Eydawn

Oh boy... that was not a good move. Even if she is a possible frequent flier (notice how she knew his name?) you must maintain your professionality. Joke about it with your buddies AFTER you hang up the phone.

Goodness! Hello, rocket scientist!

Wendy

CO EMT-B

MI EMT-B

Speaking as an asthmatic w/o VCD, it is definitely possible to experience inspiratory and expiratory wheezing that can be both audible with or without ascultation. I usually do. My typical attack pattern is onset of SOB, feeling "tightness" in my chest, coughing with increased mucus production, starting to feel dizzy, audible expiratory wheezing (and the rest I've been told by those treating me), progression to (ascultated) inspiratory and expiratory wheezing, diminishment in the bases, cessation of coughing or progress to a dry, nonproductive cough. Following use of the albuterol, slowly decreasing audibility in expiratory wheezes, opening lower bases, only wheezing in the uppers, and finally resolution. So you see.. folks can hear me wheezing inspiratory and expiratory (usually across the room) and the wheezing and diminishment travel around in my chest during the course of an attack.

Now, as to your poor friend...

If albuterol makes her feel that sick there are other fast acting bronchodilatory rescue inhalers that her doc could prescribe for her.

If she's baseline wheezing for 90% of the day her asthma is nowhere near under control. She shouldn't have to live with such a diminished capacity and quality of life (and trust me, it wears on you makes damn near anything you want to do impossible). Let's figure out what she's doing that ISN'T working so she can present a nice picture to her doctor (or to a new doctor, which it sounds like she may need) and get this under control so she doesn't HAVE to take the albuterol to function. Living on albuterol is really not fun, and yes, you will just give up and quit taking it after a while if you get frustrated enough. Been there.

What controller is she taking? Is it a corticosteroid (Flovent, Q-VAR) or just a long acting broncodilator (Serevent)? Is she taking a combo thereof? How many times per day does she take it at what dose, and is that the dose level she started at? Is she using a metered dose inhaler? Does she use it with a spacer (Aerochamber, Aeroflo)? If she's taking a dry powder disk inhaler, has she been instructed in its proper use? They're tricky (Advair, for example). Is she taking any oral steroids (prednisone)? Is she on any other medications (for example, if she's taking atenolol, which is a beta blocker, it will interfere with the beta agonist effects of albuterol); how about any antihistamines?

How long has she had asthma? When was it diagnosed, and how? Is it allergy or exertion related or both? Does she have any other allergies? What are her specific allergic triggers or does she know? Does she wake up in the middle of the night with symptoms? Apart from the baseline SOB and wheezing experienced throughout the day, does she experience concrete "attacks"? How many times per day? How long do they last? Has she ever had an ED visit due to asthma? Has she ever lost consciousness due to her asthma symptoms?

Any other health problems? Any throat surgeries, etc? History of intubation- ever?

What is her environment like? Dry, humid, hot, cold, central heating, radiant heat, A/C, etc.? How long has she lived there? Apartment or house? What's her work environment (if she is able to work) like? (Same questions for work environ). Where is she from originally? Is this her native state/city? Family hx of asthma/allergies? Does she own pets? Smoke/live with someone who smokes? Does she have a specific location where her symptoms get worse or better? Specific time of day where she feels worse or better? Does she have improvement or worsening, in general, with rainstorms? (think humidity and pressure and temperature change on that last one- how do they affect her?) Does she use body sprays/perfumes/highly scented candles, soaps, shampoos, laundry detergents? Is she a wine drinker? (sulfites in wine will aggravate asthma). Does she like cinnamon candy? The artificial color and flavor in some cinnamon candies will cause attacks/sensitivity in some asthmatics.

That'll do you for starters; I'd suggest printing it out, going over it with her, writing down the answers, and then you can choose to update us or not. In any case, take the answers to the next doc appointment. Do it soon- I hate going to the doc, but I like breathing more, and it's relatively easy to fix once you figure out a lot of this stuff and get the right medications/environment changes going.

Good luck to both you and her!

Wendy

CO EMT-B

MI EMT-B

Those commercials are very eerie but they convey the message very well. You'd think with all the other stuff we show on television we could be smart enough to use graphic depictions where it will do more good than harm. Crazy!

Wendy

NREMT-B

CO EMT-B

MI EMT-B

PETA pisses me off. 'nuff said on that matter.

Wendy

NREMT-B

CO EMT-B

MI EMT-B

Rear of belt: Nylon holster with:

Red handled shears

2 pens (whatever I can grab)

1 penlight

2pr gloves

Left cargo pocket:

Personal albuterol inhaler

1 pair gloves

Sometimes my cheapo sprague style singe tube nurse's steth (blue, if anyone cares)

Right cargo pocket:

Cell phone, wallet

Field guide if I'm feeling like I'm going to need it/be really bored posting

Rear right pocket:

Small memo pad

Gotta say, my holster is one of the handiest things ever. Put my radio on my back too, I got really agile and adept at reaching behind myself this summer.

Wendy

NREMT-B

CO EMT-B

MI EMT-B

To follow along with the late entry... if she's not currently menstruating, LMP please! What is her normal diet? Salt heavy? Nitrate heavy?

Strange question... does the house have a gas stove by any chance? And what is the proximity of the kitchen to the bedroom?

How does she do out in the fresh air on the way to the ambulance?

Any change in vitals since we began assessing her?

That'll do for now

Wendy

NREMT-B

CO EMT-B

MI EMT-B

I second that... try to get a jacket (dark blue, black) that fits you- no matter where you have to go to get it, i.e. Columbia, Target, Wal-Mart, etc and have a screen-printing or embroidering company put the same logo that goes on your company stuff on it for you. If they balk, ask them to call your employer to verify that this is a kosher order.

Good luck!!

Wendy

Looks like you have damn near everything you need out there.. of course, the one thing you need won't be in the bag when you need it. Echoing the others, keep your head down and try not to get shot, ok?!

Good to hear from ya, Dust!

Wendy

NREMT-B

CO EMT-B

MI EMT-B

There are scenes where you know it occurs but it's not explicitly shown.. I think that's the only difference, I guess. I should have just said "rape scenes" or something- you are right. I have a huge problem with visual depiction of stuff like that (really descriptive books, movies, etc) so that's what came to mind.

Wendy

NREMT-B

CO EMT-B

MI EMT-B

The question itself is enough to stir thoughts and memories regardless of if you choose to post them or not.

Shane

NREMT-P

But that is something that could happen every day, in any location depending on the nature of the memory and the stimulus recieved. For example... walking past an open door in my dormitory, seeing a young man sitting there in the same position at the same desk that another young man once sat at, before he decided to end his own life in that room 2 years ago.

Or having someone bring up that their last name is XXXX making me think of that young fellow's last name. Or someone asking me what the lamp post that is never turned off alongside the path means.

You can never tell what's going to prompt a recollection of something that had a profound emotional impact on you. I think it is a wise decision to try to find out what many of us actually face as a routine part of our careers before investing the money in EMT or Paramedic school, beginning a career, and then finding out during the first (or the second) gruesome/difficult call that you really can't do it after all... it saves the trouble of instruction and perhaps safeguards us from another situation- where someone loses it because they can't handle it. Now granted, being aware of it and actually facing it are two different things, but just knowing might be enough information for some.

And if it prompted recollections for you and was hard, perhaps you didn't read through the rest of the posts? I purposefully shut my eyes in movie theatres when something that I feel might mess me up is about to be shown (graphic rape scenes, for example) and wait fo things to move along... perhaps a measure of "knowing thyself" and censoring your forum reading intake might help. Just an idea.. maybe it doesn't work like that for some people.

That's my .02

Wendy

NREMT-B

CO EMT-B

MI EMT-B

Ask any RN, PA or Paramedic if they felt like they knew what they were doing in school. Betcha at least 8/10 say no way, I thought I was an idiot. Cheer up! It will get easier and better, or you will figure out that maybe this isn't what you wanted after all (and there is absolutely no shame in that).

Let us know when you start hitting the hard classes (O-chem and physiology come to mind...) and we'll do what we can to help ya out!

Good luck, keep us updated!

Wendy

NREMT-B

CO EMT-B

MI EMT-B

Don't know, because none of the medical staff accompanied this individual to the ED. The nurse sent one of the over 21 staff as a driver and that was it. I think b/c the patient was oriented X4 and could answer appropriately, if delayed, then her consent to go POV with our POV release form removed liability from the camp. However, this form is very similar to an AMA... but that was the advice given "let's get her out POV, find a driver". Dunno what the lawyers would have done with that one!

Wendy

NREMT-B

CO EMT-B

MI EMT-B

No, no IV started at camp... the nurse (terrible nurse) decided to send her out POV... I wanted to send her BLS, but nope, I lose... since the nurse is my boss... fortunately she didn't go downhill and made it in to the ED ok.

Wendy

NREMT-B

CO EMT-B

MI EMT-B

Ibuprofen emerges as another med.. how about that! Ok, IV initiated, patient is pretty cooperative, just really spacy. Resps, vitals, all still the same. Pt. was treated with normal saline in the ED, don't know what else they did with her. Came back that night really pissed off and got in my face because somehow everyone knew what happened... (Don't look at me, look at her coworkers... I don't break HIPPA).

Would you consider advising anyone to transport this patient POV, by any chance? (That's what the camp nurse decided to do- sent her out in a car with the nearest hospital 45 minutes + away).

Pretty simple scenario..

Wendy

NREMT-B

Pt. states that she has not had much water intake, and yes it is warm outside. Bonus... she hasn't been taking it regularly... and there is tenting!

Lithium toxicity is your answer... however... she insists that she's only taken one pill.

Her coworkers said "She took SOME pills".... and she has been really angry and then really sleepy alternately lately. Now what?

Wendy

GROAN! :roll: Horrible! lol

Kind of like what did the beaver say when he fell into the rapids? Dam, not again

Wendy

NREMT-B

BP is gonna be 100/58, resps 22 unlabored, pulse is 90 and strong. No signs/symptoms of drug abuse.

Pt is slightly diaphoretic, but it is a warm day out. Skin is pink and warm.

Patient is oriented, but has a 15-25 second delay in answering questions and is, for lack of a better word, a "space cadet".

Keep lookin'....

Wendy

Last oral intake 1 hour ago; no hx diabetes/hypoglycemia. Sugar is within normal limits.

She has a history of cyclothymia and has a 'scrip for lithium carbonate.

No history of any behavior/symptoms like this before. Pt. complains that she's dizzy and that she feels "toxic".

Pt's coworkers state that she has been really really moody and irritable lately, and they saw her take "some pills" when she got to the range.

Next set of questions?

Here's your scenario... 18 y/o F instructor at a camp archery range, is acting "funny" and "not right". Initial observation wants to scream intoxicated at you- slowed/slurred speech, unbalanced motion, general "out of it daze".

What more do you want to know?

Wendy

NREMT-B

CO EMT-B

MI EMT-B

Colorado (as far as I recall) is permit at 15, license at 16, but you cannot drive anyone under 18 unless they're a sibling or it's a valid emergency. Once you reach 18, then you can drive whoever you want around.

I wouldn't know... I didn't get my license until just before my 19th birthday- Didn't get my learner's until I was 17 and a half. Dad was a smart man.

Wendy

NREMT-B

CO EMT-B

MI EMT-B

Bits of it are quite true. We're discussing the nature of intelligence in my psych class so I sent it to my prof. I'll let ya know what he thinks of it, lol!

We all know that there are a plethora of stupid individuals... after all.. I look at them every day and go "job security!!"

Wendy

NREMT-B

CO EMT-B; MI EMT-B

Scara... didn't you have any kind of covering suit or protective clothing? If you didn't, did the plant employees? Lol... hazmat is not your friend, bro! Sounds like it was a cluster and no mistake, ha! What a story though! You get burned?

Weirdest call I've had to date... has got to be the construction worker who got hit by the forklift. Fella's lucky that it didn't skewer him... got him subscapular, knocked him down really hard. Best part: he didn't completely fit on the backboard, too tall, so his feet stuck off the end of it. He was AAOX4, no problems other than some bruising and tenderness. I still can't fathom how that thing didn't completely penetrate his back, however. It hit at just the right height and just the right direction to. Someone was lucky.

Funnier call: 3am psych transport from the local ED to a local psych unit at another hospital. Seems the patient's fiancee had broken things off with him earlier that afternoon, so he pointed a shotgun at himself to scare her a little bit. Unfortunately, she called the sheriff and the guy ended up in the EMS system... the whole time, he just had this hangdog look like his day couldn't get any worse, and he glared at me every time I had to take vitals (3x sets, lucky us!)... I wanted to laugh because come on, dumbass... if you don't want to go to the hospital, DON'T POINT SHOTGUNS AT YOURSELF.... durrh! Betting he won't do that again.

Wendy

NREMT-B

CO EMT-B; MI EMT-B

Thank you thank you thank you for trying to be accurate with the details! It makes it no less enjoyable for the mass public and ever so much more enjoyable for those of us who actually know what's supposed to happen. Watch ER with a medic sometime.... and see how they react to it... you'll know what I'm talking about. How are you developing the medical call? is it part of a larger story, or just a short story focused on this?

Wendy

NREMT-B

I might have tried a little oral glucose sublingually (not enough to obstruct the airway) before he conked out.. might be able a little bit at a time to raise the sugar level just enough to wake him up so that you could administer a full oral glucose dose.

I have a question, which maybe someone can answer... you can absorb glucose through mucous membranes.. so why, since some basics cannot initiate IV's and thus are precluded from administering D-50, don't we have a glucose suppository of some sort? Seems to me you can't cause a life threat with that and it might be beneficial especially in rural settings where your ALS intercept or transport time might be longer than desired. Any thoughts?

Wendy

NREMT-B

SILAS (it's a name, don't remember seeing anything about proper nouns!)