hammerpcp

I am going to go ahead and take a little credit for that diagnoses. Although I was not familiar with the exact process it took all of about three seconds to get to the diagnoses since I already recognized the chronic symptoms. And VS, with todays technology it isn't too hard to carry multiple reference guides in your pockets. Obvioulsly there is alot more that we don't know then that we do know what with the length of schooling we have and all........ Thanks for enabling the expanse of my brain with this scenario. And thanks to google: TCP does sound like a good idea, along with some blankets, fluid replacement (and electrolyte-hyponatremia is common), possibly glucose replacement (depending on results of BG reading, but hypoglycemia would be expected), and continue to assist with ventilations. This is awesome. Thanks for the reminder aobut TCP, I didn't even condsider that as an option. Lithium can you precept me?

Myxedema coma.

Right off the bat, i am thinking about hypothyroidism for this pt. I am not sure what would cause this acute decrease in LOC though. As far as current treatment it will be supportive only at this point. Insert nasal airway, possibly bilat, assist ventilations and increase rate and volume, insert opa if tolerated consider intubation, attain intravenous access. Reassess. Is pt still bradycardic and hypotensive now that pt is being adequately oxygenated? (i assume since you did not state otherwise) Has she been having any other symptoms recently that are unusual? Is she a drinker? Are we seeing edema/ascites/anasarca here? Any signs of stroke? In what respect was pt not feeling well before going to bed? Chest pain/discomfort? Nausea? Dizziness? Increased weekness?SOB? Fever? Bleeding?

Remove pillows and open airway with positioning. Results? Prepare resuscitation equipment. BVM, Cardiac monitor, Oxygen, airway adjuncts......... When was pt last seen normal? What is her normal? Mentation, level of functioning, self care,etc? Medical history and medications?

I am not sure anyone took the poster to "task". I did indeed question his motives though. Once you have been asked this question by every other person you meet (who are not asking because they want to become involved in the field), you may also question them. For the most part the question displays only a complete lack of insensitivity on the askers part. This is a difficult job and there is a lot of human suffering involved, both witnessed and experienced. Simply by asking "what is the grossest thing you've seen" a person is devaluing the importance and effect of this pain and suffering. They are not empathizing with the difficulties of this job, or with the patients or families of pt's that are actually experiencing unpleasantness of one form or another. They are not appreciating the self that is put into it. They are assuming that we are unaffected. They are assuming that our pts are unaffected. The asker has a distance from the actual humanity of any event. It is like TV to them. It isn't real; it's of no real consequence. They want to know for shock value. They want to know for the same reasons people are fascinated by violence on the news, why people slow down at accident scenes to get a better look. It isn't empathy that motivates. It isn't a desire to help. I for one do not like to be entertainment for people who think so little of others as to even ask this. I do accept your explanation for this persons possible motivations and that is fine. However, the vast majority of the time there are no higher motives. I think that this question also displays a degree of ignorance about EMS. They assume that we deal with blood and guts all the time, that every call is a trauma call. This is also a display of disregard for others, since they have not bothered to learn about the profession in any way shape or form before asking stupid questions meant only to entertain them. If a person even thinks on the nature of EMS for a minute, they would realize that the majority of our calls are medical. It is only logical. And a lot of the time we are called simply because someones own coping skills are overwhelmed. I do a hell of a lot more then scrap body parts off the road. And like Rid said, those are often not even the events that have the biggest emotional/psychological repercussions. Get it?

Ruffems, I am pretty sure we don't need your permission to have a discussion..........and if you believe it is a silly one, there is no need for you to read it. That was kind of Ouch. If that sounded harsh, I apologize, but take it for what it's worth. Obviously we do not agree about what we deem "silly", and what is worth our time. There are two things I can not tolerate, liars and idiots. If it falls on my shoulders to question the creditability of a poster while educating them, and other readers about anatomical and physiological improbabilities, so be it. Scaramedics story was obviously completely made up. :wink:

I will never understand why this is one of the first questions people not involved in EMS ask. In fact, I put that to you, the original poster, what motivates you to ask such a question?

Thanks for the advice, but no thanks.

Ethanol is used to treat methanol poisoning. For the good of humankind in general I inform all my clientele to drink the "original" Listerine rather than the blue. Also, take precaution with Aqua Velva after shave, another crowd pleaser, because it also contains the possibly carcinogenic dye FD&C Blue 1. Scope: 8.4 % alcohol by wt Listerine: 26.9% Patient educational handout Oh, and don't forget to tell them that whatever they don't drink can be concentrated and used to either treat that pesky gonorrhea or to clean their floors. You are welcome.

I'll let them know.

You've spent a whole lot of energy on something you don't care about.

Sigh. Questionable source, sensible and essentially TRUE answer "Dear Cecil: As a professional sex educator and sex writer, I thought I'd mention a few minor sticking points in your recent column about vaginal foreign bodies. I have gotten the "can't things get stuck up there?" question quite frequently, often from young women who are afraid of irrevocably losing a tampon inside themselves, so I've answered the general question a time or six thousand myself. In your answer, you overlooked two things. The most important is that in fact it's quite difficult for something to get "lost" or "stuck" in the vagina. The main reason is that the woman was too damned squeamish to stick a finger or two up her own coochie and pull it out. The vagina, as you undoubtedly know, man of the world that you are, is a cul-de-sac, not a thoroughfare. The os, the opening that runs between the vagina and the uterus through the cervix, is extremely narrow--in its normal state, about as wide as a pencil lead. Generally speaking, objects inserted into the vagina cannot fit through the os and get into the cervix or uterus (to insert objects into the uterus, like IUDs, the cervix and os have to be manually dilated or opened). Therefore, what we're talking about is, if you'll forgive the analogy, something like a pocket with a hole the size of a pencil lead in the bottom of it. Loose change is not going to fall through that tiny hole and get lost down your pants leg. Neither are sex toys, tampons, marbles, candles, tubes of lip gloss, hairbrush handles, fruits and vegetables, or any of the other myriad things people frequently stick in their vaginas in the spirit of exploration or eroticism. Any object that does go in but doesn't seem to want to come back out can be retrieved by simply reaching in with a finger or two and gently tugging it out (a woman can do this herself or have a partner do it for her). If that doesn't work, as sometimes happens with large objects that are hard to get a grip on, it's likely because the woman is afraid or tense and is reflexively tightening the pubococcygeal muscles, effectively narrowing the vaginal opening. The solution is to squat and bear down and push it out, just as if one were straining with a bowel movement. One can also use a finger or two to help direct the object out of the vagina while doing this. It might be a little uncomfortable, but in this case, the corollary to "what goes up must come down" is "what went in can certainly come out again." If a woman has inserted an object while masturbating and finds it difficult to remove after she has orgasmed, it usually helps to wait 15-20 minutes for all of the tissues to indilate before trying again to remove it. Vasocongestion during arousal causes swelling of many portions of the vulva, including the entrance to the vagina. Once that blood has had a chance to drain and the tissues have gone back to normal, it'll be easier to remove the object. (Relax. Read a few Straight Dope columns. It's not going anywhere, I promise. Then try again.) So, basically, there's no good reason that a woman would EVER need to make an embarrassing visit to the ER for most types of objects people commonly insert into their own vaginas. There are two cases where an ER visit is warranted, though. If a woman has got something sharp up there, or something that has broken (don't be stupid: light bulbs and fragile glass and plastic objects are not good sex toys!) or which has already caused an injury, the ER is the best bet. Same goes if she has been sexually assaulted with an object that has been left inside her vagina: medical intervention is the best bet, not only for safe extraction of the object but for documentation of the assault. The second thing I wanted to mention in regard to your things-stuck-up-the-hoochie column is that not all the objects you mentioned are actually stuck up the hoochie at all. IUDs, particularly, are inserted via the vagina, but actually are inserted into the uterus (as I mentioned above). The uterus is not the vagina, it's a separate organ. And, as I mentioned, it's a hell of a lot more difficult to insert something into the uterus than it is to insert something into the vagina. I daresay that no one is likely to manage to insert an object into their uterus accidentally--the undilated os simply won't accommodate it. IUDs are inserted by health care professionals who dilate the cervix to do it. One is supposed to check for the string periodically to make sure the placement is still correct. But sometimes the string (a tiny bit of monofilament thread usually) gets retracted back into the os so that it can't be felt by inserting a finger into the vagina and touching the cervix at the os. I dare say that doesn't count as a "lost" object, even so. Provided both the woman and her health care provider(s) remember that an IUD was inserted, they can still arrange to keep track of it and make sure it's still doing its job and not causing problems. And even if it were "lost," there's not far for it to go. A "lost" IUD can't exactly go drifting around the body like the Flying Dalkon Dutchman, it's going to stay inside the uterus." As far as your story about the woman having an orgasm goes...........have you ever had sex with a woman? It's going to take more then a violently vibrating gear shift with eighteen fire monkeys and a couple EMT's standing around gawking to do the trick. You are either a liar or a complete friggin moron who works with a bunch of complete friggin morons, and had a very clever and intuitive (perhaps a little sexually perverse) psych pt on your hands. To reiterate, I call bullsh*t on your story.

Did you just call me a bitch?

Interesting statement. What is your point?

You forgot to mention low-training, low-professionalism, low-hemoglobin.

I believe Americans and Canadians have the same anatomy. I could be wrong. I have several anecdotal experiences pertaining to diminished American cerebral function, if not size.

de combitube

Sounds like bullsh*t to me.

Whacker: Mechanism of action: The mechanism of action of whackerdom is not fully understood. BTW great picture but you've got wayyyyy too much time on your hands.

You have every right to be offended by this North. I found it offensive as well. If the tables were turned, "offended" would be an understatement to describe my feelings about it. Mwah again!

Mwah!

You forgot to mention a few things... Dogs expect you to pull the hangy sh*t particles off that are stuck to their their ass, and look completely forlorn if you don't (or they drag their butt on the floor). Dogs need their anal glands squeezed every now and then or they become impacted (especially little dogs). Dogs roll in dead things and then prance around like they just got a PhD. Dogs need their hair brushed and teeth cleaned, nails cut and ears and eyes wiped. Dogs will eat the garbage if they can get at it. Also, they will spread it all over the house. Dogs will growl and bite you if they feel so inclined. Dogs will run away if you don't pay attention. Dogs will hump your friends, your boss, your lover, other dogs, the cat, the lizards. :grommit:

Thanks guys. Very helpful indeed. :love5:

Condoms?

proppre spellign is criticle. htat bieng said i had a code fiver face down in a bathtub fully clotheed except for shoes wiht a suit case on his back. can you say suspicious circumstances? didnt have to work him though he'd been there awhile.