DwayneEMTP

A good friend of mine went to work in L.A. right out of basic class and had to take the expanded scope class before being hired.

According to him the class does not add anything to your scope of practice, it is two days explaining what is removed from your scope of practice.

I believe....and it's been a bit....that they allow oxygen, splinting etc....but remove almost everything else.

Put on oxygen, call for an intercept....that's pretty much the job I think....I'll try and get him to post here.

Dwayne

"Get out of my way, son. You're using my oxygen, you know what I mean?"

Jack Nicholson in One Flew Over the Cuckoo's Nest

One of my favorites:

Quote = "I tell you Sid, that one of these days we'll look in to our microscope and find ourselves staring right into God's eyes, and the first one who blinks is going to lose his testicles."

I've seen ems show up in shorts .I also see alot of ems workers not wearing gloves.Appearance is a must in any proffesion.The show isn't perfect, it is just that ""a tv show"'. Some people get so anal about the littles things. Thats like believing all ems sleep with eachother :roll:

What! They don't all.....

Hell....Now I need to make another appointment with my guidance counselor...

Maybe I'll be a nurse...surely they all sleep together.....

Dwayne

Hi all,

I caught an episode of "Paramedic" the other night and had a question.

I will post it the best I remember..

Call was for an 80ish female, leg pain after a fall. No loc, not other pain, no other history relevent to the injury ( I believe )

They find a very thin lady on her bed with severe pain, mid femer. She screams in pain with any attempt to move her.

These are my questions:

The paramedic did not remove her pajama bottoms....when he palped her leg, pain seemed to be nearly dead center of her femur. Was there some reason not to cut away her pajamas to expose her leg?

I reviewed my basic manual and didn't see any contraindications for a traction splint relevant to geriatrics (Though it seems that you would need to expose it to reveal joint issues etc.) Yet with the little that was seen on the episode they didn't seem to consider using a traction splint. Are there age contraindications that I'm unaware of?

Pain meds were given and she was transported on her rt side (I believe it was position of comfort)

I will hope that it is obvious that the spirit of this post is not armchair quarterbacking...(I promise I've read those posts and know it's evil) and would not judge the paramedics based on my little bit of knowledge even if I thought I knew the whole story....

I was just curious about these two things.

P.S. Follow up at hospital confirmed mid-shaft femur fracture.

Thanks all!

Dwayne

I don't pretend to understand this completely, but I wanted to play!

I cut out what I believe to be a brief summary, the complete text can be found at the link below...

http://www.emedicine.com/ped/topic16.htm

Respiratory acidosis occurs when the arterial partial pressure of carbon dioxide (PaCO2) is elevated above the normal range (>44 mm Hg) leading to a blood pH less than 7.35. Respiratory acidosis is not a specific disease. Instead, it is an abnormality resulting from an imbalance between carbon dioxide (CO2) production by the body and excretion by the lungs. This imbalance occurs in severe pulmonary disease, respiratory muscle fatigue, or depressed breathing.

Respiratory acidosis may result from an acute or chronic process. An acute respiratory acidosis can be life-threatening when a sudden and sharp increase in PaCO2 is associated with severe hypoxemia and acidemia. In contrast, chronic respiratory acidosis (>24 h) is characterized by a gradual and sustained increase in PaCO2.

By definition, the diagnosis of respiratory acidosis requires measurement of the arterial PaCO2 and pH. When the diagnosis is made, the cause should be thoroughly investigated.

History:

Does the patient have a history of headaches? With chronic hypercapnia, headaches typically occur at nighttime or when the patient awakens in the morning.

Does the patient have disturbed sleep patterns? Chronic hypercapnia can disturb sleep patterns, leading to a reversed sleep-wake cycle.

Is the patient irritable or anxious, or is he or she having trouble concentrating?

Does the patient have a possible or known exposure to sedatives (eg, narcotics, benzodiazepines, tricyclic antidepressants)? Is the patient recovering from a procedure in which general anesthesia was used?

Does the patient have symptoms of neuromuscular weakness or paralysis?

Bulbar dysfunction suggesting myasthenia gravis

Proximal or distal weakness suggesting a myopathy or Guillain-Barré

Apnea associated with a traumatic injury suggesting an injury to the cervical spinal cord

Does the patient have a long-standing pulmonary disease, such as bronchopulmonary dysplasia, cystic fibrosis, asthma or emphysema?

Does the patient have an acute change in mental status (eg, signs of stroke, postictal state)?

Is the change in mental status associated with a fever, which may suggest encephalitis or meningitis?

Does the patient have signs of increased intracranial pressure (eg, headaches, visual changes, emesis)?

Does the patient have a potential for an anaphylactic reaction?

Does the patient have a potential traumatic mechanism leading to brain injury?

Physical:

Neurologic findings

Early signs are anxiety, disorientation, confusion, and lethargy

Somnolence or coma when PaCO2 greater than 70 mm Hg

Tremor, myoclonus, or asterixis occasionally seen

Brisk deep tendon reflexes (mild–to-moderate respiratory acidosis)

Depressed deep tendon reflexes (severe respiratory acidosis)

Papilledema or blurring of the optic disc

Cardiovascular findings

Tachycardia

Bounding arterial pulses

Hypotension (severe respiratory acidosis or acidemia and hypoxemia)

Skin findings

Warm, flushed, or mottled

Diaphoretic

Respiratory findings

Acute hypercapnia in association with increase work of breathing

Tachypnea, dyspnea, or deep labored breaths

Accessory muscle use and nasal flaring (usually present)

With CNS or peripheral nervous system disease, respiratory distress may not be present

Decreased aeration, crackles, wheezes, or other signs of airway disease

Clubbing, a sign of chronic respiratory disease

Causes:

Extrathoracic airway lesions

Infections - Ludwig angina, laryngotracheobronchitis (croup)

Congenital lesions - Subglottic stenosis, laryngomalacia, craniofacial abnormalities

Thermal airway burns

Tonsillar and adenoidal hypertrophy

Intrathoracic airway obstruction - Asthma, vascular ring

Depression of central respiratory control

Drug induced - Opiates, sedatives, anesthetics, alcohol

Infection - Meningitis, encephalitis

Stroke

Hypoxic encephalopathy

Increased dead space - Wasted ventilation

Pulmonary embolism

Pulmonary vascular disease

Low cardiac output

Acute lung injury

Pneumonia

Pulmonary edema

Lung contusion

Bronchiolitis

Chronic lung disease

Bronchopulmonary dysplasia

Cystic fibrosis

Chronic bronchitis

Chronic obstructive pulmonary disease

Respiratory muscle weakness leading to hypoventilation

Poliomyelitis

Guillain-Barré syndrome

Myasthenia gravis

Muscular dystrophy

Spinal cord injury

Chest wall restriction

Flail chest

Pneumothorax

Pleural effusions

Kyphoscoliosis

Increased CO2 production

Malignant hyperthermia

Extensive burns

I hope this applies..... " Brown-Sequard syndrome"

Good science? Ehhh....who cares....

http://www.thatsweird.net/Pictures/eyeful.jpg

Hey Beach Bum, Welcome to the City!

I can't speak to all of your questions as I'm not law enforcement but perhaps I can help a little where the class is concerned.

Where are you on the Central Coast? I went through the EMS academy at Allen Hancock in Santa Maria.

The EMS course is pretty much advanced first aid. I had nothing going in except my 25 year old boy scout first aid. I found the 8 week course to be pretty challenging. We went 4hrs/day Tues, Thurs, Friday and all day on Sat. with a voluntary 4 hour lab on Weds.

Class was fun. We had many students that took the EMS course along with other classes or worked full time jobs at the same time, though many of those people did poorly for lack of study time.

I think it cost me about $800 or so for the class after books, boots, and uniforms.

I can't imagine that you would find anything but a benefit having your Basic cert going into law enforcement, but finding a job as a basic will be difficult to impossible. I interviewed twice with AMR for Santa Barbara county and I think...I don't remember for sure..there were about 15 applicants/position. They tend to interview on a regular basis but are rarely hiring. (They don't let you know until after the process that they have no jobs to fill)

I'm not sure if this helps, but If I can do anything for you don't hesitate to let me know!

Dwayne

Driven

Wow...this doesn't seem this difficult to me....

Dust, Rid, Ace, etc... seems to believe that we shouldn't STRIVE to create basic/basic squads when we know there will always be a need for ALS.

How does this not make sense?

I don't see where you find that they hates basics? I don't want a basic if I can be treated by a paramedic. If I'm at the hospital, I don't want to be treated by a paramedic if I can see the ER doc. If I need surgery I don't want to see the ER doc if I can see the surgeon.

Does this mean I hate basics, paramedics, and ER docs? That I only see value in surgeons? Nope...I don't think so.

CHOOSING to create BLS only systems seems more or less the same as choosing to create a hospital without ER docs and surgeons. I've heard that it happens, but is that the goal we want for our communities?

God bless volunteers. But to pretend that they provide the same service as 24/7 professional squads (in most cases) just doesn't seem to wash.

And I know the logic that volunteers enable communities to avoid paying professional ALS crews can't be lost on most of you...I read your post, I know you can make the leap.

I also hate the ALS v BLS threads, but mostly because they usually start with BLS screaming "FOUL" when an ALS provider points out the limitations of our BLS cert. It makes us look like boneheads when I know most of us can see the limitations ourselves.

I worked hard for my cert. I was in the top 2 of 35 in my class. But if I'm what you hope for as the standard of care in your community....well...I'm glad we're not neighbors....

When I have my MI, I want a paramedic, sitting in his ambulance, fresh out of his continuing education to come do his committed, ALS, best.

Disclaimer : Dust and others, I don't mean to speak for you. Feel free to correct me if I've misunderstood some of your points.

Dwayne

Wow...even as a basic the inaccuracies were distracting....

But put those aside for a sec...Haven't we seen the young, rebellious medic, doctor, student, fireman, cop ad nauseum ?

Was there an original thought in the entire episode?

Pretty poor acting, the storyline so predictable that I got impatient waiting for what I already know was going to happen next.

And the best I can tell (with the exception of the woman at the end) if you're a paramedic, just showing up will cure you...no patient contact seems necessary beyond "you're gonna be fine"

Pretty poor showing....maybe they need time to grow...

Dwayne

Ace, point taken. I assume from the way the question was written that he is a Basic. Perhaps I am mistaken. And as such was looking for an answer such as the one from kevkei:

Seldomly have I seen a systemic response to an ingested allergen. Usually it's angioedema.

Assess the tongue, uvula and their voice. Do they sound hoarse or muffled? Can they swallow, breathe through their mouth and nose? Can they stick their tongue out?

Decreased lung sounds is usually a late and ominous sign. If they complain of a sensation of their throat closing and you see evidence of such, believe them.

It seemed to go directly to what I believed to be his question.

I do know additional education is important to you and many of the other anchors on this board, so perhaps your approach was better suited to his growth in EMS, whether he wants it or not (I'm not implying that he doesn't).

I don't know enough about many things to know if he will learn from your posts or just be turned off of posting in the future?

Either way, I learned from the info...thanks

Dwayne

OK- I know this is basic and simple but just want some feedback.

We were dispatched for a "possible" allergic reaction to food.... we get on scene and pt stated her throat flet like it was closing.... Upon examination we found her ABC's to be fine- lungs clear, Alert & oriented x3 etc etc- seems to be in fine shape-

What is the best way to assess the airway upon this complaint? Should you visually look?- outside of ling sounds- how about putting a scope right on the midline throat area?? Just looking for quick ways to assess and decide how serious....In this case- she was totally fine and it appeared more anxiety related- but I was looking for some other ways to go about this type of assessment

Not going to get into a pee pee contest with you here ace, Because I know you will dedicate days to this silly issue.

I'm not the sharpest knife in the drawer. Could you please re post your quotes and highlight the parts that describe how to visually assess and auscultate the neck and throat as it relates to determining the severity of the effects of an allergic reaction on these areas?

I saw several bold areas that addressed a diagnosis and even some general symptoms but still did not answer his questions.

If you can find all this crap in your searches, how can you not find his questions in his post???

I didn't see it. (It may have been there, but if so, at a level beyond my understanding) And if I was SpongeDude I would not have read dozens of posts to answer a question unlikely to be asked in this specific manner.

Do a search for SpungeDude's posts, he doesn't ask a lot of redundant question....he doesn't need to be spanked and sent on a wild goose chase...

I truly do believe you are a smart person, I hope someday to be able to talk EMS at your level....why do you need to use your intellect to be a bully....I don't get it...

Dwayne

At what point did he ask about epinephrine or anaphylaxis? Once again I made the mistake of giving you the benefit of the doubt ace, and followed your links so I could read through a million completely irrelevant post looking for his answer....

If you have such a hard-on for searching...God bless you...but you waste more bandwidth with your pics than all the repeated posts together...

Get off his back, let the folks ask their questions...

By the way if you do a search for "ace-search function" you will find it's been covered ad nauseum...

Dwayne

What's that supposed to mean?

This is an example of Cotillion White and Omaha Orange, inside and outside. So I used a stock photo from a website. No need to be a smart ass.

Certainly better than this crap below.

Really Ugly ambulance, a sin

Bandaidpatrol, the images didn't show up....I'm not sure how it looks on your machine, but on ours it's only displaying a Tripod banner....

Dwayne

I was reading an article in this months Jems labeled "Underexposed: The neglected part of the physical exam"

(May-2006 pg.40-43, Mark Rock)

It seems to says that every patient should be stripped if you are to perform a proper assessment. This applies to medical and trauma, with no regard to apparent severity of the issues.

"We should approach a physical exam" (comprehensive physical exam, secondary survey, or detailed physical exam are the terms used throughout the article) "in the same way we do vital signs: something that is performed on each and every patient we make contact with, regardless of complaint or apparent condition."

Also:

"It's truly disheartening to watch paramedics start IV lines on patients wearing shirts. ... Delivering a patient in this manner indicates that the providers have not performed a proper physical exam"

It's hard to believe that this is the standard. When I went on my ride-alongs in the Basic Academy we didn't strip anyone completely....

I'm just wondering if there are providers that do actually strip everyone...? Or did I somehow fail to read between the lines and grasp the concept of this article...?

After reading the posts slamming Wankers who "just want to strip somebody!" I was a little surprised by this article...

I look forward to your replies...

Dwayne

This little boy was alone with the unconscious body of his mother for three hours!!

That is unforgivable....and it was TWO different dispatchers! (Though #2 did eventually send someone)

When I was younger, and found my dead grandmother, 911 told me to "call back when you get your shit together" and hung up.

Are these stories common? Are people calling for 911 help that never arrives?

Dwayne

We have a guy working for us that claimed during his EMT course he had adult attention defect disorder or something like that. All his test questions had to be read to him, he got longer time to do his test, and the NREMT test had to be read to him. Only thing is there was no official diagnosis of his disorder, but the community college apparently fell over itself to help him. This came after he failed his first couple of tests during the course. "Of course, it can't be you, or the fact you don't study. It has to be an illness." He failed the national, but I don't know how many times. Nice guy, but immature. Finally passed and now he's here and he's a 2/20 EMT (less than 2 years in/over 20 years experience). We never hear about the "diagnosis" anymore.[/font:ac24df9601]

Yeah, I don't get this. We had a girl like that in our class. She had to take all tests separately and untimed because there were too many distractions in the classroom.

(She came to many of our study groups...Braless...chatty....and to all outward appearances very sharp!)

(Yes Dust...she was hot)

Even while doing her NR skill, she was untimed and allowed to stop and come back if stress caused her to get confused.....

I have an autistic son, my world revolves around him....but I'm thinking he'd make a pretty poor EMSer....What happened to common sense?

Dwayne

Speed....I doubt you'll find anyone here to argue with you.

I also passed easily first time through. The sad part is that good people spent good money going to a school that didn't teach enough to pass.

Not their fault. It's so hard to verify the quality of a good school. It's pretty much a crap shoot going to the school in your area....

You can't know they didn't teach you until you get slapped by the NR.

Dust's advice (though not practical for all) is the best.

(Paraphrasing) "If at first you don't succeed, do yourself a favor and find a GOOD school"

Sorry if I'm speaking out of turn Dust.....

Dwayne

If the patient, in any way, requires skills that the BLS provider can not provide, the ALS provider is required (by the laws in my state) to assume the primary role in patient care. There are some lines that become a bit hazy, in certain situations...but if the ALS provider makes his/her credentials known, and gives any type of care to the patient, or assistance to the BLS provider, then that ALS tech is responsible for patient care until relieved by someone of higher training...this usually being the doctor at the ER. If the ALS tech doesn't accompany the patient during transport, after rendering ANY type of assistance..then its the ALS tech's arse if something goes wrong, and the patient requires ALS care en route to the ER.

Even if the patient doesn't have issues on the way to the hospital, wouldn't this be abandonment? Or in non-emergent situations, is this one of the lines you said sometimes gets blurred?

(It may seem like I'm being a smartass, but I truly don't know.... :oops: )

You are the joke...you know nothing about me. So don't even try... I've been a member here far longer than you. Take a poll....Mr. March 20. Your posts from day one have been about nothing but crappy outlooks on life and your profession because you are bitter. I'm sorry...but not my problem. You are very welcome here...but don't even try to pull that crap with me. Done...end of discussion....your juvenile comments don't upset me. I'm far beyond that. As far as a blog....Einstein...they are made to express your personal feelings...whether they make sense to you or not...as I said before... you don't know me. Serious discussions and professional conversations are for forums. If you don't like my personal and private thoughts...don't read them in my blog... As for your post...maybe so many people wouldn't be getting upset if you hadn't made such an idiotic statement...deal with it.

ps...I'd rather you just never talk to me anymore. Your mindless crap and personal insults are not my style...I have no desire to carry on further with you. Have a nice life... And btw...there's NO ONE on this board that I don't get along with or that thinks I'm mean or difficult in the slightest....just you....therefore...refer back to my first sentence. :roll:

Adios Mr. Difficult person...no time for you :cya:

:love5: =D> He'll figure out we love you best 8 .....

How to know you are a husband and a father?

You recognize every issue in rat's post!

Dwayne

What I find surprising is that after this patient had died, you would think they would have documented the bejeebers out of it to CYA, wouldn't you? I know it's not for me to say....but it seems like this case had a high probability to be scrutinized.

Dwayne

Oh my God....that is too perfect!!!

It's not censorship if it's privately owned Bonehead....

Dwayne

EDIT: ooops....The post this relates to has been removed.... :oops:

I had sex with a Baseball Bat because Im sexy...and I do what I want..... :shock:

WOWwwwwwwwwwwwwwwwwwww...... :roll:

8

Wow.....That image just broke my heart I have to tell you.....(do you have the video?) :twisted: