dera

What medication was it that she took? I strongly suspect a phenothiazine-induced dystonic reaction, but differentials I would consider would include infection, due to her hx of nausea. Treatment would be diphenhydramine, 25-50mg, IM or IV. Transport, yes.

Training AEDs need to be with training materials. As you said, they should NEVER be placed with the regular AEDs, to stop just such a mistake. Also, why was an airport laborer installing them in the cabinets, rather than an EMS person from the airport?

Well, if it starts bleeding "later", then control bleeding at this point. I don't bandage every single cut.

And if they aren't with you any longer? Say, on their way to the ER via POV? If it is a deep enough lac to need further attention, it gets bandaged.

But it depends highly on circumstances. Assume a small but deep cut, not bleeding. I may not even transport this to a hospital (if no other reason exists) but send the patient to a doctor on their own transport medium. For this I even would bandage it. But when the patient has an indication for ambulance transport, then likely because of other more severe injuries, then I won't loose time on the non-bleeding cut.

Most of the time, my patients do go via POV for lacs. But you are correct, if they require more interventions, then the lowest priority wound/injury isn't tended to instantly. Doesn't mean it can't be later during transport, though.

Again, there may be exceptions: if the wound is likely to be contaminated during transport (contact with dirt or equipment) or may contaminate staff/equipment, then I most probably would put a pad on it.

Now, getting into the microbiological aspects... ALL WOUNDS ARE CONTAMINATED. Whether by whatever flora is on their skin, to the material that caused their injury, to the ground, the air, other surfaces. This is why they irrigate the hell out of wounds in the ER; to cut down on the foreign material in the wound, including those lovely microbes. I say protect it from further contamination, if possible. Do I do this for every abrasion, and small lac? Not all the time. But if I have the time, I certainly will attempt to.

Do you really really cover each single wound? My time/benefit calculation doesn't see much sense in this.

Why not? Your patient may be more comfortable for it also. Getting it covered can reduce pain from the air blowing on it. And my previous arguments of microbiological control, along with the possibility of it bleeding later. Why not prevent a little? Just because we are the ones who deal with things as they become issues doesn't mean we shouldn't work to prevent and issue from happening, or becoming worse, IMHO.

Just because it isn't freely bleeding right now, doesn't mean it won't later.

Bandage it well to control bleeding. Check CSM distally afterward to verify it isn't too tight, and ship 'em to the ER for closure.

This was in Circulation (and is free to read): http://circ.ahajournals.org/cgi/reprint/123/6/691

Hope it helps you!

Hi all, I am Nick. I've been wanting to be an EMT for a long time, and finally I have the chance, so I seized the opportunity. I am enrolled to start my EMT-B classes in June, and I was wondering if any of you had some tips for me.

1. Don't miss a single class.

2. Ask questions.

3. Read AHEAD. Be prepared before class.

4. Ask questions.

5. Practice, practice, practice. If there are extra practice sessions, go to them.

6. Ask questions.

7. Have fun!

Learning A&P is a stepwise process.

Nailing down anatomy is a matter of memorization. There are tricks to memorizing, but it still boils down to just KNOWING the bones, the muscles, the nerves, blood vessels, etc.

Physiology can also be memorized, partly. Physiology requires understanding the anatomy first, the function(s) second, the process for the function(s) third, and the result of proper and improper function. Physiology starts at the simple and progresses to the difficult.

Where are you having problems, specifically?

So i start school on the 31st for EMT-B.... I need boots for school, so i went boot shopping and you can get a pair anywhere from $50-200... I know i dont need anything wonderful for school however, i dont want to spend money on boots now then turn around and buy boots again after school is done that will just cost more money in the long run. So i am trying to figure out a good pair of boots i can use for school then out in the field... What does everyone recommend? Also zip up or non-zip? Slip no slip so on... Thanks everyone

Have you asked your upcoming instructor or program if they have a requirement?

Many want polishable boots that are bloodborne pathogen resistant (You want them that way also!). There are some that are reasonably priced that do this. I wear 5.11 ATAC Storm boots. They run about $100/pair. Are they my boot of choice? No. But they work for me. They are waterproof almost to the top, side-zip, polishable, and decent. My boot of choice is either Redbacks or Magnums, but both are a bit outside my price range right now. Avoid the Walmart boots. They fall apart.

You want something you can work in. If your feet are killing you at the end of the day because of a crappy boot, then it isn't worth it.

Hello,

You are dispatched for a 67 year-old male with a complaint of numb feet and trouble breathing.

On arrival you find the patient sitting in bed with three pillows behind his back. He appears pale, diaphoretic, anxious with increased work of breathing.

The patient had a bad pneumonia two weeks ago which he was on Zythromax. Things seemed to have gotten better and the patient was feeling more like himself. He was able to walk short distances and get up and down the stairs.

Then, over the last 24 hours, the patient experienced a burning sensation in his feet. Which has progressed to worsening weakness in the patient`s legs and very bad lower back pain. Over the last few hours the patient has experienced worsening dyspnea and feels like he is dying.

His family says he is so weak that he can no longer more his legs very well.

The patient has a history of NSTEMI in 2007, CHF, HTN, DM, Dyslipemia, OA, CRF, as well a severe PVD with a Femoro-Femoral Bypass surgery in 2009.

Cheers..

Hmmm... a couple of possibilities...

Pulmonary Embolism is high up on my list of suspicion right now, with his HX of PVD and fem-pop bypass, along with the dyslipidemia. AAA is a possibility, especially with the back pain and difficulty moving his legs, as is an MI, but I'm putting my initial thoughts on a PE.

What are his O2 sats? What does an ECG show?

What meds is he taking aside from the Z-max?

His renal failure also makes me wonder... When did he last dialyze? Is he fluid overloaded? Fluid overload doesn't usually cause the issues with his legs, but certainly can cause the dyspnea (and back pain, BTW).

I love it!

My condolences to their families. May they rest in peace.

Here is mine:

(Yep, that's a rubber chicken on a keychain)

Ok so i Just got my county Certification In california,Sacramento to be more Specific, And im 19 Years old and i really would love to start working I Have had a job sense i was 16(this job is not in the healthcare field) consistantly hard worker, Ive applied to every ambulance company in Sacramento approx. 6 but there are a few i ignored and some i applied to even though they said the same thing as the others..... must be 21 or older.... now this really is a downer to me, and none have called back or when i call just tell me the will get back to me theres nothing more i want to do then get on an ambulance and start working and helping people, but well voluntering is not an option for me, almost no agency accept volunteers and also i have to work to live i dont have parents. Please any assistance,tips ,advice, help on this would be amazing thank you.

Being under 21 with an EMT cert is a problem in Sacramento County (and across the state), as many agencies and providers will not hire, due to their vehicle insurance, pure and simple.

SacEMT: Check your private messages.

As an employer I would appreciate an up front applicant rather than for me to find out the hard way. All that will do is alienate you and your employer and likely have you back in the employment line real quick. If I have a student who wants to work for me I make the extra effort to ensure they have time off for school and still give them as many hours as I can. I consider it a two way street. If I give them as much opportunity as possible to complete their education, then I may end up with a paramedic working for me, at least for a while.

I agree with Arctickat. I am also an EMS provider, and I appreciate honesty regarding careers. We know most EMTs don't stay EMTs, primarily due to the pay. It is an open door to begin a medical career. I work with my staff who are in school, and encourage them to continue their tracks. Be truthful to your current and prospective employers. Those who won't hire you because you are in school aren't worth working for, IMHO.

Let me preface this topic by saying that I am seeking opinions for any and all who care to discuss the topic below.

I have been with my current company about five years now, and have had the privlage of working in multiple operations through out the nation. As of recent I moved to the North East and found a practice they have had in place to cause my stomach to churn with doubt.

Post a run I am to call into the dispatch center for my run number and times. I do this and am then asked to give to the dispatcher the pt's name, SSN, DOB, and any insurance information should they have insurance.

Please understand that I have never done this practice at any other operations I have worked at, and all of those operations have been with this company. I don't feel that a dispatcher has any right to this information nor do they have any need for it.

Could this be construed as a violation of HIPPA? While I realize that it's simple patient demographics, I am intrusted with caring for that patient's information and I just don't feel right giving it to a dispatcher. Is my feeling justified? What are you thoughts! This topic has been plaguing me for a month now!

While this may not be a direct violation of HIPPA, this information does not need to be provided over airwaves. The ePCR or paper PCR can be matched up after shift to provide that information with disclosure of sensitive information that could be used in identity theft, which I think is a bigger threat than a HIPPA violation.

Our company policy is to NEVER release a patient name over the air. We do allow age, sex, chief complaint, and disposition over the air. All other data is on the PCR, and has no place in being said over airwaves.

I was called to a 57 y/o man complaining of a sudden onset of mid line abdominal pain while sitting in his office doing some paper work. Patient has a history of hypertension and high cholesterol and is non compliant with his meds. Patient had not eaten lunch yet and tells us the pain feels as if something is "pulling apart" in his belly and lifts up his shirt to reveal an vertical 5-8cm oval lump in his abdomen just off the mid line. While in route to the hospital my EMT "ride along" placed him on oxygen, moves down and begins to palpate the abdomen? I yanked his hands up telling him not touch the any of my patients abdomens, ever!

Regardless of what anyone thinks is wrong with this patient, could someone please tell me why we still teach EMTs to palpate the abdomen!

Why NOT teach them? I for one believe that it is an important part of doing a complete assessment. And I agree with the previous poster about lung sounds. It isn't hard to learn, and provides valuable information. EMTs have long had skills removed from their education, and in some cases, now it is being reintroduced (Combitube and other airway adjuncts). Remember the old EOA?

Two theme songs:

"I'm Alright" by Kenny Loggins

and

"How To Save a Life" by The Fray (The title is perfect)

A&P will definitely be of help. The anatomy portion is rote memorization, but the physiology will provide you with wonderful knowledge that will help you to understand a lot more of what you will be learning in your EMT class. If you can dedicate the time, I'd say go for it!

Agreed on the chemistry recommendation. The first week or so of A&P is the goddamn Krebs Cycle, and other molecular processes that will leave you scratching your head if you don't understand basic chemical structure.