Asysin2leads

>Charlie, I'm in the system for 20 years now, what is a "duck" in your >reference?

Oh I know! I know! I know! I know!

Ducks are in reference to firefighters. I think this is because on scene they tend to follow their lieutenant around akin to a group of ducks, or a mother duck and her ducklings. In the same vein we used to refer to the group of medical students and interns that followed the doctor around in the hospital as doclings.

Why even bother, you know the medics will just score highest. :twisted:

Oooooooh..... them's fightin' words!

Oh yeah, hee hee, Matzo box, I hadn't heard that one before, but I know what it means, and lol, that's a good one.

16. You've gestured across the street and said to a patient with a BS complaint "The hospital is right there!"

17. You think heat days violate the 13th admendment

18. You get a certain sense of relief when the person snapping pictures of your ambulance turns out to be an overweight tourist from Iowa.

19. You've heard someone say "We use to be able to get away with that in the old days"

20. You talk to the local homeless guy more than you do your own family

I think the first is my favorite

Rid, I full agree with you on treating the underlying problem, and if a brain is hypoglycemic, it can cause just as much damage as a prolonged seizure. However, from a practical point of view, administering the benzodiazapine is the better choice.

Let's give the example of Mr. Jones who is a diabetic and is so excited to see the new Dukes of Hazzard movie that he takes his insulin but, d'oh, doesn't eat a very good breakfast. In the middle of the movie theatre he drops and starts seizing. We arrive shortly, and it is reported that the patient has been seizing continuously since bystanders called 911. He is still actively seizing, and we find he has nicely identified himself as a hypoglycemic. We agree that attempting IV access on this patient while he is seizing is not a good idea, him being a diabetic with poor veins and the fact he is in fact seizing, but an IM injection would be okay.

Do you go with 10mg of midazolam IM or 1mg of glucagon? I say, give him the midazolam. This seizure needs to stop. Even if the etiology is hypoglycemia, the seizure will stop. Then we can get good IV access (and you need a good one for some sugar syrup coming your way), secure his airway better, if necessary, and do our thing. The only way the glucagon would help is IF his liver had enough glycogen stores to raise the glucose level, which is IF the patient is seizing because of hypoglycemia, and while a finger stick and the medical alert tag is a good indication, its not a certainty. From a clinical perspective, you're correct, the underlying hypoglycemia needs to be treated. From a practical, field perspective, I believe the midazolam is the better choice.

This is a pretty picture of glucagon, though:

http://upload.wikimedia.org/wikipedia/en/6...o_animation.gif

If someone is actively seizing, and they've been doing it for a while, or on and off for a while, give them the damn benzo, then the D50, or Glucagon or whatever. The seizure is the most important, presenting problem, and should be treated as such.

Let's say you have someone who is in the extremely rare status epilepticus hypoglycemic seizure. You do it my way. What happens, you have a sleepy diabetic on your hands. If however, you do it the "try and find out if glucose will stop it route" and its NOT a hypoglycemic seizure, you've just wasted some of their brain matter, and that's never a good thing. The underlying problem is what causes the symptoms, and needs to ultimately be corrected, but the symptoms, in this case, are what are going to do you in. That's my feeling.

I think I'll go with what has been said already. I'd handle it without anyone else getting involved, but make it very clear that they were not riding today and that I was doing them a favor by not getting one else involved. If they persisted, I would involve who ever I had too. If it became chronic, then I'd have to bring them to whoever.

If you are overworked from a 24 hour shift, call in sick for the next one. It's not as deviant as it sounds. A person who is exhausted and unable to function adequately at their job has every right to call in sick, because they are sick. No one said sick is getting the flu. I'd much rather have someone say "I am exhausted, I will be no good at work tommorrow," rather than go "booyah I'm tough, I'll drink some coffee AND GO BACK IN!" And if you are being over worked, it will only come to management's attention that the crews are overworked if people start not showing up for work. Complaints from the crews are one thing. Unfilled ambulances are another.

It's discussions like these that make me wonder if Abe Lincoln just shoulda said "Knock yourself out."

Right, God forbid the test should make you think. You never have to think in the field after all, ever!

I guess this would be a bad time to mention I'm a descendent of William Tecumseh Sherman?

I'm kidding, I'm not really.

I give a very haughty and indignant "Ha" to your test. Bring it.

Well, I'm of the camp of "become a paramedic" whenever you can.

My paramedic program was a two year college degree that encorporated the EMT class into the program. I was already an EMT for 4 years before going into it, so I got to skip that section.

Personally, I think there are some very narrow minded, full of themselves people who through their attitudes and procedures make it a little too hard to initiate paramedic study. I mean, there are places that have waiting lists and interviews, heck I think some even have swimsuit contests, before you can start the program. I say if a paramedic course is adequately set up, any people who are deficient should be weeded out during the program. The "old boy" network of advancement in EMS (you know what I mean, Bob knows Larry, Larry knows Sue, Sue's kid gets into the paramedic program...) should be dismantled once and for all and those who can do the job should be allowed to with out most of the accompanying BS.

From the same state the brought you the LA Riots, the OJ verdict, and the Schwarzenegger candidacy.

God help us when 99.9% of the United States thinks that "fighting evildoers" is sound global security policy.

Just to get my $.02 in here...

It really pains me when I see the people who were far removed from 9/11 (i.e. most of the red states) strutting and puffing out their chests while the ones who are really at risk of getting killed by angry misguided religious zealots (the terrorists, I mean, not the Christian coalition), scramble trying to protect themselves under the asinine and short sighted policies in place. To have a had a front row seat to the worst terrorist attack in history, then to read the local newspapers and read the obituaries as they ran for WEEKS, to talk to people who lost their loved ones, and to have visited the memorials, and now to see people with Florida license plates in their suped up pick ups with the airbrushed artwork posing for pictures in front of the pit of the World Trade Center site (its not the fucking Grand Canyon, folks), well, I'm still proud to be an American, but dammit if there are some people who don't piss me off.

Counter terrorism funding has become a pork barrel project with each senator waiting to dip their greasy fingers into the barrel and spread the loot around to their home states, regardless of what it means to the states that really need it. Currently, in the US, our soft targets in major metropolitan areas maybe woefully underprotected, but dammit if we don't have the BEST guarded county fairs in the world! Yeah!

Remember, for every backwoods Rambo wannabe first responder, tooling around the interstates in his way cool tactical gear funded by DHS, there is a police officer standing in front of the United Nations or the Golden Gate Bridge or the Sears Tower who's radio may or may not be able to communicate with other emergency workers.

Bush et al. has sold us out. Emergency workers, alive, just don't get him votes. Its only when we perish 'heroically' that he can use us in his campaigns. That's what I believe, and I'm sticking to it.

My jump kit includes:

One (1) Book of Psalms.

One (1) Flask of Whiskey.

I'm a bit of a pessimist.

I think the medics here are going to start using them when we can look at them without blushing and giggling. COME ON! YOU ALL THOUGHT IT WHEN YOU SAW ONE THE FIRST TIME!

The rest of the time Im just a dick

You don't say. Actually, no one really cares, shorthaired. Why don't you tell us again how you intubate as a basic? Hee hee.

Yes, pads are better, they stick, les chance of shocking something you shouldn't be... But but BUT

You just look so much cooler when you use the paddles! You know you do! That's the only pro-paddles argument I can think of.

no, its amonkey skill, a trained monkey could essentially do it(not literally)

Yeah, this coming from the guy who said "AHA says to pause the compressions 'cuz its too hard to teach how to ventilate THROUGH the compressions"

Uh huh. Guys like this are why we are still called ambulance drivers. Sorry USAF, I was never the diplomat

Healthy ways: Exercise (really, it works), listen to some music, forget that I'm a paramedic for a day or two.

Unhealthy ways: Cause unnecessary traffic jams (this works well too), drink, annoy uptight service providers (easier than you might think)

This attitude of "if you didn't do the skill in the field, you are just lazy/incompetent/etc. etc." needs to stop. Too many providers are putting their egos above patient well being.

unfortunately being one of the people that is involved with QA/QI, I find to many providers that fit this statement -- they are lazy, incompetent and if it is not "THE BIG ONE" they want nothing to do with the call -- so the EGO also works in the other direction

We,as advanced care providers are the ones on scene and have to make the decision on what is right for the patient at that time -- but if you have to make excuses for why you didn't treat a patient -- my opinion is then you know you should have

My point was, sometimes it is better for a patient to be at the hospital rather than the crew exhausting efforts on scene. If a patient was having an MI, and had difficult veins, and was say 3 minutes away from the hospital, I think it would be better for the patient to be transported to the hospital for intravenous access if it was failed on scene. I know many people, however, who take IV access as some sort of personality challenge.

My service deals with both short and long transport times. If we get called in the city our times are 3-5minutes. In the County it's 10-20minutes. I personally wish I had longer in back than 3-5minutes. It's frustrating not being able to get everything done because you're at the back door of the ER. I just hurry the best I can and get the most important things done first.

Dan

They way I look at it is that EMS is a continuing spectrum from field to hospital. If we get things done in the field, great. If we get the patient to the hospital really quickly and provide necessary care enroute, that's good too. I mean, if you are 3-5 minutes away from the hospital, and you have a critical asthma patient who needs intubation, and well, you just can't get the tube, I think it is the more responsible thing to control the airway using BLS techniques and get to the hospital where a respiratory therapist can give it a shot in a controlled, well lit environment. EMS works on a time/procedure factor. If it will be quicker to start a life saving procedure in the field, do it. If it will be quicker to get the patient to a hospital to have them do it there, it is in the patient's best interest to do that. This attitude of "if you didn't do the skill in the field, you are just lazy/incompetent/etc. etc." needs to stop. Too many providers are putting their egos above patient well being.