Happiness

This year has been a very special year for us Haida Gwaii Islander. Many years ago there was a stand off between loggers and the Haida's. I remember seeing the news article's (I did not live here when the stand off was happening). The result of the stand off created a beautiful national park named Gwaii Haanas. I have been through the park twice and each time saw things differently. In Windy Bay Aug 15th the Haida raised a new pole called the Legacy Pole. It is amazing to watch a pole being raised (I missed this one) and the whole community participates. There is always a feast after with lots of entertainment. Global BC did a story of Haida Gwaii and I thought I would share.

http://globalnews.ca/news/817702/a-closer-look-at-haida-gwaii/

The video that shows the crab in the dip net is where I quad with my Dobie in the summer. I know that this video is about Endbridge in general but It does show some scenery etc.

The first video is of the pole raising

The slide show has some nice pics of the pole along with the reporter and camera man in Skedan's (indian village) This is the village that Emily Carr painted some of her most famous paintings.

Enjoy Happy

Since I don't live in a place where there is traffic, but I still need to know the rules. If you are running code 3 in BC and you have to stop for any length of time, you will turn off your L&S until you start moving again and it is safe to turn them back on.

I have been dispatched Code 3 to a community apporx 105 km away. We go L&S and we may not even see another vehicle on the road, but the deer will stay off the road.

No I was agreeing with you. I was just saying that just because you go L&S to something doesn't mean it's balls to the wall... I was actually agreeing with you, and just reinforcing the idea that we both share. Did you misread something???

I probably read something wrong, its been a monday for me =)

This, and unknown med history makes getting there to assess a priority. That doesn't mean balls to the wall flooring it, but have some urgency. If this patient was on blood thinners, very likely in that setting, had facial fractures that could compromise airway, and several other possible circumstances, why wouldn't you have some sense of urgency?

L&S doesn't mean flooring it and swerving in and out of traffic. Especially at rush hour, it just helps you not waste time sitting in traffic.

Okay Scuba what did I say in post that gave you the impression I would drive balls to the wall, I simply stated I would go L&S did you miss read something ?

I work for the same service as cprted and yes we would go to this call L&S but it seems that maybe some things have been overlooked,

Fell face first out of his wheel chair = rule in/out C-spine. His age alone could rule this in. (Did have a call where a pt fell from standing face first and was unable to get her hands out in time to break the fall, she was dead on arrival)

Good size hematoma = Possible brain injury (just had a call 28 female fell from standing, got up and said she was fine. Next day being medevac for a possible subdural hematoma)

It always amazes me that when people run L&S they think it means they have drive faster to get to the hospital, when in fact it is designed to make other drivers pull over so you can proceed. Here we are allowed to go 25 km over the posted speed limit while running L&S but that is only if it is safe to do so.

It is always better to be safe than sorry, and I think in this particular case you should have gone L&S because of all the factors that this particular pt could deteriorate quickly.

We let family members go with us and it is the attending's decision. I will always let a parent go, but will discourage them if I suspect child abuse. If I feel that the person that may want to ride with the patient is to upset to drive their own vehicle (they may crash), or if the patient wants a friend or family member to accompany them. they provide support. I honestly have never refused someone else coming along.

I have a question, If you have had DVT are you prone to get it again. And shame on you dwyane for not going and having some sort of a follow up for the last episode. I am very disappointed in you.....................and plus I have to post a pic on your wall of my b-day presents this year, as per instructions from my husband

^{ewwww I hope its me}

When I started all I had to have was a class 4 license. I had no training in driving, no orientation, or advise in how to do so. My experience was just driving big fords on the beach . And yes I did slam on the brakes a little hard a few times...........................................

people have cpr songs??

Yes we do. Next time your doing CPR sing one. if your sing out loud I would suggest Staying alive, the other one is a bit of a downer.

this is a great outcome. I wonder what cpr song was going through his head. Staying Alive or Another one bites the dust.

the headless teddy bear, spenec

Make sure they have built in knee pads..................

My friend had a brain stem stroke. When I first saw him, he was sitting on the stairs crying. His wife said they were just having a normal conversation and he all of a sudden burst into an emotional wreck and said he felt weak.

I did an assessment and it was very weird as every test on both sides were equal, for example grips, eyes, smile. He had no complaints of neck or head pain. At the time I knew that the ambulance was busy with a cardiac case, so I told the wife to take him to the hospital in their car but that they may have to wait.

They did an assessment and sent him home that night.

The next day I was doing a call and the wife came to the nurses station say her husband while in the shower had right sided weakness and couldn't raise his arm to get the shampoo out. He was in the waiting room.

They sent him for a CT scan and when he returned home they said they didn't find any signs of a stroke. I was the attendant that day and as we were unloading him, he saw his mother and burst into tears. I was very shocked because if you knew his mother, you would know this was very abnormal behavior.

The doc was going to release him as the tests didn't show a stroke. I asked to talk to the Dr. in private and she agreed. I let her know that I have known this man for 25 years and I couldn't put my finger on what was wrong, but he was not acting normal. She took me seriously and made arrangements for a MRI.

We then discovered that most times when CT scans are done for strokes they do not scan the brain stem. The MRI is the test that discovered that he did indeed have a stroke.

He is a very luck man as there is a very high mortality rate and the chances are very high to have another one. It has been about 4 years since it happened and the only lasting effects have been he has a slight right arm weakness and is always cold. He use to suffer from bi-polar type of symptoms but has been put on happy pills and it seems to have done the trick.

http://www.nbcnews.com/health/brain-scans-reveal-which-vegetative-patients-are-alert-trapped-bodies-6C10902050

Wow, it does sound like someone is suffering from Head up ass syndrome in the room.

http://www.thestar.com/news/gta/2013/08/06/toronto_paramedics_and_firefighters_at_odds_over_medical_calls.html

HUMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM is all I can say

EWWWWWWWWWWWWWWWWWWWWWWWW

Wonder where traitor is these days.....................

About the old timer: My instructor ( now retired, shes way old ) did say to do CPR on babies no matter how dead, for the parents sake. and I think that makes sense, nothing much worse than losing your own child, very very sad indeed.

So how do you explain to the cops and medical examiners that you have destroyed evidence in an abuse case. In BC we do not work on codes that are obvious not viable. As for giving notification to the family, it truly is the best thing to do and they do appreciate it more than you think.

I do know that compassion codes play a part and I have also done one in 15 years. Dead is Dead and we can't fix it.

I think instead of supine, how about recovery position to help aid in letting secretions drain, then if you suction maybe you could suction his left cheek where it is draining and may not have to irritate the infected areas? I'm guessing his pharynx, tongue, and everything at this point may be affected at this point. .

I did think of that, but this is why I didn't go that way.

The patient is going to be able to breath easier in the original sitting position, moving them into the recovery position in a moving ambulance is unsafe for both the patient and myself, I would rather not pull over and take the time to do that if it means a delay to the ER , and if they code I am ready for that scenario.

Well I had my time set aside only to have to be at my station dealing with the IT guy. Well Terri you tried and Scuba apparently you were there, good on you

Well this is an interesting scenario. It's always great to call in ALS but alas I do not have that luxury. Since I'm so efficient I have all my equipment with me

As I am doing my initial assessment ABC's, I will ask my partner to get the O2 on, I am choosing a non-rebreather at 15 lts. and to get the cot ready.

As soon as this is done my patient is getting onto my cot ASAP in a sitting position unless he goes unconscious then supine it is.

In all reality getting this patient to the ER and getting notification to them ASAP is my priority.

I can help with the secretions with suction but I need to be careful not to get to suction happy or I can wipe with a gauze to help.

With the hx that has been given I am also suspecting a stint has dislodged from the infection, so that is going to tell me that there is a chance the air is not necessarily going into the lungs but the chest cavity. I think that using a BVM may be detrimental in this case as the pressure may cause more damage, but if I had to it would be very gentle.

I can only use a King if the patient codes, so if he goes unconscious I am more apt to try a nasal airway first.

I will continue to monitor and reassure this patient all the way to the hospital and stay, help in the ER and truly hope for the best.

What is air to Chair?

If you don't have a DNR in your hands, no matter what happened prior, I would have to do life saving medic stuff.

You and your partner are working in a rural community, about 2 hours from any major centers

You are called to your local health center for a BLS transfer of a 60 year old male, going for a Head CT. It's a patient you've already been acquainted with, since two days ago one of the other crews brought her to the nearby stroke facility (~75 km away) for a suspected CVA, and after being given TPA and receiving 24hrs of monitoring, you and your partner brought her back for continued care.

It's been ~48 hours since TPA was given. Thrombolytics were unsuccessful, and the patient was left with right-sided paralysis and significant aphasia (he can only say "Yes", "No", and something that sounds like "bipisa").

When the nurses came this morning to give the patient his AM meds, the patient was found to have lost the ability to swallow or chew (new finding), and seemed increasingly confused. The attending physician has now requested a repeat head CT at a center ~1.5 hours away.

When you arrive at the nurses station to receive a report, you find that all of the nurses are missing. When you look around, you discover that all of the nurses are in the room where your patient currently is. They're moving around frantically, and they've just finished administering adenosine.

The patient appears significantly distressed, is not responding to questions, and appears acutely ill. He's on a NRB at 15 lpm, has a 20g IV in his left wrist running at 75 ml/hr, and has cardiac monitoring showing a rate of ~190bpm.

What would you like to know? What would you like to do? What do you think is going on?

I would like to ask why you did this as a BLS Transfer. Most of us have stated that BLS would not be transferring this pt. and if ALS was not available I would be taking a Doc on car with me.

Personally with this pt I am picking up the air vac crew and be the taxi driver along with being extra hands if need. I am not touching this pt. with a ten foot pole.

You arrive on scene to find an elderly gentleman sitting in his recliner. He is obviously disturbed that you are here. He says that his wife called you after he told her not to. When you talk with the gentleman, you find that he is having a significant amount of chest pain that radiates down his left arm and into his jaw. He says that he is tired of hospitals and does not want you to do anything for him. He tells you that he has a long history of heart problems and was recently told he needed a heart transplant. You try to convince the man to let you transport him to the hospital for treatment, but he continues to refuse care. You ask him and his wife if he has some form of advanced directive there at home, and they tell you that "the doctor is working on it but has not sent it home yet." WHAT DO YOU DO?

· What options do you have?

· Is there anything you can say or do to convince the patient to go to the hospital?

· What if he becomes unconscious before you leave; will your approach change then?

· Would your approach be any different if the patient had a valid advance directive present?

So if you are trying to get us to do homework for you in creating these senario's at least write down what you would do and we may guide you on the right direction. No one wants a paramedic who has not done the work in class to pass and become a bad medic. just my thoughts.