Bieber

None. Verbal, GCS: 3, 4, 6. Accessory muscle use is present and he seems to be holding his own--for now--but he's really working at it. No real signs of volume overload. You're unable to auscultate heart tones over the sound of the patient's breathing. Chest wall movement is equal bilaterally. Ah, you're a step ahead of what I was. I'll give you the 4-lead and we'll say the 12-lead is non-diagnostic with right axis deviation. You go in for one of the massive veins on the patient's hand with a manly 18 and... pop! Sucker blows. Coumadin cleanup, aisle systemet. Checking your tablet, you see the patient was transported back at the start of April but no one knows what for. No recent falls, surgery, or catheterizations. None.

Surprisingly no! No real peripheral edema. O2 doesn't seem to be doing much; patient's sats are still about 83% with no change in his cyanosis.

Island, I understand your frustration with EMD software, we use it to and get "downgraded" on calls deemed non-emergent by dispatch. If it makes you feel any better, about the only condition I can think of where that extra minute saved is going to be clinically significant are cardiac arrests. At least this way you won't be risking your lives driving emergency traffic as much.

Where's the evidence of benefit for the majority of patients transported by air?

Moved to the Con thread.

He's about 5'6" 130 lbs. He appears to be in moderate health. S - Dyspnea, increased work of breathing. A - NKDA M - Levothyroxine, spiriva, furosemide, coumadin, lisinopril. P - DVT (lower extremity), COPD, CHF, HTN. L - Unknown. E - Patient was sleeping when he suddenly woke up short of breath. Lung sounds are severely diminished (little to no auscutatable airflow). Trachea is midline with JVD present. Happi, the call came out at around 2330 with time of symptom onset was approximately 2310. Also, success! A valid DNR has presented itself! It is up to date and valid.

You got it, Dwayne. HR: 134, regular RR: 24 labored SpO2: 83% on 10 lpm O2 via NRB BP: 186/102 Any other vitals you'd like? Someone's going to get the DNR... It'll be here shortly! (Well... maybe, you know how nursing homes can be.) No change in status on sitting the patient up.

Since everyone thought it was me who posted that ECG thread in the other forum the other day, I've been feeling obligated to post a scenario. Nothing overly complex, but fun. You and your paramedic partner respond with a BLS fire squad to a local nursing home for a patient complaining of difficulty breathing. You arrive on scene and head inside where you are directed to the patient's room. You are advised that the patient began having trouble breathing twenty minutes ago and are immediately told that he is a DNR. The patient himself is an 82 y/o patient who is laying almost flat in bed (x2 pillows under his head) who is obviously in severe distress. Patient's breathing is labored with intercostal retractions and nasal flaring preset. His fingers are cyanotic. You have a 25 minute transport time to the nearest hospital. Go! Addendum: Never fear, there will be some strips in this thread as well!

Boo!

I personally have gotten into the habit of never looking at the machine interpretation. You make some good points, chbare, and maybe taking a look at it more often might not be a terrible idea. I'll have to think about it. I do feel the need to point out, however, that this is how Skynet got started... =) First we're trusting the machines to aid us in interpreting our ECG's, next we're their prey to be hunted down and destroyed.

I don't know, Mike... Maybe it's just because I'm used to the traditional model of billing, but my initial thoughts to such a system are those of apprehension. I don't like mixing business with patient care, and even though I'm not oppose to advising patients about the cost of transport if they don't really need it and it will be a burden to them, I just don't know about the idea of giving patients the bill during patient care. I'd also think it would be difficult to give most patients an accurate statement when we can't file their insurance on site as well. Isn't the bill patients receive what they owe after insurance?

Given its size, I'm going to guess that Grady EMS most certainly has ALS capabilities. I'm far from familiar with how the majority of EMS services run, but I've never heard of an ALS transport service ceding patient care to a fire first response medic during transport. I could be wrong, though.

No services around here do anything like this to my knowledge, but it seems like I've heard of it being done somewhere before. I'll have a look and see what I come up with.

Mike, those people who were in favor of this, what were their reasons behind it? Like, what was the goal of it supposed to be?

Craig, sorry, man! I was trying to keep it short and sweet but still have enough options to catch all of the main stuff... AK, LOL! I knew I should have added an answer that said "Akflightmedic (or equivalent)". Sorry, everyone, I guess I should have tried to add a whole lot more answers than I did. Just specify in the comments if there's no checkbox for you!

My question is... what for? I mean, what's the point in giving them the bill at time of care? Is it to scare bullshitters off or to try and increase collections or what?

Hey, everyone. So, we have a pretty diverse forum, and I thought it might be fun to make a poll and see just how diverse a group we are. Please answer the poll and specify in the thread, if you're willing! I'm a paramedic and I work for a third-service county-based 911 transport agency.

Welcome to the forum! I was actually just looking at the Hennepin EMS website the other day.

Sure, man. What I'm seeing in lead V1 is a QR complex about 100-120 ms wide with a T that is deflected opposite of the R wave (discordant), which is appropriate for a RBBB. Tell me what you're seeing, I could be wrong, but that's my take on this ECG. Nay! Sorry, folks, I'm just here to give my own take (and to look pretty), the ECG's belong to someone else.

1. Regular sinus rhythm, normal axis. ST elevation in leads I, II, II, AVF, V3, V4, V5, V6. T wave inversion in V1. 2. Regular sinus rhythm with premature atrial complexes, normal axis. No ST elevation/depression. T wave inversion in leads III, AVF. 3. First degree AV block (P waves are difficult to see, but I'm catching a few of them in V5, AVF and lead II; plus the rate), normal rate, left axis deviation and a left bundle branch block. T wave inversion in leads I, AVL, V6. 4. Regular sinus rhythm with what I'm going to call a first degree AV block and possibly right axis deviation (?) and a (possibly incomplete?) right bundle branch block. No ST elevation/depression. T wave inversion in leads III, V1 (appropriate discordance), V2. 5. Lot of artifact. It's normal axis, irregular, narrow complex, tachycardic, and I'm not seeing any P waves. I would love to have a better ECG, but from this I see no ST elevation and I see ST depression in leads AVF, V3, V4, V5. I'm going to say atrial fibrillation for now.

Okay. After typing something up then deleting it, I'm going to post my own comment as kind of an outside observer. I don't have any place to say anything about this whole matter and I won't claim to know the full situation because I don't--I only know what I've read here on the forum--and I hope I don't offend anyone by commenting on this, but here it is for what it's worth--probably nothing at all. Lotus, I don't know you, and I wasn't one of the ones who was deceived by you because, frankly, I haven't been around for it. But I can understand why you did what you did and though there's no excuse for it, for what it's worth, I think it was courageous of you to confess to your lie. You could have left the city all together or created a new account and "started over" as a new person entirely, but you chose the harder path and fessed up. You were obviously under duress and most folks had already figured it out by the time you made this apology, but nevertheless, on the internet it's easy to run away and disappear. You didn't do that and instead you stuck around and did the adult thing and came forth and offered an apology instead of running away and never coming back. It sucks. It hurts. I know it does. It's supposed to. It hurts even worse for the folks you deceived. People are mad right now, rightfully so, but you couldn't hurt anyone unless they actually cared about you and I know that the shame you're feeling is worse than anything anybody here can say to you right now. Do the right thing from now on, be an honest person, make the amends you have to, and move on. There's nothing else you can do. People make mistakes, yours are a drop in the ocean compared to a lot of people's--including my own--and I hope you stick around if you're able to. It's hard to mess up, it's even harder to own your mistake and to accept the consequences that come with it.

Steve, I was about to deliver one of my rants about the EMS system but before I posted it I read your post. I decided to click the backspace button. You make a lot of excellent points, I'll have to pause and think about them for a bit before I reply.

Edit: Deleted.

I don't know you and I haven't been around here enough lately to really follow your posts and I can't claim to be one of those hurt by your actions, but for what it's worth I know that admitting to what you did had to take an incredible amount of courage. We all make mistakes, if I had a penny for every one I've ever made or continue to make I'd be a trillionaire. Accept it, admit it, move on. Nothing else you can do but that.

Sit him down and get him to either commit to the team or to back off of it himself. It sounds like he's passionate about this work, which is rare and fleeting; everything else about him can be changed with guidance or he can be taught/trained to do. You can't teach anyone to have the drive to be a part of this profession, though. The big issue is whether or not you can get him to commit to putting in the time required to be a part of the team. Just my two cents.