DwayneEMTP

I am Kat...I didn't recognize it until you said that... :-) I saw a blanket once that seemed to be heated from a vahicles exhaust..I can't remember where. But otherwise, what Kat said...

Good on you Kn.ght1...It's really good to have you. And something about that avatar friggin' rocks!

Maybe, but one side would demand to sing it in C minor, the other in D and it would turn into a brawl... :-)

I thought that you were going to be out of town Scuba!! When I wanted to meet up you were going to be visiting your mom or something, but when Chris comes, suddenly you're home? Ahhhh....I see how you are... :-) What an amazing visit. Chris and his wife stayed for two nights, Eydawn came down for an evening... You know what's amazing, is to meet a friend that I've had here for 7 years (Chris, I've known Wendy for a long time) and find out that he is exactly what I'd hoped, and what he'd seemed, online, to be. And to find out that his wife is beautiful, charming, and great company too?...it was unthinkable. Chris, you and your girl are welcome here any time. And the more often, then better. We would have loved to have had you Scuba...but I truly thought that you'd told me that you were going to be out of town. And CSboulder, no offense by not inviting you, but I don't know you very well yet and I worried about having to many people unfamiliar with each other together all at once, know what I mean? Each time I meet someone from the City it reminds me that we all really need to make a larger effort to make these meet and greets happen more often. The City truly is full of the most incredible people that I've ever met... Love you Chris, Wendy, Cheryl....I can't wait until next time...

If nothing is learned, or practiced here other than debating in a civilized, respectful way, then the thread has paid it's own way in triplicate...

(Title edited by me for clarity)

I'm still trying to figure out why, when you announcing that you're pregnant, you chose to post a picture of a dinosaur eye?

From the description I'm guessing a seizure disorder. I'm unaware of any other conditions that require one to by medication/symptom free for so long.. If I'm correct, I'm unaware of any place that would hire such a person. I'm sorry for the time spent that may not be able to be used, but unfortunately that's one of the things that really needs to be checked before choosing a path. Not completely their fault, as most people seem to believe that anyone can do EMS.

Though I know you have significant experience with special needs, I'm going to bet dollars to donuts that the combativeness was caused by the caregivers and the transport crew more so than the patient. There are a lot of specifics not in the scenario, so I'm going to make assumptions just for the sake of argument. (Not criticizing, but explaining why I would make nonsense assumptions). My first comment is that I wouldn't have moved this patient from a familiar environment until he was fully alert and calm. It sounds to me like he woke up in restraints in a strange place...You can bet that I'm going to kick your ass too and get back to where I feel safe. This takes time, and that might piss some folks off, but screw 'em. That's how to care for such a patient, and that's our job. Also, don't you have a medication protocol for combative patients? IM/IN? If not, that should be discussed. For obvious reasons I'd talked to my medical director years ago about creating an autistic protocol. He said, "You have a protocol for combative patients, right? If you can reasonably predict violent behavior, use it. Why would you choose to wait until someone gets punched in the mouth to mitigate the violence?" Also with medications, the mental and emotional damage that can be done to these patients, in Dylan's case it would last at least years if not be perminent, is massive. Allowing that damage to happen is not patient advocacy, right? I've also never been around a patient that was able to reason, even at a minimal level, that was unable to communicate. Normal means weren't missing in this patient, only verbal means. We communicate in other ways all the time. Facial expressions, eye movement, non language sounds....it sounds like he was communicating just fine. "I'm terrified and need to get out of here!" It's just that no one was listening and treating him accordingly. You should be able to communicate non verbally to him as well. I recently treated my first mentally handicapped patient in PNG. Just on accident. I'm not sure what flavor his pathology was....Very spastic movements, fisted hands flying in violent, apparently aggressive ways, angry, non language sounds. He actually came under my care just on accident. He had one eye swollen shut from someone punching him in the face from this behavior. When I stopped at a local market he came walking quickly towards me. It appeared from his sounds and body movements that he wanted to attack me, but when I looked in his face it was pure agony. He seemed to understand that his behavior was chasing off everyone that he was seeking help from, was trying with all of his might to control it, but was unable to do so. I didn't really know what to do, and when he got near me, a villager thinking that he was going to attack me punched him again and knocked him down, and that got other people riled up...his face seemed to say that he needed help so when he got up I lunged inside of his flailing fists and just hung onto him. Once his body had something to hang onto he clung on for dear life, buried his head in my neck/shoulder, and just sobbed/screamed for a while. We stayed that way for, maybe, 5 minutes...(Not sure really, but it seemed like a while.) After he calmed down I sat him down and someone from his village ran up and was able to translate for him that he had bad severe head pain from previous beatings. I set him up with Panadol (Tylenol), Ice packs, and some codeine for night time use, hydration instructions, etc, all given to his care provider who I had at least minimal confidence could follow instructions. (Taking him somewhere for further acute care, or other long term care is not possible for this patient in this environment) Fortunately for him, having made friends with the "white doctor" (Yeah, I know, their language, not mine) gave him an improved status and will hopefully improve his life, along with the example of his being damaged, and not mean. Anyway, the point being that it's difficult to get further away from traditional language than being with a mentally/neurologically damaged person that doesn't even share a culture, but it's absolutely possible...it just takes time, and an honest desire to help as opposed to completing a run. Know what I mean? Excellent question.

Intuitively I can't imagine a benefit to hypothermia in trauma patients, though can imagine deficits. I've also not seen or heard anything about this being beneficial. I'm thinking that your buddy heard a rumor, or heard of the possible benefits for cardiac and stroke patients and got them confused....

Mikey, why is it that when people find that they are no longer interested in a conversation that "We'd better shut it down" makes sense? If you're no longer interested, then visit some of the other threads on the City...People will lose interest and the thread will die, or it will become inappropriate and be locked, but suggesting that it should be "shut down" simply because you've lost interest...that just gets on my nerves. And the gun control debate goes to the very center of the spirit of being American. Perhaps it will never be resolved, but in the meantime both sides of the issue are talking, they're investigating the constitution, learning the way that those from different countries think about this and other things... Solving the problem isn't the only value to be had from discussing the unsolveable.

I'll give you a call on Mon/Tues...

It's horrible to see your child like that... Sending her happy thoughts for healing and good attitude...

Heh...it's early yet, so I'm guessing that you're still smokin' hot...so it should be funny! In a few months...Maybe not so much.. :-)

Heh...I refuse to reveal my definition of hand puppet... But no worries, no theateres anywhere near me in PNG, and when home I only see Disney movies...who could burn down a theater playing a Disney movie?

I didin't in my medic class, but in my Basic we had drills, PT, daily uniform inspections etc... I don't think that it's common here, but I too think that it's a great idea...

I know that YOU told me, I just didn't know that you and YOU were the same person!! I'm truly excited for you Girl. We should get together for cofffee before you get all fat and waddley....

Welcome!!

Doing skills isn't the only thing that students need to learn while in your care. I too would never trust vitals on a critical patient taken by a student, or a newer medic, or Fire, or anyone but me or a trusted partner that I had experience with. There's no shame there. At least if we're both using 'critical' to mean in imminent danger of losing their life. I once ran on a home invader that had his right arm nearly severed by a shotgun. I let a student start IVs, pack the wound, push narcs, etc. Other than his dangling arm and being really pissed off for being shot "for no reason" (as he had a knife, not a gun) I was confident that he wasn't trying to die. And for the record his condition led to my decisions, not a desire for inferior care secondary to the cause of his injury. With skills, there should be about a bazillion to one ratio of critical patients to non critical patients that they can practice on. Set them to doing something menial on the critical patients, printing out ECG to examine, bagging, holding pressure, prepping equipment if you want..Something that allows them to participate, but still have some mental energy to expend on observation. But allowing them to see a more experienced way to do things while showing that at all times patient priorities overcome any desires of the medic or the student are pretty friggin' valuable things to learn too...They don't stop learning simply because they stopped moving. We set an example, either good or bad, every minute that we are together with them... If you're apologizing for prioritizing efficient, focused care on a critical patient instead of the student's education then you're cheating them out of perhaps one of the most important lessons to be learned in the back of an ambulance.

Of course I'm not a lawyer, but I see no legal issues with searching if you're doing it for personal safety. We're not, or at least shouldn't be gathering "evidence" just checking to make sure that we'll be safe. I've searched every patient that's been even slightly hinky without permission. Most never question it, and if they do I explain why I chose to do so. None of my unaltered patients have ever been offended, and those that were were normally confusing me with something in their delusion or halucination. The bag, if going to be allowed within their reach while in my care is an extension of them, in my opinion, and I'm going to take a peek. I, again, have never had an issue with this, but my experience in the States is pretty shallow...

Congrats Babe... Yeah, I had no idea who you were! I thought, "Man, that's strange, I think I've seen about three posts from this chick and she's telling us about her baby?" :-) Babies are way owesome...I promise that one of the first things you'll learn from your little one is that no matter how hard you've tried to avoid it, you've forgotten how to find miracles in tiny things...It's really cool to relearn. And don't mind Kat. Any time he gets hinky his day care nurse cleans his ass with sandpaper...it makes him a bit crotchity...

It's just more political games... I saw something on Facebook, a picture that basically said, "Shoot a bunch of kids, blame the gun. Bomb people at the Boston Marathon, blame the bomber." Guns are just in the news. I guarantee you that if instead of shooting if I walk into a theater with a pail of gasoline and a lighter and burn a bunch of people to death, make the national news, that the next several mass killings will be done with fire instead. Craziness...

Yeah, me either MG, though isn't there a possible connection between bacterial infections spreading from jaws and gums to the heart? Man, working out here I tend to get really far out of the loop... Thanks Doc. AC, I didn't think to ask beyond relatively recent trauma at that site, and the doc was pretty confident with his diagnosis quickly so I doubt that he asked, though he was speaking pigin. I can keep up really well, but only with the broad strokes. So, short answer, unsure.

Man Mobes, not only childish humor but the need for instant gratification...I like it... Here they call it reactive arthritis, doc also correctly identified it in private as Reiter's Syndrome, though I had to Google that to be sure. WebMD also showed it with several other 'common' names, though I forgot to copy them and it takes about a half hour to reload the page to go back for them so...yeah, gonna have to do it yourself it you're interested. It begins with some type of bacterial infection, either GI or sexually transmitted. 3-5 days after resolution of GI issues, not sure if it's the same with the STDs, one joint will painfully swell. Other than the swollen joint the patients seem to report feeling unusually well, though it's possible that that is secondary to their perspective having just spent several days feeling unusually shitty. I've only followed the one patient, the rest of this information comes from the PNG National physician. But now, can someone explain the transmission of the infection from the Gut/STI area to a single joint in the body? How does it get there? Why only one joint? Why that particular joint over another? Etc? I thought the conversation would be educational, but if that's too much to ask, and I truly get it if it is, then I'll research it a bit at home... Thanks all for playing!

Good points Chris...and the only thing I really considered in this patient was gout or minor, undisclosed sprain... When I have better access I'm interested to try and understand it better..I don't understand the system relationships at all right now...But you guys can probably explain it better after we all get on the same page. I won't let this run long...