crotchitymedic1986

ddddoooooooopppppppppppp -- got to learn how to type -- that should be 5 MCG not mg

If someone has already posted this previously, i apologize. I offer you an easy way to differentiate the four main heartblocks for your ACLS or Paramedic test. It is called the CICI's Pizza Method (I realize many have not heard of this chain of restaurants, but it helps you remember). Write C I C I vertically on your paper, then write your blocks in order beside it 1-3rd degree:

C 1st degree

I 2nd type 1 (wenkebach)

C 2nd type 2

I 3rd degree

"C" stands for consistent PR interval --- so if your PR interval is consistent, the rhythm is either type 1 (which just has a longer pr interval) or it is 2nd type 2 -- where there are more than one p-wave, but the p waves march out and stay consistent.

"I" stands for inconsistent PR interval -- if your PR interval is inconsistent then it is either 2nd type 1, which would be indicated by a dropped QRS, or it is 3rd degree which would be indicated by multiple random "p" waves that do not relate to the QRS

*** In real life, patients may go back and forth from one block to another as you monitor them. This is to help you pass your test only. It helps you whittle it down until you get very familiar with the blocks.

I have been doing this so long, i have most of them memorized -- but here is an easy way to remember dopamine, which is usually the hardest --- multiply everything together / divide by concentration. Example, give 5mg for 80kg pt : 5mg x 80kg x 60minutes = 24000 / divided by concentration of dopamine (my truck was 1600) = 15

way to go mateo -- you hit it on the head. The clue was the new exercise routine, which also included a new crazy fad diet (at 3am i didnt think to ask about that). His potassium bottomed out which caused the muscle weakness and arrythmia. A little KCL in his IVbag and he was as good as new.

yes delta, it is nice to have all the information.

i hear you, but please humor me -- give me your top 5 you would no longer transport under any circumstance

I feel your frustration -- but the problem comes in "where do you draw the line". You could make a legitimate arguement that over 90% of the people who call 911 are not experiencing a life-threatening emergency and would survive a trip to the ER or doctor in their car. But lets just wave the magic wand for a much smaller percentage than that ---If your services call-volume dropped by 20-30% (once everyone is educated to only call for emergencies) over the next year, do you honestly believe you would not feel some cuts in service. Look around at fire departments that have done such a good job in code enforcement and education, that they had to close fire stations due to lack of fires.

Where would you draw the lines --- kids with fever, isolated upper extremity fractures, cold/flu, chronic illnesses/pain, abdominal pain, UTIs, Migraine HAs --- who would you refuse to transport ----- and would it matter if you were a taxpayor funded system and the person had no transportation (assume its rural and there is no transit system). Not argueing with you, just wondering how you are gonna implement your plan ?

well then, i would schedule some training for those medics, because they obviously didnt know the signs and symptoms of someone who was bleeding to death.

I don't have to tell you people, times are tough. You read the papers. The country's going to hell. Now you take inflation. Recession. Welfare.

Harry Fishbine - mother, jugs, and speed.

take the oil, leaving an x-rated version of charlie brown, where linus, charlie, and pigpen gangbang the red-headed girl

I had no doubt that you would transport those with lifethreatening symptoms, what i meant was that i would transport with a minimal illness or injury (flu or simple laceration) if they demanded transport. Because I have seen what happens when you dont and the patient files a complaint stating you didnt take them because you were racist or because they didnt have insurance ---blah, blah, blah. I found that i could either not transport 16 patients during my 24 hour shift, or i could transport 6-8. It was easier to just drive them the 8 miles to the hospital and be done with it, rather than argueing with them on the scene, having them call back later, then have them file a complaint.

But i feel your pain -- we had a drugseeker who called 8-10/week, we would transport him to the ER, they wouldnt give him the narcs he wanted, he would get a friend to drive him home, and he would call 911 again to go to a different hospital. PD wouldnt touch it (as an abuse issue), so we had our medical director make an order that if he called 911, we would only transport to the hospital in our county, and he worked with that ER to insure they wouldnt prescribe him any pain meds -- so he started taking his own car to more distant places, and stopped calling 911.

WIthout all of the information, its hard to say. Were orthostatics taken -- the patient may have had a much lower b/p standing (especially with the H&H you stated --- which may be why the doctor was upset, because they did do orthos and found a much lower number). Was the patient average truck-driver size or a tiny fellow ? I probably would have bolused with 500-1000cc and then rechecked v/s. Either way, he needs a transfusion more than he needs fluid, so they should have been happy that he had 2 IV sites.

If they were filming your shift of calls for a tv show, what background songs would you want played for the calls you ran today:

example

GSW to the head -- another one bites the dust

MI -- achey-breaky heart

Psych -- insane in the membrane

Seizure - shake, rattle, and roll

sure you guys can do better

I am not aware of any law, but I am aware of:

1. If you are hospital owned, you fall under JCAHO. I am not aware if it was every clearly clarified if the hospital owned ambulance being called is the same as coming to hospital property. Meaning you can not refuse "care" - defined as stabilization - not transport. I have seen inerpretations of that rule in both directions.

2. While there may not be a law, I think it is a bad practice to refuse transport of someone who is REALLY ill or injured, as there is no defense for your actions in a court of law if you are wrong and the patient has a negative outcome. Just open up the checkbook and be prepared to write a big check. Ambulance crew refuses to take patient to the hospital, never sounds good on the 6pm news.

3. I knew of a 911 service that implemented a no transport for DNR patients, which was disasterous. Grandma dying, ambulance comes, refuses to take grandma -- family and nursing homes are upset.

1. Dress professionally -- not sexy.

2. Dont wear perfume -- you will probably be in a small office with the door closed, dont want to overpower them.

3. Be atleast 20-30 minutes early.

4. Be prepared to answer questions in detail with real life examples -- most employers have moved away from yes and no questions. Instead of do you work well with others, you are more likely to hear, "tell me about a time you had to deal with a difficult customer or coworker" or "tell me about the biggest professional mistake you have made in your life, and what you learned from it", or "tell me about a time when you went above and beyond at your last employer". The purpose of this type of questioning is to hear the "real you" not the "interview you" -- be careful how you respond, as honesty can trip you up -- for instance, "at my last job, i had this boss that was an asshole -- he was constantly writing me up, so i demanded a transfer to a different shift".

5. Smile

6. Be positive -- no negative answers to any questions

7. Be concise, do not get diarrhea of the mouth.

8. Ask a good follow up question like, "are there opportunites for advancement here, if i work hard", or "would i have the opportunity to work on special projects or committees".

9. Do not get too much into salary/benefits during first interview -- let the boss bring it up.

10. Get a business card from the boss/HR person and email them later that day to thank them for the interview.

Great point dustdevil, as i typed the line about "the driver only had to be trained in CPR", it immediately hit me that we have come full circle with EMTBs being allowed on the bus. And you are right about the trickle down effect, but i would say that is true in all of medicine. Everything "new" is usually driven by a new invention, gadget, or drug. What is really "new" in hospital care over the past 20 years ? Thrombolytics, heart caths, CABG, stroke treatment, implantible defibrillators/pacemakers -- we still cant cure the cold, blindness, diabetes, CRF, or met. cancer. For all of JCAHO's involvement in improving hospital care, I would say you have twice the likelyhood of being killed by a medical mistake or getting an infection during your hospital stay.

They say if you arent part of the solution, you are part of the problem, so how do we solve this. I have read suggestions regarding "national standards", but what if the new national standard is set at the minimal level -- we would like to think it would be a higher standard, but typically government sets low thresholds. I have read suggestions about more education and four year degrees, but I am not sure that will improve EMS or its pay, because our pay is proportional to reimbursement. Medicaid typically pays a hospital the same amount for a child birth whether it is done by a midwife or a doctor. Medicare changed to a reimbursement rate for ems that was based on georgraphy a few years ago. Are we to assume that they will pay more for an ALS transport because the medics on the truck had a degree, especially when the current insurance model is to hold/reduce cost and payouts ? If there is no increase in reimbursement, can our employers afford to pay you more (my answer to that is yes -- just as we have seen with recent fuel prices, they found a way to pay it, but if you asked them 3 years ago what they would have done if fuel prices went above $4.00/gallon, their kneejerk response would have been, we would have to go out of business.

So what is the answer ? How do we take EMS to the plateau that is talked about in this forum ?

or 2nd choice ....... leaving an original, still working, hand-held coleco football game machine.

take it --- leavin a pot of pinto beans and cornbread

not sure where we got off point -- but i did read the whole thread, so to save you the trouble:

I think what the OP was trying to say was:

1. You can not watch nudity on tv in any other business, and in most businesses if you were caught doing so, you would receive disciplinary action.

2. Wathcing nudity in the workplace at best was unprofessional in his/her opinon, could be possible sexual harassment.

3. Most people who have replied thought there was nothing wrong with the practice and that the original poster was an idiot, religous zealot, or a virgin.

I think that sums it up.

as doc said, we had them, but you had to make your own -- folding aluminum boards had hit the market, but were too expensive versus making your own -- I cant imagine bringing the wooden ones back; splinters in the hand, couldnt really get blood out of them once the polyurethane wore off -- and there was nothing like the pucker factor you experienced when you lifted a large patient and heard the board "crack".

The last service i worked at before getting out had the hydraulic/battery powered stretchers -- god, what a difference there would be in my spinal cord if we had those back in the day.

you will be humming this one the rest of the night, sorry ................

They're creepy and they're kooky,

Mysterious and spooky,

They're all together ooky,

The Addams Family.

Their house is a museum

Where people come to see 'em

They really are a scream

The Addams Family.

(Neat)

(Sweet)

(Petite)

So get a witches shawl on

A broomstick you can crawl on

We're gonna pay a call on

The Addams Family.

take it, i need some sausage -- leave a copy of Mother, Jugs, and Speed on DVD (now i have really dated myself)

ok

how about amiodarone versus lidocaine -- worth the price to keep amiodarone ?

Use of steroids in acute spinal cord patients in the field

pain management protocols in ems (narcotics for pain relief)

the use of CPAP or dobutamine for CHF

appropriateness of chemical sedation in the field

proper restraining techniques -- google "death by EMS" on merginet

Albuterol usage in CHF

I remember reading a good debate on here (cant remember which forum) about why medics do not use charcoal very often -- it is on the truck, we transport OD patients everyday, but ask a medic when was the last time they administered charcoal -- answer is usually never --- why is it ok to allow the drugs to continue being absorbed in the body when there is an antidote (for some) sitting in the drug box.

my bad, forgot this is a multinational/state forum --- "10-13" is a term for those mental patients who are committed to psychaitric care against their will. So this is about transporting psych patients who are suicidal, homicidal, or drug abusers. In many areas this is a PD function, in others areas ambulances transport them to the psych hospital. The issue is whether or not it is safe in an ambulance, and is appropriate since medics do not have "police" powers

a few more popped in my head -- and that should have been "will" instead of "what" in the question about universal health care.

Should ambulances transport 10-13 patients.

Are medics really underpaid/overpaid for the amount of education they have and number of hours worked versus other occupations with similar educational requirements

You want to approve RSI as a skill for all paramedics nationwide, it would be up to each individual state to set up rules/regulations and training standards -- is this a good thing or bad thing.

Are helicopters overused in EMS

You are a 911 provider who is struggling to meet budget cuts and your service may be privatized -- one proposal is to start running non-emergent/convalescent calls --- Pros, more revenue which may do away with the yearly privatization threat, more employees, more advancement --- cons: more calls, calls that take more time to run, employee morale/retention/recruitment.