ncmedic309

I really wish I could agree - but I'm just not content...

Thanks for the advice Dust - I do it out of nothing more than spite just to get under your skin. It appears that it worked once again as it's a very easy task to accomplish. Thanks for your ever so wise contributions to the thread as usual - I enjoy reading them thoroughly. :roll:

Well, thanks for the clarification - we're starting to actually get somewhere now. A good job to the crew that handled this call - not only did they follow policy and procedure - it appears that they managed a tough situation quite well. Way to go! It's much easier for everyone else to sit back behind the comfort of their keyboards and make these harsh comments towards the crew and criticize their decisions. I highly doubt the same would occur if the crew was present in person to defend their actions. It's also nice to know you all have the entire story and know just exactly how the scene presented - I just wish you would share it with the rest of us. As previously mentioned, "we don't need any more information" - you've already got it figured out. :roll:

Thanks for helping me prove my point - we don't have the entire story and this whole thread is full of nothing but a bunch of "what if's" and monday morning quarterbacks.

I'm not looking for explanations of feelings or rationale - I'm looking for your exact policy or procedure in regards to these types of situations. We can sit and debate personal rationale and feelings all night long - I want the facts and that has yet to be provided.

Who here has the entire story on this? Who has all the facts of this story? I’m figuring at least several of you do since your already calling for their termination and bashing their decision making with this incident. Would you stop? What if you had no other option but to stop? What if your on a narrow New York street and come across this vehicle that’s crashed and blocking the roadway? You can’t continue past because your travel path has been blocked. You can’t turn around – your truck just doesn’t have the ability to levitate and do a 180. What if you can’t put it in reverse, you only have 5 other vehicles behind you. What do you do? It should be in your instinct as a medic to investigate the incident at the least and see if anyone needs further assistance. The car is mangled; it appears the driver is trapped. What now? You call communications and advise them of the same and to get units rolling your way. You will give them more information as soon as you can provide a size-up. While doing the size-up the whole situation takes an unexpected turn when you get a gun pointed towards you by the occupant of that vehicle. You go into retreat. You can’t get your unit out of there so you do the only other thing you can – you get your patient, the patient’s family and your partner to safety and call for further assistance. What more can you do as this point? You re-evaluate your initial patient. You were transporting is a 9-month-old seizure patient. It appears that she’s had a febrile seizure after several days of cough and congestion. She’s alert now and stable but the parents would be more comfortable if you transported her to the hospital for further evaluation. At this point you can’t do much else but hold down your current location and try to prevent harm to yourself, your partner, your patient and other bystanders. What now? All that, is just my speculation based on the article presented – the same article that all of you read. I don’t have all the facts, just the little bit of information that was given by the author of article. However, I’m reading it with an open mind and not with the intent to bash a fellow provider or find fault in every little situation that occurred with this incident. It’s a messed up situation no doubt, but what else could have been done? I try to put myself in their shoes and then take another look at it all from a proactive point of view. What would I do? I would have stopped either way – blocked road or not. If the patient in the truck was critical – I would have likely just continued on to the hospital if the option was available. I would have assessed the scene. Once I realized that the patient was armed and dangerous – I would have left the scene at once. It would be preferred to do so in my ambulance, but on feet would be just as good at this point. If I couldn’t leave the scene in my unit, I would have had another unit meet me at the next closest and safest cross street and then transfer care. I then would have made my way back towards my unit once it was safe to do so. With that patient out of my care, I could now focus on the driver of the vehicle once it’s safe to do so. If the patient appeared viable after the gunfight with police I would have transported him – if he was pulseless and apneic upon my initial assessment – he would have stayed that way right where I found him. So aside from all the assumptions and more – how does your agency or department specifically address the protocol and procedure for these types of incidents? Do you just call it in and keep on going if your enroute to another call or have a patient on board or do you stop and assess the situation? Is it specifically based on the priority of the dispatched call or the priority of your current patient or does it make a difference. I know we all have personal preferences and have in mind what we would want to do – but what’s written where that specifically addresses how you manage this situation? Who’s got something for me?

Your first code as a paramedic and in turns out to be a TRUE SAVE! That's awesome! It sounds like you did a great job managing the patient. I would have been a little more cautious with Lidocaine administration due to the AV block but otherwise it seems you did an excellent job. Keep it up!

I would love to see a 12-Lead on this patient - it's definitely a wide-complex tachycardia - possibly VTACH. I'm not trying to bust any balls, but in situations like this with these type rhythms, it should be a high priority to obtain a 12-Lead EKG if you have the ability to do so. I wouldn't be too quick to form a treatment modality based on this EKG, we need more information - we can determine much more from a 12-Lead. Just looking at the 3-Lead we can tell that we have left axis deviation along with a likely LAHB or quite possibly a complete LBBB. This might be causing the wide-complex that we're seeing... EDIT: Sorry about the continuing 12-Lead rant, I just noticed that they had been hammering it home in the last few posts, I didn't read it all before responding...

You can also add streptococcus pneumoniae to that list, it's also a common gram positive etiology of Epiglottitis...

What? There's nothing to check, I had it right the first time! :wink: In most cases, Croup is caused by a virus. There have been cases of croup that have been linked to a bacterial infection, but more times than none it's caused by a virus. Epiglottitis is almost always bacterial. Which onsets quicker - a viral or bacterial infection? In the case of croup (viral) the incubation period is usually 2-5 days. Epiglottitis which is bacterial has a rapid onset with little to no warning. In regards to remembering the difference between viral and bacterial etiology - I was taught this: Croup (short word) is Viral (short word) Epiglottitis (long word) is Bacterial (long word) I know, kind of silly, but it seems to help students differentiate between the two when it comes to etiology.

You could easily argue Croup vs Epiglottitis with this presentation. Just to clarify a few things about the two... * The patient's age - croup is quite common between 6 months and 3 years of age * Croup is typically caused by a respiratory virus, the most common being the parainfluenza virus. * Usual history of cold-like signs and symptoms * Increased RR - Increased HR - elevated temperature (usually less than 102.2F) * Harsh-high pitched cough (seal-like bark) Epiglottitis is a bacterial infection, usually caused by the haemophilus influenzae type B. However, it's becoming less common due to a vaccination for HiB. The age group typically infected is 4-7 years of age. Unlike croup - the epiglottitis patient is quiet and doesn't make much noise unless the airway is extremely narrowed causing stridor. The absence of cough in this patient and a much higher fever (> 103F) would make me lean more towards epiglottitis. The onset of epiglottitis is also much quicker and doesn't typically present with cold-like signs and symptoms. Given the above scenario - I would go with Croup all day long on this one...

Can you explain the way you immobilize a patient using the KED? Where does the LSB come into play?

I was attempting to give you the hint - that you need to re-consider your differentials for those three cases - but it seems that your heading in the right direction now... Case 1 TB is highly possible Case 2 Cardiac, Sepsis, Pneumonia - just not enough information to be sure Case 3 Considering the age, cold like signs/symptoms, "high-pitched cough" I would go more towards Croup

I'm having a hard time putting that picture in my head - a patient sitting upright on the stretcher in the KED and a LSB in behind them. I don't think it would fit in the truck unless you had about 7 feet worth of headroom. :wink: When I use the KED or XP1 - I just secure them to the device and move them to the stretcher. I might use a LSB to assist with moving the patient or sliding them onto the stretcher but once the patient is on the cot, there's no use for the LSB. The KED/XP1 is substituing for the LSB and keeping them immobilzed without putting them in a supine position. Does that make sense?

I attach them to the same side - it's the way I was taught. I've never seen them crossed and attached to opposite sides. This tool is still very useful - some folks might forget they have it on their unit when it could be utilized quite often. I used it just a few days ago on an MVC. The patient had COPD and needed to be immobilized. How long do you think he would have tolerated or survived being on a LSB?

I would take another look at your differential diagnosis in case 2 and 3...

Here's a couple more for you that might be more beneficial... EMT Cirriculum EMT-P Cirriculum

Your right, some people do equate scope of practice to education. However, I'm not one of those people. The EMT curriculum in the U.S. is a joke at best. There's no doubting that the U.S. is behind in the times when it comes to educating it's EMS providers. The curriculum for EMS providers in Canada is probably one of the best you will find in the world, but that's just my opinion. I have the upmost respect for the EMS education system in Canada and only hope that one day the U.S. will adopt similar standards. Moreover, I would rather have an highly educated paramedic, functioning at the highest and most beneficial level of scope than either of the previous two that you mentioned. I'm unsure of where you attempted to obtain your information? Either way, if you would, please visit the following link and you should get the answer to the majority of your questions. If not, please ask, I will fill in the blanks. NC Medical Board Approved Skills and Medications (PDF)

No, I wouldn't take the job... Here's the main reason: I'm a paramedic - why would I want to take a job that's going to allow me to have reciprocity, but only at the basic level? It's my understanding that the American EMT and Canadian PCP are about identical in terms of scope of practice. It wouldn't be a lateral move, it would be a move that would put me behind in my career. Where's incentive in that?

Awesome video!! Thanks!! How about that last tube? The size of that tube compared to the glottic opening, is it just me or could they have dropped down a little on tube size?

There's no doubt that the pay of EMS professionals in the states is pathetic at best, but you must factor in the cost of living of the two countries and then take another look at the wages. The cost of living in most areas of canada compared to those in the states are higher, which in turn means you will have higher wages...

How about an EMT with 18 years in the service making $21/hr vs the Paramedic with 1 years of service making $13/hr? Is it fair to lower the wages of that EMT just because he/she makes more money than the lowest paid paramedic? I disagree that a paramedics pay should "ALWAYS" be higher than a EMT because every situation presents itself differently. I agree that the hourly wages for paramedics and emts need to be much higher than they currently are, but you need to take in the amount of expeirence and education when considering wages.

I would like a lot more details on the patients presenation. The more you can give, the more we can give...

No offense taken... Here's the way I see it... I get reamed by my medical director for performing a procedure that I'm not allowed to do, a procedure that's out of my scope of practice and end up losing my job over it. At the same time it's brought up that the medic did a procedure that he wasn't trained to do and the patient had a poor outcome, "the medic must have killed the patient". Now I'm not only without a job, but i'm in court, criminal and/or civil (probably both at some point) and being sued/prosecuted for the death of this patient. In our screwed up court systems, that's the way it would go down and I would most definitely be at the losing end...

I'm coming in on this one a little late, but to answer the questions... I would not perform the procedure and I would refuse to do so if given orders... I don't have the proper equipment, it's not within in my protocols or my state scope of practice and that doctor isn't going to do jack for me if I end up in court over it all... I agree that you can round up the adequate supplies to perform the procedure and you could probably be easily walked through the procedure over the phone/radio, but I just don't see it happening...