wrmedic82

Granted but you have vertigo so you fall over every few steps... I believe it would look something like this

I wish my senior year of high school was done

btw I'm new here

Wish granted you are done with your senior year but now you have been solicited by your parents to babysit the neighbors screaming 2 year old.

I wish that we no longer run nursing home calls or renal round up

These are our protocols

Psychiatric Emergencies (including Excited/Hyperactive Delirium)

Basic Life Support

1. Maintain scene safety. If scene is unsafe, leave and stage for the police department.

2. Consider requesting law enforcement assistance

1. Advise against the utilization of a Taser if Excited Delirium, especially

multiple Taser use.

3. ABCs

4. Oxygen (as indicated)

5. NPO

6. History & physical, vital signs, secondary assessment

7. Measure blood glucose as indicated

8. Provide protection and maintain body temperature or cool patient as needed

9. Reassurance and position of comfort, if hypotensive, elevate feet

10. If patient is spitting, apply an approved spit hood.

Intermediate

1. Airway management as indicated

2. Intravenous access (if possible)

ALS First Responder

1. Cardiac monitor

FRO Advanced / Lead Secondary Paramedic

1. If the patient is violent and a danger to himself/herself or others:

a. Soft, four point physical restraints – utilize properly manufactured soft

restraints on upper and lower extremities

b. Midazolam 5 mg deep IM/slow IVP/IN if needed to protect the patient

and/or crew;

i. As a last resort, you may administer IM through the pants on the

lateral thigh

c. 250ml normal saline IVB, may repeat if necessary

2. 12-lead ECG acquisition and transmission (if available) as indicated

Conditional Primary Paramedic / Primary Paramedic

1. If it is probable that the patient is in full cardiac arrest from a Excited Delirium, refer

to the appropriate ACLS protocol and administer first round of ACLS medicines first,

then administer Sodium Bicarbonate 1 meq/kg IVP.

BSP Orders

1. Additional Midazolam

2. Haloperidol (Haldol) 5-10 mg IM only

3. Benadryl 25 mg IVP/IM for dystonia

4. Further therapy orders

when in doubt, shock the person into a rhythm you can treat. j/k I think you will do find. you probably have seen how to do the skills a million times. You can do it. I have faith in ya.

I run my tired butt all day with very little downtime. I work 16hr shifts and its not uncommon for us to run 15 people to the hospital.(this is minus release at scenes, and AMA's) The company runs as a whole anywhere from 300-400+ calls a day. Sometimes we get to sit for some time but thats a crapshoot.

It wasn't as if he had an abnormal amount of gas, he was farting to make people laugh and be obnoxious. I don't see a problem in the suspension. It falls under "disruptive behavior"

I have never heard of anyone having any type of problems other than being disgusted by the smell of flatulence in the air. Its not like he ( the bus driver) never ripped one and the kids behind him were left to suffer.

And come on its not like they were lighting a bag of poo on fire for him to step on.

(sorry been watching billy madison)

It just blows me away that RN instructors can teach this program when very, very few have ever actually run a code nor ever intubated anyone ... sheesh.

Flash box ? Funny thing that's a BLS skill set ? I even had one bystander tell me we were not following 30:2 with an intubated patient ... hmmmm.

Last course I was on a senario was presented ... Pulmonary Emboli .. The RN instructor told the student that "Coarse Rhonchi" heard over the affected side .. I quietly protested to the MD oveseer and it was never corrected ..... OMG shock and awe.

Because they set the standards ?

cheers

Was the bystander a health care provider or someone who took a heartstart coarse ? That would explain that. If they were health care providers...then they just dont know any better. But anywho, about ACLS. I guess you cant ding EMS or say that's the day EMS died as much as healthcare as a whole.(going off the main topic not the quote above) MD's RN's EMTP's and so forth take the same class, same tests, and everything for the class. If Im getting this wrong feel free to let me know. Ive been known to put my foot in my mouth a time or two. Spenac can testify to that. But is there really any data out there that suggests true competency or incompetency with ACLS providers?

Not sure I can agree with you on that point. Nothing to suggest she was "stupid." The incident occurred and she initially felt fine, had no noticeable problems, and refused. I dare say many of us would do the same thing.

What are we to do, demand a CT with every injury? As Doczilla stated, there are pitfalls to having CT's. Even one CT may potentially increase your cancer risk. While it is common technology, it is a diagnostic procedure with potential risks.

Take care,

chbare.

I was making a generalized statement, nothing towards the person on topic. I guess I was somewhat still hinging on my last post as when a patient that is fully informed that they could die or be a vegetable, and they choose to take chances. In that case you cant help stupid.

judge 3....weak

From the report I read, she was NOT seen by a paramedic- the ALS crew was held up enroute and did not make patient contact because the patient did not want treatment. She signed a release and later developed symptoms. I wouldn't fault the original providers, assuming they gave the usual warnings.

cant help stupid...that is a preexisting condition

Only thing I can say to this sad story is always advise patient's of the risks of not being evaluated. Im not saying they all have to be evaluated in the ER, but by a physician. Whether that be primary care, or a doc in a box. (not that I think highly of doc in a box places)

After you have given the patient enough information to make an informed decision, mindful that they are legally competent to make a rational decision. If they still want to take their chances and go on their own. Then its on them.

Cant help on my lunch break

DE DE DE

ok yes this subject and similiar subjects got hacked to death a while back to the point of near violence, this will be death of us.......we need to get away from fire.............we all need to be fire.....................loose the attitudes.................more money.............national unity of one way to operate and treat........ok fine yea yeah yeah.

look we cant bitch at each other that gets us nowhere.

WE NEED TO LET THE POLITICIANS KNOW WE ARE TIRED BROKE PISSED UPSET AND SICK OF ALL THIS NONSENSE.

unless one of you have a better realistic idea...........REALISTIC IDEA...ONE WITH REALITY THAT WILL WORK. no bitching amongs each other what will work that all parties will like......im not a politician i hate politics but they are the ones controlling things like insurance reimbursements and all that

anyone have a purposal ????

What I tell everyone who bitches about fire/ems. Its not the service, its the attitude of the provider. If the medics attitude is not towards the well-being of the patient, patient care ultimately suffers. This can also be seen in private ambulance services as well.

I know in the state of Texas, Firefighters are only required 20 hrs CE per year to renew certification. It also is the firefighter's responsibility to maintain their EMS cert. (72 hrs EMTB, 104 hrs EMTI, 142 EMTP). I do agree that more focus should be on education per year vs every 4 years. I am also for 1 uniform certification for all EMS providers. I am also for designated drivers trained only to drive the ambulance to and from calls. I also think there should be legislation on the books that give certain criteria for lawsuits concerning health care providers. (not just EMS). I also think there should be a law making it a class B misdemeanor for abuse of the 911 system.

I have cast my 2 cents there.

take care, be safe.

Whats even worse you can now do EMT, EMT-I, and EMT-P online. Welcome to the new information age of EMS

Ive also seen a 15 day EMT-B Boot Camp, as well as 3 month accelerated paramedic program.

Hope your a fast learner.

Anytime fire runs EMS, EMS is affected.

My belief on that is, its not necessarily the occupation (i.e. Fire/EMS) but rather the attitude of the medic on the truck. If someone wants to be there to help people then that's what they will do. If all they want to do is fight fire, then they will suck at their job. I don't think its completely fair to say all fire medics perform crappy patient care. But there are a lot of them that don't want to be on a ambulance. Which sucks because I foresee lot of municipalities moving faster towards fire based EMS in order to cut costs. I do think running BLS only would be a big mistake for Columbus though.

That is my opinion care to disagree if you like.

3 words

-Soft Restraints

-Versed

We use priority dispatch in our system. I have never been too fond of it. One draw back to it is that people are getting "smart" and learning what to say to get a ambulance to them quick. So they know what to say to get a P1 or P2 response (L&S). I have noticed that in our system there has been more critical patient's with P3 response (no L&S) in which we have run to the hospital P2.

So I do think that is hinders the system to a certain point. Also our dispatchers rarely use discretion so that may also play a part in it as well. Some that have played in the field do. But for the most part its all scripted.

Im assuming ( i hope lightning doesnt strike me by saying this) this is a 3-lead strip. Since 12-lead is unavailable. I would say you can take the LA lead and place it where V1, V2 ect to look at individual leads. Takes more time and not as reliable..but its something to go by to give you an idea.

Now as far as giving nitro to the patient w/o IV access. Thats a judgement call you would have to make based on how the patient presents to you. If they are a bit tachycardic and they have the systolic above 110, you can give probably 1 spray and might be able to get away with it. However you leave yourself vulnerable if it just so happen to work a little too well.Its also possible the only way the patient is compensating to sustain that pressure is because of the tachycardia. Trendelinberg could be an option to help raise BP, not that Im a big fan of trendelinberg as I have read in a study that it can cause more harm than good.

(in a nutshell by placing patient in trendelinberg, fluid shifts to the torso, thus tricking the body to thinking it is ok, and stopping the release of catechlomines. so once patient returns in the ER to a semi fowlers postion, the body has a difficult time catching up)

And for those spell checkers out there I will say this in advance.. Bite me lol

Have a good night.

Just when you thought you have seen humanity at the lowest levels.....then you watched that...... Makes me appreciate all those psych calls I get 5 minutes til end of shift.

Im with EMT on that. regardless of cause of the increased ICP. The patient needs a neurosurgeon like a fish needs water. I know its a corny analogy but its early for me.

Its the governments solution to helping parents who dont know how to be parents...we all know the type...not saying its right..But who's going to start the initiative? we know who should, but lets face it there are alot out there that dont which screws others that act like parents. it sucks

I also meant to ask what do the pupils look like?

Any signs of trauma?

Based on the presentation stated above I would assess ABC's (that how I start on every patient regardless of CC) manage airway if indicated. I would also put the patient on O2. Since we have the fancy shmancy monitors that digitally monitor ETCO2 with NC. I would put them on that and see what readings we get. ECG.d-stick.Attempt IV access so I can unload benzos if needed. Monitor and reassess. So now what I would like to know is this

Rate and Rhythm

ETCO2

Glucose mg/dL

SpO2

No necessarily in that order. Also I had a brain fart is there any PHx?