DFIB

Years ago I had to meet a deadline and knew I could only meet it by not sleeping, I investigated that astronaughts when in space sleep 20 min every 4 hours. They could do this indefinitely. I tried it for four days and it worked pretty good for me. At the end I was tired but only slept my normal 6 hrs once I got home. I have "lost time" while driving for long periods of time. I have arrived at my destination but don't remember the last three hours of driving. Passengers said I seemed normal. I lost 2 days in the 80's after taking Halcion but that is a different story. I took and passed a microbiology test and don't remember any of it. Sleep every chance you get. When traveling wiht a partner I do the 20 min sleep per four hours activity and it works well.

If I remember correctly systolic pressure is "driven" by cardiac output and diastolic pressure by norepinefrin. In a hypovolemic patient the sympathetic system is hyperactive. Systolic pressure is down because the volume is low but the diastolic is high because of the sympathetic is crazy trying to vaso constrict. So it would be just the opposite of your post, a narrow pulse pressure would be hypovolemia and a wide pulse pressure would indicate shock by vasodilatation such as anaphylaxis or septic shock. Edited to check spelling

"A patient with dissecting aortic aneurysm may also exhibit difference in blood pressure between arms" Emergency, Care and transport of the sick and injured, Tenth edition It is in the textbook but that is all it says. Pretty ambiguous. .

Seems that she was indeed critical as well, The triage call was good. Even teh secondary assesment team might have missed a bleed in an active, vociferous patient. If you could do over would you have tagged her yellow or made the same decision based on the information you had at the time?

Thanks for making an exception on the passed around quotes. Us new guys haven't heard them that much.

From a BLS guy the only thing I would worry about is the BP and would have re-checked after 10 min. Was she on meds for hypertension that she had forgotten to take? What position did you transport in? I would have gone with Fowler or Semi-Fowler. I would have wanted to know if her pain was related to her breakfast. Did she eat anything different for breakfast and what did she have? Had she had any carbonated drinks? It sounds like the call was pretty flawless. Good transport desision. She definitely needs meds for BP.

I hear you friend, We get to see and interact with the best and worst of humanity on a daly basis. We are constantly aware of our own humanity, suffering we cannot ease, pain we cannot control. If we are true "healers" we will carry the weight of those we could not heal. It makes us better I think, but it is still a weight.

The scariest thing to responding as a civie is that there is no possibility of transport. What you walk up on is what you got until the bus arrives. Scary. All emergency calls will wait until you begin to eat, regardless of the time. Any patient, when given the option of either going to jail or going to the hospital by a police officer, will always be inside the ambulance before you are. In any accident, the degree of injury suffered by a patient is inversely proportional to the amount and volume of agonized screaming produced by that patient. Always assume that any Physician found at the scene of an emergency is a Gynecologist, until proven otherwise. What do you call the student with the lowest GPA in Med. School? Ans. Doctor

If I know the patient is there and needs immediate help I go get 'em. Don't care about the door, window, pet or even the potted plant. It is always good to have LE and FF on scene, LE to watch and shoot the dog and FF to do bust the door and break the plant. Going solo is risky but probably cleaner. Edited for spelling

Ash, We;come to the forum. It is good to see you are considering studying EMS. It is a grat profession both exciting and compassionate. Are you in Cleveland, Texas? My son is studying EMT near there and I could give some pointers.

Vote for Pedro!

Ruffiens posted in another forum – “Two quick sprays of Nitro dropped the dog in about 5 seconds. I did hear from the cops that the dog did come around, not sure of long term issues but it was truly a matter of time on that call before the dog attacked.” Has anyone else used Nitro on dogs? In a medical call the patient is my primary concern after the safety of me and my crew, If the 160 lb vicious monster the patient calls a "pet" is in the way ... feed 'em rice. just not all that interested in the animal. If it is a poodle called Fifi that can easily be controlled it is a different story.

Welcome to EMS City. You will find this forum to be stimulating and informative. I agree with Dwayne that if you want to be an RN there are more direct and better ways to achieve that goal. If you want to do Paramedic with your new hubby that is cool and should be a lot of fun to do together, although I would recommend being realistic about your options and your reasons for training and your expectations as well as his. I am not saying that you are not being realistic but your post raises questions. As far as watching TV to get a feel for the job ... nothing on TV can prepare you for what you will encounter in real life emergencies. Real life is better and worse all at the same time. Regardless of your choice or your reasons, the medical field is exciting and gratifying. Love your wedding picture.

Inter personal relationships are always difficult. I have found that "waiting and watching" is a technique that works for me. It could be that the person giving you grief is simply having a bad day and is pretty cool the rest of the time. It could be he/she had a fight with their spouse/partner before leaving home, they could have financial problems, cyclical hormonal spikes or they simply might not like you. Who knows why people act the way they act on the first day. I someone has a lot of bad days, everyone else notices as well and you gain esteem among coworkers by being cool. If it is just an isolated incident you gain esteem by being cool. Most people with bad attitudes are well known by their co-workers and don't necessarily need the new guy to confirm. Most people with unprofessional behavior fall under their own weight. Another technique to diffuse a situation similar to yours is to ask for a post-call discussion with the crew. If your in charge or proctor has a chance to voice "what we did well" "and what we can improve" it often diffuses the lousy written reviews. Be ready to accept criticism with an positive attitude. In these sessions the offending person will probably have to eat crap, but often talking it out helps. Finally we can only control our selves. We cannot control others or their attitudes. They only have the power over us that we allow them to have. Take the good and use I, ignore the useless and negative. So study hard, learn the equipment and the protocol, take a step back and enjoy EMS. It is worth the effort.

I would be interested in what areas of the supermarket she had been through. The potential for allergens in supermarkets are great, fruit from all over the world, cleaning products and packages that have been stored in warehouses all over the country. The absence of hives and itching is troubling but shouldn't exclude an allergic reaction. Did the hospital run a tryptase level or ELISA panel?

I have been watching shsrk week with my 14 year old daughter. Every time someone gets bit a will ask her: "So what would you do? Most of the time they need a touniquet since they are shark bites. Yesterday I asked her the same question as we watched TV and she said "That guy doesn't need a doctor, he needs a priest! The point is that we can take every day occurnces and turn tham into learning oportunities,

See the inherent problem is that we doubt "other" EMTs judgement and ability to handle a firearm in a rescue situation. There are many who carry all the time and would not shoot themselves in the foot.. Most good citizens who carry don't train to kill others but to preserve their own wellbeing. I have no problem with any trained, licensed person carrying at any time. I am also sure that EMS services will probably never let non tactical EMTs carry. Defending yourself and the innocent is not vigilantism. It is humane. It is just. If someone had a weapon in Norway or Virginia of Columbine the death count would possibly have been diminished. Who knows maby the bad guy wins, but at least the prospective victims have a chance. Just because a man is armed doesn't make him a wolf, more like a guard dog in my oppinion but he definitely ceases to be a sheep Why not let law abiding citizens who are licensed to carry do so in their work place. Are americans constitutional rights suspended soley because they choose to be postal workers, students, teachers, social workers, nurses or EMT's? ,

I would be inclined to lean toward intracraneal pressure (blown L pupil) The rapid onset makes me think of a bleed. Although the proggressively worsening behavior could indicate a tumor, cisticercosis or some other rapid growing intracraneal mass.

I like the idea of medics attached to tactical teams being armed. It only seems reasonable since they could be in situations where they would have to defend themselves or their patient. A law that protects them is promising. Personally I wish CHL holders could have similar protection although it seems very unlikely anywhere. CHL holding school teachers have tried to be able to carry to work and failed except in one case that I can remember. (I can't remember where but I think it was in Texas). The topic gives much food for thought.

Where I live the news agencies put the patient’s faces and identities in the paper and on TV. They try to take pictures of the trauma victims and diseased to run them on the front page. We are in the news a lot and I really hate it. Often folks will be at the funeral and pictures of their loved one, lying in the middle of the road are circulating in the local paper. We have to treat the news guys decent because they can twist the story however they want.

It' sounds like a neat group of people. Creating a first aid culture within a church community is an interesting concept. Great for the community. Good idea.

I was reading an article on the hormonal cascade of pain and injury and realized it was way above my pay grade but very interesting. I began to wonder if it had any effect on pregnancy. Maybe one of the Docs will chime in. They have to be tough, I get tired carrying 8 lbs in my backpack.

There were some reality shows in the USA that followed paramedics arround I have seen. They look like they were filmed in the 80s. I think one was in LA but I specificly remember a show done Nashville,TN. If you can find who did them some of those guys might still be arround and would have an educated opinion.

I think all pregnant trauma patients are at risk of miscarriage and should get at least one IV line and should be treated as high priority patients, It is an idea I am forming and wondered if I was on the right track. I was thinking that simply the adrenergic effect of pain could possibly be sufficient to trigger labor through catecholamine production and it's general systemic interaction, but catecholamines inhibit the production of oxitocin I know it doesn't always occur but heard of a pregnant patient that sustained an ankle dislocation without direct abdominal trauma, and miscarried hours after. I am not sure what the mechanism is but think pregnancy and the prospect of new life merits extreme care. I haven't figured out the mechanism .... any thoughts?

I have three questions. 1, Do any of you guys consider pregnant patients with any level of trauma as a risk for miscarriage? 2. Do you start IVs on all pregnant trauma patients? 3. If not why? Edited to check spelling.