paramedicmike

I wasn't taught this. But I have seen it done. I've always wondered why. Unfortunately, when I asked, the answer I got was, "I don't know. It's what I was taught." As with any IV start and medication administration, we monitor the IV site for patency. We don't aspirate with any other med. I couldn't understand why people did it with D50. So long as you're paying attention to what you're doing you're good. -be safe.

Switch the two. Adams was number 2. Jefferson was number 3. Then Madison, Monroe, and John Quincy Adams. Adams, on his death bed, was quoted as saying, "Thomas Jefferson survives." Little did he know that Jefferson had died only hours earlier. They died within hours of each other on July 4, 1826. Adams died in Massachusetts. Jefferson died in Virginia. Colonial Williamsburg does put on some excellent programs. I'd be interested to hear their argument. -be safe

So is that what you're saying? You don't make the rules so you transport *everything*? -be safe

And this is exactly why I wouldn't hire you. So you're a dedicated student. Big deal. See the comments made by Asys. If you're freaking out over a test then how will you act when there's no preceptor there to catch you when you fail? And trust me, you will, at some point, fail. We all have. And if we haven't yet that only means it's coming. As Asys noted, this job is constant judgement. Quality assurance programs where your trip sheets are reviewed are programs of consistant and constant judging. You will always be judged by your peers, supervisors, patients and their families and medical directors. There is no aspect of this job where you will not be judged on some level. Depending on the department for which you work, that judgement may even extend to off duty behaviour. If you have a problem with that, leave now. I have several suggestions. Get over yourself. Relax. Stop trying to impress us with bravado. Your actions will speak more to what kind of provider you'll be than your big mouth ever will. And right now you don't seem to be winning many friends. Also, reread Rid's, Somedic's and others comments here. They offer thoughts you should seriously consider. Good luck to you. -be safe

I used to work with a guy who has a BTK amputation. He's been that way since he was five years old. Prosthetic leg and all, you'd never know it. He does walk with a bit of a limp. But I worked with him for more than six months before I knew that's why he limped. It's not a big deal for him. He can do everything anyone else can do. It doesn't slow him down a bit. Up stairs or down. Overweight patient in the stair chair or not. Granted, he's had longer to adjust than you to the idea of a prosthetic. But there is nothing slowing this guy down. If I see him or talk with him I'll see if I can point him in your direction. Something else to consider, I recently ran the Army 10 Miler in DC. There were more than several soldiers running with prosthetics...legs and arms. Some of these guys were only injured in the previous year and there they were running a 10 mile race at a sub 9 minute mile pace. Just food for thought. -be safe

AK, why are you responding to this bonehead? Your credibility is not in question here. Nor is the respect that many people on this forum hold for you. For some unknown reason, this guy has a bone to pick and he chose you as the subject of his insecurities. The thoughts and opinions of those who really matter here, which is basically everyone other than this guy, will not be changed by his admittedly uninformed and ignorant position of who you are and what you do. Just my humble opinion. Be safe over there.

Fair point, Phil. Perhaps I should've clarified my position. I will sound very similar to AZCEP, Rid and Dust on this. We can diagnose to a point. However, a more definitive diagnosis than what we can adequately determine in the field must come from the hospital and the doc. I can call it a stroke and have suspicions, based on patient history and presentation, as to ischemia or hemorrhage. But I don't have the diagnostic tools to say for sure. Nor do I really want them or need them. That comes later. As to Ruff's follow up question, I think we should take any and every class we can get in to. This includes college level classes, con-ed programs, seminars, conferences anthing that would expose us and motivate us to research a particular problem. Of course, and pushing for an increase to the minimum educational standards is something we should be working towards as well. -be safe.

Absolutely! We diagnose in the field all the time! Now, the question should be "are we correct in our diagnosis and if we're not then why?". When we formulate a list of differentials, we're looking at all the diagnostic possibilities. The more information we get from our detailed assessments the more we're able to limit our differentials. The more we limit those differentials, the closer we get to a diagnosis. When we call the hospital and tell them "This patient is having a stroke", we diagnosing based on the assessment in the field. Sometimes it's easy to do. Take for example two patient's I had yesterday. One had fallen and her arm had a rather nice deformity. It's a pretty easy diagnosis to say, "Ma'am, I hope you don't have to cook Thanksgiving dinner because you're arm is, in fact, broken." Or the other lady who had sudden onset left sided weakness, slurred speech and a pounding headache. She was having a stroke. That's what I called it and the ER doc confirmed it. However, it's not always so easy for us given our limited education and training (yet again, another topic). Legal standing aside, we make diagnoses every time we look at a patient. It's our determination, based on our assessment, of what is wrong with the patient. In order to prescribe drugs (yes, we do that, too, in a fashion), we have to have a diagnosis. -be safe.

Did you guys not see this very helpful link hfdff422 has provided? Or did you just go out of your way to ignore it and spout off again? The search feature is your friend. The person who is nice enough to go out of his/her way to find the previous thread and post the link is even more your friend. Please show some respect and continue the linked thread instead of blindly forging ahead here. Thank you. -be safe.

And can I hear an "AMEN" for brother AK here? Can I? I know you got it in you! Say it loud for everyone to hear! AMEN Not only should he be fired, he should be publicly flogged, tarred and feathered. And maybe a "D" branded on his forehead...for "Dumbass" -be safe

This is funny how? Considering the glide path on the approach to National Airport goes right next to/over the Pentagon, which has had some unpleasant experiences with planes in the recent past, I'd say your friend is neither intelligent or funny. -be safe

For those who say vaccines are dangerous etc... go read the book The Great Influenza by John Barry. It's a bit of a dry read. But I think you'll be amazed. Then, after reading that, try and argue that vaccines are a bad thing. Just a thought. -be safe.

Vitamin C supplements don't help fend off the flu. You're better served by eating well, exercising regularly, and proper and thorough hand washing. I get a flu shot every year. Studies have shown that when you vaccinate kids against the flu the rate of illness in adults drops. Following that, if I can keep from getting sick I won't spread anything to my patients. And if they're already sick then I won't get it. I certainly can't help them if I'm sick. Vaccinations are part of our responsibility as health care providers. Failure to keep up fails our patients, our families and ourselves. And I must say, a basic college microbiology class can go a long way to ease the paranoia some feel about such things. -be safe

Is there a question in all of this? And it's not "in content". The word is "incontinent". As in, "She was incontinent to urine". Please make a note of it. -be safe

I question your use of the word "lifestyle". Just what about having a job in EMS is different from any other job? So your work schedule is a little goofy. So what? Unless, of course, you're a whacker who lives, breathes and eats EMS. In which case, it's not that she's going to get fed up with you. She'll just be fed up your inability to separate different aspects of your life. You've been with this girl for three years and you're just *now* getting serious? There are larger issues with this relationship than your job if that's the case. Run, don't walk, away from her. If she's telling you that she's afraid she'll be high maintenance, she means she is too high maintenance. I dated a girl for a long time who eventually told me that she was jealous of the attention I paid my patients. She said it attention she should be getting. I walked away. Best damn decision I'd made in a long time. -be safe

Wow! Tough call. That really sucks. Sorry you had to deal with that. I don't know that I would've made the same decision to cardiovert this kid. What you saw on the monitor could've been from a variety of things with hypoxia being high on that list. You said his airway was full of fluid. I've seen these airways. They absolutely, positively suck. But I think Id have spent the effort on airway first. If, in the off chance, you get a tube placed, correcting the hypoxia could correct some of the other things you're seeing. Did you manage to get a BP with the pulse? I'm not a huge fan of the NIBP cuffs but in a case like this they can be a good thing. With palpable pulses and a BP combined with your amazingly short on scene and mercifully short transport times I would have not gone the same way. I'll add the disclaimer that I, obviously, wasn't there. It's fine and easy for me to type this from the comfort of my kitchen table. So please keep that in mind as you read this. Good on you for trying to take care of your partner. Good on your partner for trying to figure out a better way to handle things for the next time you find yourself in a similar position. Perhaps convince him to follow up with your medical director or an ER doc you know and trust to talk about how the call went? That might be beneficial to you guys, too. Tough call. If you need us for anything else just let us know. -be safe

Started the parkinson's meds when? How compliant with the meds has be been? Taking too many? Not enough? Food with the glass of wine? Stomach pain from the ulcers? All this and his sugar's pretty high, too. Start a line and bolus some fluid. High flow oxygen. Reassess. How's he change? -be safe.

Absolutely agree that this was a very appropriate flight. Agree 100% with you and your partner. Agree completely with Dust's assessment of the greater situation. Maybe you should direct some of that criticism towards this thread and have them read what we're saying. Of course, they may be pissed at the whole idea that they're incompetent. But sometimes the truth hurts. Nice job on this. -be safe.

If you have to use one of these and the patient is still conscious, for the love of God, *PLEASE* flush it with lidocaine first. Placing the thing isn't the painful part. It's the flush into the IO space that's painful. I know of two instances where lido was not included in the initial flush. The first one I heard about when the supervisor brought it up at a QA/QI meeting after one of our medics flushed without it. The second was done by my partner who stopped after A) I smacked her over the head with the lido saying "Use this NOW" and the patient screamed bloody murder. (Yeah, my partner and I had a nice talk over this one after the fact.) If they're unconscious it doesn't matter that much (but I'd do it anyway since you aren't sure how "unconscious" they really are). But if they're awake, make sure you flush with lidocaine. They're great tools to have. In one particular case, bilateral IOs were the only thing that helped us keep the patient alive as that was the only access we could get. -be safe.

Dude! You so need to get over yourself.

You're going to have to explain this one. He was the first man elected with the term "president of the United States" under the guise of the then brand spanking new US Constitution (article 2 section 1). The preceding government offered no more leadership than a congress with no clear definition of who was to lead that body. While he did hold the distinct honor of being the first Commander in Chief during the Revolutionary War, he was also the first man elected president under our current government. Now, if you'd like to argue that the first "president" was John Hancock, who was president of the Continental Congress at the time of the colonies' declaration of independence from Britain, you may have an argument. But the first man elected as president under the current constitution was, in fact, George Washington. Yes. I am a geek. -be safe

Just because Robert Palmer died doesn't give them license to ruin what is otherwise an excellent song. Geez...no respect for the dead! I'm only half joking. -be safe.

Well, if the patient was a known drug dealer, and the cops were on scene, why was he placed in my ambulance without a police pat down first? I don't care that he's unconscious. He still gets checked. But, in an effort to go along with AK's exercise, let's say it happens. My first reaction at pulling such a wad of cash out of someone's pocket would be a very auditory, "Holy SH IT!". This would probably draw an immediate reaction from my partner. Should I manage to keep my mouth shut upon the initial find, I don't know that I'd keep it shut for long. I'd ask my partner to radio ahead and have the cops meet us at the receiving hospital. I don't want that much cash. I wouldn't know what to do with that much cash. Most importantly, it's not mine. It doesn't belong to me. I would not keep it or make any attempt to conceal it from either my partner (a.k.a. very important witness to all of this) or the police. Not because AK presented this scenario and I'm worried about what others might think of me should I say, "yeah...I'd keep it." Turning it into the cops is the right thing to do. I may be a lot of things. But a thief I'm not. And taking this dealer's money would make me no better than him. And I'm not about to stoop to that level. The right thing to do is turn it over to the cops. That's what I'd do. -be safe.

Vermont, here in the States, has such a law. Here's the link: http://www.leg.state.vt.us/statutes/fullse...p;Section=00519 Basically, if you see it and no one else has stopped you need to stop. This applies to anyone. Not just a healthcare provider. It's not a national law by any means. Hope this helps. -be safe.

Uh...so why were the firefighters on oxygen? Seriously, though. Nice save! And yes. This must only happen to you. I've been a $hit magnet lately. But nothing like this. -be safe.