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Scaramedic

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Posts posted by Scaramedic

  1. The thing with Diabetic patients is that the IV is going to be a short term IV 90% of the time. Also once you get the IV and give D50 the patient will be wide awake, and during the transition from decreased LOC to alert they tend to be a might combative.

    So you pop in an EJ, give D50, and restrain the patient. You hope he doesn't pull at the pain in his neck, and then you have a patient A&O with a very painful IV that you might have to pull because they don't want to go to the hospital. So you now have to pull an IV in a major vessel that is dangerously close to the airway. You pray the pressure is enough that it doesn't create a very nasty hematoma that can show up twenty minutes after you leave.

    I'm sorry I disagree, I am all for using EJ's when necessary but an EJ is not an IV to be taken lightly. It is much more dangerous then peripheral veins. It is also painful and not a great place to have an IV in a moving and alert patient.

    In this case I would have searched for alternative sites. I've done finger veins for diabetics. Keep in mind you do not have go with the D50 mixture, pop the D50 into a 50ml bag of D5W and run it in as D25. It is easier to run into small veins. I personally would look at all options including Glucagon before I placed an EJ in a Diabetic.

  2. Reminds me of the time Jimmy and Adam from the Man Show dressed up like pilots and went to LAX. They were walking around the terminal acting hungover, Jimmy actually laid down and took a nap in a planter. It was hilarious to watch peoples reactions. This was pre 9-11 of course.

  3. Many of the changes in EMS come down to technology. Either being used in the field or being used in the lab to change our ideas on how the human body works. The changes you are seeing are just the tip of the iceberg. Everyday new discoveries are being made and new theories are being tested.

    For many years emergency medicine took a back seat to other specialties. Now the changes seem to be coming on a daily basis due to the change in emphasis on emergency medicine. Partially because once again we are country at war. The things being learned in Iraq and Afghanistan are making it over here. Quik-Clot for example. Hell think about tourniquets, they were a taboo. Now uniform companies are offering ACU's with built in tourniquets.

    I've often said that the treatment for snakebites changes so often it should be written in pencil in protocol manuals. Emergency Medicine is a dynamic specialty and that is a positive thing. Everyday a new study is being released and a new theory is being tried. This in time will make EMS a more active part of healthcare and a better provider to our patients.

    Does this mean that the core concepts of EMS have changed? No. Does this mean that 'Old School' providers have no place in EMS? Of course not. We are still the frontline of medicine, we still do out best to help the patient. Also many of the changes talked about here are not common place yet. Some larger cities have different technology and others are part of studies.

    I believe if you jumped in a rig tomorrow you wouldn't feel out of place, you might be a little rusty, you might need a CEU or forty to catch up. But in a few hours in the back and I guarantee you'll start to feel at home.

  4. Paramedic Injured

    Posted: April 8, 2008 06:23 AM

    Updated: April 8, 2008 12:11 PM

    One person is taken to a Tulsa hospital in an auto-pedestrian accident on the Broken Arrow Expressway Tuesday morning.

    Tulsa Police say an off-duty EMSA paramedic saw the driver of a car hit a big pool of water. The paramedic parked and went to check on the man.

    As he did, the driver of a pickup hit the same body of water, hit the car and then the paramedic.

    The paramedic was taken to the hospital to be get check out.

    No one else was hurt in the accident.

    Unfortunately, this isn't the first time in recent years that an EMSA medic has been injured while lending aid to crash victims on the side of a Tulsa highway said EMSA spokesperson Tina Wells.

    In November 2006, an on-duty EMT evaluating patients at wreck on U.S. Highway 169 was hurt when a vehicle careened into a crash scene, sending the original vehicle hurtling into the medic.

    Wells says traffic should slow down when approaching a crash scene or stopped emergency vehicles and should change lanes, to give workers a wide berth, whenever possible.

    P.S. They really need to hire a Copy Editor for their website. "The paramedic was taken to the hospital to be get check out."

  5. Ok so now some questions? What is some of the terms that you have been using? But the one things that I can't figuer out is how bagging once every 5 seconds= 12 Resps per min, and if you bag once every 7-8 seconds it is faster but if I do the math and bag once every 7 seconds it is like 8 breaths a minute? That is where I am confused because the RT said that pt need 14 breaths a min so how many times is it?

    That is a rate of squeezing the BVM every 4.2857142857142857142857142857143 seconds. :D

    But since the laws of physics and the ability of the human mind cannot do a rate like that with a BVM the closest you can get is a breath every 4 seconds. That equals out to a rate of 16 or you can go every five seconds for a rate of 12. This patient should have been on a vent, then you have much more control on rate, volume, PEEP, etc.

    Ok you told me of the storm and how to get ready for it. And I am waiting for the first snowflake.

    At times it is going to seem like a whiteout, to continue with the snow analogy, but you can slog your way through until it makes sense.

  6. Scribble my resignation onto a run report, sign it, leave it in the truck, and find a bar. :shock:

    Turn uniform shirt inside out, rub some debris and dirt on my face. Find Red Cross, grab a meal, find a seat with a nice view of the action and enjoy my dinner in peace. Fake my own death, have wife claim millions, meet her in Jamaica and live large as a Ganga dealer. :lol:

  7. They forget to mention that it is a law that you do not use the letter R when you speak. I believe you can buy a New England to English dictionary in bookstores. Remember car rhymes with saw not bar. :wink:

  8. Virtually anyone can issue such a certificate, since there is no regulating body or standard curriculum to define it. It doesn't mean much to have "EMT-Tactical". The only question is whether or not a SWAT team or educational program will recognize your basic 5 day TEMS course as a valid prerequisite for membership/advanced training/whatever.

    Schools offering a comparable program:

    Tacmed (www.tac-med.org)

    Global Operations Response Group (www.gorgrp.com)

    RTI (www.emtt.org)

    ISTM (www.tacticalmedicine.com)

    National Tactical Officer's Association (www.ntoa.org)

    Cypress Creek EMS (www.ccems.com/catt_team/class.html)

    'zilla

    So Tac-Medic is kind of like Wilderness EMT, tons of courses but not really recognized nationally?

  9. First off let me straighten out a few things, I was not using my family as anecdotal evidence. My father joined the WSP in 1946. He retired before vests became an issue. My brother retired after 37 yrs, yes 37! When he started out vests also were not a common thing and when they first came out they were bulky and uncomfortable so he never liked them. I mentioned merely as a lucky thing not as evidence.

    Second if you want to wear one go for it. If it helps you in an MVA great. But when it comes to helping you in a shooting situation your forgetting one big issue. The reason most cops survive shootings is they can shoot back and disable the shooter. What are you going to do after your shot?

    I've worked in some particularly nasty cities and I have only known one Medic who was actually shot. The bullet bounced off his key carrier on his hip. Maybe we should all wear key keepers instead.

    I know several LEO's who were shot, via my family. One was shot by his daughter in his POV, he is a C 3-5 (completely blown away) quad. Another one was wrestling a suspect and the suspect pulled a gun during the scuffle. He fired the weapon and the bullet went between the side panels and entered his abdomen. He survived. One was shot by a suspect going over a fence, bullet went through his foot. And finally a friend of mine with PD who shot himself in the leg pulling his gun while getting out of his vehicle. Oh and this Officer I never met (obviously) who went through Shelton with my father and was a friend of his.

    Capture-3.jpg

    He was shot in the back of the head by a twelve year old if I remember right.

    Do vests work yes. Should EMS agencies spend a large portion of their budget on them no. I would rather see the money being spent on a course like Street Survival that has worked so well for LEO's across the country. A course I have been through and found amazing. My point is that more EMS personnel are going to die from poor health, MVA's, and falling from the sky than will ever die from GSW's. So the money would be better spent on making EMS workers think of situational awareness and trips to the gym than Body armor.

    P.S. I am still waiting for all this evidence of Medics being shot.

    P.S.S. Dust, one of your incidents would have been avoided if the back of the units had a proper restraint system for Medics. Now there is another place the money could be spent.

  10. Here's something new for us Coast people. I had never heard about until a Seattle girl came down with it after taking surfing lessons in Hawaii. Something to keep in mind if your planning on learning to surf on vacation.

    Surfer's Myelopathy.

    Case Reports

    Spine. 29(16):E353-E356, August 15, 2004.

    Thompson, Todd P. MD; Pearce, James MD; Chang, Gonzolo; Madamba, Joseph

    Abstract:

    Study Design. The authors reviewed a series of nontraumatic spinal cord injuries associated with surfing lessons.

    Objectives. To characterize a unique syndrome of paraplegia/paraparesis to improve clinical recognition, treatment, and prevention.

    Summary of Background Data. Surfer's myelopathy is a previously unreported nontraumatic spinal cord injury that affects inexperienced surfers. Nine patients with paraparesis/paraplegia were evaluated and treated after nontraumatic surfing events.

    Methods. An office-based registry tracked patients with surfer's myelopathy between July 2001 and December 2002. A retrospective review of hospital records searched for additional patients. Nine cases of surfer's myelopathy are retrospectively analyzed to characterize the incidence, risk factors, and outcome. The literature related to surfing injuries is reviewed.

    Results. Nine patients were detected with surfer's myelopathy between June 1998 and January 2003. The average age was 25 years. Most patients presented with back pain, paraparesis, and urinary retention. Other presenting symptoms included paraplegia, hypesthesia/hypalgesia, and hyperesthesia. At the time of discharge, three patients had a complete recovery and four patients had mild weakness without sensory deficits. Three in this group had residual urinary retention. One patient remained paraplegic. All patients had abnormal signal change in the lower thoracic spinal cord by magnetic resonance imaging.

    Conclusion. Surfer's myelopathy is a nontraumatic paraparesis/paraplegia that affects first-time surfers. Although most patients have a complete or near-complete recovery, complete paraplegia has occurred.

    © 2004 Lippincott Williams & Wilkins, Inc

    Another great article on it.

  11. The last three GSW deaths of EMS workers were in 2004. Two were killed in quarters by an ex-boyfriend and the third was an ambush/sniper situation. Vests (that EMS has access to) don't help head shots and high powered rifle hits.

    Now if we're talking Dragonskin then one of them would have survived, but how many EMS personnel want to pay for Dragonskin. If they could even get it.

  12. Another problem I have with body armor is the mentality that it produces that the wearer is safer then they are.

    Yes it provides some stab protection, mostly slashing and upward stabbing motion. But a strong downward stroke, like at the chest will go through it like butter. Also keep in mind that hardcore criminals know this better than most cops. They study books like Gray's and learn where to stab and kill even with a vest. Same with shooting, they know as much as officers about head shots and leg shots. Keep in mind the last three deaths of record were 2 assassinations and 1 sniper, a vest would not have helped.

    Maybe it's just me, my brother and father survived as Police Officer's without vests and I don't see why I should wear one as a Paramedic.

  13. Moronic question.

    On soap box..

    PPE/BSI is the standard for all calls. I don't give a damn if I am going to upset an AIDS patient because I am wearing gloves. This AIDS bullsh*t has gone too far. The whole world can know if you have Herpes or Gonorrhea, but if your HIV/AIDS then you have special rights in some idiots mind.

    Why is HIV so prevalent among gay males? Because they were the ones having unprotected sex in bath houses while the disease spread like wildfire. Some local politicians tried to close the bath house in San Francisco and got slammed for being homophobic so the bathhouses stayed open. In turn, as the title of a great book says The Band Played On. This went on in LA and New York also. HIV spread amongst the population that refused to acknowledge it and when they finally did they demanded special rights of privacy.

    The government as a whole was slow to respond and that also lead to the outbreak. So to make up for their stupidity they put the onus on health care workers to give special treatment and rights to HIV infected people. Where are these rights for Hep C pts? Hep C is an STD that's incurable. Why do we not have a question like the one mentioned involving Ebola?

    Political correctness in medicine is going to far. An average of 40,000 women will die from breast cancer this year. An average of 40,000 men will die of prostate cancer this year. Yet how often do you see light blue ribbons for prostate cancer? Hell you can buy pink notebooks in my colleges bookstore with the money going to breast cancer research. I am still looking for the light blue books with money going to what killed my father.

    Maybe we should ask why is breast cancer receiving so much attention especially since it is the second most common form of fatal cancer in woman. Lung cancer is number one. So what about lung cancer? Where is the special I-Pod to buy to help Lung Cancer? I have an idea let's try to find a cure for CANCER! Not just one kind of cancer because some think tank thought it sounded politically correct to choose one cancer over another.

    It's time for Medicine as a whole to stop with the PC crap and quit dividing up patients by sex, race or by who they got infected with a deadly disease with.

    By the way heart disease is the number one killer, cancer number two, guess what number three is?

    Climb down from soap box and waits for hate mail.

  14. I have heard (not actually done yet though) that if you inflate a BP cuff in the small of the back it can provide some relief

    Been doing that for years, never had a BP cuff not returned. I always carry an extra Large adult just for that reason. Pump it up, clamp it with hemostats (which I carry in my kit, not on my person) and remove the sphyg. Of course it helps if you carry the kits with the screw off sphygs. :wink:

    Also having been on a backboard I cannot stress enough just how uncomfortable they are. I swear you can feel every bump on the road and they become outright painful damn quick.

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