romneyfor2012

Do any of you have any recommendations for online training sites for CEUS ?

Actually, i googled this info and read that Texas led the nation in gun injuries, will have to go look for the actual stats again, so she may be on to something there, not sure what

His personal doctor will sign-off, he sees it as an insurance policy to protect for all those narcotics he prescribed. And I should not have limited it to a he, the celebrity can be male or female if that swings you one way or another.

In light of what all has transpired after deaths of celebrities due to drug abuse, how would you react to the following scenario: You respond to a lovely mansion to treat an elderly female who is complaining of chest pain. You immediately recognize one of the family members as a very famous celebrity. You save his granny's life, and after the call, he asks if you would consider becoming his personal medic. He confides that just like the tabloids say, he parties hard, and has been to rehab several times. He will pay you the salary you demand, give you a home on his compound, nice car, whatever you want. You will be expected to excort him to all of his parties, in case he takes a little too much of that drug of the day. 1. Would you take the job, realizing you will be a witness to a crime on a daily basis (prostitution, drugs bought/sold/used) ? You are never asked to do anything illegal, or to administer any drugs other than the typical ACLS drugs you would use to revive him (you do not have to administer prophylol every night) 2. If you do, what would be your price to become his personal protector ? He has already purchased defib/monitor, his physician stocked him a crash cart previously. 3. Do you have an ethical duty as an emt/medic to report him to the authorities to help protect him from himself now that you have knowledge of his plan.

Actually, I frequently tell patients to not take stuff to the hospital that they initially might consider bringing: jewelry, wheelchairs, walkers, suitcases full of clothes, as these things are not needed. With that being said, I would take the dog. But to play devils advocate to your statement vorenus, hospitals typically do not allow children to stay with the patient during their stay, and may not allow family visitation under certain circumstances. Wouldn't your family be "needed" more than a dog ? Say you are a first time mom, and you got MRSA in your c-section wound, and now you can not hold or breastfeed your baby, would that not be traumatic emotionally ?

I believe it is like everything else in medicine, we know enough to be dangerous, and can help each other as long as we do not go too far past our limits. You start IVs every day, and cannulating an artery is not impossible for us, but should not be done. We counsel patients and our coworkers everyday (mentally/emotionally), and as long as we keep it at our level that is fine, but we start pretending to be psychiatrists we have gone too far. I always provide a shoulder to cry on and an ear that listens, but I also know when it is time for me to back out and let the professionals do what they do best. How many times have you had a partner who had all kinds of jerry springer moments in his home life, so you counseled him on what you knew from your life experience. Nothing wrong with that, but if he is depressed or suicidal, you send them to the professional.

I will throw a different tactic at you. This guy's behavior has been accepted by everyone else, you seem to be the lone voice against. Being confrontational or immediately going to the supervisor will probably not make you very popular. How about this, why don't you find something that you like to do frequently, that requires him to miss some of his family and/or meal time. Tell him you have a cousin that plays in the league his kids do not, and you want to go see his games, go visit a family member or girlfriend, decide you want to take music lessons while on-duty. He may not realize how rude he is being, since this is the way he has always done it, let him walk a mile in your shoes and see how he likes it. I agree with crap, gay porn on the TV seems to chase everyone out of the room.

I have to disagree to a point. I agree with crap that if you have serious mental health issues you should see a professional. But how many EMS/Fire people have benefits that allow you to go to a mental health person, and how many would actually go if they had the insurance coverage ? I think allowing the group to vent about what they have been through is a good thing. I have been to a handful of these and was frequently the "moderator"; I did not pretend to be a mental health professional, I was just the veteran in the room who had seen it before. Frequently, grown men cried, which told me that they needed the moment to express what was bouncing around in their head. As long as the meetings are voluntary, I see nothing wrong with it. To me the statement from WHO is nothing more than a commercial for counselors who feel threatened and do not want to lose business. Just because something bad happens does not mean you need to see a psychiatrist, you might just need a hug.

I applaud your wish to go to the "nth" degree, but you will mess yourself up with National Registry if you go down this path. Stick to the cookbook and keep it simple for now, once you pass the registry you can dig way deeper into all kinds of scenarios that are outside of the ACLS book. The registry exam is stressful enough, you do not need to add anything that can confuse you.

Nursing school has become far more competitive and hard to pass, if you can even get in a program. Conversely, EMT/Medic school is far easier to get into, but has also seen an increase in admissions. Do what you love, no matter what it pays. But realize there are few EMTB jobs out there, so if you are going to take the plunge, paramedic should be your goal.

OK, lets test some scenarios; for every one, your partner asks for PD, and dispatch tells you that due to heavy demand, there are currently no police officers available for at least 20-30 minutes: 1. Person down in the yard, unknown age or cause, in a middle class subdivision. 2. Injured in a fight at a Middle School. 3. Female overdose, unconscious, in the hood 4. Unconscious stripper in the dressing room of strip club (known for drugs and prostitution) How long do you wait, the full 30 minutes ? What if you are caught on camera "sitting" at the business around the corner, and the patient dies. Does having a truck full of hose monkeys behind your rig change your mind ?

So the next obvious question to me is HOW long is too long to "Stage" and wait on PD, for a non-violent call ? I realize in the big city, PD might be pretty close by, but in many rural areas it may take PD 15-30 minutes to respond. Your patient could be dead by then, and no I am not talking about a known hazardous house, lets just say it is a shady neighborhood as suggested here, with no known violence.

I memorized all the .01s, the .1s, and the 1.0s in order from top to bottom

Hard to say without having ever met or interviewed you. I would say if you are getting interviews and not getting offers it is about you, your interview skills, or your lack of skills. If you are not getting interviews it is probably more about the economy. The best thing you can do is network, but remember most governments have been furloughing employees and have not been filling vacancies. It took government about 18 months to feel this economy after private businesses, so any recovery will take 18 months longer for government to rebound. A private service is probably your best bet.

I hate to sound like crotchity, but is this more about the location than the call ? Does your partner equate indian reservation to poor, thus has a fear that he would not have if responding to mansion in a white neighborhood ? Now before everyone gives me negative scores, ask yourself how often you ask for PD on medical calls in affluent neighborhoods (not trauma or violent calls). Personally, I would have been fine not asking for PD. I frequently went into some very dangerous neighborhoods, I found that if you treated them and talked to them like they were your family, I had no problems. But others who came storming in as a white authority figure, looking down their nose, routinely needed PD to save their ass.

I would always go EJ before IO. I believe IO is overused due to poor IV skills of the medic. I am not saying that it does not have a place in your treatment algorhythm, but a patent IV is almost always superior to IO. Now before the OP asks, I would not put an IO in the patient he referenced (bedridden with contractures) except in some very rare and serious circumstances.

You are close but no cigar, not a brain thing. Look back on page 1, the box that has the weird lines below my post, the link is in white ink, if you drag your cursor over it, you can see the link if you want to cheat.

The normal sat is around 78-80, today he/she is hovering around 70-72%. I do not think that positioning upright in a car seat will hurt, not sure it will help either, but worth a shot. To whoever said too much O2 is a bad thing in this condition, you are correct. That would be very bad. Physicians try to hold their patient to "their normal" sat, which could be anywhere from 60s-to low 80s depending on the patient and where they are in the process of repair, the good news is the parents are usually educated about O2 sats, and they can tell you where the patient should be. Now without reading my article, and using only the google articles you found can you tell me why too much O2 is a bad thing for this cyanotic patient ?

OK Quake, how much O2, by what method, what type of sat are you trying to target with O2 (where do you want the patient to be) ?

The sats are lower than usual today. Which is a clue, most of these parents will know what sat is normal, and where the sat should be. I will post a link to an article in white ink below, highlight over it to show the link and read if you want, I don't want to give up the answer so quickly as others may chime in later on. The variable that is different in this patient is the use of oxygen. Getting their sats up to a level we feel is normal is very bad for the patient, and a common prehospital/non-pediatric ER mistake: http://paramedicine101.blogspot.com/2009/11/blue-babies.html

Unfortunately DFIB, that is a US rule only, wont help you in your part of the world. But Doc is correct, once the patient is on their property (or within so many feet/yards from it), it is their responsibility to provide a screening exam, and then arrange transfer to another facility if it is something they can not treat. Did I miss it, or did we ever say what was really wrong with the patient ?. I would nicely and respectfully share your story with the ER Director, as allowing an outside person to treat patients in their ER should raise some concerns for him/her (not saying you did anything wrong, but if I were a patient or visitor and saw EMS have to treat a patient in the ER because the staff refused to jump in, I would be concerned).

Maybe a little, but if you have good circulation at the finger tips, then you have circulation.

Probably a little of both, but i believed it was more about not trusting the science, and the integrity of the cleaning agent used (usually in a gallon jug out in the bay, exposed to temperature extremes).

You are very correct in your description of the syndrome and corrective measures, but a bit off on the prehospital treatment plan, anyone else want to take a stab at it ? And P.S. it is difficult to find the correct treatment plan online as most websites discuss the symptoms, surgical treatments, and causes, but do not go into non-surgical treatment too much, so don't feel bad if you do not know.

It is always best to start distal and work your way in. Even with contractures, you may still find good veins in the hand, forearm and upper arm. You need to practice finding veins by feel instead of using vision, Do this: Put a tourniquet on your partner's arm, blindfold yourself with a triangle bandage or just close your eyes, and see how many veins you can find by "FEEL ONLY". Once you get good at that, you will find veins on 99% of patients that others can not find. Nurses will freak out, but i have used feet/leg veins when I had to, but then after they miss the next 3 sticks and put in a central line, they are glad i gave them something to use until the central line was in. Vein anatomy is generally the same in all people, so if you know where the veins are supposed to be, and learn to use your fingers instead of eyes, you should be great at IVs.