no longer be a frat house, it would be forward moving, thinking man's profession. Cant have that.

I am thinking morphine may be a bit strong for your SS patients. Much like the patient who has learned to go an hour away to get his narcs, once word gets out that you are giving morphine to these patients, they will always call the ambulance. Do you have a less potent narcotic like Fentanyl or Versed ?

I am shocked you whities didnt come up with more, I left the door wide open for you. But if you are out of african american comments, we can move to other groups --- what would it be like if mexicans, asians, canadians, or white rednecks join in ?

I would be interested in seeing the ER's chart. What were the initial v/s the ER got, how long was it before he coded. The details we have been given were from an EMS review, where a rosier picture may have been painted by medics who knew the patient died and were covering their butts. The H&H stated is hard to believe with the B/P listed (not impossible). If the patient died within 10-15 minutes of ER arrival, I am thinking the medics may have not recognized the severity of the situation. Obvioulsy, I wasnt there, so i cant second guess them, but my guess is this was an altered, pale, critical patient who got a "pediatric bolus".

I am sorry, but with those scant details it could be anything from an orgasm to a AAA or SA --- give us some details.

I wished I had a copy of one i had last year that perplexed me for several minutes -- the patient had a pacemaker which was firing with every beat. The "p" wave initially looked as though it was "moving", indicating a complete heart block, but when you measured it out, you discovered that she was really in wenkebach, but the pacemaker wouldnt let the QRS drop.

You didnt mention why the patient is on two narcotics. The most likely scenario is granny was high. I would have started with some Narcan and see if LOC improved. But the main lesson to be learned here is that all old people need to be transported. I cant tell you the number of times i have seen medics leave elderly people at home that have had a single syncopal episode. I am sorry, i dont care if you are 98 or 18 it is not normal to lose consciousness. My general rule is that i transport everyone under age 5 and over age 70, regardless of complaint.

Thats odd, I would think Madonna's bikinni waxer would have the germiest job.

OK, and here is one for EMT CITY POSTERS -- sorry if i step on someone's toes here. If you are the first to respond to someones question or post, there is no need to copy and paste that question or post into your response. It's right there above your post, we can see it. And if we dont need to copy and paste it twice, we surely dont need to copy and paste 6 or 7 times. If you must cut and paste, can you please just copy and paste the name of the poster, or maybe the first line of their question, instead of the entire 200+ word rant ?

How about the amount of money we waste on 911 Centers. Why do we need one for every county and city ? If microsoft and dell can handle all of their customer calls from one center in India, why cant we cut down the 911 centers to maybe 2 or 3 mega centers per state ?