THE_DITCH_DOCTOR

What if you ARE the supervisor? If it was me, I'd be calling the local sheriff's department for a breathalyzer test. Settle it once and for all.

Until such time as someone can provide actually copies of the records in regards to the patient, and not just the carefully spin-doctored version we're getting from a bleeding heart media source, no further discussion of this is necessary as it is a moot point- the patient is dead, a patient with little if any societal worth and nothing we can say here will change either of those facts. Time to move on.

Excellent point SHP.

How about if I post the risk assessment for PE? The scale we use (which is a standard scale by the way) would classify this girl as a relatively low risk of PE. And yes, I believe she was in there because she was a drug abusing criminal- you don't wind up in a child prison for being an honor roll student who feeds the homeless in his spare time- and somehow I believe that if you screw up and make a habit of lying repeatedly then yes, we should be hesitant to believe you. Maybe it comes back to something my parents instilled in me, that a lot of people didn't learn- it's called "personal accountability". She deserved what she got...it's a shame she didn't learn to tell the truth sooner then she might have been a believable person and still alive (but then again that would mean that there would be one more crack addict sponging off of society.....hmmm, maybe it wasn't such a shame after all ) What kind of a medically trained person am I? One with a whole lot more education and experience than you, I'm a damn good practitioner and a markedly empathetic one at that. Have a nice day. :wink:

Yes one of the product is CO2, but ATP is yielded as a product of the reaction and the most significant of them from a physiological aspect. But since you've decided to be anal about it. Here goes: If I remember correctly (and I should seeing as I am a biology major and I have to know this for most of my classes) it's something along the lines of: GLYCOLYSIS Glucose ----->2 mol pyruvic acid (I'll skip how ATP is converted into ADP during this breakdown and how glucose-6-phosphate, inorganic phosphates, NAD and NADH all play roles in this for the sake of brevity) I I I V TRICARBOXYLIC ACID CYCLE (aka Citric acid cycle or Krebs' Cycle) Pyruvic acid-----*acted upon by Coenzyme A-----> CO2 + NADH + Acetyl-Coenzyme A -----> the coenzyme A seperates from the acetyl group yielding a citric acid molecule---->broken down into a CO2 molecule, a 5-carbon molecule and 2 hydrogen ions which bind with NAD to form NADH which enters the electron transport system for later use in the production of ATP----->The five carbon molecule is then broken down, yielding another CO2 molecule, 2 more hydrogen ions (which bind with NAD to form NADH, and enter the electron transport system) and an ATP molecule as well as a four carbon molecule, and so on....it continues back around, yielding off a couple of other pairs of hydrogen ions before coming full circle and starting the cycle over again. Granted it's a whole lot more complicated than this (with lots of other chemical reactions going on, other intermediate chemicals and other factors, but this is more than sufficient to prove what I am saying). So you see not all of the glucose is transformed into CO2 in this cycle so the next time you want to discuss cellular physiology look me up.

I'd give the glucagon. Your primary goal in any case is to correct the underlying problem if at all possible. The benzos would not do anything for the patient (although it might stop the seizures) and you would still have a dangerously hypoglycemic patient on your hands.

Not experienced the business end of a tazer personally, but I do know that one of the local sheriffs accidentally got shot by one of his deputies with one. OOOOPS. You have to wonder what the sheriff did to that guy as punishment?

http://www.myspace.com/12439145 No, not as in like the commander-in-chief sort of president, just the president of student government for an university. I'm thinking about running simply because I know I can do a better job than the douchebag who's currently in office.

I've been working on a test demonstrating what I think should be known by the average paramedic as a result of some discussion with Ridryder and others on this site (mind you I'm just doing this for the sake of argument). Do you all think I should share it with those members here? Do you think you could pass it (keep in mind I would demand an 80% for "passing")?

Just a quick note, ATP is a chemical, not a cell. It's adenosine triphosphate (in no way related to the cardiac medication adenosine by the way). It is the basic unit of energy for all cells (glucose has to be broken down into ATP in order to be utilized as an energy source for the cell) and it is very rapidly expended during cardiac arrest- this is the reason why VF will become finer and finer before finally ceasing all together- the cells become less active as they burn up their ATP reserves and therefore are unable to contract effectively. This is the kind of issue that indicates why we need to move away from training EMS personnel and towards educating them. This debate would be much more fruitful if everyone understood the underlying physiology. Once again, I reiterate the evolutionary theory called the Red Queen theory applies very well to EMS: "You have to run as fast as you can, just to stay where you are."

Bleeding hearts all around I see......

I guess I've argued my case. All I can say is I disagree with you CO.

Yes, but at the same time I do believe in personal responsibility. There's a difference between being a Democrat (which I am) and being a bleeding heart liberal (which I certainly am not) that most people have seemed to forget about. MCAD, the patient wasn't in extremis initially- she just appeared to just be whining and malingering, playing up her asthma. Granted the way the patient was handled once she crashed was less than stellar, but that can be probably chalked up to thorough unfamiliarity and lack of practice with emergency procedures. EMT's and paramedics, since we handle this kind of thing on a very regular basis, tend to assume that everyone is up to speed and well versed in how to manage any emergency that comes their way. However, let pose another question- How many of you have worked a code or emergency in the office of a physician whom you respect, but the emergency went badly because they don't practice emergency response. Just because things went badly doesn't mean they are stupid, incompetent, or anything else other than what they actually are: nurses who don't handle emergencies often; now if they were ER or ICU nurses I said hang their butts out to dry, but since that is not the case no one deserves to be punished for what happened.

Like we've (Rid and I) said it sounds like they did anything that could be reasonably expected given the circumstances. As has been said before, what happened in the end was unfortunate, but I would be able to sleep quite soundly if I had proceeded as the medical staff did with this case.

Exactly Rid. Well said.

Stop and look at it from a logical standpoint- she was known to lie and was an uncooperative patient, with a condition that is largely diagnosed based on presentation. PE is difficult to catch even in the best of circumstances and this was far from that given the patient in this cases. She had a known condition which would have seemed to account for her SOB and chest pain, as well as her known propensity to lie to gain her way. There was no indication, until her collapse, that was some wrong more than perhaps her asthma being uncontrolled through poor compliance upon the part of the patient or a patient who was simply malingering to get out of work details. Inmates are notorious for faking illness in order to get their way, so Chipmunk does that mean that everyone of them should get a V/Q scan to rule out PE? Who's going to pay for that in the patients with a low risk presentation, such as this one? Can we bill you for the $6000-7000 for each of those procedures? I'm sorry but there are just better things to spend my tax dollars on than on what would be in 98% of cases nothing more than a wild goose chase. But then I guess I'm not a good person because I don't feel all weepy over the death of this obviously shining member of society. Like I said, maybe if she hadn't been such a dirt bag, maybe she would have been a believable patient.

Line of Duty Death Remember the two big killers among FF/EMT's are heart attacks and MVA's.

She's combative and being belligerent. Sounds like they did everything that could be reasonably expected. PE is notoriously hard to diagnose even in a perfectly well behaved patient, let alone one who is uncooperative and would to even a well seasoned observer appear to just be malingering. That would have been my assessment of this patient. Like I said, I don't see anything wrong with the actions of the staff given what we know about the manipulative type of person the patient was. Her lying and deceitful ways cost her her life. I almost hate to say it but: Oh well, one less psychotic trouble making junkie.

She screwed up and she paid with her life. If she hadn't have been a crack addict she wouldn't have wound up in the situation she was in. Her prior abuse is no excuse. She's is the one solely and totally responsible for her situation, in fact she probably received more medical attention inside the detention center than she would have as a roving crack addict.

Sounds like the fantasy of a wannabe.....I know someone like that.

http://www.nybooks.com/articles/18050

Schiavo Autopsy Shows Massive Brain Damage http://news.yahoo.com/s/ap/20050615/ap_on_...HNlYwNjaWQ3MTg- LARGO, Fla. - An autopsy on Terri Schiavo backed her husband's contention that she was in a persistent vegetative state, finding that she had massive and irreversible brain damage and was blind, the medical examiner's office said Wednesday. It also found no evidence that she was strangled or otherwise abused. But what caused her collapse 15 years earlier remained a mystery. The autopsy and post-mortem investigation found no proof that she had an eating disorder, as was suspected at the time, Pinellas-Pasco Medical Examiner Jon Thogmartin said. Autopsy results on the 41-year-old brain-damaged woman were made public Wednesday, more than two months after her death March 31 ended a right-to-die battle between her husband and parents that engulfed the courts, Congress and the White House and divided the country. She died from dehydration, Thogmartin said. He said she did not appear to have suffered a heart attack and there was no evidence that she was given harmful drugs or other substances prior to her death. He said that after her feeding tube was removed, she would not have been able to eat or drink if she had been given food by mouth, as her parents' requested. "Removal of her feeding tube would have resulted in her death whether she was fed or hydrated by mouth or not," Thogmartin told reporters. He also said she was blind, because the "vision centers of her brain were dead," and that her brain was about half of its expected size when she died 13 days following the feeding tube's removal. Michael Schiavo said his wife never would have wanted to be kept alive in what court-appointed doctors concluded was a persistent vegetative state with no hope of recovery. The Schindlers, however, doubted she had any such end-of-life wishes and disputed that she was in a vegetative state. The medical examiner's conclusions countered a videotape released by the Schindlers of Terri Schiavo in her hospice bed. The video showed Schiavo appearing to turn toward her mother's voice and smile, moaning and laughing. Her head moved up and down and she seemed to follow the progress of a brightly colored Mickey Mouse balloon. They believed her condition could improve with therapy. However, doctors said her reactions were automatic responses and not evidence of thought or consciousness, and Thogmartin's report went farther. "The brain weighed 615 grams, roughly half of the expected weight of a human brain," he said. "This damage was irreversible, and no amount of therapy or treatment would have regenerated the massive loss of neurons." Thogmartin said the autopsy report was based on 274 external and internal body images, and an exhaustive review of Terri Schiavo's medical records, police reports and social services agency records. He said hospital records of her 1990 collapse showed she had a diminished potassium level in her blood. But he said that did not prove she had an eating disorder, because the emergency treatment she received at the time could have affected the potassium level. Testimony in a 1992 civil trial indicated that she probably was suffering from an eating disorder that led to a severe chemical imbalance. Over the years, the Schindlers had sought independent investigation of their daughter's condition and what caused it. Abuse complaints to state social workers were ruled unfounded and the Pinellas state attorney's office did not turn up evidence of abuse. Calls seeking comments Wednesday from the Schindlers and Michael Schiavo's attorney, George Felos, were not immediately returned. Speaking before the report was issued, Felos, said the Schindlers continue to engage in a "smear campaign against Michael to deflect the real issues in the case, which were Terri's wishes and her medical condition." During the seven-year legal battle, federal and state courts repeatedly rejected extraordinary attempts at intervention by Florida lawmakers, Gov. Jeb Bush, Congress and President Bush on behalf of her parents. Supporters of the Schindlers harshly criticized the courts. Many religious groups, including the Roman Catholic Church, said the removal of sustenance violated fundamental religious tenets. About 40 judges in six courts were involved in the case at one point or another. Six times, the U.S. Supreme Court refused to intervene. As Schiavo's life ebbed away following the final removal of her feeding tube, Congress rushed through a bill to allow the federal courts to take up the case, and President Bush signed it March 21, but federal courts refused to step in.

I seriously doubt it.

Icyhot. He was praising the verdict in the chat room.

Ladies and gentleman: The bastard has been acquitted of all charges. :evil: