Curiosity

It's nice to say "you can do anything you want if you set your mind to it" but there's a considerable chunk of change involved here. I remember my first day of class a girl asks "when are we going to get to see blood because I don't think I can handle that" all this money spent...and turns out, she would pass out at the sight of blood. Had she taken the initiative, done dome research, shadowing, an observational day at an er, she would have realized sooner that she couldn't do it. Would have saved time and money. I would personally recommend going to your local EMS and talking to them, ask questions about what they think you should be doing to figure out if you can physically do the job. Ask them if there's a specific gym they go to, inquire about trainers who know a thing or two about the physical requirements of this job and try to train with them. I don't want to discourage anyone from doing what they want, but be informed of what you're getting involved in. Do your homework, and if you figure out you are physically capable then I wish you all the luck in the world and hope to see you around here more often.

I've heard nothing but great thing about the Humber pcp program from employers and students alike. You also have the advantage of precepting in some busy services which will give you some great exposure to all types of calls.

I know around my area (Ontario) there are agencies who have put together physical testing specific to paramedics. They are kinesthesiologists who have followed EMS around and have developed specific criterias and weights to test our capabilities before we start working. Maybe look into something like that?

Doc, I would imagine at 28 weeks a baby would be more susceptible to internal decapitation right? These doctors may have done nothing wrong. Even with the diagnosis of an enlarged abdo, I wouldn't have guessed that at 28 weeks, this would have been a difficult vaginal birth. As far as pushing the head back in, what else was he suppose to do? If you know the baby's not coming out that way, it's gotta come out an other way right? And as far as the blood part, the patient and her husband probably didn't know what to expect.

Sounds like what Dwayne said. Internal decapitation during delivery and as you mentioned, coming out is hard enough, it probably doesn't go back in so in order to get the baby out, the head had to be detached completely and delivered vaginally while the body was delivered through the c section. No one commenting on the fact she was not anesthetized prior to the start of the surgery? Baby is dead, why make mom suffer more? An extra minute or two isn't going to harm the baby. Right?

I'm wondering if it wasn't just a separation of the skull from the spine and not a complete decapitation and the blood they saw is normal. Edit: I found a more detailed article seeming from the court about it. It has a few more details. http://www.courthousenews.com/2012/10/02/50841.htm

HUGE pet peeve of mine. I had a partner that did that to everyone and it drove me up the wall. They are not your dear, sweetheart, or what ever pet name you give them. That is something your wife/husband/gf/bf/mother... call you, not some total stranger that just walked into your life not 3 minutes ago. I remember when I was in the hospital and a nurse called me dear. I asked her if we had some sort of a personal relationship, she said no, I said, then why are you calling me dear? I find it disrespectful and always call my patients sir or ma'am until they tell me otherwise. (nothing personal towards you, I'm just very passionate about showing the proper level of respect to my patients)

Thank you. I'm in Ontario.

WOW...that is insane. I've been to NH to pick up patients who had fallen (as per the NH policy as you stated) but never for a patient who is capable of making his/her own decisions. They are patients with dementia who are incapable of telling you if and where it hurts. Has anything come up about the NH probably lying about the patients symptoms?

BGL? Headache? Pupils?

And get called back a few hours later at the same residence for 99yo male with chest pain...OOPS

Hahaha can't say I've ever been asked for condoms before but I can try to start that type of conversation by offering some. Just hope my next patient isn't a 98yo woman who has no idea what a condom is. That could get awkward...

I tried to spin the thread in a different direction. Unless there's a post somewhere else for my question as well.

How do you react when someone answers you opening line with something like "I called because I stubbed my toe and it hurts"? I've found myself staring at patients with a blank stare for what felt like a few minutes before coming up with something not insulting to say. How do you handle these situations?

I just got your book. I'm not a quarter way through the first story and I'm in tears!! You have an amazing way with words. It's fantastic! I'm still not done the first story and I'm emailing friends the link Edit: I can't read through all these tears!

Great case. Had me stumped at the X-ray though. It was fun doing the research, I can't believe how much more I'm learning from these scenarios.

What a beautiful way of looking at life. Your father had the right idea in my opinion. I think a healthy sense of humor goes a long way in our profession when used in the appropriate situation. I'll never forget this patient i had treated during my preceptorship. He had experienced a sudden onset of violent nausea and vomitting and his family was concerned and called us. Very nice man, smiling at us while laying on his floor white as a ghost. His assessment was normal minus the vomitting. He had this sorta mischevious look to him though. I cracked a few jokes with him, he responded with his own, it seemed to put his family at ease. I was told, after the call that it was inappropriate to joke with patients. A few weeks later, the service received a letter from this gentleman and his family thanking us for our caring nature and our sense of humor, that it really helped diffuse a tense situation and they were really glad we we around. Now maybe I got lucky and happened to have read him properly, but if a bit of clean humor can help patients, I think it's a good way to go.

I'm still going with pneumomediastinum. I'm trying to figure out the exact mechanism of this from a perf bowel but I'm having a tough time with it. Here's what I got: The reason is anatomical spread through the retroperitoneal fascial compartment, which extends through the posterior mediastinum to the neck.

During a colonoscopy, the colon is insuflated with air. A tear could cause the air to collect either in the peritoneal cavity or the retroperitoneum. From there, the air can travel up to the mediastinum (pneumomediastinum) and the neck,causing the subq emphysema. A pneumomediastinum would also explain the chest pain.

Wow that is insane! See how fast that moved on those trees? Crazy video.

Possibly a complication from the colonoscopy which caused a perforation which forced the air into the Mediastinum causing the subq emphysema and abdo pain? Ok this is a scenario so I'll work it like a scenario. My next step would be evaluate his resps, make sure there's no airway compromise, IV, transport. If it is a tear in his colon, he's at high risk for infection.

Any recent trauma? any subq air noted anywhere else? Any trauma visible anywhere? Are his psychiatric problems well controlled? What meds does he take? Is he compliant with his meds? Lung sounds, heart sounds? Any complications with the colonoscopy? Any bleeding? Bowel movements since?

I was reading an article today and it quickly mentioned valves in the jugulars. I did some research and it would appear that both the EJ and the IJ have valves at the superior vena cava, the EJ has some more scattered along its length and the IJ has one more near the top. I read they are there to prevent back flow created when coughing, bearing down etc... I didn't think there we're any in the upper extremities either.

Hello to every one! I'm a brand new ALS and was surfing the net to find things to read up on ems buisness. My search led me to this site and what an amazing site it is! I've read most of the topics and It made me appreciate how much I have to learn! I'm looking to better myself, and I think this will be a great place to gain new knowledge and insights on how others view things and do things. I'm really glad I found this site.