Arizonaffcep

I agree with the fact that malnourishment is not always an easy thing to spot...but if a patient is SO MALNOURISHED that they DIE 2 HOURS LATTER, you'd think they'd be...unconscious/unresponsive? Altered mentation...all of which should spark a thorough assessment and transport. As for the abuse thing...you can only do what you can do. What I mean is if the situation appears that it is NOT abuse, and or there is no reason to suspect it, the 2 hours latter the husband/significant other kills them...that's not your problem, especially if it's an unforeseeable event. Now, will you get sued...probably. But that's the nature of people...give me money because (insert favorite thought here). The area that you'd probably MOST likely get into trouble with this is if you don't recognize a hypoglycemic event (or are unable to predict it), or if the person is SI and attempts suicide after you leave. But...it all boils down to the provider being able to competently assess their patient, even without laying a hand or instrument on them, and then taking the next step and turning the "welfare check" into a call if need be.

First off, at least in Arizona, EMS is one of the mandated reporting agencies for abuse...no matter what the age. It is required by state law that EMS contacts 1. CPS if the patient is a child and the thought of abuse entered your mind (even if it was just a fleeting thought), 2. Law enforcement, and if the patient is an adult, we call 3. APS. We don't have a choice in the matter. This gets the ball rolling, and the "monkey" off our backs if we document who we talked to at every agency. For the patient to die from malnourishment...takes a while. You would expect that if you visited them even a DAY earlier, you'd notice the S/S...if you didn't...get out of the field and get a refund on the box of Cracker Jacks you got your cert/License from.

Ok...here's one for ya'll! I was reminiscing the other day about things we did in high school, and of course we got on the topic of senior pranks. So...here's my question: What are some of the pranks you guys remember? Can be something you did-or someone else did-just something memorable. I'll start off: I sold my high school. Ya...you read that right. Keep in mind, the school I graduated from is part of the Scottsdale Unified School District. Which of course...make it so much better! Anyway, I placed an add in the classified's to sell it, and placed for sale signs all over the road which read "For Sale, By Owner" with the Principal's office number on them. It caused a little buzz, but was overall regarded as funny as it wasn't destructive.

Astrology or astronomy? Astrology=into things like zodiac signs and other things (nothing wrong with it, if you are into it) Astronomy=study of stars and "universe" type stuff.

So...it sounds like the consensus is a thoracic AA-what other S/S might be associated with it? The interesting part for me from the CE was the pain difference-anyone care to venture why this is different from cardiac CP? I'm not talking mechanism...but onset, quality, etc. And of course, the ever popular question-"WHY?"

Morephine does lower his BP slightly...still fairly elevated though...nothing else.

Onset-"I was reaching for my coffee when I got this unbearable pain in my chest!" Radiation-"No-it's right here <<points to center of chest>>" SOB-A little Skin-Pale/Cool/Diaphoretic No nausea Nothing seems to make it better-but the pain is increasing. Similar pain-"No! I've never had anything like this before!"

"What is the average air speed velocity of an unladen Swallow?" Bridge Keeper Monty Python's: The Holy Grail

The way I do it, because we have only 2 forms, a PCR and a refusal, is if it's something I feel comfortable that the patient can treat at home, then I educate them on it. A caveat to that is, I always say after the education, that if you would like to go to the hospital, I would be happy to take you. If they say "no, I'll stay home" or whatever, then I have them fill out a refusal...because it just became a refusal :wink:

The way to do it is to stay "in-service" while doing the welfare checks (?). This way, you are available for 911 if need be, and you are working with the "frequent flyer" person. This provide what they need (some attention, which, just like a kid, if they can't get good attention, they will seek bad attention) and lower your call volume a little. After all, would you rather haul this person to the hospital for no reason, or see them at their home and have a conversation with them, then go? The conversation is usually a lot easier, and LESS PAPERWORK!

No one dies in the back of my box... :wink:

I completely agree with you, its a huge liability! But...the companies I used to work for use it as an intimidation factor...they are the only games in their respective counties.

FSBS-113 325mg ASA given PO-no change. What kind of and how much of a betablocker do you want?

O2 is applied at 15lpm and 12 lead done...no SETMI noted. Radial pulses +, neg pedal pulses. No pulsating masses noted. Pain is described as "It really hurts! Do something!" Pain did not change with O2. No STEMI noted. Only change is in vitals- B/P-210/140 Pulse-115 RR-20

No known HX of a hernia.

No abd pain...for R/O purposes, you have given a GI cocktail. No change in pain. No prob! Everyone's human. :wink:

Meds are as listed previously. Pt states he sometimes forgets his Atenolol. No change in pain with respiration. LS as stated previously. No leg pain. EKG shows sinus neg. ectopy (AKA NSR). Nothing changes the pain. Pt states "pain is intense!" Pain is center in chest. No prob. Just ask.

Lets stick to questions, plz.

Appearance: Pale, cool, diaphoretic. Last meal: Country Fried Steak, mashed potatoes, lots of gravy, coffee. Pertinent HX: Previous MI, 2 yrs ago, HTN, high cholesterol, NIDDM Meds: Glyburide, Crestor, ASA, Atenolol BP: 160/100 Pulse: 98, regular Resp: 18 LS: Clear = bilat Recent Illness/Surgery: None Occupation: Truck Driver

Ok...here's a scenario that was presented to me today during a CE: You are dispatched to a 55 yom, C/C of CP. Location is at a local Flying J Restaurant. Questions?

If ever you get to a point where you feel the call is getting out of hand STOP! Take a deep breath, then continue. Also, it is NOT YOUR emergency...you are only there to help, which is often to restore a sense of order upon chaos. Best wishes! Have fun! And be safe!

I use 3 monitors...at the FD I worked for and at the hospital, we use the Phillips MRx (absolutely LOVE them!). At the Ambo company I work for, they use the Zoll M's for interfacility (only 5 lead capability), and for their 911 cars, LP12's with all the bells and whistles. All of them have issues with their respective NIBP's...I've been told this is mostly due to movement in the chord while getting the pressure. All are ok and fairly easy to use...although the hardest one to use is the LP12's with that stupid dial.

If I had to guess, are you using the 3M Red Dot 'trodes? They are known for doing that with Zolls.

The GI Bleed hell...worse than code brown.

1. My drug box MUST be complete and dates checked on EVERY shift before I think about rolling. 2. Will NOT run without spare monitor batteries...I once went through 4 different batteries (fully charged, crappy batteries but the FD wouldn't buy more, very $$) on a vf code...shocked for 25 minutes during transport-unresponsive to EVERYTHING we had. Eventually, batteries died and we could either get one more shock or continue to montior the patient...no joke, I immediately went out and bought a DC-AC converter. Then, I didn't worry too much about it, cause during transport we could run and charge the montior off the rig power. 3. I'd be ok with a D tank of O2, we can't carry any other gas. Must have a 1/4 full primary tank in the rig (very large tank) and one FULL portable. 4. If we have blood tubing, then I can live without 10gtts. If not, then no. Need one or the other. 60gtts' are not large enough for trauma codes. 5. Refer to #1. Although we switch/exchange drugs 30-60 days prior to expiring. 6. Must have all airway equipment. 7. Must have a radio. You said it...safety issue. 8. Again, refer to #6. 9. Soft goods, 4x4s, trauma pads, kling, etc. As long as I have a little of each, I can survive.