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Everything posted by HERBIE1

  1. Actually I found out the hard way the effects of albuterol on labor. The wife was in labor, and she is an asthmatic. We waited until contractions were pretty close- 5 minutes apart- before we went to the hospital- 10 minutes away. (2nd kid) Only 3-4cms dilated, so we did laps around the floor for awhile, and things were progressing nicely. Of course she got winded, took some albuterol, and things came to a grinding halt. I asked why the slowdown, and they told me exactly that- albuterol is similar to something used to stop preterm labor. Took about an hour to wear off, and then things went into overdrive- to the point where I almost delivered my daughter on my own in the birthing room.LOL
  2. I responded on your blog, but I will reiterate some of what I said here, and offer a tip or 2. Since your experience is lacking, I would try to differentiate yourself from other management candidates with education. As spenac says, whether or not an area "appreciates" a degree or education is highly variable. Look into management and leadership courses- specifically ones that provide you with theories in various types of management and leadership styles. Ideally a degree would be best, and it does not need to be specific to EMS- management is management- but again- make up for your lack of practical experience with education. As I mentioned, the trick is being able to apply those principles to EMS problems, and for that, you may need some help- depending on what you have experienced so far in your career. I have known a couple folks who had very little practical experience, yet managed to find office gigs within the EMS system. Rare-yes. Also consider taking classes that you could apply to more than one situation- maybe branch out into Homeland Security or public safety in general. Good luck.
  3. I thought I posted this before but it seems to have disappeared. The leave 'em dead thing was a JOKE- from years ago. It was not a comment on the drug's efficacy. I haven't been here in awhile and I forgot how flip comments are too often misinterpreted.I thought this was a more lighthearted thread- my bad.
  4. Not sure if it caused emesis, but I did always hear it referred to as "Leave'em dead". LOL Aminophyline was another one famous for causing projectile vomiting- not a good thing for someone already in respiratory distress. . Sadly, I recall times when aminophylline and epinephrine were the only medications we had on board to treat asthma. Lots of people died because we were so behind the times.
  5. HERBIE1

    Last blog post

    I see you did your initial foray into EMS in 1978. Not sure when you returned, or how long you've been doing it again. As for getting into management, generally yes, you do need some field experience for credibility and to really understand the issues facing the providers and the company in general. Is it mandatory? No- especially in a company where their may be multiple managerial positions- such as operations, clinical, training, etc. If you have managerial training without the field experience, you could lean on the other managers for advice on how to integrate leadership and managerial concepts and direct them to EMS issues. Obviously this would mean you needed to convince a company of your value- despite a lack of field experience. Good managers are rare- especially ones who have the educational background in leadership and management, and the ones who berate and belittle employees clearly are lacking in that department. Bottom line- EMS needs better leaders AND better managers, Good luck,
  6. Never had physostigmine, but I recall "fondly" squeezing Procardia capsules. Another drug that I was extremely excited to see go by the wayside- at least for prehospital use- was Verapamil. Never had a chance to use it on the streets, but YEARS ago(25+), I was working in an ER and a 25 year old kid walked in off the street, c/o being dizzy. Turned out he was in SVT and being a pretty new medic, I had only witnessed a couple cardioversions- chemical or otherwise, so I was really interested. The ER used Verapamil, and to make a long story short, after the drug was pushed, the kid's BP immediately bottomed out, he coded and died. To this day I recall that incident like it happened yesterday. I thanked the EMS gods when adenosine became available.
  7. HERBIE1


    Sorry- didn't finish the prior post. Hope all is well with everyone here, and I will try to jump back in. Looks like I will be teaching again in a couple weeks, have another couple possible adjunct teaching gigs in the works, so it's time to get my brain back in gear. Happy to be back!
  8. HERBIE1


    Been awhile, folks. Life gets in the way sometimes, and unfortunately, said life sucks. Going through a divorce, helping mom recover from an aortic valve replacement a couple months ago, dealing with her altered mental status-which worsened after the surgery.
  9. Richard- forgive my tardiness in replying. Sorry to hear of your troubles. Positive vibes being sent your way...
  10. This may sound good in theory, but it's simply not practical. I don't know where you work, but there are many places that simply cannot afford to have ALS providers. In less populous areas, you may only have a couple advanced level providers for an entire county. In my state, there are more than double the number of EMTB's as there are paramedics, and we have several large cities. I would imagine in the more rural states and areas with a lower tax base, that disparity is even higher. Unless federal funding is secured to upgrade all services- from training, to equipping the providers, to upgrading the hospitals with needed supplies and equipment, updating telemetry and radio equipment and personnel, I don't think- especially in this economy- it's a feasible concept. Hell- in many places, there is even a shortage of certain doctors because there is no money to pay them, and the cost of malpractice insurance makes it not worth it for them to provide their services in these areas. In our state, other than the major cities, it used to be you could count on one hand the number of neurosurgeons and OB/GYN's practicing. To my knowledge, it's still a problem.
  11. Can seizures be faked? Sure. Obviously you need to take the situation into context as part of your overall assessment. Just because someone was not post ictal, incontinent of urine, or have bitten their tongue, it also does not mean it wasn't a seizure. That said, if a hysterical 16 year old female who just had an argument with her boyfriend c/o chest pain, would you immediately give her a couple NTG's, ASA, alert the cardiac cath team, and fire off a 12 lead EKG on her, to rule out an MI? As was mentioned, zebras may be interesting, but unless you live on the African plain, they simply are not very common.
  12. For the love of all that is holy! When will we actually force parents to be parents? Ethylene glycol(antifreeze) apparently tastes sweet, which is why dogs and kids often drink it. Should we make it taste like crap just so kids and dogs aren't poisoned? Marbles and small toys are choking hazards, so should we redesign toys so that nothing is smaller than a basketball? I can't wait for the inevitable lawsuit on this- that is if one has not been already filed....
  13. Wow. For all the worries and problems I had when mine were young, nothing compares to what you went through. The emotions you must have been feeling then and now-paralyzing fear, anger, frustration, terror, joy- I cannot even begin to imagine. I hope they figure this thing out, bud. Hang in there...
  14. I'm trying to think about the various types of MCI's I have been involved in and where hand signals could possibly have been used. If we were close enough to see hand signals, we would have been close enough to yell, or even take a second and run over to talk face to face. The only things I can think of off the top of my head would be cases where law enforcement is the primary duty and we are standing by- ie a HBT, high risk warrant stand bys, or bomb threats. In each of these situations, things are generally quiet, we are not moving around, and we had a controlled perimeter so there were no extra responders or bystanders running around, getting in the way, or making noise. SWAT and TEMS teams use hand signals, and I see the value there for obvious reasons. When we deploy with LEO's, a major issue is communication. As you mentioned, ambient noise may be a problem, or radios may malfunction. The problem is, EMS is usually in a safe zone, and depending on the number of officers, their locations relative to EMS, and where EMS may be located- in multiple places, under cover- we cannot see those hand signals and are not aware of what actions are taking place. Generally there is an officer assigned to EMS units to protect them and keep them informed of what is happening, but that's not always the case either. Interesting topic. Making me think.
  15. There is no way to change the opinions of some people. You could be the best damn EMS provider on the planet but someone will still find fault with what you do, or demean your profession. Not a damn thing you can do about it, and no amount of arguing, cajoling, or convincing will change their minds. I have found that many people WILL get it- whether they be doctors, nurses, RT's, unit clerks, or even the housekeeping staff. Folks usually know who the "good ones" are- either by observation of their clinical skills, listening to them speak, their demeanor, their professionalism, their appearance, or simply their interactions with patients, staff, and family members. All you can do is the best you know how, and always strive to be better the next time. Or- if all else fails, I guess there is always the snarky approach. Simply turn the tables and ask them why they have not advanced beyond being an ER nurse or respiratory therapist.
  16. Run- don't walk away from this. Dwayne nailed it. Make it perfectly clear to your girlfriend that this guy is bad news. Not sure if your girlfriend is of the opinion that this is her Christian duty to remain friends and/or help this guy, but I see nothing good coming of this for your girlfriend- and by association with her, for you. You hate to be so cut and dried about this, but I agree that you need to give your girl an ultimatum- it's either you or this felon. She needs to cut all ties to him. NOW. From what you describe, this is not simply a stupid youthful indiscretion or mistake, he appears to be on a path to being a career criminal, and he clearly has major psych issues. Unless you are a parole officer, a missionary, or therapist, you probably do not have the tools to deal with the drama this will surely bring. These folks generally create a nasty vortex around them, and tend to suck in anyone who comes too close. Not worth it, dude.
  17. Asys- Interesting idea, but I question how practical it could be. If you are line of sight, then I suppose simple gestures may work, but how many times are there vehicles, personnel, bright lights, bystanders, or other obstructions that clutter a scene? I totally agree that the weak link in an MCI is always communication. In nearly every critique of a large scale- or even smaller scale event with multiple agencies or responders, the number one complaint always relates to communication problems. Either you encounter a dead spot in radio reception, there is too much unnecessary chatter(most often the case), there are interoperability issues, or not everyone has access to their own radio. I have found that especially in MCI's, a runner- someone in staging, or that is not specifically assigned to triage, patient care, FSR activities, or other duties can serve as a means of communications when all else fails. Obviously these would need to be simple messages- ie "Please inform the transport officer we have 2 yellows and are awaiting an assigned destination", or "We need more manpower for lifting help or to assist with patient care," since we all know what happens to messages as they are passed from person to person. I supposed a standardized signal method IS possible in theory, since one of the basic tenets of NIMS training is to utilize standardized language on the radio and omit 10-codes and other agency specific language. I just wonder how useful it would be unless you have direct eye contact with the intended message recipient.
  18. Rat- I am so sorry to hear about your mother- please accept my sincerest condolences. I hope you are able to come to terms with your loss. Also- thank you for your kind words.
  19. Mobey- you clearly are a smart cookie. You have taken the critical first step- recognizing there is a problem. You have also taken the next step- outlining a plan, and I think you are dead on in your ideas. Food, health, exercise- and mental health assistance PRN. As was mentioned, it does sound like PTSD- not necessarily from one specific incident, but the cumulative stress and pressures of the job. I have never been a big advocate of therapy, but recently have began seeing a psychologist- for personal issues, but those issues impacted my work and how I perceive my life and my future. It's too early to tell what will become of these sessions and if they help or not, but I can see the value in them. As you say, an outside, nonEMS, impartial observer is vital to get to the root of the problems you are having. I always thought asking others in the business(trusted friends and coworkers) was key to getting a handle on things. They have been there, they understand what you are going through, but I think too often they are not forcing you to dig deep enough to get to the core of what is really affecting you. In my brief sessions, I have learned that the problem often lies not with the type- or even volume- of issues you are having, but our perceptions of those problems and our reactions to them. The way we respond to stressors and problems is key in determining if we are adequately coping and processing things. I think when we are new to the business, often times we are single, with no family and few responsibilities beyond ourselves. Coping is a lot less complicated. Having a rough stretch at work? Take a few days off work, take a vacation, go hang out with friends, indulge in a favorite hobby- whatever makes us happy. There is nobody we need to answer to, or consider when taking these mental health breaks. We do not need to focus on anyone else, and handling stress is easier. Once families come into the picture, life becomes more complicated, and the accumulated stress of years of bad calls, lousy sleep patterns, poor eating habits, and the baggage adds up. Anytime you need to talk- shoot me a message, and I would be more than happy to help out. I'm about as far away from your working situation as possible- busy urban area vs rural, but I think the essential issues are universal. It's a lifeline, brother, and I wish someone had tossed me one(or recognized if someone did) some time ago. It would have saved me a lot of heartache. You are not alone.
  20. HERBIE1


    Welcome. And I second Island's question: What is a flagger?
  21. CM- So sorry to hear about your troubles. To say you have a full plate would be an understatement of epic proportions. It's funny- in our business, we tend to always put others first- whether it's our patients, our family, or both. We can solve problems- at least short term- of our patients, and we move on to the next. Nice, except we have no real obligation to them after we drop them at an ER. In the case of our personal lives, the problems are ongoing, and often seemingly endless. I'll offer advice- sort of- and take it for what it's worth. I understand that family comes first, but to be honest, as a couple folks have mentioned here, sometimes there is only so much YOU can do, and the other folks need to step up to the plate and take care of themselves. Point them in the right direction, give them encouragement, support, and some level of assistance, but do not forget that ultimately it's THEIR problem to handle. This is akin to the empathy we show our patients- be involved, but not TOO involved. I've been going through some major personal issues myself over the last 8-9months now, and interestingly during this time, I reconnected with an old friend who is in a similar situation. We compared notes, I offered her advice- which she described as spot on, and very helpful. I was able to boil down her issues to the basics and clear up the superfluous BS that was clouding her decision making process. She was simply too close to her problems to have any perspective. Unfortunately she could not offer me similar help, and my struggles continue. I mention this not to blow my own horn as a budding therapist, but to show that often times we may be able to see others problems far more clearly than we see our own, and sometimes we cannot- or will not- take our own advice. You need to take care of yourself first. Unless we are talking about dependents, then at some point folks really do need to work things out on their own. In the end, they will succeed or fail on their own- our help and support is really only a small part of the equation. As strange as it may sound, I think sometimes we need to ignore our hearts and follow our heads. My nickels worth... Good luck.
  22. We could go on all day about the clinical signs and symptoms as well as the textbook definition, so I'll stay fairly subjective and anecdotal here. Pallor is good, weakness, general malaise, simply looking like crap. Depending on the type of shock, I think we can all pretty much say that if we have a GI bleeder for example, it's pretty obvious if they are in trouble. Quiet patients of these types scare me- soft spoken, appear apprehensive, weak, fearful- they generally are the ones who are severely compromised. I had one GI bleeder lying in bed- looking like crap, and before we could even get vitals he sat up to greet us, had a syncopal episode, and arrested. As we were leaving his house, only then I noticed the massive amount of blood on his bathroom floor and toilet. It drives me crazy that I still need to remind some folks I work with that just because someone is normotensive, it does NOT mean they are not in shock. Hypotension is such a late sign that by that time, the person is in real trouble. Good topic.
  23. Wow- the thread that would not die. LOL Well, I'll jump back in. The problem is perception and interpretation. I looked up the word discrimination and depending on the context- legal, social, civil rights related, etc- there are many different nuanced definitions. Here's a pretty standard, generic one: The unjust or prejudicial treatment of different categories of people or things, esp. on the grounds of race, age, or sex. Those 2 words are key. Is it unjust or prejudicial to exclude women from a private club? No- they are entitled to make and enforce their own rules, as long as they do not violate the law. They do not say women are inferior to men, so they should not be allowed. They do not say they are not capable of golfing. So what exactly would you call Augusta's policy? Archaic- sure. Misogynist? Depends on your point of view, I guess. I'd argue that last point though since I'm quite sure most of the men in Augusta love and respect women- they just prefer them not to be members in their club. They let women use the club, just as guests. I can't join Women's Workout World or Curves- I have other options, and have been a member of Bally's(now LA Fitness) for 25+ years. Women cannot join Augusta National. SO WHAT? Is this the end of the world? Is someone truly being harmed by this? I find it amusing that the folks who are complaining the loudest have nothing to do with the club nor are they even affected by the policy. There are plenty of country clubs that would be more than happy to take outrageous amounts of money from any woman who is so inclined to provide them with it.
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