mediccjh

Combative, agitated, odor of ETOH after hitting her head. Strong MOI.

These factors make me question her competency. Was she alert and oriented? Or did she get angry and sign?

This still sounds shady.

PRPG

Exactly.

Obviously, this patient is UNSTABLE.

Atropine first, and while you have the line, if the Atropine doesn't work, go for pacing. If you have Etomidate, use it. You do not get the hypotensive effects that one would with Versed or Valium. I would get on the horn w/ the doc for guidance, since the tightrope is starting to quiver.

What good is it if it doesn't carry oxygen?

I'll stick to my PolyHeme, thank you.

I'm sticking with Rid on this one. And I know what Asys' protocols are too.

Give the Lido. With transport time, and the assumption that the medic knows basic math, the dose would not be enough to worry about toxicity. Along with the lower threshold, that's an increased of chance of the next V-Fib conversion going into Asystole.

Treat the patient, not the monitor.

Dilated pupils are a part of going into shock. Remember boys and girls, the B/P goes UP before it BOTTOMS out in shock. That would explain the tachycardia, along with the agitation and the feared FEELING OF IMPENDING DOOM (for the unintelligent, that would be the part about him talking about death).

He is on the compensated/decompensated fence. He hit with enough force to take the windshield out, so it wouldn't be a surprise if he sprung a leak on the inside.

I think this is why we are starting to see an increase in agencies bypassing the ER and going straight to the cath lab. Completely eliminates the "slow" factor. Several hospitals in Houston are doing this and the time to revascularization is remarkable.........

University Hospital in Newark is going to be starting this. During the day, the 12-Lead is beamed to the Cardiac Cath team AND the doc in the ER, and they make the determination whether or not the pt is going to the ER, or straight up to the cath lab. Unfortunately, being that I work at night, all my patients are going to the ER.

Lehigh Valley Hospital in Allentown trusts our 12-Leads for the most part. We don't have telemetry capabilities, but as long as we tell the doc our findings, they will usually call the MI alert based on our recommendation. It has saved some of my patients.

1.) I am responsible. and I do my best to learn and further myself and take this with the utmost seriousness, I do the best I can for every patient.

In EMT and EMT-P class, one is merely taught the foundation, fundamentals, and building blocks of paramedicine, and EMS as a whole. It is up to the individual provider to better themselves, to make them a smarter and better provider. It is also one's own responsibility to learn how to think outside of the box.

A monkey can be a paramedic. It can be taught when to give a certain drug and when to do a certain procedure. It can also be taught protocols. However, the monkey does not know why to give the drug or do the procedure, and does not know what to do when a situation from "outside the box" occurs.

EMS is not cookbook medicine. It is dynamic, ever evolving and changing. To be a good provider, one must be able to change also. And most importantly, learn every day.

Report: Prehospital RSI for Head Trauma Safe

2006 JUL 10 - (NewsRx.com) -- Prehospital rapid sequence intubation (RSI) for trauma patients can be safely and effectively performed with low rates of complication and without significant delay in transport when a select experienced staff are properly trained.

According to a recent study from the United States, "Recent reports have questioned the safety and efficacy of prehospital RSI for patients with head trauma. The purpose of this study is to determine the rate of successful prehospital RSI, associated complications, and delays in transport of critically injured trauma patients treated by a select, well-trained group of paramedics with frequent exposure to this procedure and a rigorous quality control system. A helicopter paramedic group's database of patient flight records (1999 to 2003) was merged with registry data of a suburban Level I trauma center."

S.M. Fakhry and colleagues, Inova Fairfax Hospital, wrote, "Both databases included comprehensive performance improvement data. After Institutional Review Board approval, data were analyzed to determine RSI success rate, impact on oxygenation, delays in transport and complications associated with attempted RSI. Attempted RSI was defined as any insertion of the laryngoscope into the oropharynx. In all, 1,117 trauma patients were transported. One hundred and seventy-five had attempted RSI (74% male, mean age 31.1±19.2 years, 91% blunt trauma, 88% with Head/Neck AISgreater than or equal to2, mean Injury Severity Score 25.6, mean scene Glasgow Coma Scale score 4.8±2.4)."

They continued, "One hundred and sixty-nine patients (96.6%) had successful scene RSI. Seventy percent were intubated on the first attempt, 89% by the second attempt, and 96% by the third attempt. Of the six patients (3.4% overall) who failed RSI, (2.3% overall) had scene cricothyroidotomy and two (1.1% overall) were managed by bag-valve mask.

"Complications included five (2.9%) right mainstem intubations and 2 (1.2%) endotracheal tube dislodgments en route. There were no esophageal intubations. Four patients in extremis (2.3%) had arterial desaturations associated with RSL arterial blood gas analyzed upon arrival revealed (mean pCO2 36.6±8, median 37). Attempted RSI was associated with a mean of 6 minutes of added scene time. Prehospital RSI for trauma patients can be safely and effectively performed with low rates of complication and without significant delay in transport."

The researchers concluded, "This study suggests that resources for prehospital airway management should be focused on training, regular experience, and close monitoring of a limited group of providers, thereby maximizing their exposure and experience with this procedure. This is particularly important given the high rates of traumatic brain injury encountered."

Fakhry and colleagues published their study in the Journal of Trauma - Injury Infection and Critical Care (Prehospital rapid sequence intubation for head trauma: Conditions for a successful program. J TRAUMA, 2006;60(5):997-1001).

For additional information, contact S.M. Fakhry, Inova Fairfax Hospital, Trauma Service, Inova Regional Trauma Center, 3300 Gallos Rd., Falls Church, VA, USA.

Publisher contact information for the Journal of Trauma - Injury Infection and Critical Care is: Lippincott Williams & Wilkins, 530 Walnut St., Philadelphia, PA 19106-3621, USA.

OK boys and girls, have at it.

Good morning, ladies and gentlemen, and welcome to today's episode of "What's wrong with this picture?" I'm your host, the World Infamous Herbie of Medic 9 Fame.

Today's contestant comes from New York City. Our contestant(s) have a glorious history of being the heroes of everything, and never doing anything wrong, as well as letting tradition impede progress. Ladies and gentlemen, join me in giving a round of applause to the FIRE DEPARTMENT OF NEW YORK!

<applause>

OK, here's the picture:

If you can't see, here's a link to the picture:

http://img.photobucket.com/albums/v204/med...DumbassFDNY.jpg

OK ladies and gentlemen, let's play, WHAT'S WRONG WITH THIS PICTURE?

One really cannot criticize the extrication unless we have pictures of the crash.

That being said, if they did screw up and caused his death by delaying care, and he not having immediate life-threatening injuries, then they all need to go.

There is a good article in July's Emergency Medical Services Magazine about assessments. Start there. Then, look in the March 2005 issue of JEMS. There is an article entitled "25 Assessment Pearls." I strongly recommend that one too.

From The Cleveland Clinic:

What is Munchausen syndrome?

Munchausen syndrome is a type of factitious disorder, or mental illness, in which a person repeatedly acts as if he or she has a physical or mental disorder when, in truth, they have caused the symptoms. People with factitious disorders act this way because of an inner need to be seen as ill or injured, not to achieve a concrete benefit, such as financial gain. They are even willing to undergo painful or risky tests and operations in order to get the sympathy and special attention given to people who are truly ill. Munchausen syndrome is a mental illness associated with severe emotional difficulties.

Munchausen syndrome—named for Baron von Munchausen, an 18th century German officer who was known for embellishing the stories of his life and experiences—is the most severe type of factitious disorder. Most symptoms in people with Munchausen syndrome are related to physical illness—symptoms such as chest pain, stomach problems, or fever—rather than those of a mental disorder.

Note: Although Munchausen syndrome most properly refers to a factitious disorder with primarily physical symptoms, the term is sometimes used to refer to factitious disorders in general. In this article, Munchausen syndrome refers to factitious disorder with physical symptoms.

What are the symptoms of Munchausen syndrome?

People with this syndrome deliberately produce or exaggerate symptoms in several ways. They might lie about or fake symptoms, hurt themselves to bring on symptoms, or alter diagnostic tests (such as contaminating a urine sample). Possible warning signs of Munchausen syndrome include the following:

Dramatic but inconsistent medical history

Unclear symptoms that are not controllable and that become more severe or change once treatment has begun

Predictable relapses following improvement in the condition

Extensive knowledge of hospitals and/or medical terminology, as well the textbook descriptions of illnesses

Presence of multiple surgical scars

Appearance of new or additional symptoms following negative test results

Presence of symptoms only when the patient is alone or not being observed

Willingness or eagerness to have medical tests, operations, or other procedures

History of seeking treatment at numerous hospitals, clinics, and doctors offices, possibly even in different cities

Reluctance by the patient to allow health care professionals to meet with or talk to family, friends, or prior health care providers

Problems with identity and self-esteem

What are LeForte fractures?

Got a camera phone... click it.. & call the City Manager/Mayor. This is not rocket science folks..it is an illegal substance at the work place, beer, Vodka, weapons, drugs it is all the same.

If they gave me sh*t about it, I call the chief @ home, if need be. If need be they get in line for a pee test as well. He definitely does not want the press to get involved... you can kiss their careers good by for being stupid... in my opinion good riddance, we don't need any more idiot's .. and if your that stupid to bring alcohol to work place, then so be it.... then your obviously have no common sense to deal with someone life.

R/r 911

Come on Rid, you know better.

Alcohol does not show up in the whiz quiz. Inflict pain and draw blood instead, on the whole crew.

Or ensuring a means for you and your parteners quick egress as needed...

That's why you always prop the stairchair in the door.

No matter what you do, never, never, NEVER! go into the house without your airway bag and oxygen.

A toothache.

On Christmas Day.

For the past 3 days.

I love da Brick.

Welcome to the club.

4) Down here, if you are a Firefighter, you are automatically expected to help, as most, if not all Firefighters are EMTs or higher. Its not a "I run into burning buildings, and you dont, you are a sissy" thing. I never wanted to be a Firefighter until I moved here, and then I relized that they do more. So just cause you aint a FF, doesnt mean I hate you!! 8)

Don't worry, I was being my typical ballbuster self. I hate everyone equally.

What does it matter that you are a firefighter? Was the patient on fire?

http://www.state.nj.us/health/ems/documents/njac840r.pdf

http://www.state.nj.us/health/ems/documents/njac840ar.pdf

There are your answers.

Don't be a wacker. No one here likes hoopie wackers, even though most of us used to be one.

I used Glucagon on a pediatric beta blocker OD once w/ wonderful effects.

Oh, and Whit, I'll take the 23 y/o PRPG as a partner anytime before the older you.

And I'm only 25, and work in the biggest and busiest EMS systems in the nation.

Ok, Ive heard this before. Several times.

It annoys me. But...im curious if anyone else has heard this?

Is there a difference? Between full, and the apparent partial cardiac arrest?

Lesson to all.

Theres NO such thing as FULL cardiac arrest.

(/rant)

So does that mean we get to fire anyone who uses that term?

I believe in the power of chemical sedation.

Ahhh...come on now..It's all the same really. They're all like right up the street from each other, No big difference...errr..deal...eerrr..matter..Right!??!?! :wink: :wink: :shock: 8) I mean, garbage washes up on all of your beaches just the same as I recall.. hahahaha,,,.... :wink: :!: 8)

You tha man cchjh.

Ace

The only good things to come out of Boston:

The band Boston.

The band Aerosmith.

Dropkick Murphys.

Clam ChowDAH.

Fenway Park (I've been there, great place).

And Jersey is full of wanna-be New Yorkers in the north, and wanna-be Philly people in the south.

And it's cjh.

Ohhh....Boy, You PA-NJ guys really like to stir the 'shtuff' don't ya?!?!? 8) :wink:

Why don't ya big Poppy This.....................

LOL

out here,

ACE844

How dare you insult me. I'm not from Jersey, I'm from Brooklyn NYC. I merely work in Jersey.

Hey, someone had to break the ice.