TechMedic05

Not only is it degrading, but I think you missed the basic bashing I hid in there, as well. You're a smart guy, you'll find it. In other words: GUILTY AS CHARGED. :violent3:

Not safe for work: New definition for 'Road Head', I guess.

First off, 250 NS will probably do a rather decent job at improving her orthostatic state. Is it permanent? No. Definitive? No. But will it help her out for now? Absolutely. As far as starting an IV, why are you worried about starting another bleeding site? And besides, just because a patient has heparin [be it overdose, or appropriate] - that doesn't mean that bleeding is instantly non-controllable. I understand not waiting on scene - that's managing a good dual response or intercept style EMS system, kudos for the thoughts! We apparently have a slightly hypovolemic patient in early signs of shock. Renal failure aside, how sick does a patient need to be to warrant ALS treatment? Only in very few instances should travel time to the ED be an issue, as well. if they're sick, work them up. Doesn't matter how long or short of a transport, right?

Ace, I think it does! Congratulations, you've single hanedly improved EMS for the world today. In doing so, there'll be more helpful and better prepared EMT's and Paramedics to treat the carpal-tunnel syndrome that you've managed to give yourself today through all these posts. Hi-5!

Excellent points, Rid! And definitely, those pulmonary hypertension patients are rahter difficult to manage. Above all, understanding that not all CHF is hypertensive, not all pulmonary is non-hypertensive, especially with multiple disease processes taking their toll.

Suddenly the last

all four directions

Niiiiiiiice! 8) 8) I'm loving it. Although, I would like to intubate myself at one point or another just to say I could.

Okay, thank you GA for making this post, then editing it afterward, and still not actually answering our questions. I had attempted to make the point that blood pressure alone is not a reliable determinant for assessing dyspnic patients. Thankfully, AZCEP jumped in, as well with: "The biggest issue is determining what the problem is. Is it truly pulmonary edema? Is it pneumonia, that is moving enough air to sound like coarse pulmonary edema? Is it in fact cardiac asthma? Too many possibilities to say that the blood pressure will make the determination. If it could, don't you think someone would have used that method already? Blood pressure will guide treatment, but it does little to tell you what you are dealing with." And he's right-on. It may help guide, but it's not reliable to make a definite diagnosis alone, like you were suggesting with: "You dont need any fancy machines, just look at the blood pressure." Regarding Dobutamine - This posting by Ace844 is a good reference, which includes the following statement:" Dobutamine is a catecholamine that acts directly on the beta-1 receptor, causing both a chronotropic and an inotropic response from the heart. Dopamine is also a catecholamine that increases both the chronotropic and inotropic responses of the heart. In addition to its beta-1 actions, dopamine also works on both alpha and dopaminergic receptors." Maybe I'm a dumbie, or drinking too much caffeine and not eating enough of my SSRI's of choice for the day, but that sounds awfully similar to me. Dobutamine appears to be a bit more selective in it's actions, not exactly "totally opposite". I, myself, am not completely familiar with Dobutamine, so I may be incorrect. If so, please correct me. Please. I hate being wrong all the time. And second to last: "and it is the deciding trigger we have used for the past 3 years, and we have yet to be wrong. In fact, our Doctors are amazed at our accuracy in the absence of a chest x-ray" I know I'm still new and all, but I wish I was always right. And: Worked up, eh? A little, but when someone comes on, throws around a few numbers based on 'personal observations' and their own systems' outcomes - I want more information. Something a little more legitimate for reference would be appreciated. Not too many can jump aboard, ruffle a lot of feathers in other threads, then throw around statistics without any backing other than 'I said so' and be taken seriously, and then have the audacity to state "And yes I could give you many long paragraphs explaining why, but this thread is already too long." to say C'mon, GA. You're smart, too. Should've seen this coming. "You are a smart guy techno, give it 10 minutes I know you will get it." The reason why I stated I didn't completely get it is because you haven't thoroughly and adequately stated an appropriate answer, that you tried to cover with laziness. I honestly don't thoroughly believe you know exactly what you're talking about. You know a lot, sir, but some things just aren't adding up to me yet. And the name's TechMedic05. There's actually no "n's" or "o's" in it.

Did you, or the FD request the helicopter? Quite possibly only for placing the blame, but it's a legitimate consideration. Confusion, loss of consciousness, mechanism of injury, and the helicopter was started early, so no waiting on the ground on scene or at a 'helispot' for intercept. We can't quarterback a call, but I don't see any tremendous issues right off. Provided it was done within your protocol, medical direction if required, etc. etc. Where I work - most people are either "Fly right off, and get it there" or their "wait and see, and just bring to the hospital anyways" Do what needs to get done. Every system is different.

The first half, I'm trying to follow, but sorry - I'm not completely getting what you're hinting at. And I assumed you had meant onset - but it was not stated as such. And I think everyone knows you meant dobutamine, as myself and AZCEP both used dobutamine in our responses, as well. Thanks for getting back to me - take your time on the information requested.

We use disposables. And we're lucky enough to have ambulances. What do you do to keep your blades clean, GA?

Hey, GA. Use that pencil of yours, and start explaining. I want sources, legitimate sources. Now. Please. And if you can't list sources, I want reasons why you believe so. As well as the pathophysiology that explains the 'vital signs' you're expecting. Even if pulmonary is "normotensive 99% of the time" - can't CHF also be remotely normotensive? what do you do then? Thread length has nothing to do with it. Longer the better, provided it's a well thought out, well written response that's legitimately relevant. Don't go being lazy and having all the people that come through here "Just trust you" because you said so, and you're too lazy to explain your thoughts, beliefs, and disbeliefs. And if you treat your dyspnea calls based on blood pressure "99% of the time, and no, not 142/92", you might want to at least try a few other assessment techniques. Although, throwing dobutamine at everyone who can't breath I guess is a good idea, no? Works like D50? I didn't know Dobutamine worked as a carbohydrate. Why not just give D50 to CHF patients, then?

Ace, pal. I seriously think I just had a seizure while reading your line of animations. I'm going to try and do it again now.

G'morning, Ace. Perhaps we should rename ourselves... You can be Benjamin Franklin Pierce, and I'll be BJ Honeycutt. Nice graphic, I always knew you were a straight shooter. I'm trying a new approach - It's called "playing nice." We'll see what it gets me. Apparantly I angered a few local squads around here at one point. Things are better - but my partner at the time made a good point: "Whenever you say something stupid, or someone's angry, just compliment them, like: "Dude, who's got that wicked sweeeet lightbar on the truck out there?" and all will be good. It's worked the one time I've had to use it. So, yeah. We'll see if we can get Lordie there some constructive education here. Again, not out here to be the bad guy [all the time] :wink:

System- "and I rag on the nurses.. who cares??" We do. They're professionals. In many cases they know more than you or I. We want to be professionals, too. Professionals don't go 'ragging on' nurses in forums all that often. If you don't wish to be professional, bye "because you dont share my point of view on my own opinion is rather sordid!!! You must be the belle of the ball! " No, we don't share all of your points. And that's okay. Not everyone needs to agree on everything. Others were trying to converse about logic and reasons why someone would think that, and even a little further education. Which leads to: "So I did my research on eclampsia...." Thank you. " I think we can all differentiate btw an emergency where u need to go NOW.. then something where we first have to fix the problem and then go." NOW. There's only about one or two times when you need to go NOW, opposed to now. I'm thinking prolapsed umbilical cord or breech presentation could result in rather hasty transports. If the patient is already in a semi-appropriate facility [an ER] and they can effectively initiate treatment to help stabilize her for transport of any length, they should. Wait, no. They NEED to. "We dont really use fixed wing and our helicopters are unfortunately reserved for " true emergencies " this one not being one!" If this is not a "true emergency" in this system, then helicopters must never be used there. Nobody, I believe, was trying to quarterback the call, but as far as 'sick' patients go, between mom and baby, it doesn't get too much worse in this field. All food for thought. "unfortunately I dont deal well with " wanker " and glib comments! " Well, when things don't make sense, and it's tough to differentiate who panicked, it happens. Thick skin. Get as much as you can. Buy, rent, steal, borrow, take, lease, obtain any way possible. And as far as ribbing goes - as mentioned - It's not so nice to rib nurses, doc's, janitors, patients - but we sure as hell can do it to ourselves. most often it's constructive in nature...sometimes. "As I roam around the forums I do hope to learn some new stuff..." Glad to have ya, hope you enjoy yourself here! Input is always welcome, and there's centuries of advice to be given. We're all here to learn, too. That's all. I can't speak for everyone [Right, Ace?] about not being antagonistic, but if the general consensus brings up a few good points, there's probably a good reason. That's it. :wink: Tech

ALS. Borderline orthostatic [but going to assume so based on BP. Pt. may be on B-Blocker, skewing HR results], clammy skin, and lightheadedness [with the orthostatic changes] is ALS for me. I'm typically a rather conservative Medic when I triage to BLS. Honestly, it doesn't happen all too often where I currently work - It was easier in clinicals where there was a lot less true 'ALS' calls. I would not feel comfortable triaging a complicated medical patient [Renal Failure] who has an active, legitimate, ALS complaint. This isn't a bash against any BLS crew - but it's what gets me in trouble because I don't 'triage down enough' - so they say. [small, not busy service that's semi-rural...BLS wants everything triaged to them.] Tech

soft pet chinchilla

Uh... I think we missed some sarcasm... maybe? I'll go back and pick it up.

Well, I thought The City already had a system like that in place... Dustdevil...Rid...Ace...AZCEP...PRPG...Asys...[and the list continues...]

Only because I > google - "Made"? #1-"This is your last chance! Surrender now!" #2- "DEATH FIRST!"

Awfully demanding, must be a manager somewhere. :wink: I can find something, somewhere. Revamp protocol? That's a lengthy process involved at the state level...Not normally on a service level. Ill do one. But please, GA. Don't ever slap me with a glove. Nevermind a latex glove. I have a sensitivity. And regardless of whether people do or do not, there's always the ability to gripe about their service. Some gripe so others may learn. :wink:

500 lbs? That's it? :wink: :wink:

Three weeks ago I'd have never thought I'd say this...but. Whit, I agree with you. We can't assume that what patients are being told is consistent. Does it need to be consistent? As long as everyone covers the absolutely required minimums by your services...for example - What to look out for, multiple attempts to convince for tx, contact primary physician, and to call EMS back if worsens/ reoccurs. Granted, they need to be consistent in those aspects - but if I want to explain "Your wrist will hurt for a few days" and my partner Ace tapes 13 articles about calcification of bones, bruise formation, internal bleeding, and the possible differential diagnosis of potetially undiagnosed carpal fractures - that's fine. But not truly 'consistent' All in all, Be smart, stay clean, and CYA.