Para-Medic

Sure, the patient would probably deny back/neck pain, but he also has a destracting injury. Of course, without actually examining the patient it is a null argument. Not boarding any trauma and boarding every trauma is not an answer. There has to be a happy medium someplace that takes into account both the mechanism and the presentation. Blindly following protocol can be just as dangerous as making stuff up on the spot.

Well, I think that C-spine immobalization protocols are just sometimes to general. The biggest indications of a needed CSI for me are poor sensation/motor skills, visible damage, obvious MOI that is known to cause C-spine damage, head/neck trauma, etc. For example, if someone falls off a small ladder and hits a rock that breaks their arm (lets say he fell from 4 ft high) we would splint their arm. Obviously, this would be done after the proper examination. Let's just say the examination revels this patient to not have any other complaints or obvious problems besides the broken arm. On the other hand, some people could say well maybe this guy didn't show signs of internal nerve damage but it would be on the safe side to board him. That arguments is hard to counter because you can't prove them wrong or right. So most people would just say just to be careful board them.

Who puts this $h!t on the internet anyway? That poor kid... and who keeps $%&*( filming after the initial wups, got stuck in the hoop moment? That poor kid writhing around in pain is not F%&*() amusing at all. I can see watching the initial part... but jeebus. Makes me heartsick.

Wendy

NREMT-B

MI EMT-B

CO EMT-B

Oh come on wendy, not to be cruel but that kid knew what he was doing. He was planning that jump out and all. I just hope he learns not to make such idiotic decisions like that anymore.

ok, here is a video that I saw that made me think about the question I asked:

http://video.google.com/videoplay?docid=-3868751167005642764

Now, you must be laughing because I know I was. It's not exactly visible but lets just say the kid broke his leg. It was a fall, it was a cushioned fall, but basically a sudden stopping force can be considered the MOI in any situation. Now, the kid didn't hit his head or land on his back or anything. But he still sustained an injury, now if the kid said he didn't have any back/neck pain would you still c-spine immobalize him? I say yes because the sudden stop could of jerked something out of place. But I know some would say no becuase the kid wouldn't be complaining of neck/back pain and because he didn't really land or hit his back or head. So what would you all say?

Hi,

Im trying to find if this could be a rule of thumb to determine if someone should get C-spine immobalization. Consider if someone's body was traveling at a rate in which the impact of a stop broke a limb or dislocated it, would you consider this as a rule to place someone in c-spine immobalization board? The acceleration could be caused my a fall, car, being thrown, etc.

OK Guys,

This post is a bit late, but beter late than never .

WHen should you commence CPR? This has to do with the level of perfusion primarily in your brain and in your body. Our bodies stop perfusing efficiently after we've dipped below a MAP of 70 mmHG (MAP- Mean Arterial Pressure),that's why we get cold extremities and suchlike. Once we start hovering aound 60 then we get into real trouble, there will be a marked change in LOC because of decreased cerebral perfusion. The goal is not to let the MAP go below 60 as then our body will shut down and we'll begin the processes that lead to MOF (Multiple Organ Failure).

But how do we measure MAP? Well, the LP12 with a NIBP capability will do it automatically for you, but otherwise:

(1xsystolic BP+2xdiastolic BP)x0.3.

eg: with a patient that has a BP of 130/80, you'll see they have no problem:

(130+160)x0.3= 87

but with someone with a BP of 60/40 it's:

(60+80)x0.3= 42

Hope this helps to clarify the situation.

Carl.

quick question.

If someone was showing poor MAP as you suggested you would commence CPR right? They would also have to be unconciouss and showing signs of poor perfusion too right? If this person was on a monitor and showed a heart rate of 10-15 would you want to do compressions as the monitor shows? Or just count every 2 seconds?

I agree with Rid and ak.

If the patient is abnormally large (read: obese), lying flat will make it next to impossible to get good chest expansion. Raise the head of the board 10-15 degrees so the weight is moved a bit, and things should improve. Anxiety states need a calm voice to reassure them that they will be okay.

Re-assess lung sounds and vital signs. Somewhere I remember reading that chest trauma can cause shortness of breath, right? Worse comes to worse, coach their respiratory rate, and maybe assist with a BVM. Doesn't happen often, but it can be useful, if the patient will let you use it.

Just to be sure, only assist with BVM if signs of poor perfusion are present, right?

Interesting statistics say that in states that have implemented the law allowing this to happen, the incidence of mothers dumping babies in dumpsters has actually increased.

I was actually looking for this information. Could you tell me where you found this info?

It's called "Safe Haven". It didn't happen at our FD, but it did happen at the ER that I work in. I wasn't working that night, but my wife was. The PD and child services are called. The baby is given a complete physical (obviously) and released to child services.

During that moment is the parent or guardian withheld for any reason? Do you need to get any important information from the parent or make them sign a form?

Hi everyone,

This might be random but since the news about abortions it got me thinking. I remember there was something about women who wanted to leave children/infants could go to fire departments to drop them off there. I'm guessing to reduce infant deaths from abandonment. So, I'm wondering if anyone here has had this happen at their fire departments. Also if you all have some sort of procedure to handle this situation.

Hi everyone,

I remember we had a discussion about this is class about identifying which is the entry/exit GSW. Besides asking the patient or any witnesses how would you identify it? From what I have heard the exit wound is sometimes (or usually) the largest gap while the entry is small. Still, our instructor told us he has seen some GSW where the entry wound was bigger than the exit and vise versa. So I wanted to know if you all know how to properly identify them. Also, would identifying them change or influence the care of the patient (either BLS or ALS)? If yes, how? Just curious on these sort of things. If anyone has any advice please post. THANKS

What are your devices to use when a C-collar doesn't work. Living in Houston it's amazing how many people just have huge necks (of course when you are considered the most overweight city in the US it's not much of a surprise). I have seen some people role up towels and use them kind of like blocks. The problem is some partners of mine just get stressed and pretty much say f*** it and use tape to hope their head and head blocks. I wouldn't like for them to do this if there was a serious injury (which we never know when it could be) so I was wondering if anyone has some suggestions. Hope to hear from you all. THANKS : )

No. Once it is on, it stays on. Rapid fluctuation of oxygen intake is not consistent with the principle of homeostasis. It taxes the system. You simply have not the sufficient means nor knowledge to properly evaluate the patient in the depth necessary to reduce or remove their oxygen. They need to be at the hospital and have blood gasses evaluated before that happens.

Yeah, that's what I thought. I really just do not know enough about it to make such a decision. What about lowering the LPM?

I think I understand evaluating a patient and supplying what is needed. Still, I don't think I would withhold O2 from a patient at the beginning of my assessment. I mean, let's say we have a call 78 YO Male with COPD who has a C.C. of SOB. As soon as I arrive. I ask what's wrong and listen to what they have to say while evaluating. I would check airway, breath sounds, O2sat (this wouldn't take long). Then as soon as Im done evaluating respiratory I would give them O2. While taking the rest of their vitals/history/meds/evaluation I would monitor how the O2 would help them. Depending on how the O2 affects them is when I would make the decision on keeping them on O2 or not. Still, I probably wouldn't take them off the O2 because our paramedic would immediately ask us why this patient that called with SOB didn't have O2 on. Would you all consider this to be a reasonable way of treating the patient stated above?

I found one but dunno if it's too explicit for ya or not:

http://i23.photobucket.com/albums/b356/Mel...s/jennafire.jpg

Just to muddy the waters, I have more than once seen a COPDer misdiagnosed as a psych patient by providers, both pre-hospital and in-hospital. Could it be that your patient is acting combative because of hypoxia? Could it be that your patient is hallucinating because of steroid psychosis?

Could it be that we aren't teaching either one of those concepts adequately in EMT and paramedic schools?

That is exactly what I thought about afterwards. Seriously, I really do wish EMT-B classes were more detailed in things such as pathophysiology, more anatomy, etc. I mean, our class was like 4-5 months long. Personally I think the reason they don't go too much into detail about it is because it would confuse us. Remember how I said my partner got mad at me for giving them O2 through NRB instead of nasal? Well, I think she just studied too much on COPD and CO2 retention, hypoxic drive, etc. and now would think about limiting the amount of O2 to give patient. Like Asys said just give them O2, that is what they need. If you have someone thinking about hypoxic drive and etc. they loose concentration on the main issue. Still, I think with the proper education we would all benefit from it.

And to address the question about a COPDer who is not in distress and has a low O2 sat. Why are they calling? I find if a COPDer is calling because they have SOB they are usually really sick. They deal with SOB daily. Now if the patient is calling because they havn't had a BM in a week and their O2 sat is 75%. They get whatever dose of O2 they are getting at home.

It was for this psych patient I mentioned. I think she had a broken wrist for some reason but I cant remember.

ok thanks for answering my question. I asked this because I remember we once had a patient with COPD, c.c. was something psychological, and when I saw her sat I just freaked (this was when I was barely starting). So I put her on some O2 NRB. When we arrive at the hospital my partner said that it was bad for me to have given her o2 due to possibility of CO2 retention. That if I had to give her O2 to do it with nasal. I thought, well O2 is O2, if I see her getting worse I'll take it off. Her o2 sat returned to normal but I forgot to lower the setting from 15 to 10 (I think it was 15 or 12). Since then I always wondered if there is any proper procedure for giving O2 to COPD patients.

could keeping a patient, who has COPD and had difficulty breathing, on high flow O2 even AFTER he felt and looked better be harmful for the patient?

Hi everyone,

I was reading the "was I wrong" thread and a question popped into my head. I know that there is a large debate on COPD patients and oxygen (because of oxygen/carbon dioxide retention). So there is always a debate on what device should be used on them. Of course, if the patient is in distress NRB, but what if you have a copd patient with low O2sat without any signs of distress? Canula comes to mind, but would it make a big difference if you had the patient on a NRB instead?

Not only was the HFD figure a gross exaggeration, but the figure for your "head paramedic" is also a fantasy. If an HFD medic gets a full arrest per shift, and he intubates both of them instead of his partner doing one of them, then that comes out to 2 intubations a week, which is the number I stated. In over twenty years, much of it in the ghettos and barrios of Dallas, it was pretty damn rare to get two tubes a shift. Certainly not twenty. They don't see that many patients per day. Not even in a week. In fact, the vast majority of ghetto runs are BS runs.

Now you're saying that this "head medic" gets twenty a week and she's not even with HFD? Come on, dude. I hope your math isn't really that bad. Otherwise, you can forget ever taking the hyphen out from between para and medic.

It was just an expression! comn even I know you don't get 20 intubations a day. What I meant to say is that the HFD guys just get to do more als interventions than our cheif medic does.

Well, we still don't know what "HFD" is. :?

Regardless, the biggest HFD I can think of is Houston, and even their busiest medic would be lucky to do 2 intubations a week.

Me thinks you might be exaggerating a wee bit.

You're right sorry it's Houston Fire Department. I don't agree too much with what you said. HFD is having a shortage of paramedics. Recently, they had a recruit class and one of the conditions to join was that you had to become a paramedic through their fast pace course (i know I hate the idea too). Some of our paramedics work around 3rd or 5th ward (pretty ghetto areas). So they always have someone getting shot or almost dying in the areas they work at.

edit: yeah its an exageration but they really do more als interventions at hfd than we do here.

Okay, I'll bite. What makes "HFD" (whatever that is) medics so special? I'm willing to bet they suck.

Nothing really makes them special. In no way are any of those HFD guys smarter than her. Just they intubate like 20 people a day. While she intubates like 20 in a week. So by "skill" I mean they have done it so many times that they really have it down.

Let me clear this up, I'm referring to "in charge" as being a paramedic that out ranks the other paramedic on the truck based upon education, ability, and skill performance, not time with the service. Many of the services here in Houston run what they call an "in charge" paramedic in which this paramedic has the final call on what happens and is usually out ranked by a supervisor. These positions aren't determined by how long you've been with the service, but by how much education, ability, and skill (usually done with a test).

Yeah, we kind of have something like that here. She has about 25 years experience (although one other has about 30 years experience) and she is pretty much the head medic here. She's pretty much buddies with the MD and you could say this gives her an advantage, but at the same time she is just one of the most intelligent people I have ever met. She continuously studies and studies and would have as much knowledge as a nurse if not a physician. It could be argued that she might not have as much skill as some of our HFD medics but she still knows what she's doing. Her rank is captain if I'm right.

Ill have to mention this to our supervisor. We use just cheap pads and not to complain, but it's just insane how much time we spend trying to keep those things on while the benzoin sounds like it would help a great deal.

what does Benzoin spray do? Just looked it up and it looks expensive.