Ace844

Nope...

Here's another hint::

[stream:797b3f7be1]http://www.moviewavs.com/0085934086/WAVS/Movies/Boiler_Room/notoriousbig.wav[/stream:797b3f7be1]

"Notorious B.I.G. said it best: Either your slinging crack rock, or you got a wicked jump shot.' Nobody wants to work for it anybore. There's no honor in taking the after school job at Mickey D's. Honor's in the dollar, kid. So I went the white boy way of slinging crack rock. I became a stock broker."

I thaught it was a play on letters like S.A.M.P.L.E. I've been seeing it here and on run reports.

Not the things in oysters.

The closest thing I can think of off the top of my head is that you were seeing this as part of either a neuro exam and or to document ocular findings and lack there of PEARL:

Pupils

Equal

And

R[sub:da1b3eab6b]2[/sub:da1b3eab6b]Round/Reactive

{not listed but said} TO

Light,

Some clinicians will also add-Accommidation; as well.

Is this what you were referring to? Furthermore, doing a search would have helped you as well and would have yielded additional mnemonices which you should learn.

Mnemonics?

EMS Terminology I

Medical Assessment...

Medical Patent Assessment

Things you've missed

Out Here,

ACE844

What is the pathophysiology of Mitochondrial disease?

http://www.clevelandclinic.org/health/heal....asp?index=6957

Mitochondrial Disease

What are mitochondria?

A mitochondrion (singular of mitochondria) is part of every cell in the body that contains genetic material. Mitochondria are responsible for processing oxygen and converting substances from the foods we eat into energy for essential cell functions. Mitochondria produce energy in the form of adenosine triphosphate (ATP), which is then transported to the cytoplasm of a cell for use in numerous cell functions.

What are mitochondrial and metabolic diseases?

Mitochondrial medicine is a new and rapidly developing medical subspecialty. Many specialists are involved in researching mitochondrial diseases, including doctors specializing in metabolic diseases, cell biologists, molecular geneticists, neurologists, biochemists, pathologists, immunologists, and embryologists. Much of what we know about these diseases has been discovered since 1940. In 1959, the first patient was diagnosed with a mitochondrial disorder. In 1963, researchers discovered that mitochondria have their own DNA or "blueprint" (mtDNA), which is different than the nuclear DNA (nDNA) found in the cells' nucleus.

Mitochondrial and metabolic medical conditions are now referred to as mitochondrial cytopathies. Mitochondrial cytopathies actually include more than 40 different identified diseases that have different genetic features. The common factor among these diseases is that the mitochondria are unable to completely burn food and oxygen in order to generate energy.

The process of converting food and oxygen (fuel) into energy requires hundreds of chemical reactions, and each chemical reaction must run almost perfectly in order to have a continuous supply of energy. When one or more components of these chemical reactions do not run perfectly, there is an energy crisis, and the cells cannot function normally. As a result, the incompletely burned food might accumulate as poison inside the body.

This poison can stop other chemical reactions that are important for the cells to survive, making the energy crisis even worse. In addition, these poisons can act as free radicals (reactive substances that readily form harmful compounds with other molecules) that can damage the mitochondria over time, causing damage that cannot be reversed. Unlike nuclear DNA, mitochondrial DNA has very limited repair abilities and almost no protective capacity to shield the mitochondria from free radical damage.

What are the symptoms of mitochondrial diseases?

The types of mitochondrial diseases are categorized according to the organ systems affected and symptoms present. Mitochondrial diseases might affect the cells of the brain, nerves (including the nerves to the stomach and intestines), muscles, kidneys, heart, liver, eyes, ears, or pancreas. In some patients, only one organ is affected, while in other patients all the organs are involved. Depending on how severe the mitochondrial disorder is, the illness can range in severity from mild to fatal.

Depending on which cells of the body are affected, symptoms might include:

Poor growth

Loss of muscle coordination, muscle weakness

Visual and/or hearing problems

Developmental delays, learning disabilities

Mental retardation

Heart, liver, or kidney disease

Gastrointestinal disorders, severe constipation

Respiratory disorders

Diabetes

Increased risk of infection

Neurological problems, seizures

Thyroid dysfunction

Dementia (mental disorder characterized by confusion, disorientation, and memory loss)

How common are mitochondrial diseases?

About one in 4,000 children in the United States will develop mitochondrial disease by the age of 10 years. One thousand to 4,000 children per year in the United Sates are born with a type of mitochondrial disease.

In adults, many diseases of aging have been found to have defects of mitochondrial function. These include, but are not limited to, type 2 diabetes, Parkinson's disease, atherosclerotic heart disease, stroke, Alzheimer's disease, and cancer. In addition, many medicines can injure the mitochondria.

What causes mitochondrial disease?

For many patients, mitochondrial disease is an inherited condition that runs in families (genetic). An uncertain percentage of patients acquire symptoms due to other factors, including mitochondrial toxins.

It is important to determine which type of mitochondrial disease inheritance is present, in order to predict the risk of recurrence for future children.

The types of mitochondrial disease inheritance include:

DNA (DNA contained in the nucleus of the cell) inheritance. Also called autosomal inheritance.

-- If this gene trait is recessive (one gene from each parent), often no other family members appear to be affected. There is a 25 percent chance of the trait occurring in other siblings.

-- If this gene trait is dominant (a gene from either parent), the disease often occurs in other family members. There is a 50 percent chance of the trait occurring in other siblings.

MtDNA (DNA contained in the mitochondria) inheritance.

-- There is a 100 percent chance of the trait occurring in other siblings, since all mitochondria are inherited from the mother, although symptoms might be either more or less severe.

Combination of mtDNA and nDNA defects:

-- Relationship between nDNA and mtDNA and their correlation in mitochondrial formation is unknown

Random occurrences

-- Diseases specifically from deletions of large parts of the mitochondrial DNA molecule are usually sporadic without affecting other family member

-- Medicines or other toxic substances can trigger mitochondrial disease

How are mitochondrial diseases diagnosed?

Diagnosis of mitochondrial disease can be invasive, expensive, time-consuming, and labor-intensive. Therefore, evaluation is not taken lightly. Doctors experienced in diagnosing and treating these diseases will take either a step-wise approach to diagnosis or, in some centers, the evaluation takes place over a few days. The evaluation includes a combination of clinical observations and laboratory tests.

Under ideal circumstances, the evaluation will produce an answer. However, even after a complete evaluation, the doctor might not be able to confirm a specific diagnosis or put a name to the disorder. In many cases, however, the physician will be able to identify which patients do and don't have metabolic diseases.

Mitochondrial disease is diagnosed by:

Evaluating the patient's family history

Performing a complete physical examination

Performing a neurological examination

Performing a metabolic examination that includes blood, urine, and optional cerebral spinal fluid tests

Performing other tests, depending on the patient's specific condition and needs. These tests might include:

-- Magnetic resonance imaging (MRI) or scan (MRS) if neurological symptoms are present

-- Retinal exam or electroretinogram if vision symptoms are present

-- Electrocardiogram (EKG) or echocardiogram if heart disease symptoms are present

-- Audiogram or BAEP if hearing symptoms are present

-- Blood test to detect thyroid dysfunction if thyroid problems are present

-- Blood test to perform genetic DNA testing

More invasive tests, such as a skin or muscle biopsy, might be performed as needed and recommended by your doctor.

How are mitochondrial diseases treated?

There are no cures for mitochondrial diseases, but treatment can help reduce symptoms, or delay or prevent the progression of the disease.

Treatment is individualized for each patient, as doctors specializing in metabolic diseases have found that every child and adult is "biochemically different." That means that no two people will respond to a particular treatment in a specific way, even if they have the same disease.

Certain vitamin and enzyme therapies, along with occupational and physical therapy, might be helpful for some patients.

Vitamins and supplements prescribed might include:

- Coenzyme Q10

- B complex vitamins: thiamine (B1), riboflavin (B2), niacin (B3), B6, folate, B12, biotin, pantothenic acid

- Vitamin E, lipoic acid, selinium, and other antioxidants

- L-carnitine (Carnitor)

- Intercurrent illness supplement: vitamin C, biotin

Diet therapy, as prescribed by your doctor along with a registered dietitian, might be recommended.

Antioxidant treatments as protective substances are currently being investigated as another potential treatment method.

Important: Specific treatments should always be guided by a metabolic specialist. No patient should take any of these supplements or try any of the treatments unless they have been prescribed by their doctor. Taking inappropriate supplements or treatments might lead to delays or failure in establishing an accurate diagnosis.

What is the prognosis or outlook?

Once a patient is diagnosed with a specific mitochondrial disease, the patient's medical problems have already been identified or can be identified with proper testing so treatment can be initiated to relieve symptoms and delay the progression of the disease.

There is no way to predict the course of mitochondrial diseases. They might progress quickly or slowly, even over decades. The disease might also appear stable for years.

For parents considering having other children, genetic counseling is available. Although complex, prenatal testing is only available for a few types of mitochondrial disorders. Please discuss your concerns with your doctor.

What is P-Mitrale, and is it clinically significant in isolation-when asymptomatic, also what is the DX criteria and Phys?

Good point, but once you have your treatment areas set up, you should have enough help there so you wouldn't have to use the same blade multiple times...theoretically that is. I work in a rather large system so that if we did have a big event we'd have our mass casuality unit, multiple other ems units and more than likely our logistics staff present at some time during the event. I know not every system has that available to them but that's how we do it here.

Your operating under the assumption that Mr. Murphy and his pal the fickled finger will go along with your carefully laid plans. In these atypical situations one needs to adapt, iprovise, and overcome! Don't count on your plans to go how you expect, and don't expect resources that are 'suppossed to be, told to maybe, or will be, available.' For sure Ringling Bros, Barnun & Bailey will be making an appearance. Food for FUBAR situation thought,

Out Here,

ACE844

"Viper,"

I hope you enjoyed 'Ray's' program. As far as the comments about 'LifeLine' here, this company is brand new and essentially all of the old long term management of Armstrong, who left to do this start up. This includes the old CEO and HR managers, etc.. It is too early to tell if they will suffer the same myopic afflictions which Armstrong was famous for. As far as the original question. Really it depends on you. There are perhaps 2 actual progressive EMS serviecs in this state and even they have their issues like anywhere else. That being said, one of them is Paramedic only. Next as far as choices, this has to do with a myriad of factors most of which would need to be based on personal situation and information. Take anonymous career advice from an internet forum at your own risk. If you have specific questions feel free to post them or PM me I will be happy to help anyway I can.

Out Here,

ACE844

Here's a link to a PPT lecture which should help as well:

http://www.sh.lsuhsc.edu/intragrad/211/Int...,50,Therapeutic Uses of Antimuscarinic Drugs

Also, here's a great article on anti-hystamine Tox:

http://www.aspca.org/site/DocServer/toxbri...ddInterest=1101

And Here's some info which i was refering to with the valium, and yes I know it uses dogs in the article{and that it is a primary vetrinary study} as an example.

Next here's some further discription of an anti-cholinergics activity and mechanisim in the CNS..This also describes the sedation process.

http://www.brooksidepress.org/Products/Ope...tingAgents.html

Since we're talking assessments, I was wondering what is a pearls assessment?

Care to be more specific? Are you asking about clinical PEARLS? The things you find in oysters? WHAT?

We do aim to please!

Some simple pathophysiology, sprinkled with a bit of pharmacology, stir in some critical thinking.

Bippity, Bobbity, Boo! You know how something works.

Alittle bitty PSA message as to why EDUCATION IS SO IMPORTANT IN THIS CAREER! Also, a bit of quick insight as to why we all say it's so important.

Strong work and succinctly put "AZCEP,"

Out Here,

ACE844

Do a search for pulmonary physiology, and or there is some info in the etco2 threads.

Out Here,

ACE844

Surgi-lube the windshield wipers of an ambulance.....

Matter of fact I believe he is a member here, and soem simple research and a PM will probably be most beneficial to you if yuo have questions or would like to know more.

Out Here,

ACE844

Ace844, I am not sure. I have not heard that Valium is specifically contraindicated. However, in very severe cases benzos may not work and the use of Physostigmine may be required. Here is a good article covering toxicity of antihistamines.

http://www.emedicine.com/EMERG/topic38.htm

Take care,

chbare.

Thanks, I just had the following rationale stuck in my brain for soemreason. This is that the mulit-receptor effects of the Diphyenhydramine, and the valium, and other anti-seizure meds would cause an excess of neurotransmitters in the CNS, as well as potentially inducing seritonergic syndrome...not sure, but I'll look it up and check the link, thanks again,

ACE844

Well let's hear it from someone on this site who's girlfriend in college was raped and then murdered in her apartment 15 minutes after I had left. The assailant was caught running from the apartment with her blood on him.

He was convicted of 1st degree murder and sentenced to die.

Did I forgive him? NOPE

Do I hate him for what he did? YEP you bet your ass I do.

Would I start the IV and push the drugs, probably at the time, due to the emotional nature of the situation.

would I now - NO way. There is no way that any paramedic out there or EMT or Nurse should be administering the lethal cocktail to these people. It just goes away from all what we are taught - the original rule FIRST DO NO HARM

You really cannot allow medics to be doing the execution and still follow that Ethical Rule.

My opinion only of course.

"Ruff," I'm sorry to hear of your tragedy...No one should have to live through that.

ACE844

"ChBare,"

Now I may be recalling incorrectly, but isn't there some kind of mechanisim or clinical pearl which says not to use valium for this?{the seizures}

ACE844

You're right Ace. These people deserve to be treated with compassion and love.

Wait...a...second...

Not! Still don't have any compassion for a baby raper or wife/mom/girl murderer! Sorry! Never will!

Not saying the Russians were tops in that area but "Keep It Simple Stupid" can apply to more areas than EMS.

Interestingly though, I remember seeing an article on the tele that said the russians felt themselves more compassionate because they didn't give a specific execution date. Just went in, fetched 'em, brought 'em out back, tied them to an old box spring, and carried out the orders.

It's all about the point of view too.

Still loving this discussion...

ug

I never stated an opinion about this matter, but as far as the Russian side, just facts. Next, I happen to know someone who spent 10 yrs in Lubyanka as a political prisoner for printing an 'anti-state article in a newspaper. The guy didn't even write it, he was just working the press the night they printed it at the paper. As far as the executions being anonymous, perhaps in some areas. The individual I know said they knew when they were executing people because they only did it on nights where the elevator worked (this was sporadically) and it made a hell of a rucus, and also some of the guards there would tell the prisoners. Makes for some interesting stories when he feels like talking about it. Best of luck with your lethal injections, YMMV,

ACE844

It should be noted that the 'Russian bullet option' which you mention was often preceeded by a (potential 3k mile walk, later train ride to Siberia, but not always) period of sensory and vital needs deprivation and torture...The bullet came after all of that usually, and mostly you hoped the guys pulling the trigger were sober.

ACE844

A 'Non-profit, private Transport Company'..... That AMR bought, and yet there was no profit involved???

HEY ACE!!!!!!!!!!!! YO MAMMA

But to get back to the thread, the info posted by Ace is spot on. Great research.

Your papa....

The bit about H1 receptors causing "wakefulness" is interesting, I didnt know that. Hmm.

Still,

This is the mechanism that I am specifically asking about. It seems like it should go the other way, doesnt it? I mean- if parasympathetic tone causes the "feed and breed" (and sedate?) response, why wouldnt antagonising that system cause the opposite (or, at least, less sedation- not more)?

Most antihistamines cross the blood-brain barrier and produce sedation due to inhibition of histamine N -methyltransferase and blockage of central histaminergic receptors. Antagonism of other central nervous system receptor sites, such as those for serotonin, acetylcholine, and alpha-adrenergic stimulation, may also be involved . Phenothiazines are thought to cause indirect reduction of stimuli to the brain stem reticular system.

Now to break this down into some easily understood english.

1.) The basic ethylamine group common to antihistamines (Read molecular structure) is also common to anticholinergics, ganglionic- and adrenergic-blocking agents, local anesthetics, and antispasmodics, some antihistamines may exhibit some of the activities of these other classes of drugs. They do so by competively binding, in some cases blocking, and or activating these receptor sites.

2.) The 1st generation of H1 Blockers like dyphenhydramine are able to croos the blood brain barrier due to their lipophylicity. (READ THEIR ATTRACTION TO THE FAT IN THE CELLULAR MEMBRANES WHICH ALLOW IT TO CROSS THE BLOOD BRAIN BARRIER)

3.) Because some of dyphenhydramines action is in the 'higher brain centers it's neurotransmitter effects this is how you get soem of the sedative properties.

HTH, ACE844

Here's a link to a study describing the pharm dynamics: http://dmd.aspetjournals.org/cgi/content/full/34/6/955

"Fiznat,"

Here is some information related to your request.

Antihistamines and anticholinergics (agents that block the action of acetylcholine) may be effective in the treatment of motion sickness as the result of a similar action: the ability to block the transmission of information from the vestibular apparatus (the part of the middle ear that is involved in balance) to the emetic center in the medulla oblongata, which is a part of the brain involved in coordinating various reflexes (e.g., swallowing, vomiting).

Why is drowsiness a usual side effect?

Histamine, acting via H1 receptors in the central nervous system, increases wakefulness. Therefore, antihistamines that block the binding of histamine to H1 receptors and which enter the central nervous system cause drowsiness. In addition, anticholinergic agents cause drowsiness and, thus, antihistamines which possess anticholinergic activity also produce drowsiness via this action. Thus, older agents, such as diphenhydramine, which enter the central nervous system, cause sedation, while newer antihistamines, such as astemizole (HISMANAL) and loratadine (CLARITIN), which poorly penetrate into the CNS, are nonsedating. Patients vary in their susceptibility to the sedative effects of antihistamines.

HTH,

ACE844

What is Beck's Triad?

JVD, NArrowing Pulse Pressures, and muffled Heart sounds found in Cardiac Tamponade.

What is Grey-Turner's sign and the physiology behind it?

I just joined the forum as well. I'm an 18D currently in OEF and looking into medical options for my return stateside. Dustdevil, you mention that these tactical courses focus on tactics, do you mean law enforcement tactics or tactical ways to give care? I'd like to hear from guys who are prior military who have taken a tactical EMS course, how did the tactics compare to what you were taught in the military? Obviously tactics will differ for use in the civilian world (ie. it may not be a good idea to kill everyone with a gun when clearing a room back home).

BTW Dustdevil, I saw your pic of that mini-gun, man those things are freaking awsome! Got to see one in action from the ground, there is no morale boost like seeing your exfil bird silence all incoming rounds with a ten second burst. The bad guys had no idea what hit them. Good luck over there.

"MissingLink,"

If your an 18D guy whom it is not unreasonable to presume that you have alot of time 'down range,' and 'in the box', you will find CONTOMS and most probably event the H&K style courses a waste of time. They won't compare even remotely to what you encountered at 'the stockade' {if you went that far} or out at SOMC-McCall-Pope. If you have contacts at the Q-SOMC you may consider 'auditing' some courses there or even re-running the 'goat' lab a few times to get back in the swing. IMHLO, the big sifference you will see from Military medicine and Civilain is the 'medical' side which as a vanilla military medic you may need more exposure to as oppossed to the majority of 'trauma' which they see. Yet again though with your 18D I'm sure you've practiced more autonomous medicine than most here ever will.

Depending on your situation and opinions it may be a good idea to do some intl stuff for a few years post-service and this will help you get your warchest in to an ideal position for later when you want to settle down. "Dust," mentioned a few and I will also add SOS Temps to that list. You may also try to look at contacting the Natl Regisrty and they may allow you to challenge the exam although they may force you to entertain the possibility of 'taking a refresher' through USASOC-SOMC. Food for thought, Hope this Helps,

ACE844

the carina

What is your RX of choice in a Verapamil OD? And what is the coreect dosage?

What is TETROLOGY OF FALLOT?

How can you do a field diagnosis without using results from tests you dont have access to. You treat off the most likely from the combinationof symptoms.

Be careful when using diagnosis.

Because 'testing' is not necessarily synonmyous with lab results or radiological surveys. Testing can also mean parts of the P/E and H&P which include psychomotor actions and interactions one on one with a pt. Example, Lung sounds, Kernig's sign, Dolls eyes test, webber-rhine test, caloric test, stereographic function, graphestesia, etc......Those are things whaich could be done in the field, and don't require a hospital or technology.

Out Here,

ACE844

Seems to me we recently had the definitive care debate ing the 'Is EMS Definitive care Thread'; Is EMS definative care?....hmmmmm..Guess are going to end up going back there. A furthere reply will be forthcoming.

ACE844

Tank you PRPG. at last some common sense. AZCEP, I also stated, which you apear to have overlooked, that you treat what you see. Waht you see is based on your observations, history etc. This can only provide you with a PROVISIONAL DIAGNOSIS, a platform from which to commence any NECESARRY interventions. as has been stated repeatedly, a DIFFERENTIAL DIAGNOSIS can only be done when it has been confirmed by results of tests not available in a pre hospital environment.

It all boils down to what is the role of EMS? Pre Hospital care. Not difinitive care.

“Aussiephil,”

I disagree with your last statement, and since you have yet to provide ANY evidence as requested, to support your claims, I think now would be a prudent time to make sure we are clear about what we are talking about.It seems we need to be sure of the terms that we are using here freely. Below are a few sources and definitions to help us all. As you will see what we do and what physicians do are relatively one and the same.

="MedTerms medical dictionary AZ List”

Definition of Diagnosis

Diagnosis: 1 The nature of a disease; the identification of an illness. 2 A conclusion or decision reached by diagnosis. The diagnosis is rabies. 3 The identification of any problem. The diagnosis was a plugged IV.

The word diagnosis comes directly from the Greek, but the meaning has been changed. To the Greeks a diagnosis meant specifically a "discrimination, a distinguishing, or a discerning between two possibilities." Today, in medicine that corresponds more closely to a differential diagnosis.

Diagnosis, differential: The process of weighing the probability of one disease versus that of other diseases possibly accounting for a patient's illness. The differential diagnosis of rhinitis (a runny nose) includes allergic rhinitis (hayfever), the abuse of nasal decongestants and, of course, the common cold.

Definition of Retrodiagnosis

Retrodiagnosis: Retrospective diagnosis. The proposal that the mysterious illness that killed Alexander the Great more than 2,300 years ago was West Nile fever is an exercise in retrodiagnosis.

=”Dorland's Illustrated Medical Dictionary “

definitive (de•fin•i•tive) (de-fin´ĭ-tiv) 1. established with certainty. 2. in embryology, denoting acquisition of final differentiation or character. 3. in parasitology, denoting the host in which a parasite reaches the sexual stage.

care (care) (kār) [A.S. caru anxiety] the services rendered by members of the health professions for the benefit of a patient. Called also treatment.

Now let’s further see what the other definitions we are using are.

=”Federal Law and Emergency Medicine

Emergency Medicine - Legal Aspects Of Emergency Medicine

Last Updated: February 21, 2006

Author: Robert Derlet, MD , Professor of Emergency Medicine, University of California at Davis School of Medicine; Chief, Division of Emergency Medicine, UC Davis Health System

Robert Derlet, MD, is a member of the following medical societies: American Academy of Emergency Medicine, American Association for the Advancement of Science, Infectious Diseases Society of America, Society for Academic Emergency Medicine, and Wilderness Medical Society

Editor(s): Francis Counselman, MD , Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School; Francisco Talavera, PharmD, PhD , Senior Pharmacy Editor, eMedicine; Matthew M Rice, MD, JD , Vice President, Chief Medical Officer, Northwest Emergency Physicians, Assistant Clinical Professor of Medicine, University of Washington at Seattle; Assistant Clinical Professor, Uniformed Services University of Health Sciences; John Halamka, MD , Chief Information Officer, CareGroup Healthcare System, Assistant Professor of Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical School; and Steven C Dronen, MD, FAAEM , Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center"

Definition of an emergency

Federal law defines an emergency medical condition as follows:

"Emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances, and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in:

• Placing the health of the individual (or, with respect to a pregnant woman, the health of a woman or her unborn child) in serious jeopardy;

• Serious impairment to any bodily functions;

• Serious dysfunction of any bodily organ or part; or

• With respect to a pregnant woman who is having contractions:

o That there is inadequate time to effect a safe transfer to another hospital before delivery, or

o That the transfer may pose a threat to the health or safety of the woman or the unborn child.

See Prudent Layperson Definition of Emergency Medical Condition . : The prudent layperson definition of an EMC is widely interpreted yet generally defined as a medical condition that a nonmedical person with an average knowledge of the world would consider as needing emergency care. A recent survey of 1000 laypersons in the field attempted to define the prudent layperson definition for a number of specific complaints. Even among widely divergent socioeconomic groups, there was good agreement on what conditions needed ED care.

Stabilization entitlement for treatment of emergency medical conditions

Federal law requires that all patients with EMCs be stabilized within the capacity of the institution. Stabilization means, with respect to an emergency medical condition as defined, “that no material deterioration of the condition is likely within reasonable medical probability to result from or occur during the transfer of the patient from a facility” (or discharge). Patients must be stabilized regardless of ability to pay. The legal definition of stabilization under EMTALA may mean something different from the medical definition of stabilization. Full stabilization need not always occur in the ED, but in the most appropriate acute area of the hospital. For example, full stabilization of a patient with a gun shot wound to the abdomen may occur in the hospital's operating room, full stabilization of a massive myocardial infarction in the cardiac catheterization laboratory, and full stabilization of an obstetric emergency in the labor and delivery department.

Now lets see another source in addition to all of the above in my original post which support my point and claims.

=“http://en.wikipedia.org/wiki/Diagnosis”

Diagnosis (from the Greek words dia = by and gnosis = knowledge) is the process of identifying a disease by its signs, symptoms and results of various diagnostic procedures. The conclusion reached through that process is also called a diagnosis.[/b]

The term "diagnostic criteria" designates the combination of symptoms which allows the doctor to ascertain the diagnosis of the respective disease.

Typically, someone with abnormal symptoms will consult a physician, who will then obtain a history of their present illness and examine them for signs of disease. The physician will formulate a hypothesis of likely diagnoses and in many cases will obtain further testing to confirm or clarify the diagnosis before proceeding to render treatment.

=“http://en.wikipedia.org/wiki/Diagnosis”

History taking is a fluid process that adapts to the information as it is presented. Almost invariably the patient presents with a complaint. Even the unconscious patient presents with the implicit complaint of being unconscious. This presenting complaint leads to the formation of hypotheses. Rather than consider the myriad of diseases that could afflict the patient, the physician narrows down the possibilities to those conditions likely to account for the presenting complaint. The history taking then proceeds to test these hypotheses, often narrowing down the diagnosis within a few questions. Sometimes the initial hypotheses are ruled out and the physician must then move on to look at other hypotheses or multiple ones. Occam's razor is then invoked to attempt to simplify the number of provisional diagnoses and it is only with some reluctance that a physician will make several provisional diagnoses to explain the symptoms elicited.

The physician then moves on to the physical examination. However, the hypothesis testing does not end at this point. Signs may confirm the provisional diagnosis or cause the physician to consider the question further and even lead to more questioning. An unexpected finding on examination may cause the physician to reconsider the initial diagnosis.

At this point the physician usually has at least a differential diagnosis and probably a provisional diagnosis if not a firm diagnosis. Further tests are then requested, in part to confirm or disprove the diagnosis but also to document the status at that time and before treatment is started. Consultations with other physicians and specialists in the field may be sought.

Treatment itself may indicate a need for review of the diagnosis if there is a failure to respond to treatments that would normally work.

Despite all of these complexities, most consultations are relatively brief, partly because many diseases are common and pattern recognition allows the physician to recognize the diagnosis early, but also because the decision trees of most hypothesis testing are relatively short.

=“http://en.wikipedia.org/wiki/Diagnosis_of_exclusion”The term diagnosis of exclusion (per exclusionem) refers to a medical condition whose presence cannot be established with complete confidence from examination or testing. Diagnosis is therefore by elimination of other reasonable possibilities.An example of such a diagnosis is "fever of unknown origin": to explain the cause of elevated temperature the most common causes of unexplained fever (infection, neoplasm, or collagen vascular disease) must be ruled out.

Hope this helps,

ACE844