TechMedic05

I guess I was wrong: In all honesty, bad money aside: Private companies around here start EMT-B's anywhere from 8.00/ 12.00 per hour. Medics start from 10.00 to 17.00 an hour. Municipal FD's start medics from 35-45k/year. Someone mentioned McDonalds....But D'Angelo's [a sub (sandwich, grinder, hoagie, hero, for those who aren't familiar) shop chain if anyone isn't familiar :wink: :wink: ] starts off about $9.50/ hour in many places...So, it's not even that much of a stretch [of absurdness] Besides, no frozen fish at D'Angelo's.

Eeeeeeee-wwwwwwwww.... That's gross. And then some. but probably true....

Mine's green. With dead men on them.

Good job Itku2er! Thanks for the scenario, Ace! Waaaay over my head. :wink:

Not sure if it quite fits: While working with a FD - Called to the residence to install a smoke detector. That's legit --> Next week - Called the ambulance to help her rearrange furniture. While working at an amusement park - "My son's feet smell, do you have anything for that?" "Do you have anything for dandruff?"

without any ammo

Fire Dept. does it for us, however, they're usually busy, so a mutual aid fire dept. will come in and set up a 'helispot' for us. Haven't had any mjor issues. Our [semi] local flight service is 20-25 minutes away, so for trauma patients with extrication issues, we will land near the incident. For the majority of our medical flights, I personally like to get going to the hospital. They can meet us there. [Hospital drive time is 15 minutes vs. 20-25 for helo] It normally works out well. One issue we have is the ambulance we interceot with will call for one, put it on stand by, then cancel, then call again. By then, weather's changed, and they refuse to fly. Although, where we are...a cloud anywhere near Kansas is enough to not lift off. [Yeah, I know there's real weather challenges, and other demands. We work around it.] ...I live in New England. Side note - Recently completed the ICS-200 class, instructed by a State Trooper - Who emphasized more on incident demobilization and "Lets not shut down the interstate...ever...for any reason..." instead of how to do it corectly. Granted, it does make his job a lot tougher, gotta do what we have to do. Sorry, sir. Luckily the FD's like to cut lots of cars all to pieces, and like to fly people beause it's cool. And luckily, they have the legal authority. [it was beat into our heads severely that Police and Fire have the legal authoriy only...We are just a transportation service...ugh...] I'm glad we get along mostly.

without an egress

Was left closed

During the middle

Wow, that's just awesome. I think everyone in EMS, except a rare few, understand that sometimes you may be called near the end of shift - or, more aggravatingly, sent really really really far away on a transfer half an hour before end of shift. It happens. For those that know about it, you already know! Just do the call!. For those who do not know about it - Now you know. Just do the call! It's frustrating, yes. Guess what, being an EMS provider in the majority of systems automatically puts you at the bottom of the 'totem pole' of the world. We bow to the needs of towns, cities ["Operational Need"] as well as hospitals and nursing facilities, and even our own companies [again, "Operational Need"] who, in my experience, rarely back you up. It happens. This case is truly a shame, in my opinion. Granted - I am in no position to Monday morning quarterback these calls - If your statement above is accurate, the responding Paramedic admits [somewhat] that s/he should've done something there. Sorry, pet peeves.

"TechMedic05 wrote: Onset is questionable [detailed questions below] - however the 'migraine' without relief is not exactly a good sign, as well as the assumed weakness, dizziness and nausea she is experiencing. Good point, care to carry that further? " No, not really. :-P Either her migraines have changed [be it type, location,etc.] or simply become refractory. All things mentioned, and after much research [Have to look at things, I ain't that smart. tech or not, wiseguy :-P] her symptoms do mostly fit the description for a Basilar Migraine, however...I still want to see who's next to that in the line up. Understanding she's not orthostatic, whats her temp? Any nystgmus present? When the patient was up and about last, any gait disturbances? Perhaps better judged by a family member. Can we get a better description of the dizziness? circling, room moving, falling? Oh, and I can't fit it in right now, but I'm thinking smoking may play a role, too. G'd'dmmned suicide on the installment plan. More to come tomorrow.

Look, I'm back!!!

What is going on here? - Well, after a few questions and assessments I'd hope to put my finger on it. Right now, I'm leaning towards SAH Why do you think that? - Only cool things get posted on scenarios? just kidding --> Onset is questionable [detailed questions below] - however the 'migraine' without relief is not exactly a good sign, as well as the assumed weakness, dizziness and nausea she is experiencing. What else would you like to know? - Oh, lets see: What were you doing when it happened? What did the patient do yesterday? How did this start [Gradually or suddenly]? 0/10 pain at onset, and presently. Has their been any relief? Anything making it worse? Any association of movement with nausea? Photo-phobia? Any syncope? Any urine output? Any other past medical history? Specifically HTN, DM, SZ? What are your assessment ?'s. - Airway, RR, pattern, depth, LS, Pulse, Skin color, temp, turgor, lesions? Vital Signs - HR, BP [and orthostatic if patient is tolerant/ able to - partially dependent upon answers from previous questions] Monitor- fsbs, pain in calves? Stroke scale [to local preference] We use Cincinnati around here - Facial Droop, Arm drift, Slurred speech. Pupils, able to track equally? Whats your clinical impression? - Depends upon some assessment findings. DDX below If your an ALS provider; how would-do you utilize your BLS? - Hate to be picky - but depends. If they were on scene first, Take report, and help them to continue to assess, and involve them in further assessment. And depend ant upon the system you work in, direct them to assist with monitor lead placement and/ or IV preparation [setting equipment] Do you triage down, and clear, or ALS the patient, and why? - sounds awfully ALS to me. As stated, a lot depends on assessment findings, however: This patient's differentials include CVA, SAH, viral infection/ meningitis, dehydration, or heat illness [being heat stroke or exhaustion], on top of migraine cluster headache, just to name a few. Not being able to completely rule out [as of yet] many of those, and have several [3, right off the bat] risk factors [Obesity, smoking, BCP use] for CVA, is enough to 'work it up', for potential degradation of patient condition. What do you do for this patient and why? I want to not only know the treatments you would do, but why you chose those options over any other. YOU ARE WRONG (EVEN IF YOU ARE RIGHT) IF YOU DON'T EXPLAIN YOUR ACTIONS. The purpose of this is to make sure not just the "this is what we do" but the "this is why we do what we do" of EMS. Also list any questions and their relevance to your assessment. - Currently, assessment as stated - to find what we have. Establish IV access - Depends on what we have - Currently, an IV lock until the necessity of IV fluid is known. Provides access. Again, this is if assessment warrants ALS Tx. If so, an IV gauge that your receiving ED prefers - understanding a possibility of contrast CT. Oxygen - Nasal cannula - Just some supplemental O2 - depending on my diagnosis - reasons could be increasing Oxygen, lowering C02, providing a minimal amount of cerebral vasoconstriction to hopefully lessen a bleed, or damage. Increasing oxygenation to all tissues. If Hypovolemic in nature, to help correct a likely metabolic acidosis through increasing O2 and decreasing C02. Again, lots of reasons - depends upon diagnosis. Yes, we do diagnose. If we do not diagnose a problem, how can we treat it? Regarding the mother's hospital choice - If this is where I think it may be - If ___________ General hospital happens to only be a few more minutes to the west, and have 24 hour Neuro available, on the Statewide Stroke Point of Entry list, I'd think it's a good idea. especially if the hospital in town is a smaller community hospital. What's your DDX? IF your BLS what's you Rx, ALS, list yours as well... All as stated above. just taking a stab.

shaking on sticks

containing pyroclastic clouds

with automatic flushing

in a large

through the watermelon

Went absolutlely wild!

fueled by gasoline

All the time

but baby boy

was nine months

through bendy straws