Vorenus

Yeah... being bilingual from the start is definately excellent. I`m a bit frustrated that my Romanian is that bad, seeing that my father comes from Romania, it could be alot better (makes - the seldom - family gatherings with the romanian half of the family really frustrating sometimes).

I dno, monolingual, isn`t it?

I`d say bilingual. German and English. At least those are the languages I am able to converse in fluently. But I speak a litlle bit Romanian (it`s really more of a minimal understanding, than actual speaking) and I had Latin for six years in school (although that wasn`t really productive), too.

... lol. @OP: I`m going to make a wild guess and present the theory, that your buddies problem aren`t really due to a language barrier (if it is really only about the terminology). I guess he just has to learn the stuff - I mean it`s not like he has already known the terminology when he came to the states and now has trouble to translate that (seeing that he was 13 at the time). Seems like he had to learn the terminology from the scratch (in English to begin with), just like everybody else. Especially in this case - I couldn`t imagine language barriers as a problem. Only thing might be, that he might not be able to translate his english terminology rightfully into romanian. So, I`m guessing it`s eiither a learning problem, or a problem with his general language capabilities - if the latter would be the case, he propably should deal with this before attempting another test. Anyways, English and the romanic languages aren`t really that different as it might sound.True, the pronounciation is totally different, but many English words have their origin in Latin as well/originate even from a romanic-language-family background. But even regardless of that, if it`s really only about the terminology and the language - most words considered medical terminology have their original linguistic background in Latin (some Greek), which makes them sound pretty similiar in nearly every language which has at least a streak of a latin/romanic influence. So it`s pretty easy to identify at least the medical terminology, even if that`s the only thing you understand in a conversation. For example: English is not my mother tongue either, and although I never specifically looked into the translation of special medical terminologies - I have a fair idea of how they would translate just from the latin origin of the word. I might have to look up the spelling, but that`s a different story - and if you have a basic understanding of the foreign language, even that can be pretty easily assumed. To conclude, I`d say the major problems lies in either your #2 problem or his general language capabilities.

Doesn`t look like it`s an adipose problem - the form of that belly seems to indicate differently. As for the back problems - I guess that was a rhetorical question...

I struggle to imagine that many narcotics on a rig and that many other drugs.... Actually, I call bullshit on that - or that is a very sickly overindulging business.... No offense, though.

Propably that was an exaggeration to prove your point, that the differences are huge. But in case it`s not - 50 narcotics and 200 drugs? I doubt that....

I have been waiting for ages for glasses with windshield wipers! Anyone who wears glasses and once came into a warm room out of the cold knows what I`m talking about...

LOL. But really, this does look like a classical ascites. I had one patient, where it manifested itself school-book-like. Really, like the classical horrendous pic out of an EMS textbook. The bellybutton was turned outward due to the fluid and formed a litlle spherical. Looked like an apple on a really large enourmous apple.

Why would that be?

Yeah... ascites would be my bet, too. I`ve seen similiar symptoms on patients with ascites.

A friend of mine is a tatoo artist and another friend got his wiener tatooed (I HAVEN`t seen it ) - both of `em never accounted of problems like this (although I never specifically asked).

Taking this even farther - we don`t really have any standing rigid SOPs/Protocols/Guidelines (at least not in the way seen in many other countries) which could be easily compared to your system.

Ak, cool story - a way worth admiring! As for me: When I was in my last year in High School I wanted to become a doctor initially - due to some misinterpretations and some mistakes on my side, I thought that I wouldn`t be eligible for med school right after school, as I thought I would lack the appropriate qualifications. I can`t really remember, when I started thinking about EMS - I never had a drastic moment of tragedy or something, that pointed me into this. Anyways, I somewhere read about it, started research a bit, applied for a Para (RettAss) course and got in. Then, when I finisihed High School and found out that my grades were better than I had expected and I propably would be able to enter med school right away, I had to decide wether to apply for medicine or take on the Para course I already had an offer for. After some thought, I choose the Para course (with the plan to study medicine afterwards), because I wanted to do something practical and "real-life" before sitting on my arse again for another six years. In the summer I finished Para school, I had also applied for medicine (but it was a fucked-up thing in the first place, since I wasn`t really sure wether I wanted to do this anymore - so I spontaneously applied on the last possible day to keep all my options open, but fucked up with some bureaucratic stuff), but I didn`t get the place I was hoping for. I had an offer for The University of Erlangen, though, but didn`t wanted to go there. So I finisihed Para school - and had nothing. Not the offer for med school I had half-heartedly hoped for and neither a job in EMS, since the service I was training with had no vacancies. Luckily (more or less) I quickly found a job with a private service and started to work there as a Para after one month of unemployment. The position didn`t really suit me `cause they weren`t really employee-firiendly, so I left after some months to get back to my former service (due to some vacancy). I`ve been working there since that swap. Right now I`m thinking about changing my job and geographical position, but that`s another story.

True enough, try to learn as much of the basic skills in hospital as possible. Especially as it`s not getting any easier in the field. It`s a bit different without good lightning, enough space and a cosy warm temperature. When I had my OR rotation, one doc insisted that I`d have to sit while doing an IV (`cause back when he was in training, their chief insisted on it, too). I thought, like - yeah... real helpful, `cause that`s how I`ll do it in the field, too.

That`s a long tradition. Roman legionairres trained with wooden gladii (swords), that were weighing twice as much as their normal sword, to train their muscles. Sry, just me being a smartass.

Ah... I only kinda slipped through the thread. You`re right of course. Regarding that matter, it of course depends on your local protocols.

LOC is an essential aspect in START and SALT triage (just to name some prominent examples), as well as it`s an important factor in ANY anamnesis, regardless of the diagnose.

I dunno why this needs to be pointed out. It should be common courtesy to say goodbye and wish your pat. well...

World of Warcraft, I guess?! Anyways, welcomce!!

Do you know Ken Burns documentary "The civil War"? It`s about ten hours long and pretty good (lots of recitations of original sources and such).

We don`t!

It has no direct connection to the original song that was posted, but the topic somehow reminded me of that song. This might not be the kind of music most of you like - but the lyrics are really great. This is more of a critical/depressed/resignating approach on shootings. This is btw one of my favourite bands.

I`d like to answer more, but I really need to go to bed. Just some things. I don`t see the constant need of Rocuronium here. Why didn`t you just sedate with Ket and Versed? First guess would go into the raw direction of pulmonary edema - regarding to the EtCo2 getting better after CPAP. How much PEEP did you apply?