medicgirl05

That's because LADIES ROCK!

Well working in south Texas I surely have a little experience with this issue.

First, for us anyway, is the snake venemous? If so, we need to find which of our area hospitals carries antivenom. Not all do and sometimes it is out of stock, in which case we may consider a flight to a better facility.

According to our protocols, we wash the bitten extremity with saline in hopes of washing off any venom that is not already in the wound. There is not much else we can do for the actual bite but we treat the patient accordingly. We mark the affected area periodically to determine how fast the venom is moving.

As for the patient response, 2 snake bites come to mind.

First scenario- 13 year old girl with bite to ankle. Rattlesnake.

Patient found seated at home with significant pain but appears calm. BP is elevated, Pulse is elevated. All other findings appear normal. During the approximate 30 minute transport time the patient remained calm, no crying, but complained of pain on touch or movement of the extremity with the redness and swelling continuing up to reach the top of her calf.

Second-40ish male with copperhead bite to hand

Patient found outside crying in pain. BP, Pulse elevated. Patient complains of nausea/vomiting. Approximate 45 minute transport patient has no change in symptoms and receives phenergan for Nausea which removes that from the equation. Patient complains of significant pain throughout transport and due to his allergies I was unable to medicate him. Swelling and redness did not continue up the arm during transport and symptoms remained unchanged at time of transfer of care.

I think snake bite severity has many factors; location of bite, tolerance for pain, previous exposure, other medical history, and the amount of venom injected. Some things you should probably know before going, nearest facility with antivenom, and if snakes are venomous.

Good luck!

Welcome!

I personally know people who have been approved by the state of TEXAS and have similar misdemeanor charges. Just make sure you report it on your applications.

So good luck to you!!!

Just wanted to share my thoughts.

Antiemetics- We carry phenergan, whcih works pretty well. However the local ER's don't like it because it causes tissue necrosis if the vein is not patent. We'd like to carry Zofran but our supervisor says its too expensive, though I dont know if that is true.

Pain Management- We carry Morphine, which is a great drug. However we find that lots of people are allergic to Morphine and we have no alternatives. We used to have Nubain, which works well, but the ER Dr.s don't like it because it causes narcotics to not work after the nubain wears off. So we quit using it.

Nitro- We use the spray. I've never used anything else but it seems to work.

Here in Texas I am using rapid ce. I am looking for an alternative though as some of their material is not current.

Some of my co-workers have used them for all their CE hours. I am unsure of the pricing, as it is paid for by my employer, but their are quite a few CE topics.

Good luck to you!

I recently had a very similar call.

In Texas DNR orders do not expire. Also, we discussed what treatment DNR orders cover. We came to the conclusion that intubation is mechanical ventilation and unless otherwise specified a patient with a DNR does not get tubed.

However, if there was any doubt in my mind as to wether it was the correct thing to do I would tube the patient as a tube can be pulled later.

That's just my opinion though. Im curious to read other responses...

This scenario just sucks...but it sounds like you did what you could for your patient.

In hindsight I would say a 12 lead may have been helpful, but on a routine transfer I can't say I would have done one. In fact I can probably say I would not have, with the info you provided. With his history it would be difficult to know if a "new" event was occuring anyway.

Don't beat yourself up about this. In my opinion there isn't much you could have done differently.

I seem to recall it fell from favor, as personnel would use the procedure on an arm they had just put large bore IVs into, defeating the reason for the IV.

HAHA!

Reminds me of my paramedic class...Instructor asks where you tie the tourniquet when you do an EJ. Student(not me!) responds----Around the neck!

Seriously??? The rest of us just sat in stunned silence....

I think this is just a personal preference situation. There are many options that are acceptable. It just depends what you and your partner are confortable with...

Personally, I would probably use the stretcher. If it is snowing I think it would be easier to keep her warm that way. Pus she is light enough that it won't be much trouble, and for me and my partner it would be the quickest way. However, that is just my personal preference and I'm sure others may have different opinions that are perfectly accepatable solutions......

How heavy is she? And how serious is her condition?

Some of my back problems can probably also be related to the Ferno model 30 T-C. It was a good solid multi-level cot, but the problems were, and are, mostly the lifting in and out of the ambulances.

As for borrowing a chair from the household, my suggestion is DO NOT DO IT!!! While I am too lazy to look it up, I do recall reading on this site (I think), of a patient that got injured when a crew, using a kitchen chair to move the patient down a flight of stairs, had the chair come apart on them, dumping the patient down the stairs, and causing bilateral peralysis below the waist to that patient. Home chairs were not designed for the strain of the front legs being pulled one way, while the chair back is being pulled the other, such as would be put on them in this type situation.

Just to clarify, I would never use a houshold chair for an entire flight of stairs. However, there is an occasinal situation where a household chair works well. For intance, they generally slide well along linoleum surfaces to get you around corners with ease. I have used them to get my patient down an occasional step or two(or maybe 5).

Also, you should inspect the chair prior to use. I realize that all issues are not found on a visual inspection, if there is ANY doubt in your mind that a chair will not hold up find an alternative....JMO.

I usually just use the stretcher for five or so stairs. We have been doing that for about 5 years with no incident. Othertimes we have used a regular sturdy chair we may have found in a patients home. We have stairchairs but they are pretty lame, too low for proper lifting. Most of the time my patients are unable to sit up or we are in a hurry to get them out as I work for a 911 service. I do understand your concerns but you just have to do what is best for your crew and your patient when the time presents.

I've never had a student bring donuts. They usually don't even have money to pay for their meals!

Just wanted to add: make sure you show up on time or about 5 minutes prior. Being late is not a good way to start the day!

I completely understand wanting to have a quick reference guide. I don't recall ever using mine on a call but I like knowing I have it in case I need it.

I have found it helpful when I don't know what a medication is prescribed for...

I use the Informed Brand EMS field guide. ALS version.

When I first started I made my own little guide with phone numbers to all the area ER's and all the hospital codes. That didnt last long though. Lol

In our jump bag we carry:

Compartment 1-BP cuff and stethoscope

Compartment 2-IV caths and supplies, drip set, 500 NS, sharps shuttle

Compartment 3-Airway kit(tubes, magills, suction caths, tube tamers, bitestick) BVM, Bougie

Compartment 4-Portable O2, NC, NRB, oral airways, thermometer, glucometer

Compartment 5-Bandaging supplies(4x4's, 5x9's, cold packs, heat packs, cravats, ace wraps, tape, scissors)

HAHA! I used to tear my Barbie apart so I could bandage her back together!! Thought I was the nly crazy one out there! Lol. Nice to meet ya.

Ok. Next time medical control will be contacted.

Things that I didn't post- The patient denies skin contact of anything in the RV. So we are only dealing with inhalation. (not saying decon wasn't necessary, just clarifying)

The ER staff was aware that decon had not been performed. After we were assigned to a Trauma bay there was some discussion about moving him to a private room so an exhaust fan could be used. They didn't move hime though...

So...I'm wondering what treatment would be provided after decon. EKG shows sinus tach at 140. IV established and infiltrated. I stuck the patient 2 more times and didn't ever get a succesful line. He was a previous IV drug user so his veins were shot. No airway burns. 25 minute transport time.

GO!

Thanks all for the input. I did CE on this last night after the incident and didn't get much out of it......

ok,

let me ask you this

If these men were possible exposed to a hazardous materials situation which is what a meth lab is, did you decontaminate them or did you just let them in your ambulance?

Did you know it was a meth lab prior to putting them in your ambulance?

This I think is the first question that needs to be addressed if we are going to truly critique this call for you!!!

When we arrived on scene DEA and SO was already on scene. We were advised that decon was not necessary. Also when we arrived at the ER the staff was not concerned with decontamination. That's part of my question. I'm unaware of how to handle such a situation. At the moment when I was told by SO and DEA that decon was not necessary I figured they had more experience with such matters than I did. Maybe that was a mistake but since the ER staff was not concerned I figured I had done the right thing....???

I am looking for information as I've never had a call like this before. I know that some of you who work for more urban systems have encountered similar situations so I'm looking for your advice.

Call came in for 2 patients with "possible meth contamination". The location was approximately 15 miles out of town.

Upon arrival SO is already on scene. We find our patients walking around. No obvious distress. We have them all get in the truck and assess. 2 refuse transport, which leaves me with one patient.

He states that the men were working and his boss sent him to an RV on the back of the property for some tools and when he opened the door he smelled ammonia, so he shut the door and went and told his boss. At this time the three men returned to the RV to figure out what the smell was , they opened the door and the one went in before deciding it might not be safe, and they called 911. At the time of our arrival SO had no idea if it was a meth lab or not. So we took the men at their word.

So....we load the patient up.

Vitals-BP180/80, P-140, R-24, O2-99% RA. Patient is complaining of Nausea, dizziness, feeling weird, and a racing heart. Transport time is 25 minutes. What treatment would you provide?

Thanks for your input.

My protocols allow for 3 NTG SL sprays as long as the BP is ^90 systolic. If the pain is not relieved then we move to morphine.

We administer 2 doses of Atrovent before calling medical director for direction.

Valium is administered as we see fit.

We carry thiamine but I have never used it or seen it used.

I am lucky that our medical director is always a phone call away. We have 2 medical directors and we have both of their personal cell numbers and home numbers. For the most part I am able to do whatever I ask for as trust has been established in the 5 years that I've worked here.

I am at least 30 minutes from a hospital with the possibilty of being over an hour away depending what part of the county the call originates in and the level of care required for the patient.

Hope this helps.

It's also hard to use an hourly rate as most EMS schedules allow plenty of OT. I work a 48 hour on/72 hour off schedule, so one pay check I am guaranteed 12 hours of OT that usually turns into more depending on the call volume. I know many EMS services around in the area that also guarantee OT.

Sweatpants? Really?

I would like to know what is going thru a persons mind when they walk out the door headed to an EMS call wearing sweatpants?

It's people like that who give us a bad name...

I'm wondering what online CE source is recomended? Any opinions welcome...

I work in south TX. My full-time job is at a rural 911 county-based service. Pay is better than surounding areas. Paramedics start at 12.50. With cost of living raises every year around 3 percent and really great benefits. We have county provided health insurance, cancer insurance, ICU insurance, and life insurance. Also a great retirement plan. Plus uniform shirts and all CE payed for. Its a great service.

The surrounding services may pay similar but the benefits don't come close.

I also work part-time for a private service making 15 an hour.

I have friends in other states that don't make near as much as I do. I guess it's important to say that cost of living is very low where I live compared to other places.

Hope this helps.

Well I've had some experience with torn meniscus so I'll add my 2 cents.

First, knee pain sucks. For me there wasn't much that helped with pain control except heat.

Second, for me personally, the hardest thing was that I lost alot of muscle in my knee from waiting too long for surgery. Ask your dr or find a therapist for leg exercises. There are a few you can do that keep your leg in shape without further pain or injury to the knee.

I had meniscus removed twice from my knee. The first time I played softball 1 week after surgery. Knee felt absolutely fine. The second time recovery was longer as my muscles had deteriorated prior to surgery.

Hope you find this helpful....