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Spock

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Spock last won the day on June 2 2017

Spock had the most liked content!

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    Male
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    Pittsburgh

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  • Occupation
    CRNA, Medic, Hazmat Tech

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  1. Recently, one of our crews responded to a 30 year old female seizing. Upon arrival, they found she was one week postpartum and they called me for backup. We worked her up as eclampsia and gave six mg of magnesium and ten mg of versed but she never stopped seizing. They had initially suctioned her and assisted respirations with a BVM but when I arrived she was breathing and I had the paramedic student keep the BVM sealed and do a jaw thrust. Sat was 100% and ETCO2 was 40. I did not want to intubate her without RSI drugs so we maintained her for the 15 minute transport. Turned out she had
  2. With all of my DMAT deployments over the past 12 years I can safely say that working in the austere environment is a bigger challenge than all of the thoracic cancer patients I see every day in the operating room. My top five would be: Epinephrine 1::1,000 Aspirin Benadryl Ancef Toradol Good question and the other posts all have merits but I would't have any RSI drug nor would I have any scheduled opioids. When we set up a clinic in Texas for Harvey, we immediately posted a large sign in triage that said we would not refill opioid prescriptions. Saw a lot
  3. WOW! Dust may have passed into the great unknown but his legacy is alive and well when you realize he has prompted vigorous discussions so many years later. I never met Dust personally but I did have several off line conversations with him and I can only say I thought he was one of the most perceptive and caring persons I ever encountered. He really wanted everybody in EMS to excel and fools and idiots were not tolerated. Sadly every profession has far to many fools and idiots. Dust was an icon and everyone should strive to attain the pinnacle he set and be satisfied to only reach 70% of
  4. Sorry I am so late to respond to this topic but I just saw it and have a unique background. My first career was as an athletic trainer and I worked at the high school, university and professional football levels and I have maintained my license to this day. I am also a paramedic, registered nurse and certified registered nurse anesthetist so I can say with complete certainty that EMS providers of any level and registered nurses are NOT qualified to make return to play decisions. Every youth sports team should make provisions for medical care during practices and games and certainly cost is
  5. I'm not going to weigh in on this topic either way because although I have worked as a paramedic and a firefighter, I never had to depend upon either profession to pay the bills. That said, I almost peed myself laughing over the comments by Van. Troll to be sure but I did find it funny in a sarcastic sort of manner. Choose a profession that allows for growth and a new challenge every day otherwise you will wither and fade into the dust. Spock May the tube be with you.
  6. I am certainly not an expert on billing but the face sheet from the hospital is automatically imported into our computerized charting system. Our biggest problem is the insurance companies write the check to the patient and not the service so some folks see this as a windfall and never pay the EMS bill. Screwed up system to be sure. Spock May the tube be with you.
  7. Completely agree with Mike. It is NOT a sign of weakness to ask for help no matter what some folks in medicine may say. EMS may not be an option for you but a good counselor will steer you in the right direction. Mike is also correct that it may take a few counselors to get you straight but don't give up quickly. Good luck and the City hopes the best for you. Spock
  8. The issue is not how many intubations you have, but how many airways did you manage successfully? The vast majority of EMS calls require no active airway management skills so you could say you were were mostly successful. I ask is MOSTLY good enough? Five times the number of years experience equals 135 which is a slow three months for me. Ruff is good people but we have to be realistic about our capabilities and recognize that practice and every day training is vitally important for good patient care in all areas of medicine including but not limited to airway management. Ruff was correc
  9. OK, I think I am a reasonably intelligent person but when it comes to computers, I am a Neanderthal. I couldn't read the original petition or any data but since I am not on Face Book the reason should become clear. One of these days I am going to invent my own anti-social network called "In your Face" and I bet it would be a hit. But I digress. I presume this is in response to the proposal to remove endotracheal intubation (ETI) from the paramedic scope to practice. This has been bounced around for quite some time and the literature I have read is conflicting. First, the original lit
  10. OMG, Calvin and Hobbes! My all time favorite comic stopped and I went into a six month funk. How about a Spaceman Spiff Club? This made my day! Spock
  11. The Pittsburgh School District once had a Public Safety program where students took classes in law enforcement, fire suppression, and EMS while also completing the standard reading, writing and arithmetic classes. It was successful in supplying the city with good candidates for those professions but was eventually discontinued due to low enrollment. Wish I could help with classes in Texas but I would encourage you to keep looking. Any 17 year old that wants to pursue this type of thing is special. Go for it! Live long and prosper. Spock
  12. Off Label has a great post. I really do believe that obese patients that fall and can't get up for an extended period of time will exhibit signs and symptoms of crush injury. How long does that take is unknown but I suspect it depends upon BMI and the amount of tissue compressed. I've had patients with crush injuries from traditional causes (building collapse) and medical causes and they are very challenging. Prehospital concerns are acidosis, hyperkalemia, low BP, and pain. A crushed extremity that does not hurt is a very bad sign and will result in amputation and possibly death. Saw fa
  13. Crush injuries are well documented in the literature. They are usually caused by trauma but can be from medical conditions such as the diabetic patient that passes out and lays on the floor for days before being found. Glucose levels are through the roof and the patient is in DKA. We saw a lot of crush injuries in Haiti after the 2010 earthquake and amputated many limbs. Biggest concern for crush injuries is the sudden release of toxins when the offending structure is removed from the patient. They become acidotic and will crash as fast as you can say boo. Have the bicarb and calcium rea
  14. Plagiarism is a major problem in academia and can never be tolerated. I'm not accusing anybody of this but one must be careful and any publisher worth their salt would be all over this type of thing. I have worked with two friends and our third text went to the publisher this week which meant we went out and had dinner and MANY drinks to celebrate! Our current book is similar in topic and is titled "True Stories from the Athletic Training Room." We collected stories from colleagues and came up with some real doozies including many that dealt with interactions what EMS but all are credited
  15. Spock

    CHF & Low BP

    Low dose dopamine is notorious for causing tachycardia and it has been seen in higher doses also. CPAP can drop the BP because of the increased inter-thoracic pressure causing a drop in preload. Let's face it, this patient scenario is a nightmare for ANY health care provider and if you get your patient to the hospital or to the end of your shift with a pulse, then you did a great job. A puzzlement to be sure. May the tube be with you. Spock
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