Lone Star

Kaisu, There is nothing I can say that will help ease the pain of you and your family, and I am distressed by it. My deepest condolences to you and your family in your time of sadness. know that we are here, if you need an ear, shoulder or sounding board. I wish ther was more that I, or we could do to help you and your family get through this.

The standard adult dosage of albuterol is 2.5mg in 2.5ml of NS. The standard pedatric dose is 0.15mg in 2.5-3.0 ml of NS. This is about 1/17th of the adult dosage. As far as the child in the pond in Crothity's senario, if the rescuer isn't trained or equipped for water rescue, they could end up making the situation worse. While it's noble to try to save the child, what good are you really doing if you end up drowning in the process of trying to save the child? The same applies to the asthmatic in the original post. Howmany medics have we heard talking about cardiac drugs and make the statement "It was one of those 'A' drugs..."? Was it Adenosine? Atropine? Amyl Nitrate? Amiodarone? Asa? Part of the problem here is that the general public only knows what they see on television. They see cops solve major crimes in an hour and think that this is the way 'real life law enforcement' should operate. They see these action drama shows like "Trauma", "Third Watch" and "House" and think that we save every patient Just be cause Mr. Smith has an albuterol MDI in his pocket, doesn't mean that little Jane Doe gets the same dosage. If an educated medic can confuse those 'A-drugs', how can we reasonably expect the general public to understand that just because the name sounds the same, it could turn out to be vastly different drugs and 'bad things happen despite good intentions'. Remeber, that the road to Hell is paved with good intentions, but it's still the road to Hell.....

WRONG! First off, even as a multimedia first aider (like they teach in Boy/Girl Scouts; you should already KNOW when to activate the 9-1-1 system. Giving a patient someone else’s medication simply based on ‘she recognized the name of her medication’ is akin to prescribing medications without a license. In GA and MI, even EMT-I can’t just raid the drug box because the patient recognizes the name. We can ASSIST the patient taking their own medications. Actually Ug, there are more ‘rights’ (you only mentioned 4). They are: Right patient: This holds true, especially when assisting the patient who is taking their own medications. This also precludes the good Samaritan from offering up their medications. Right medication: The general public usually can’t tell you WHY they’re taking a medication (other than “the doctor gave it to me.”), why would you trust “that sounds right”? Right time: This doesn’t mean that since the next dose is to be taken at 1800… that we make sure it happens. This includes right indications, no contraindications and the right conditions (i.e.: no nitro after taking Viagra within the last 72 hours. Right date: Is the medication expired? Is fluid medications like epi clear? Right dose: I think this one is self explanatory. Right documentation: Document the administration of the medications, and all pertinent positives and negatives (responses to the medication for which it was administered. i.e.: If you give albuterol, did it relieve the symptoms?)

People need to realize that just because you have the RIGHT to say what you want, doesn't mean that it's always appropriate...and what you say DOES have consequences. The guy should have known that what he posted on the deputy chief's page woult have the same effect as saying it directly to the chief. Just because you have the right to speak your mind, doesn't mean that you can say whatever you want wth no consequences. Even the right to free speech has its limitations. You cannot inflame, incite to riot, slander, or defame, (just to name a few limits). Ultimately, this guy, Kennedy, crossed the line, and now he needs to pay for his sins

Sorry to hear about this Moby-lyzer! Hopefully there's something that can be done to relieve your pain, and get you back on your feet again. No need to apologize for trying to take care of yourself and the issues you face. Good to see your face around the place, and I hope we see more of it! LS

As far as the whole Waco incdent, the reports are clearly divided into two sides. The supporters of David Koresh and the Branch Davidians will say that the government used incendiary devices when they started launching tear gas grenades into the buildings of the compound. There is evidence to prove that the fires that wiped the place out and killed so many were started in multiple locations in response to the tanks being used to breech the walls of the buildings. Timothy McVeigh and Terry Nichols used both Waco and the stand off at Ruby Ridge, Idaho as 'justification' for bombing the Afred P. Murrah building in Oklahoma City. As far as St. Nicholas goes, the Port Authority DID offer to move the church, and even offered more money to help with financing reinforced walls because it was being built over the screening area that led directly to the parking structures being built at Ground Zero. What ISN'T being said is that St. Nicholas already had their own property and only wanted to rebuild on it, but was denied. Further, if the church HAD built on the proposed site offered by the Port Authority, the church was limited to size and height because of it's location to Ground Zero. Unfortunately, none of these restrictions were made on the mosque/cultural center that has everybody up in arms. No, the Port Authority didnt HAVE to offer the property to the church, but by the same token, the church DIDN'T HAVE to move, they already had their own property that they've owned for years. Ultimately, the Port Authority backed out of the deal when the officials at St. Nicholas wanted to see the proposed plans for the screening area that was going to be directly under their church. Additionally, the particular board that approved the plans for the mosque/cultural center has no authority in regards to churches and religious matters. These points are mentioned around page17 and later in this thread. http://www.usatoday....odox23_ST_N.htm

I wholeheartedly concur with your findings on this subject, Bushy. I sat here reading Systemet's response while drinking my first cup of the day; and by the end of the post, I was crying 'uncle' (and I wasn't even the one to make an offending statement)! :bonk: I am but a poor medic student, please show mercy upon me due to my lack of complete education! The television show "Emergency!" showed a couple episodes that almost seem inspired by this very thread. I ended up watching them because of this thread....what a vicious cycle! http://www.hulu.com/watch/47100/emergency-trainee http://www.hulu.com/watch/12088/emergency-problem *Edited to add last statement and links to full episodes

I've always thought that after the initial and secondary patient assessment, we followed up with what's known as a 'continuing assessment' to provide the results of our treatments and to trend the patients condition. It is during these 'ongoing assessments' that the modality of our treatments may or may not change. I haven't seen a posting to this thread that advocates the "Let's try this and see what happens!" mentality. The responses that disprove Crotchity's premise of "I know everything NOT in the book!" seem to be based on solid evidence, rather than conjecture. Crotchity, Since you know 'everything NOT in the book", why haven't you followed through with your responsibility to furthering the field of pre-hospital care, and begun to publish what the rest of us obvious idiots don't know? While I've got some experience in a really major EMS system (I think metro Detroit qualifies as 'really major EMS system') I'm far from ever being confused with any MENSA members, (past or present); but I would be willing to follow the teachings/orders/directions/ advice of the respected physicians that are assoiciated with this forum (i.e.: Dr. Bledsoe, ERDoc, Doc 'Zilla, et al) and the guidance of the 'rock star members' that obviously know more than this mere 'medic student' will ever know. Sure, equipment fails, it has its limitations, but given that we mere mortals do not have xray vision, clairvoyance and the God like power to heal by touch, I'm going to have to rely on those electronic devices to help guide me in the treatment of my patients. They are not the sole source I base my treatments on, (thats where education comes into play),but they ARE developed and used to help diagnose whats wrong with our patients.

One of the initial 'rubbing points' in that Port Authority deal was the fact that the Christian church was limited in the size and height that it could build to, while the cultural center was pretty well unrestricted. If I remember correctly, the church was told that it couldn't dwarf or obstruct the construction at ground zero, but the cultural center is allowed to overshadow it in height. I said it before and I'll say it again, if you're going to place restrictions on one, place them on all; and if you're going to allow one to have special priveliges, then you have to grant those same priveliges to all. You cannot grant special dispensations to one group while denying the same dispensations to another group so that you wont offend the first group. This is NOT how you promote healing, harmony and unity of the two diverse groups. If you go back and read through the earlier posts, there should be links to this information as well (providing that the links are still active).

I can understand their reluctance to volunteer such information in front of a bunch of witnesses, but in this scenario, all involved appeared to be either healthcare providers or school administrators. Not the usual suspects that one would encounter in an identity theft incident. Part of the reason we get the social security numbers in EMS is so that when it comes time to pay the bills, we know the 'right person' to bill for services rendered. In the hospital, it's part of patient identification; this ensures that getting the right chart for the right face...... Its amazing how fast the reporter was to villify an entire profession, by insinuating that we're just predators looking to screw our helpless patients.....

The biggest problem that you'll find when you set a hard and fast inflexible rule to govern all situations along with penalties that are enforced for non-compliance, is that there are far too many situations where it cannot be applied to. Michigan's biggest rule is that patients are transported to the closest appropriate facility. This simply means that if you have a cardiac patient, you're not going to transport them to the trauma unit (unless it's the same hospital that has the local cardiac unit). It's amazing hat as we disprove the 'Golden Hour' and the 'Platinum 10' rules; someone like this does their best to keep things in the dark ages, despite evidence to the contrary!

I got into EMS simply because it was required for the fire department I applied to. In fact, it was the only thing holding me back in the selection process. I went into my first class, and during the 'meet and greet phase', we had to identify ourselves and tell why we were interested in EMS. My response was "I'm only here because I HAVE to be!". As time and the class progressed, I realized that not only did I 'have what it takes', but when my classmates were getting grossed out over pictures of trauma, I realized that there was more to it than I would pick up in that class. I'm currently 46 years old, and working on my Associates degree in Paramedicine. I've been mistaken for faculty by students outside of my class. Don't let the "older than all of my classmates" thing get to you! At the rate I'm going with all of the 'setbacks' I've faced, by the time I graduate, I'll be able to draw Social Security (if it still exists)!

Presuming that 'off duty' means not in uniform, and not being compensated by their employer. This leads to the next question...if they were off duty, why were they hanging around the E/R, and why did they get involved in a situation that clearly violates HIPAA? Since he/she was not directly involved in patient care, or related to the patient...they had no business even setting foot in the treatment room with that patient. I don't care if they were 'banging one of the nurses'...who hangs out in the local E/R on their days off? In my book, the excuse 'Just so I can be near you and spend time with you' isn't a satisfactory response. The E/R isn't someplace you go to hang out and socialize. That is someone's place of employment and if you're not an employee of that establishment, you don't need to be under foot! Even if said nurse is causing you to either 'pitch a tent', or gives you 'panty puddles', use the appropriate venue for socializing.

Aren't administration sets pretty much universal? Of course, this would exclude 'brand speciffic' for infusion pumps...

*gives Dwayne his missed dose of Haldol, and sets him back in his chair in the corner of the room (where all the dust bunnies hang out)*

* Edited to add quote and image

I think I broke my alphabet!

A couple things that I learned in the field (under fire, you could say) was 1. what a disgusting feeling it is when you're doing CPR on an 85 year old female and you feel every one of her ribs either break or separate from one side of the sternum 2. We constantly hear about the patient expressing that 'feeling of impending doom' ("I think I'm gonna die!"), but they NEVER tell you about walking into a patients room or house and YOU getting whacked with that feeling of 'impending doom', and its so thick you could cut it with a knife.... I think what sucked the most about learning those two lessons, is that I had to learn them BOTH on the same call. Unfortunately, she didn't survive (even with ALS on scene)...yeah, that one tends to stick with you for a while....

It was drilled into my head during my first EMT-B class that the typical B/P has on average a 40 point 'gap' be tween systolic and diastolic pressures. I was further told that widening B/P gaps signified hypovolemia (whether internal or external) and narrowing pulse gaps were indicators of rising ICP (as from closed head injury/CVA). Am I remembering this correctly, or has my alzheimers kicked in again?

I remember seeing a television show that featured him. Didn't the police also suspect his brother as an accomplice?

Ok, it's about time you quit laying around and soaking up the sympathy! Get better quick! LS

I'd be leaning toward an anaphylactic reaction to a previously unknown allergen. We've seen people develop seasonal allergies that have never had them before, so why wouldn't that apply here? One question I would like answered is, "Which department of the supermarket was she in when the symptoms started?". Another question is, "Is this a regular supermarket like A&P/Kroger's/IGA, or is it a store like a Super Walmart? Could it have been induced by another patron? We've all come across those people who seem to think that perfume/cologne is something you bathe in. I had an incident at school where I got into the elevator to go to my classroom, and found that someone who had used the elevator before me had so much perfume on that it was actually suffocatingly heavy in that little metal box. Based on no urticaria isn't sufficient evidence to rule out anaphylactic reaction. Complaint of 'light headed and dizzy' may be a result of hyperventilation. Did they complain of tingling in the distal extremities? What was the ambient temp both inside and outside the store? Any complaint of N/V? I think that initial treatment would include monitor/high-flow /O2, IV (NS/KVO), transport.