HERBIE1

I have been keeping a close eye on this. I am glad that they are getting what is coming to them.

Hopefully they bury these guys. They seem to be the slip and fall lawyers of the internet age.

Isn't this the group that threatened our board admin here?

Copyright troll Righthaven in its death throes, domain going up for auction

http://boingboing.ne...hthaven-in.html

Excellent teaching moment, Metal. It's easy to get tunnel vision and not consider ALL the possibilities.

Recently had an AMS call- R/O CVA, Found a slightly confused elderly female oriented to person and place, but was having trouble with short term memory. The family assured me that grandma is always sharp as a tack, but all day today she's been getting more and more confused, unsteady gait, and weak. Vitals not bad, but I cannot recall details.

She was negative on the Stroke scale, but after further questioning, we find out she had tripped and fallen 2 days ago, struck her head on a curb and received a large "goose egg" on the back of her head- no loss of consciousness. Refused to go to ER or allow medical attention per family at that time, said she was fine. No real evidence of trauma now. Light bulb goes off. I press for specifics, and the first responders look at me like I'm crazy. Isn't she having a stroke, they asked. I said it's possible, but more likely I tell them on the side this lady may have a subdural. They say- "But she fell 2 days ago!" I quickly explain the etiology of subdurals, how elderly are very susceptible to them, and this lady may be in big trouble.

Not sure how that one turned out but a CT confirmed the hematoma, and they were getting a neurosurgery consult when we left.

HERBIE1 ... sorry mate

I don't see arrogance at all but I do see some humour in in his post, 9orange is making a good point .. perhaps we all should be using a real thermometer(s) it is a vital sign.

<cough> There are those that do use antibiotics AND antipyretics IV as well as inducing hypothermia OR treating it in the field.

ps Don't set your sights so LOW ...... Please.

It is essential when treating hypothermia to have a rectal probe up the chute as "cold and waxy" to the touch on a patch to an MD 600 kms away on a sat phone just doest cut the mustard.

cheers

Allow me to direct your attention to this passage:

"I think the point of this is for folks who do not use thermometers prehospitally to come up with best way to determine if a patient may be febrile WITHOUT the use of a thermometer. We don't use them in our system, nor do many folks, so I think these tips are a good idea."

Notice the MAY and MANY qualifiers. I know how varied our job responsibilities are here, and some folks here are a few classes- and a few dollars short- of being MD's.

Like I said, if this was undetected sarcasm, then I apologize, That was not the way I read it, but it certainly would not be the first time I was wrong.

All good advice, especially from the ladies who have been in your position. You call this guy "superior", but is he actually someone who has authority over you, as in a chain of command, or is he simply a more seasoned provider? If he is a boss, you need to temper your response, but as was said, you still need to stand up for yourself in no uncertain terms. I assume you have no issues with other peers in your job?

Often times- especially in the fire service and EMS, this is a form of "hazing". Not saying it's right or wrong, it just IS. The old timers-essentially anyone who has a bit of seniority- like to bust the chops of the newbies- just to see if they can handle it and how they respond. That said, this guy may simply be an asshole, but either way, do not allow yourself to be treated like a doormat. Make certain you fulfill your job responsibilities, be eager to learn, provide good patient care, and follow the rules, so that way there will be no question of your competency. If that does not earn you his respect, then you may simply agree to disagree- he won't be one of your allies at the company. You will still need to have a sit-down with him and lay out the ground rules about your working relationship. Ask him exactly what his problem is with you- maybe he's be honest about it, but most likely he will not. Ask him exactly how you are not fulfilling your obligations or living up to expectations.

Look- you cannot mandate how someone feels about you. Sometimes we just have personality clashes. It happens, but regardless you still need to have a working/professional relationship, so either you stop this mistreatment, or find another job. This guy sounds like he won't let up any time soon, so you need to be proactive about this- it's YOUR career.

I use the part of my hand that's holding a thermometer. A tympanic probe might be +/- 5°C but that's far more accurate than "I think it feels hot".

Maybe a good idea to get a general tenor of the patient's temperature by using the back of your hand, inside of your wrist or your fingers/palm, but I wouldn't go basing any patient treatments off of voodoo, no matter how you do that voodoo so well.

There's a whole lot more of the clinical picture that we're leaving out here. I would expect hyperthermia to have associated reflex tachycardia, flushing, altered mental status, etc. I would also expect that hyperthermia that is the result of an infection to have my patient present with a "toxic" apperance, shivering at room temperature, general malaise, etc. With hypothermic patients, I would expect them to present with peripheral cyanosis, bradycardia, also altered, perhaps if they were septic a more noticable "toxic" apperance than relative hypothermia...

There's more to this than "what part of your body are you using to check your patient's temperature"... I think if you're relying on subjective data for patient treatment or assessment, it's bad medicine.

I realize you are brand new here, but let me make a suggestion: maybe you're first post shouldn't be filled with such arrogance. (If this was not your intention, then I apologize)

Of COURSE feeling with the back of your hand or your wrist isn't the most accurate way to check a patient's temperature. That's like saying feeling for a radial pulse is not the most accurate way of obtaining a blood pressure. I think the point of this is for folks who do not use thermometers prehospitally to come up with best way to determine if a patient may be febrile WITHOUT the use of a thermometer. We don't use them in our system, nor do many folks, so I think these tips are a good idea. An elevated temp can indicate a million things, but unless you have some lab values to go with that specific number, it's essentially meaningless-especially since most EMS field providers won't be prescribing antibiotics or even giving an antipyretic.

To all my cyber friends here, I wish you the happiest of holidays- whatever flavor of religion- or lack thereof- you celebrate in your lives. Eat a little too much, drink a little too much(but don't drive), laugh a little too much, and enjoy yourselves, your friends, and families. You never know how much longer we have on this planet- make the most of each day.

Be safe out there.

Not hyperbole, it is facts. I think we can all agree that the divorce rate is around 50%, here are some stats about what that creates:

http://www.civitas.o...experiments.php

and that is in the UK, which has a more socialized type of government and has a better safety net than the US.

To those who say this is the norm, that society pushes the boundaries every year. I agree, but look at the crime statistics of teenagers in the 50s versus today. If you do not think that the angry lyrics in rap music do not influence young gang members you have your head in the sand.

No, these aren't facts. There is not a provable cause and effect of song lyrics and poor behavior, but any reasonable person can INFER that this is a factor in the equation.

It's a lot more complicated than song lyrics. It's a general deterioration in our society- in standards, morals, ethics, and it's a push that started back in the 60's. Since that time there has been a slow but steady shift away from personal responsibility. Since that time, we "learned" that thanks to pop psychology fads, we can blame all our problems as adults on our parents and absolve ourselves of responsibility for the stupid decisions we make. We "learned" that we are all responsible for things our ancestors did centuries ago in regards to slavery. We "learned" that nobody has the "right" to cramp our style, or tell us what to do. We "learned" that we don't have to stay in school, work hard, support ourselves or our families or even live within our means, because the government will take care of us from the cradle to the grave.

And we also "learned" that even if we have a head full of screwed up wiring, we can blame our behavior on mom not breast feeding us as a child, or on violent video games or music, and some idiot who is an alleged expert will actually support and even promote such an opinion.

New generation.

That would be like saying all you homosexuals are nothing but a bunch of rave-going puffs that like to do ecstasy and poppers and wear assless chaps while occasionally dancing around naked to 'Macho Man'.

Don't generalize the inactions of a precious few and say it 'pretty much applies to everyone'. I think we all know that narrow minded kind of thinking doesn't get anybody anywhere.

Just because there are shitty parents out there doesn't mean every parent now is the same. And just because a few kids are stupid enough to really take a song that far, doesn't mean they all will.

Very good point. I have a friend who was telling me about when saying the word pregnant on television or radio would get one fired and a reputation tarnished forever. But do we think we can shelter each up and coming generation from 'whatever happens next'?

Old TV standards are hysterical. They could not show couples in bed, and then when they did, it was in separate beds, essentially fully dressed. Today on network TV we can see exactly what folks do in those beds.

I realize that change is inevitable, but there always used to be a certain line that could not be crossed. At some point- the 60's- it became more important to push limits and challenge the status quo than to try to maintain and/or enforce any type of societal standards. I'm no prude, and I certainly am not advocating a return to Puritanical times, but it seems to me there is a huge area of common ground between our current "anything goes" mentality here and a Sharia Law or Scarlet Letter type society.

Anytime I hear someone questioning the lax standards, there is always a push back, with someone claiming folks should have the "right" to do whatever they want, and the "right" to express ourselves, and that nobody has the "right" to tell me what to do. Yes, things like ethics and morality are subjective in many ways, but I refuse to believe that we cannot agree at least on some basic common themes for a civilized society that would draw a line in the sand. We would finally be able to say that yes, something IS wrong, and yes, someone DID go too far.

Keep your head on a swivel. Pay attention not only to your patient, but to the family members, bystanders, the surroundings, any heated arguments going on in the background, etc. Regardless of what your patient's chief complaint is, you need to be aware if multiple family members are intoxicated and squaring off for arguments or fights. Stay close to and listen to the senior members- things can and do go south in a hurry.

In many households, family members who actually never speak to each other all year are brought together a couple times a year. Someone gets some liquid courage, and begins to tell their cousin/uncle/nephew how they really feel about them- and all hell can break loose. Seen it many times.

I find myself with the unenviable task of actually agreeing with flaming. Does listening to a violent/misogynist/racist/drug referenced song CAUSE such behavior? No, but in someone who is susceptible, it certainly can push them over the edge.

I knew this song- heard it many times on the radio and saw the video on the music channel at the health club. Problem is, I never could understand most of the lyrics so I never had a clue what it was about. Catchy song- all I know.

Look- with each generation, we think the current generation behave like devil's spawn, and their music/antics/behavior/language- will cause the downfall of our society. Going back to the flappers and probably before, each generation pushes the boundaries of what is appropriate. But- let's look back just to the 50's. Does anyone recall the outrage over Elvis's gyrating hips- to the point where they would only show him from the waist up on TV. Things have "progressed" from there to the point now where much of what we can see and hear on network TV these days would make a sailor blush.

I simply feel that standards are a good thing, and if we keep lowering the bar, I wonder when does it stop- with explicit sexual acts on the Disney channel?

I agree that in this patient that it almost certainly did no harm...

But If I was BEorP what I would be reading here is, "It's close enough to zero difference, and this situation almost never happens, so what difference does it make?" As I know you all, I know that that isn't what you're saying, but that's how it could be read I think.

While the point I get from him is, "Leave for the hospital if you can, as the 3-5 minutes 'might' make a difference, and sometimes catching all of the 'mights' can add up to a significant difference." And man, I get this completely.

I once stayed on scene with a medical patient trying to get his sats up above 50%, convinced that if I could just get some friggin' air into him I could make him stronger before moving him...I won't go into detail but I had terrible compliance to bagging so made multiple nasal intubation attempts, chest decompression, etc, on scene. He went into cardiac arrest enroute.

The problem arose when I looked at my timeline while at the hospital. When I considered my scene time it turned out that he would have been at the hospital, though not really much of a hospital, 5-10 minutes before he arrested had I just bagged, scooped and ran.

I told the doc, "You know what doc, I totally fucked this one up. I would have been here 10 mins ago if I'd just scooped and run. I don't know what that means for him, or for me, but I'm not going to cry over whatever beating that I've got coming."

He said, "It meant nothing to him, but yeah, you fucked this one up. Next time make better decisions." I said, "What would the better decision have been here?" He said, "Obviously to bag and run, right? Look at your timeline. But I probably would have decompressed and tried to intubate before leaving." and then walked away. I remember standing there thinking, "So what does that mean!! What should I do next time??"

With my timeline as a guide I wish I would have just run to the hospital. Without hindsight I know I would have always hated the fact that I transported him for 15-20 minutes with his sats in the 50's. I was confident that if I didn't get some O's into him before moving that I would be running an arrest in the back on my own, so didn't think of doing these things on the way. I think the doc was telling me, "Sometimes medicine sucks. Get used to it yet still make better decisions on very call." Which I try and do, with varying success.

Turned out that he had a big spontaneous pneumo, so the decompression was appropriate, a significant P/E, was end stage lung cancer...etc, etc...

If I could have gotten him ventilating/oxygenating again I believed he would have been hugely improved before we moved him. Unfortunately even if all of my brilliant interventions would have been successful the P/E means that I still wouldn't have achieved my goal. Goddamnit!

I guess my point is that there is always a balance between making our patients strong enough to be moved, and to travel if we can without denying them access to the really smart people as soon as possible. I really, really wish I had a machine for that decision.

It's a balance that I'm not anywhere near 99% on, even with all of our fancy gadgets....

Dwayne

That's why they call it "practicing" medicine, Dwayne- even though we aren't officially practicing on our own. We make decisions out there, based on our patient, our capabilities, transport time, available resources- and yes, sometimes those decisions don't always work out. It sucks when things go south- sometimes it works out, sometimes not. We do the best we can, and speaking for myself, I learn VOLUMES when things go bad. I think- damn- I will NEVER do that again, or geez- next time I will try this. The problem is, no 2 patients or scenarios are exactly the same, so it's rare we get a true "second chance" with the same parameters.

It's easy to play Monday morning QB, but we simply do the best we can for the patient, and hope for the best.

Actually ak it could nave happened to you. I changed the diagnosis to protect the medics. This patient had a rare ailment not seen by ems often and the only med that fixes it is prednisone, not other steroids or respiratory meds. When it happened the er doc had never dealt with it nor any medic I discussed it with. If I had listed the real disease it would have made the medics known. This patient was walking and talking in her home, all vitals normal, she went down very fast, with little warning, which is what generally happens when they have respiratory issues. ** Edited for typo created by autoword on my cellphone

Excellent scenario. It seems that local protocols differ as to what to do in such cases, and clearly it would depend on the specifics of the situation- vota;s of the patient, traffic, distance to ER, time to get more help, injuries or not at the traffic scene. In other words, yet another grey area for EMS. What reason was given for the suspension- leaving the scene of an accident? Which company/system protocols were violated? As I said, in my system, if there were no injuries, my first obligation would be to my patient, and a cursory evaluation(essentially a quick triage) would have told me that barring any life threats, the accident victims could wait until the next arriving unit could do a proper exam and refusal of service as warranted.

So I assume the medic violated policy by leaving the scene? Bad, but I would have done the same damn thing and bought the 16 hour suspension. Then again, in our department, this would be viewed as unfair discipline and a party would have been held to recoup the losses incurred.

Really? You can't believe that in a thread of the Hottest First Ladies, no one else mentioned Hillary Clinton?

Yep, what a babe.

LOL

It's hard to "see" sarcasm on the computer. For anyone who knows my political views, my comments would actually be hysterical.

Then again, God help me-I would actually much prefer Hillary over who we have.

If they delayed transport to start an IV on a trauma patient, they were wrong. I don't mean to seem like I'm not open to a discussion, but I really don't see how there is much more to say on this. Prehospital IVs in trauma patients don't save lives. This type of patient is why the OPALS study showed that severe trauma patients treated by ACPs (likely getting IVs) had worse outcomes than patients treated by providers not certified in IV therapy.

If the patient was trapped and they popped a line in then, it would not have been mentioned as a deviation from accepted practice since it would not have delayed them on scene.

Despite her chances of survival being incredibly low, this girl needed a doctor, not an IV.

This is not a lawsuit, it is a coroner's inquest. The jury is mainly trying to answer basic questions about the death and is also likely to make non-binding recommendations to prevent future deaths. More information here.

Thanks for the info- very informative. Sorry, but here in the states, we are a litigious society, which means everything is about assigning blame and looking for someone to pay up. (That's why so many folks here have been campaigning for tort reforms in recent years.) That was simply my knee jerk response because of my perspective.

Agreed about delaying transport for an IV being flat out wrong- unless there were extenuating circumstances as I mentioned above, but I find it impossible to believe that this in any way contributed to the death of this patient. The docs even agreed this patient's outcome was not affected by their actions.

Depends on local protocols, but in our case, your first priority is with the patient in your apparatus. Our policies dictate that if there is someone injured on the scene, then we must wait for help to arrive before we can leave the scene.

In this case, I would be calling dispatch, advising them of what happened, that there are no injuries but to send additional units to the scene to verify nobody needs EMS and to properly document refusals of service, instructing dispatch to send law enforcement to the scene and for them to meet us at the hospital to complete the paperwork, advising the base station of what happened and that there would be a slight delay, and I would have proceeded to transport with my patient.

It does not specifically say what the charges are here- negligence, malpractice, etc. It also says that this seems to have started with the coroners request that the ER doc review the case in regards to the fact that the closest ER was not available and whether or not that played a role in the outcome of this case. It seems that the lawyers are using the shotgun approach- dissect every aspect of the case and see if they can assign blame/fault/culpability- which in essence means they are looking for the ones with the deepest pockets.

As the doctors testified, "We believe any small delays would not have made a difference and taking her to a trauma centre would not have made a difference." and "Most trauma centres would have recognized the outcome and would not have continued for that period of time."

In other words, if a trauma team couldn't have saved this woman, what difference does a couple minutes make if they did try to start an IV? Maybe they were trying for IV access to sedate the patient, since apparently she was combative? Not knowing local protocols, the patient's vitals or injuries, nor the legal system there it's hard to know any more but it does not sound like the medics did anything egregious, and certainly nothing negligent.

I agree with the doc's statement that load and go is the preferred treatment on a critical ill trauma patient, but patient and crew safety comes first, meaning she needed to be restrained before they took off.

I cannot imagine they will find fault in the prehospital treatment of this patient.

What specifically was the patient charged with, and was it enough to force him to actually spend any time in jail, or simply be bonded out? You certainly do NOT need to file charges on this guy. If the hospital cleared him and felt he was not a suicidal risk, then your and their job is done. You had the professionals evaluate him, and apparently they were not worried about him following through in his threat. If he did-still not your problem. Not sure why LEO's are forcing this issue. If they want to keep the guy locked up, then they need to come up with something to hold him, and not rely on some trumped up charges and forcing you to get involved in this.

I've had countless drunk folks who claim they want to kill themselves, and while I am certainly not a shrink, I think it's pretty easy to tell which ones are actually serious about it, and which ones are talking through their booze. Regardless- anyone who says those magic words(I want to kill myself) ALWAYS gets a ride and an evaluation at an ER. That said, in your case, if a guy was sitting there with a gun, that elevates the situation, so he's not only is he expressing suicidal thoughts, he has the means to accomplish his goal. He must have done a great job convincing folks he was not really suicidal.

I cannot believe someone did not mention Hillary Clinton!

Well I AM over 45, I do have CRS disease(can't remember shit), and apparently I am also a pervert.

I gave obvious answers to everything except the first word. My initial thought for _ _ ndom: Kingdom.

YES, I know that would not fit, it was a quick look, but what disturbs me more than anything is my semi-religious answer for the first word, while the rest were all dirty. Hmm... I guess a shrink would have a field day with me.... LOL

So let me ask this. AS for the Gay accent. Just how do you Gays er I mean homosexuals get that accent? Do straights have an accent?

I'm very curious about the answer to this question.

CM- awesome story. It cannot be said enough times- its the little things we do that people remember. As a newly minted EMT or medic, that is a lesson that takes time to learn. I'll echo what was said above- I think there is far more skill involved with knowing WHEN we need to use all our toys and skills vs actually doing it.

I find that some of the older folks- particular men- enjoy telling a joke- probably more out of nerves than a desire to make anyone laugh. I had a guy who was in moderate resp distress- a COPD patient that had sats in the low 80's when we arrived. He was initially pretty ornery, and we attributed it to hypoxia. Sure enough, as his sats improved with O2, albuterol and atrovent, he calmed down, began perking up, his sats were soon in the low 90's, and suddenly the guy thinks he's a stand up comedian. I wish I could recall some of the jokes, but he was like Rodney Dangerfield-self deprecating as well as taking shots at his wife(she was not there). This guy was FUNNY, and had me in stitches. I had a heck of a time not laughing as I was giving my telemetry report on the radio. A couple times, HE began to laugh, started to cough and would drop his sats. I told him to take it easy and not talk so much, but he was on a roll, and clearly enjoying himself. As we hit the ER he was comfortable, and in minimal if any distress. My partner opened the back doors and asked what the hell was going on, and what was so damn funny. The patient and I just busted up laughing again.

My report to the ER staff started with- "Have Mr. Smith tell you the one about the..." He thanked us for helping him, and I thanked HIM for making my day.

Rule #23:Never mess with a Medics coffee if you want to live.

Totally agree here.

If you want to see a grown man sob uncontrollably, watch what happens if I drop my coffee.

(And my corollary to this, or

Rule #23a):

Life is too short to drink lousy coffee.)

Dwayne I love you but you have no idea what you are talking about, which is no surprise as a white straight male, walk a mile in my GUCCI moccasins, then you can preach to me about when and why I am discriminated against.

1. My second employer openly asked in their 20 page application if you were gay or bi, guess what happened if you answered yes ?

2. You should see the icey stare I get from every dad when I have to transport a young male child, you can just hear it circling in their brains "you better not touch his pp"). Like being a gay man makes you a pedophile.

3. I do not "makeout" with my man in public, but like I said before, if we just sit on the same side of the booth or hold hands we get the stares from other people in the area.

4. When I am at the fire station and I call my man to tell him good night and that I miss him, you should see how quickly everyone leaves the room. They don't do that when their girlfriends call.

There is all kinds of porn, something for everyone, but it is mostly for a male audience, which is why you see 2 females alot, because it is every straight man's fantasy to have 2 women at the same time. What you guys don't know is that when it does happen, the women are usually more into each other, and not you. Which is not to say that women do not watch porn, but statistically women use "romance" novels and movies as their porn.

2. You should see the icey stare I get from every dad when I have to transport a young male child, you can just hear it circling in their brains "you better not touch his pp"). Like being a gay man makes you a pedophile.

I'm curious...

Why do you get these icey stares? Do you carry a sign that says you are gay? How would anyone know your sexual orientation?

One of the local ER's here has switched to a system similar to that first picture, but they still stock standard angiocatheters for EMS replacement. To me, those are definitely not the best for EJ use, but like anything, I guess you get used to them.