DwayneEMTP

We don't have access to vitals on this guy yet, we're still deciding whether or not we want to lay him down...No reason to suspect any kind of hinky trauma. He saw the scaffolding failing, just sat down into his harness and was laughing and joking up to the time that he became unresponsive. Curiosity, why would you expect arrhythmias? How much bicarb would you like to give? When? Do you have any concerns about giving the bicarb? A bolus of what? How much? Only one type of fluid? To the rest, do you want to lay this guy down to assess him? Why, or why not? As to his vitals, what would you expect to find in a patient that presented in this way, with this history? I have been taught over and over that you ABSOLUTELY don't lay this guy down...looking for reasons for or against, as that would be the very first decision to be made, before considering other interventions...

Doc, would CMS be interested when I'm a self pay?

Ok, after giving this some half assed thought, I've decided to expound... When I went to the doctor, it wasn't only for the transient runs of tachycardia, but also, transient, at rest, 6/10 chest pain from sternum radiating to my left arm, upper back, and up into my jaw, though without any other commonly associated MI symptoms. I'd had the issues off and on for maybe 6 months, 30 seconds to 2 minutes per episode, maybe once or twice a month or so. But they'd been increasing to a couple of episodes per day, at rest. That's what had me the most freaked out previous to returning to the jungle and being away from care. I was embarassed to admit to taking Cialis, so didn't mention it in my initial post, (though I did to the doctors involved), but finally decided, screw it, I'm not a kid any more, not home that often, my libido still thinks I'm 20 despite the Little Commander insisting on fair work practices...so....there you have it. It's not like I've no bared my soul her a hundred times before... The reason that I was looking for a physician level assessment was that though those symptoms are scary when combined in a 50 year old male, I wasn't convinced that they were really linked symptoms. But if they were, I didn't want to come back to work without them being resolved. I wanted someone that would weed through it with me. That's why when the doc didn't come into the room that I didn't insist on seeing him. I wanted a doc that would be interested enough to root the issues out instead of going with the first, simplest answer. I was confident that a doctor that I had to force to see me wouldn't be terribly motivated to spend any time looking for zebras. And zebras were the issue, though not rare zebras...like, looking for the zebra at the zoo maybe...like that. As I don't have insurance, I chose a walk in clinic instead, hoping to get lucky. The first clinic that I went to had PAs (Physician Assistants) on duty so I politely explained that I'd like to see a physician instead and they referred me to the clinic mentioned here. At the next clinic I made it clear that I needed to speak with a physician, and they said that they only had a physician on duty, so that was no problem. After leaving the clinic pissed off I went the next day to my PCP who fit me in because I was getting ready to leave the country. My PCP was unsure about the chest pain, ECG was clear, so decided to trial Prilosec (I think) for a month for acid reflux despite my not having common heartburn and such. I had no confidence in this plan, but it turns out that it completely resolved the chest pain/radiating pain issues. Exactly the reason that I wanted a doctors advice instead of continuing to follow my own.Thank goodness too, as they were scaring the hell out of me. During her actual assessment we both felt that a logical place to start looking or tachycardia issues was with the Cialis. I assured her that I was careful to monitor it, and didn't really use it as often, or at anywhere near the commonly acceptable maximum dosages and had had no issues with it for year and a half or so that I'd been taking it. So she started walking down the list of relative and absolute contraindications and we came across grapefruit juice..that I'd started to drink periodically only recently. It seemed that the issues began with the grapefruit juice, in general, to the best of my memory. I've stopped drinking it and have had no further episodes.(You can Google grapefruit juice and Cialis if you're interested.) At the clinic, no heart sounds, no lung sounds, no touching of any kind really except for the tech that took my blood pressure and the chick that did my ECG. Logic seemed to be, "Ahh...tachycardia, ED issues, stressful job, handicapped child= anxiety. " No physical assessment necessary with such an obvious problem. What about the chest pain? "It's probably associated with the anxiety." PCP's logic seemed to be, "50 y/o male, stressful job, transient runs of tachycardia...I think he might be going to die, so lets do a full assessment and see if I can prove me wrong." Full assessment, ECG, 20 minute long discussion of history, differential, trial interventions to validate differential (while trying to stay within my non insurance budget.), issues resolved, provably so. I guess that this is why I'm so pissed off, and really disappointed in the original clinics treatment. A 50 year old male with the above symptoms should have been taken pretty seriously, yet they didn't even do an EMT B level assessment, being satisfied with the medical student's diagnosis of anxiety issues. It's not just that I didn't get anything that I'd asked/paid for, but that it was really, really bad medicine. I've never worked for a company that I don't believe would have fired me on this one case alone if I'd done such an assessment on such a patient... Anyway...This is my first access to a computer in ove two weeks so I'm kind of ranting, but I thought some of you might find the above interesting and I wanted to add it for those of you that were kind enough to give me your time and opinions... Have a great day all!

I've been looking into suspension trauma a bit since I've been back in country as I'v not looked at it for a while and there is a lot of harness work being done on this project. I was a little bit surprised by what I found.. This is meant to be an exercise in memory as well as physiology and treatment logic without reference. I'm asking that you participate, if you choose to do so, without referring to references of any kind. Bring only what's in your head, and we'll hopefully, reason out the correct answers together...(I know, we always seem to have someone that pretends that they just happened to know the exact correct answer from memory despite it matching up closely with the top Google searches, but lets do the best we can.) If you're already positive that you know the best, most current scientifically supported answers then I ask that you participate in a way that walks everyone else through the logic instead of just stating the answers. I would like this to be a mental exercise as opposed to, "What is the obvious right answer according to...X" Ok, enough of that... You are called to the scene of a 30 year old male that was working at a height of approximately 40 feet when his scaffolding collapsed. For about the first 10 minutes he was laughing and joking with his buddies about how cool it was to get paid to sit in a swing and look at the jungle, but about 3 minutes ago he stopped talking and seems to be sleeping. The rescue team was quickly on scene, within 5 minutes, but didn't see any reason to call EMS as the patient hadn't suffered any trauma. When you arrive they have lowered him nearly to the ground, he is still in his harness in a sitting position, probably about 30 seconds from touching the ground where the rescue team has set up a collar and long board in preparation. (For the record, if you're going to ask for hinky ECG readings, blood gasses, etc, I won't be able to provide them. Once I ran into things that surprised me when looking into this I stopped looking and decided to try and reason it out with everyone else. I have no idea as to the right answers here...) In my opinion this is the most nerve wracking type scenario to participate in (No references, no studies allowed until after completion), as it asks you to hang your ass out and look ignorant because we all seem to believe that we're supposed to have remembered every single thing we've ever learned, even if we've never used it. But you can trust me when I tell you...looking ignorant isn't terminal. If it was I'd've been enbalmed years ago.. What would be your initial interventions? And very specifically, why? Thanks for playing...I'm really looking forward to this...

What is CMS?

I've seen the term "mandatory reporter" many times here, does that mean the same thing to everyone? Who are you obligated to report to? It seems that part of the OP was asking if he should speak to the police. Being a mandatory reporter is awesome, but unless the OP knows much more about it than I do, that statement alone doesn't really help much. Also, if this child comes from one of the American war zones that we call 'inner cities', then being to galant can put this girl in more danger than she is now. It's important that when we start to skirt the system, which I'm a fan of and do regularly, that you consider the unforseen consequences and don't cause additional pain, which I've also done more often that I'd like to admit. Sometimes are best efforts outside of the system spiral out of control due to our ignorance of 'the big picture' and our good turns ugly, and often passes beyond our control to mitigate that ugliness once it does. Awesome post. I'm not clear why you would choose to not continue your discussion. This topic is so important, and too often ignored...

Thanks Kate... Yeah, I'm pretty pissed off now, so will be following this up to the highest levels that I'm able... I truly expected, after all was explained, that they would say, "Ooops, sorry, we dropped the ball that day." But I'm a complete believer that mistakes will be made, and should be forgiven if those that make them are honest about them. Now that I know that they will try and cover their behavior with lies I can't really let it rest. Plus, I've kind of been aching for a fight, so this gives me one that I can feel pretty good about...

I might be able to see some side of this from the cops point of view if it hadn't been so completely obvious from the beginning that the one cop was doing everything in his power to create a violent confrontation... Everything about this is disgusting...how, as a father, do you live the rest of your life after listening to your son crying for you to save him while he's being unjustly beaten to death?

According to a message left at home the Dr. is claiming that he saw me and did a full assessment. Babs sent me his bio from the hospital web site, with his pic, and I do remember seeing that doctor sitting in a little computer nook visiting with some nurses or such, but he never spoke to me, and certainly never entered my exam room... But if all involved are willing to lie about it then I don't really see any way that in not going to take a bath on this... In fact, the last thing that the medical student said to me was, "and the doctor agrees with my diagnosis.." but like an idiot I'd assumes he was doing some polite bragging before the doc came in.. Babs is doing the research regarding the steps necessary to file a formal ethics complaint, starting with the link kindly provided by the Doc, but if they are all willing to lie, what can be done? It's so frustrating trying to fight this from another country on a gig so remote that I only have phone or internet foe a few hours per week...but it's gone way past being an issue of money now. I can't really lay down on the ethics..

Oops...sorry...Yeah, Colorado Springs.... (Apologies to all for my crappier than usual posts. My computer died so I'm posting on my Kindle...it's a trial..)

I'll have Babs check the Bill for the doc's official title...I'm assuming the kid is from a local school...

Good on you Beibs....

Thanks...not ignoring the thread but traveling back to work... No insurance...it's under review...but I'm going to make it ugly if they don't play ball ...Thanks for all of your help...I'll update with a resolution...

Man...it's so good to have you back!! Your new job is much more near and dear to my heart than either of your old ones could ever be...I'm excited to hear about it!

I love that you're sharing this in the thread instead of privately....really cool Mike...

Welcome to the City! There is much to learn from the people here, as I'm sure we have to learn from you. Don't let your language stop you! Practice away! Dwayne

Good protocol DFIB, but you'll need to address altered mentation also...

During my recent tachycardia issues I went to an Urgent Care to get an ECG. I'd asked specifically if I'd be seeing a physician, as I wanted a physician level assessment, as was told that I would. While waiting a young man came in an introduced himself as a medical student and asked if it was ok if he interviewed me while I waited for the doc. I said 'sure.' It was obvious that he had no real idea how to do such an interview, he kept checking a sheet of paper for further questions, but ended up asking only a half dozen or so. No touching of any kind was done. They did an ECG, and he then came back in an explained that he was confident that I was having anxiety issues and that I should try and relax, but not to worry about it. When he was leaving I said, "How far along are you in school?" He said, "Well, actually I'm just starting my second year of school." I'm not sure if that is medical school, or school in general. He left, and then a girl came in and started to take my information, gave me a printout of my diagnosis, and then it occurred to me I wasn't in fact going to see the doc at all. I thought, "Well, screw it, I'll pay my hundred bucks and go to a different doctor." I'd asked about price before my appt and was told that they couldn't tell me specifically, and then after, that it couldn't be figured right then because of the ECG, that I would be billed. But I recently received my bill for $954.00. I've never known an urgent care to charge so much, but $400 of that is a "new patient physician consult." The next doctor I found did an actual assessment and ecg and discovered a dangerous medicine interaction that was most likely causing my tachycardia issues and could have been really dangerous if left undiscovered... I'm guessing that this medical student doesn't have any legal level of certification, so I'm wondering, as I wait for my next phone call to fight my bill, if it's even legal for him to treat patients without direct oversight? And are there morals and ethics surrounding the doctor billing for his physician level services yet sending his medical student in instead, and only? And lastly, has anyone EVER been billed a grand for a quick care/urgent care visit???

It's nearly impossible for me to imagine a multi casualty scenario where I would hold C-Spine. Triage needs to be performed, bleeding needs to be stopped, unseen patients need to be looked for, follow up assessments need to be done. C-Spine in such a situation is only valuable to people that don't know what else to do... Even when you have your hands free and nothing else to do, stabilizing the spine is much more a verbal exercise than a physical one. Sit people down, lay them down, explain to them that help is one the way, put families together so that they don't feel the need to wander into the road looking for each other, remind them to lay still until they can be assessed by a medic, and continue on. In every single patient, remember, "Life Before Limb"...Getting them to the hospital is what's most important, get them calm, organized, rate the injuries and WRITE THEM DOWN....then do it again, and again until the Calvary arrives... And if your local law enforcement thinks that you're dirt? There's probably a reason for that. Instead of accepting it as fact, look for the reasons that that relationship exists...you'll be able to find them, and change them if you choose to.

We once had some folks steal our pulse ox...Pretty crazy...Went back in and asked for it and they pulled it out of a drawer in the bedroom we'd been working in. It turned out that they were just 'keeping it safe until they could return it to us..." Upstanding citizens after all...

Yep...safe bet the spine is clear unless you see a bunch of other naked people, a trampoline, and maybe a few barn animals...then, please consider possible comorbidities...

Damn it TH, I thought maybe you were dead! Good to see you back Brother....

Damn it... "You and yours, Brother.." But you knew that, didn't you??

Thoughts for you and your Brother...

Responded to an altered patient, glucometer read "hi", it was reported by the ER that his labs showed 1,500 mg/dcl. He died the same night...unsure of comorbidities, but none physically apparent.