paramedicmike

Seems rather silly, too, to insult someone who's simply trying to answer the question *you* posed. Not a smart move. Or a good way to make friends. -be safe anyway

You're pissed off that they didn't do more. What more did you want them to do? -be safe

There was an interesting story on NPR tonight. I thought it was interesting that they actually did the story. The comments are interesting, too. -be safe

I think this pretty much settles this discussion. Well said 49393!

If it can't be splinted in place without too much manipulation, I much prefer to give pain meds prior to moving/splinting/tractioning. There are situations when time doesn't allow for it. But pain management before manipulation (or as soon after as is practical) is better. -be safe

BLS stabilization measures notwithstanding, the realities of transport don't always allow for simple methods of pain management. The best position/splint won't stand up to the rigors of a bumpy road. We carry pain relief and administer it quite freely. One of the ground units for which I work uses entonox. Well, I say "uses" I mean they carry it. I don't know anyone who's used it. Both ground units and my flight job have morphine and fentanyl as options. If one doesn't work well on a given patient we'll switch to the other. I don't think I've seen an instance where neither option worked for control of pain. Every patient is queried as to their pain. If we can do something about their pain we offer the meds. Some take it. Others don't. Hope this helps, Bushy. -be safe

I encountered an hospice patient recently who was being given sublingual atropine to "suppress coughing" according to the hospice nurse. This was the first time I'd seen anything like this. The RN didn't have much more information other than to say that "that's what we do". My own research on sublingual atropine is turning up mixed results. Some studies say it works (more with Parkinson's patients than with anything else. The patient in question was not suffering from Parkinson's.). Others say there's not much to it. Anyone else ever come across anything like this? Can you shed some light on the practice? Is this common practice? (Like I said, I've never seen this before. But then again, I don't work in hospice.) I'm presuming the mechanism to suppress coughing is the anti-cholinergic effects in reducing oral secretions. But that's only a semi-educated guess. Anybody have anything to contribute to the general knowledge base here? Thanks. -be safe

Thank you, Michael.

This isn't really EMS news but we are involved as a bit of a side issue because we do transport some of these people. I'm curious as to the details here. What kind of questions were asked in the survey? Were the docs aware of the events leading up to the arrest? This isn't intended to bash cops so let's not go that way. [web:97fefe9d33]http://news.yahoo.com/s/nm/20081224/hl_nm/us_police_er[/web:97fefe9d33]

No. A false sense of security shouldn't be taken from those numbers. And each patient should be assessed based on their own mechanism. As P3 noted, the numbers referenced are all based on healthy adults. Chances are you'll see sats holding longer in some trauma patients than you would in say a medical patient needing aggressive airway management. That's not hard and fast but it happens. With regards to pharmaceutically assisted intubation (with no paralytics available) versed/fentanyl is actually an excellent combo to use. I've used this before and it works well. Like Dust said, you use what you have. If this is what you have, then this is what you use. And one of my medical directors supports this approach. -be safe

There is a distinct possibility that I'll be able to swing this!!!! -be safe

If you need to emergently manage an airway you don't have time to premedicate. Etomidate, succs, intubate, versed, vec, fentanyl. Under ideal circumstances it should take less than two minutes to tube placement. I don't see any discussion regarding an airway assessment. What grade airway do you have? Potential difficult airway indicators? Are you willing to paralyze a patient if you're not 100% sure you can effectively bag the patient should your airway fail? What kind of back up airway do you have? Have it ready even if you are positive you can place the tube. Have suction ready, too. I can, and have, RSI-ed on many occasions. It is something we review frequently. It is not for everyone and I know plenty of medics who should not have this capability. It'll be interesting to see where this discussion goes. -be safe

Are you even really a paramedic?

Taken ACLS recently? And how do you not stop CPR? Attempting CPR in the back of a moving ambulance, or on a moving stretcher, is pretty much worthless. It's the same as not attempting CPR at all. And what do we have to give them change for? I don't normally carry that much cash on me anymore. -be safe

Confirm asystole on my equipment. Call the doc. I'd be really hard pressed to work this as presented in the OP. If, for whatever reason, I do start it'll go similar to what P3 and ERDoc described. CPR, three rounds, stop. -be safe

Well, no. Space may not be an issue. But size may be. That's small enough to get lost pretty easily. And, as a magnet, it stands to be rather inconvenient if it sticks to something. I can think of two occasions where it would've been nice to have. But a little sedation helped for the ride to the ER. I have seen patient's who have their own magnet. It may be worth it to ask the patient if s/he has one. -be safe

I'm just annoyed that he Blago cashed my check and now I won't get the Senate seat. Poor form, I say. -be safe

So if I go and work part time at my family's business even though financially I don't have to means I'm volunteering? Even when I'm getting paid for it? I think I see the point you're trying to make but I don't know that it follows along the lines you want it to. -be safe

Sorry, CB, but your information is wrong. Straight from the MIEMSS website, you can't be a paramedic in Maryland without NR. You can't remain a Maryland paramedic without renewing your NR. It's been like that for years. You can't be a CRT (EMT-I/99) without passing the NR EMT-I exam. (Although you don't need to renew it to maintain the cert level. Maryland went to NR EMT-I/99 around 2002/2003. Before that it was just a state cert.) EMT-B in Maryland is their own thing. As to DC, I remember eight to ten years ago considering applying to the DCFD to work as a medic (fortunately, I came to my senses and never went through with it). They required NR for paramedic back then. I don't remember about EMT-B with regards to the District. -be safe

If you get paid, even a stipend, you are not volunteering. So the answer is "no". -be safe

This was written by a physician but I think some of it applies to what we as prehospital providers encounter from time to time. I thought it to be an interesting discussion. Thoughts? -be safe New York Times December 9, 2008 18 AND UNDER What to Do When the Patient Says, ‘Please Don’t Tell Mom’ By PERRI KLASS, M.D Some years ago, in the candor of the exam room, a seventh-grade boy told me that he didn’t really have friends at school, and that he sometimes found himself being picked on. I gave him the pediatric line on bullying: it shouldn’t be tolerated, and there are things schools can do about it. Let’s talk to your parents, let’s have your parents talk to the school; adult interventions can change the equation. And he was horrified. He shook his head vehemently and asked me please not to interfere, and above all not to say a word to his mother, who was out in the waiting room because I had asked her to give us some privacy. He wouldn’t have told me this at all, he said, except he thought our conversation was private. The situation at school wasn’t all that bad; he could handle it. He wasn’t in any danger, wasn’t getting hurt, he was just a little lonely. His parents, he said, thought that he was fine, that he had lots of friends, and he wanted to keep it that way. When treating older adolescents, pediatricians routinely offer confidentiality on many issues, starting with sex and substances. But middle-schoolers are on the border — old enough to be asked some of the same questions, but young enough that it can be less clear what should stay confidential. At my own eighth-grade son’s pediatric checkup last year, I of course left the room, because I didn’t want to embarrass him or inhibit him, and because I wanted his pediatrician to have the opportunity to hear anything he wanted to say. (I am reporting this with my son’s explicit permission.) But as I waited, I thought of that seventh grader, and of the other middle-schoolers who have told me things that left me agonizing about the ethics and the wisdom of confidentiality in this age group. I’m not talking about the child who tells you something that makes it clear he’s in danger. Those are the “easy” ones (though in another sense they can be tremendously difficult), and I’ve had my share: The 13-year-old girl who is frightened of a much older guy who sometimes seems to follow her home. The 14-year-old boy who has been thinking about dying a lot ever since his grandmother died. The seventh grader who is being beaten up on the playground. No matter the age, when I feel the child is actually in danger, I explain that I have to let the parents know. But as I talked to my colleagues — including my son’s pediatrician, Dr. Herbert Lazarus — we all kept coming up with ambiguous cases. Because you do value the child’s trust, and you don’t want to lose it. I’m not talking about the child who tells you he shared a beer with his friends one day after school. Most sensible parents, I think, know that once they’re out of the exam room we’re going to review sex, drugs and rock ’n’ roll with their children, and most sensible parents, I think, are grateful. And many middle-school children seem grateful for the opportunity to mention that yes, they have been in situations where people are drinking. “They’ll preface it with ‘My mom’s not going to know about this, right?’ ” said Dr. Lazarus, who is also a clinical associate professor of pediatrics at New York University. “I’m going to talk as much as I can about why this is not good, and all we know about alcohol and marijuana. There are enough studies out there that show how bad this is for brain development.” But what about if it’s more than a beer? One of my colleagues had a story: a 13-year-old girl who was drinking and stealing from her parents’ liquor cabinet. “She did admit that to me,” the pediatrician said. “She was doing it by herself, not a good sign, not social drinking.” The child did not want her mother to know, and the pediatrician, who had known her since infancy, negotiated a compromise: the doctor would advise the mother that the girl needed counseling, and as long as she went to counseling, and discussed the drinking and her underlying issues with the counselor, the pediatrician would not tell her mother about the liquor. But even though it worked out, even though she continued seeing the patient regularly, the pediatrician still felt less than completely comfortable. “I did personally feel bad,” she said, “because if I were the mother, I would want to know, and I actually did tell the mother just to keep a closer eye on her without going into the details.” So what about the child who trusts you with the information that he’s being picked on, or that all is not well at home? You want to keep that child’s trust — all the more so if the child isn’t talking to the parents, because you want to be available for more confidences if things grow worse. “The balance changes in part based on what the level of the health risks are, how mature that young person is, how much parental oversight they’re receiving,” said Dr. S. Jean Emans, chief of adolescent medicine at Children’s Hospital Boston. Experts say the middle-school years are particularly challenging. “It’s a fine balance because it’s developmentally appropriate for kids to want to develop some autonomy and it’s the time when they should be developing at least in part a private and confidential relationship with a physician,” said Dr. Carol A. Ford, director of the adolescent medicine program at the University of North Carolina, Chapel Hill. “Middle school is really when you see a lot of variation in pubertal development and cognitive development and social development,” Dr. Ford went on. “A 12-year-old who looks like an 18-year-old — you can’t assume they think like an 18-year-old. You can’t assume their skills of negotiating the world are related to their physical maturity.” Or as Dr. Emans put it: “You do have to make tough choices. There isn’t a little book where you look up, ‘O.K., this can stay confidential and this can’t.’ ” So what did I do with the seventh grader who had told me he didn’t have friends at school? Well, I asked him a bunch of questions, and I decided that he wasn’t feeling suicidal (or homicidal) and that the situation in his school didn’t threaten his physical safety. I urged him to talk to his parents, especially if things grew worse — and I scheduled an appointment for him to come back and check in with me. But with his mother, I limited myself to one of those “generic” comments: this is an age when he really needs you to be involved in his life, to talk about how things are going at school. “Your role as a physician is different than your role as a mother,” Dr. Ford said. “If you lose the trust of the kid, you’ve lost a lot; they won’t tell you what’s going on in the future, and that’s not in the best interests of the kid or the parent.” If I had been his mother, I would have wanted to know. But I was his doctor, and he wanted it kept confidential. Perri Klass is a professor of journalism and pediatrics at New York University. Her most recent book is the novel “The Mercy Rule.”

Good advice has been presented. However, with all that being said, just remember that you will not please all the people all the time. There will always be people that, no matter what you do or say, will always regard you as a "para-god". Nothing can or will change this. You could be the nicest person in the world and they will still try to be down on you in this manner. You must learn to ignore it. You must learn that the people who treat you this way are either jealous of your level/position, so completely ignorant of what's going on that they feel the need to lash out or they're so insecure in their own position that they feel name calling is the only way to take the focus off of them. It sounds like you're on your way to avoiding the whole mess. Keep in mind the advice of many of the above and you'll be fine. Just do not be surprised when, no matter how hard you try to avoid it, some bonehead calls you that. Remember, chances are pretty good they have no idea what they're talking about. -be safe

Look here. Good luck. -be safe

Dude! Happy Birthday! Forty-one, eh? You're just one year away from the answer to life, the universe and...everything! When you get the answer will you let the rest of us know? Hope it's a good one and that your wife doesn't scare the crap outta you! -be safe

I scored as well as JP.