rat115

Hmmm...... Gotta wonder about that story.

Ok..... Here I go. I've been a member here for about 3 years. I've used chat to ask questions that I would have prefered to post in the forums. The reason for this is that people here can't stick to the thread topic. ALS vs BLS.....Volley vs Paid.....I can go on and on with the constant and STUPID debats. We've beat those horses to death!!!!!!! Folks, you know it's a heck of a lot easier to learn if people can keep on topic and start another thread if you want to debate or to question something that's not supposed to be in the thread. When you add all the side convos in, people have to wade through all the BS to get to the grit that the thread was started about. That's what's ALWAYS put me off of reading any threads on this forum and why after years I don't have thousands of posts here. Hopefully, that will help some of you who keep dumping in threads to SHUT UP and start your own threads so the people who start their threads can get what they're looking for in them. PLEASE!!!!!!!!!! AK, you're right about you get what you pay for. I miss chat. I miss being able to get answers to questions without all the bologna going on in the threads. I'm not asking for huggie-kissie crap. I'm asking for consideration for the person who started a thread, especially when it's in a forum where we're talking about EMS related things. In the non-EMS discussion forums, it's not normally very much of a distraction. Where a post has been started to educate, even if just the person who started a thread, it's a MAJOR distraction. If I sound BITCHY, it's because I feel that way right now. I posted a thread to help me. I did get some help, but I had to wade through a lot of crap that didn't belong in that thread to get it. It just disgusts me that people here spout off about being professional but they can't help educate without adding digs to others because their views differ some but are overall the same. Ok. I know someone will take a pot shot at me for this thread, but I'm just so tired of having to wade through all the side convos and beat to death debates in what's supposed to be an educational thread. Maybe Admin should put a catagory just for debates for everyone that likes to repeat these over and over. Now, I've spoken how I feel. Hopefully, some of those who keep doing this will read this thread, NOT POST ON IT, and JUST GET A CLUE! luv ya'll! Ratty

Thanks!!! This makes me think that there was definately something neurological going on. That was an early impression because her blood glucose was only about 30 mg/dL high for her and the fact that there was too much going on with her speech and comprehension. I may have to go for a walk and see if I can talk to the husband. That's the only way I'm going to find out what the dx was.

Ain't it a fact and ain't it disgusting!!!!!!!!!

Welcome to the City. From what I've seen of your posts so far, I think I'm going to enjoy your posts.

Can we put them out of our misery? PLEASE??????? Don't get me wrong. Fire departments do a lot of good and necessary work, but you can't do 2 jobs at 1 time. I also agree with the question of how the devil they plan to move a pt on the fire truck. Get the EMS providers in there and help us get the funding. Don't take our funding and then gripe because it takes too long to get an ambulance when one's needed.

I'm thinking that by "mobile data terminals" you're talking laptop computers, tough books, etc. We have laptops in 2 of our ambulances. We run the ESO software on them. It's a good program, but it's set up for a tough book or a laptop computer with the ability to have someone sign on the computer. I think it's a bit of a PITA when you can't do that and you have to tell the nurses and patients/patients' family to sign "somewhere at the bottom of this page" because there is not a place for them to sign when it's printed. As for our computers, they really need to be updated. They've been dropped and one has a crack in the case. ESO doesn't like Mcaffee, so it won't download if the firewall isn't set correctly. We have to be careful if we're going out of town on a transfer to open ESO before we leave town or it will sometimes tell us that it can't open and we end up handwritting our report.

Scotty, this is an interesting pt, and I wish that I were able to find out more about the final dx on her. The perfusion problem is a normal with this gal with her age and diabetes. This isn't new, but it was worse than normal. As to the the lab results, I really wish that I could get a look at them. It would be a nice wrap up of the call to get a complete feedback on it. It would also help since I have a feeling we're going to be seeing this pt again. You're correct that it is our policy to get a 3-lead strip for the ER. Considering that this pt was moving around so much when we took her in the 1st time that the ER was unable to get a good 12-lead, I wanted to get one in case she started getting worse again, and I just barely got it before she started thrashing around again. Oz, you gave an excellent description of a dystonic reaction. The question your description brings up for me, and this is to you, Scotty and any others who've seen this before, is if the pt's speech was slurred or more of a babbling that didn't have any real words mixed in? I ask this because what you described very well what was going on, but she was alternating between slurred speech and where there was no real form to her words. When she'd stiffen up, she'd fling her arms out and writh as if in pain but she told me that she wasn't hurting when I asked her about pain. She didn't say that she was in pain just when she was writhing. At the same point, she told me that she had 27 kids when she has 3 and was born in 3 when she was born in 1927. That made me think neuro with the strong possibility of stroke therefore I wanted to get her to the ER asap. The thought that it might have been something to do with a medication change also occured to me, but she'd had that changed a couple of days before this occured. I'm asking questions because this is something that neither I or the other 3 EMS providers who worked with me between these 2 calls had seen before. I'm trying to educate myself. I know that I may never know the full dx for the pt, but I want to learn from it. I know that, personally, I made sure to cover as much BLS care as was needed and that could be provided between the time on scene and the time en route. To all of you who've stayed on topic without the rude stuff added in.... Thanks for helping me and others learn more. For you others, you're the reason that I've been a member of the forum so long and have so few posts. I get sick of the nasty attacks of EMT-Basic vs Paramedic and paid vs volley. Too much of that is total BS, IMO.

Is it going to take more than saying hey get over here? Is the pt going to die while your partern is looking for the student? THAT"S what I mean. If you got a GSW in the ghetto, your student isn't very smart to take off. Yes, we're supposed to bring everyone back. That's why I said that it would only be acceptable if it "DEFINATELY" would make the difference between life and death. Most of us in the field realize that the time to yell for someone to get over to the ambulance isn't going to make that kind of difference.

You got that one right, Wendy.

I don't agree with leaving a student behind. I do believe that the rest of what you said here in numbers 1-4 is good. If you've got a student that's more than 5 feet away from you 1) he/she is not learning anything, 2) the preceptor can't make sure that what the student is doing is correct and 3) that the student is not within close reach of the preceptor is something that should be taken up with the instructor either by email, phone or through the evaluation forms that the student has. If the student is causing problems, there's always the option of making a trip back by the base area to drop the student off early or having a supervisor pickup the student from the ER. In my opinion, the only reason to leave a student behind is if it DEFINATELY means life or death for the patient. On the other side of the coin, I've had preceptors who expected me to be able to figure out what was going on without being communicated to. I've been with crews that had been working together for so long that they didn't have to talk but a couple of words here and there about what they were doing on scene and then they expected me as a student and someone who didn't know their team to blend in without any changes on their part. They were excellent EMT and EMT/Paramedic teams, but they made horrible preceptors because of their lack of communication on scenes.

On the first run, her BP did start dropping after we got her on O2. I was watching for focal neuro problems. Didn't see them. On the second run, we were only about 2 minutes out from the ER so after getting a BP and calling in a report to the ER, there wasn't much else he could do. We were moving her from the cot to the ER bed when the airway obstructions started and an ER nurse took care of it because we had our hands full of sheet. We couldn't get a temp either time because of her rolling around the first time and screaming the second. Labs were drawn at the ER at least the first time and probablly the second to see what changes there might have been. We were unable to get the information about medications from the husband or daughter. Her doctor was the doc on call with the ER that day, so he had the information and wouldn't share it either. (Personally, I don't like this doc.) The dementia had been getting worse and she'd had similar episodes that the PD had to be called for but this was worse than those were according to the PD on scene on the first call and her husband both. The husband and daughter noted that she has days that are really bad and days where she's almost like she was years ago mentally, but the second type are slowly getting less and less often. This pt has had a tendency in the past to have her BGL get up that high. She's only tended to have problems with the hyperglycemic side when it hits above 250. Our normal call for her is her being hypoglycemic. On a personal side, I've got an uncle with a form of dementia. When he was first starting out with his dementia, it was like this. I tried to find out the pt meds on this call because the form that my uncle has can actually be worsened by certain medications. He's got what's called Dementia with Lewy Bodies or Lewy Body Dementia. It's a tough one because it also has s/s of Parkinson's Disease mixed in with the dementia. Mobey....Sorry that you don't like volly EMS. There are some areas where if it weren't for the volunters there wouldn't be any EMS. I can tell you for a fact that HERE none of our EMTs work at McD and none plan on going there to work since they have majorly messed up schedules. You have to realize that I'm 3 hrs from any metro area. The towns in the area I live in range from about 500 to 3500 in population and normally take about 5-7 minutes to drive across. Right now, we're trying to get our county commisioners to hire at least a couple of people to cover days since we're having a hard time getting coverage from 0700-1700 Monday thru Friday. Unfortunately, we're also dealing with them trying to take budgeted money from us for equipment upgrades that we seriously need to cover shortcomings elsewhere in the budget. It's something that our EMS Director has been fighting for for almost 3 years, and Colorado just passed a tax increase on auto tags that's to go to rural EMS agencies for the sole purpose of hiring full-time staff. SO.......Until we all live in the perfect world, there will still be areas where people must volunter to know that their family and neighbors are taken care of.

Ok....this was an interesting couple of calls. 1st call..... 0220.....82 yr old female.... hx of diabetes and c/o choking..... Arrived on scene to find 2 PD officers standing in the room with the pt. Husband very frustrated trying to get her glucometer set up and take her BGL. Pt laying on the bed alternating between (1) laying still and speaking either with non word babbling and unable to correctly answer any questions beside her name and (2) writhing around and screaming as if in pain. Poor perfusions of extrimities a normal thing on the pt so unable to get BGL with pt monitor and had to wait for my partners to arrive with our stuff. (We're a volly service and I responded straight from my home since it was only 2 blocks from home and I'd have to pass the residence to get to the shed.) After amb arrives, we get a BP of 230/100, pulse 100 regular and strong, BGL of 175 mg/dL and unalbe to get a SAO2. Started O2 at 15 lpm NC and tried to assist pt to the cot since she was calm as we started to move her but had her start screaming and collapse when we moved her so we ended up carrying her to the cot. No weakness in grips or deviation in eyes. We got her loaded, and the hubby told the EMT driving that she'd been dx with some form of dementia while we were en route. Unable to get any complaints from the pt beyond the abnormal behavior. This pt has been picked up going into diabetic coma but no one on the crew had seen her like this before. 2nd call..... 1105......dispatched to a local resturant for unknown medical which dispatch changed to a party choking........ Arrived on scene to find the same 82 y/o Fe laying on the floor with her head in her daughter's lap. Daughter stated that the ER had just released her mom about an hour before. No Dx from the earlier tranport given to us by the daughter. She stated that they were sitting at the table eating and "Mom suddenly clutched at her chest and started screaming and talking in babbles". Daughter stated that she had her mom in her arms and prevented her from falling onto the floor by lowering her. Pt calm enough that we were able to place ECG leads and print a strip for the ER (no ALS provider so no one authorized to read on the amb), pulse 68 regular and strong, SAO2 96% on RA. Went ahead and started O2 at 15 LPM NRB due to s/s, moved pt from the floor to the cot, loaded and transported. BGL not checked due to trying to get her out of the resturant and the EMT in the back didn't get it done once we were rolling. Pt did start having frothy spit as we arrived at the ER and started gaging on that, but it was the first we'd seen of anything like that. No dehydration noted either time. Family noted that this behavior had never been so bad before and that she'd recently been to the doctor for med changes. Both times, the husband was worried and feeling way out of his depth in caring for his wife. Wish I had a copy of the strip to show, but I don't. From a BLS stand point, I didn't see much else we could do. Comments? Questions? I'm trying to review this mentally myself incase we have similar with this gal again.

I had to put that OB pt up to a yellow instead of a green because of the scenario. If she's fallen and her b/p is already a bit high, I'm going to watch her close. THere's a chance of complications with the baby that may not show because of the fall alone.

Can't say that this surprises me at all. It's not just diabetics who are doing this. I had a guy complaining to me the other day that the pharmacy wouldn't refill his meds until he'd gone to see his doc. Somehow, he'd made it 6 yrs without going in for a full physical eval with both asthma and cardiac issues. And that wasn't a pt of mine on the ambulance.

Ahh.....to the old times. We have a store here that still carries the candy cigs. The kids get a kick out of em.

Hey, don't ask me for a refund for that property. It was a no refund deal Glad to have ya back!

Left a SAO2 monitor on scene once. Have left the O2 bottle in the ER a few times and once on a scene. Left a BP cuff or two on scenes. Only thing we weren't able to retrieve was the SAO2 monitor. We had an EMT left on scene this winter. Our protocal is to send 2 ambulances on all MVAs. He'd come out on our secondary ambulance. When that driver left, he didn't make sure he had both EMTs who'd been with him on the way out and thought that this EMT was in the primary with me. My driver wasn't listening to the UHF radio, so my driver continued to pull out when this guy had called for us to wait. He ended up hitching a ride with the fire department. He's still razzing the guys who were driving that day.

The service I run with finally got our own pump. Before that, we would borrow one from our local hospital and return it after the transfer. Since we're a BLS service and have only 2 ALS providers, we don't often start IVs in the field that need a pump and only tend to have them on transfers.

Sounds to me like you seriously deficated in someone's Wheties and he wants you OFF the service no matter the cost. I'd be in contact with a lawyer about this and possiblly someone at your state EMS or at least county SO level. Document everything that you can. If you lost the chance to document where the budget was being misused, you screwed up BIG time.

Being a BLS provider and not having ALS nearby, you're going to have to make a judgment call, as Scotty, Zilla, and chbare pointed out. You did what you could. Watching pt vitals and SAO2 readings is exactly the right thing to do. Sounds like you made the best call for your pt. Jeepluv, you're taught those things for the extreme cases. You'll learn to use your judgement as you go through clinicals as to when O2 at 3lpm nc is better than 15lpm nrb. It comes with time and training.

Good thinking! If you can't fly them immediately, they become a priority to be stableized while waiting for their turn to fly. Good resources around to care for the pts. Remember that 9 peds alone may not overburden the local hospital but the total will. I'm working from the point of view of having a 25 bed hospital with a 4 bed ER. We can handle it, but it becomes a MCI for us. Someone commented about getting and IC set up. Good thinking there. You're going to have those who refuse to go on the bus and those who refuse to go anyother way. You're going to need to keep track of where the kids are sent for higher level of care. This will also give you control to make sure that no one else on scene ingests anything without your team knowing what they're eating. Good teamwork is very important in a situation like this in any area.

Our protocal for a minor is that anyone under 18 is transported if we don't have parental consent to not transport. The fact that this boy was agitated would have had me pushing and calling for a doctor to back me up to get him in for evaluation. I would have done everything that I could have to get him into the ER within reason.

Not sure what you need interpreted. Zippy's in the UK. Things are done a good bit different there than here in the US....especially here in CO. In the UK, they have dispatchers and Drs prioritize ambulance dispatch for non-999 (non-911 for us). They don't use lights and "noise" or sirens unless it's absolutely neccessary. Not much more to interpret from that.

Ok.....We've DXed what's going on. When are we going to outline what's being done with the pt's? I know a lot of the people who post often on here work in the city. I find it interesting to see if you can figure out he logistics of getting these people to treatment. Ruff, you said that there's only a small bus. Not in a small town!!! We've got kids to be transported in from the farms. We need a big bus some where within 20 miles. I'll pick up from here and see if you can figure out your logistics.