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emtannie last won the day on May 16 2011

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About emtannie

  • Birthday 10/25/1966

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    anything medical

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    pushing for change

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  1. Old folks Still here?

    I haven't been here in ages! But, this thread kept showing up in my feed, so I am succumbing to peer pressure and responding.
  2. Just wandered back to see what's new....

  3. Failed

    As some of you know, it has been a long time since I have really been here in the city... and to be honest, I have been avoiding it, mostly in shame. In 2009, I started paramedic classes... I loved it, even though juggling a not-so-stable home life, running my own business, and being guardian and sometimes caregiver for my mom was sometimes a challenge. I did well in my classes, and was looking forward to my practicums. In 2010, two tours into my practicum, my mom became acutely ill, and within 3 days, I had to make the decision to remove her from life support and explain it to the rest of my family. As I was not allowed to take time off from my practicum, I withdrew for a year, as was required by the college. I went back in 2011, and struggled through my first practicum. I felt my preceptors weren't being the mentors I wanted. When I asked for clarification, they said "look it up." When I asked for them to quiz me on medications, they said "later." Although they signed off on all my skills and competencies, at the end of my practicum, they informed me that they were not going to pass me to go on to my next practicum because "you are not sociable enough." Not with patients, but with other staff... they said I studied too hard and didn't spend enough time having coffee with staff (WTF???). They also refused to complete the final evaluation, so I was in limbo.. I contacted the college numerous times to see what my options were, without getting a response. Finally I appealed to the Dean and President of the college. Instead of accepting my completed competencies, I was required to re-do that practicum AGAIN. I did not perform well. I was frustrated, and I struggled. I lost focus, I was making dumb mistakes. One of the staff where I was doing my practicum told me that my preceptor had been told by the college to make my practicum as difficult as possible, so I would leave, because I had embarassed them by appealing my previous practicum. I couldn't do it... I gave up and withdrew... I failed in my attempt to be a medic, something I always wanted... and in the year since then, every day I wake up and hate the fact that I didn't make it. I hate that medics I work with tell me that I should be a medic, that I am better than half the medics out there, and yet I couldn't do it. I hate that I wasted all that time and money, and have nothing to show for it. I hate that there are people who I thought were really good friends, who haven't spoken to me since I left school. I should have fought harder. I should have done better. I should have been successful... I stalk this site, and read the posts.... and think "I have nothing to add... " so I don't.. I am not posting this for sympathy... I don't want sympathy... I am posting so those that asked, know why I am not here anymore. I don't think I have anything to contribute... and until I figure out how to regain that confidence, I won't. I won't go back to school - I can't afford it, and on the positive side, my business has really expanded in the last year, and I still work casual on an ambulance, so that helps keep me busy. Be safe all...
  4. Truths for grown up folks...

    Dwayne.... please please PLEASE delete my browser history if I die... Why fold a fittes sheet anyways? No one will see it. #10: Bad decisions make good stories.. AND KEEP ME EMPLOYED... I think another one to add to your list is: does anyone know what that blue screen of death on the computer really is? We all know it is bad, but then what?
  5. No SOB, no complaints, but wheezing?

    I have been following this thread for a couple days... and it is bothering me... I feel like there is something I am missing when I read the thread... The patient is wheezing, but has no history to support it, and vital signs show no distress... I get that the event could precipitate an asthma attack, and I can see where a neb could be justified. But, I can also see why comfort only is ok, since patient has good sats and is not complaining of any breathing distress. I want to dig a lot deeper into his history... is there anything.. ANYTHING.. that this wheezing can be attributed to? He may not think that something is pertinent until we ask the right question. Where does he work? Any possible exposure to chemical inhalant, asbestos, silicone? Chlorine from a swimming pool? Was there anything leaking from the vehicle that could have been an irritant? I just want to question this guy to the point where I am annoying... And turnip - I am fully in favor of the therapeutic head slap for texting while driving...
  6. Refusing To Assist With CPR Because of No Gloves?

    For those who are questioning why the OP was using an AED or had their monitor set to AED, look at his profile – first responder… that does make sense. I am assuming that the medics got there after you did… I am curious – what are the protocols for a medic to say a patient is a non-workable code? Here, if the arrest was not witnessed, and the patient has obvious signs of death (lividity, rigor, cool temp) we can call it on scene, and do not have to work the code. This may have been a situation where working this patient may not have been the best option; I was not there, so I won’t say that this is an absolute. And, not knowing what your protocols are, you may not have the option to not work a code. I agree with others here – the “no gloves” excuse is an excuse, and he could have come up with a better one. It does sound like your ER and EMS staff do need to review codes though… between you, your EMT-I partner, 2 medics, and the ED staff, you didn’t have enough people to rotate through doing compressions? Drawing up the meds and getting the IV line in place (or IO) doesn’t take very long, and I am assuming it was done on scene (it should have been, since the patient was tubed on scene). Epi and atropine should be in pre-dose syringes… The patient was tubed on scene, so that was taken care of… At the ER, one person should be on airway, one recording, one on the chest, and the others should be stepping in to spell someone off as needed. Your medics should have been able to instruct you to stop compressions for a few seconds, look at the monitor, say “asystole, continue compressions” and advise their partner to give the appropriate med…. Other than during transport, you shouldn’t have had to be on the chest for extended periods. Nope – don’t report him… what good would it do? He was off duty – he really didn’t have to assist at all. His excuse was lame, but, he really had no obligation.
  7. saw a great fridge magnet today - "My dog makes me happy.. you, not so much." I now own that magnet....

    1. Show previous comments  1 more
    2. emtannie


      LOL it was at one of those expensive gourmet dog toy/clothing/food places in a mall... of course, I had to buy a few things for my dog...

    3. DwayneEMTP


      I want one that says, "My dogs not a bitch...." Well, you know.. :-)

    4. Happiness


      I have a sign "Husband and dog missing 25 cent reward for dog"

  8. The Man and the Ostrich

    A man walks into a restaurant with a full-grown ostrich behind him. The waitress asks for their orders. The man says, "A hamburger, fries and a coke," and turns to the ostrich, "What's yours?" "I'll have the same,"says the ostrich. A short time later the waitress returns with the order. "That will be $9.40 please," and the man reaches into his pocket and pulls out the exact change for payment. The next day, the man and the ostrich come again and the man says, "A hamburger, fries, and a coke." The ostrich says, "I'll have the same." Again the man reaches into his pocket and pays with exact change. This becomes routine until, the two enter again. "The usual?" asks the waitress. "No, this is Friday night, so I will have a steak, baked potato, and salad," says the man. "Same," says the ostrich. Shortly the waitress brings the order and says, "That will be $32.62." Once again the man pulls the exact change out of his pocket and places it on the table. The waitress can't hold back her curiosity any longer. "Excuse me, sir. How do you manage to always come up with the exact change out of your pocket every time?" "Well," says the man, "several years ago I was cleaning the attic and found an old lamp. When I rubbed it a Genie appeared and offered me two wishes. My first wish was that if I ever had to pay for anything, I would just put my hand in my pocket and the right amount of money would always be there." "That's brilliant!" says the waitress. "Most people would wish for a million dollars or something, but you'll always be as rich as you want for as long as you live!" "That's right. Whether it's a gallon of milk or a Rolls Royce, the exact money is always there," says the man. The waitress asks, "But, sir, what's with the ostrich?" The man sighs, pauses, and answers, "My second wish was for a tall chick with a big ass and long legs who agrees with everything I say."
  9. When To Use Glucagon IN

    I went to that site, and wandered a bit - there is some good information there. FOr those who don't want to spend the time, here is a clip I found: "Literature overview and discussion A moderate amount of literature exists demonstrating that intranasal glucagon is effective in treating hypoglycemia. Most of this literature suggests that nasal glucagon is optimally absorbed if mixed with a surfactant additive (such as sodium glycocholate rather than the sterile water diluent that comes with the package) to enhance absorption. The literature is also fairly clear in showing that intramuscular or subcutaneous glucagon leads to more rapid rises in blood glucose with longer effect.[3, 4] Pontiroli and colleagues have published the majority of data on this topic.[4-7] Other authors have also confirmed the effectiveness of IN glucagon when mixed with absorptive enhancers." (http://www.intranasal.net/Glucagon/default.htm#Literature_overview_and_discussion) I can see where IN would have advantages, especially in combative patients, or patients with very poor vascular access. I'm not convinced it should be "the standard" for glucagon administration, as the research shows that it is not as rapid as IM injection, and the goal is to improve glucose levels as fast as possible.
  10. Clinical Judgment and Protocols

    Wow - I am gone for 24 hours, and I am 5 pages behind on this thread. Johnboy, twice I have asked you for specific references to show that glucagon intranasally is a superior option. Twice I have asked you to provide your protocol so that we can review it. Twice, you have ignored me. I see that since I was away, you have posted "references" without actually citing the sources. THis is not just bad form, it will get you a zero grade if you tried this on any paper you tried to hand in in your medic class. Rather than have intelligent debate, you have resorted to namecalling, rather than citing medical sources to prove your point. Medscape is a good site, but when you can't even attach the link to the information you provide, your post is useless. So, again, I will ask: 1. Please provide recent medical journal references that specifically refer to glucagon IN as an appropriate intervention, and shows that is has a faster response than glucagon IM. 2. Please provide your local protocol which shows the hypoglycemia algorithm allowing you to use IN glucagon and under what circumstances 3. Can you tell me if you reconstitute the glucagon when you administer it IN, and if you also add a surfactant to it? I am curious. You have called all of us here "idiots" and stated that "this is not a site for learning." Johnboy, I am trying to learn - I, and others, have researched glucagon IN and haven't been able to find where it is the "current standard" as you have stated, so we are asking you to educate us in this. How can you say that this is not a site for learning? We have asked for the information, you have refused to provide it' therefore, you are the one who is preventing learning, not us. Johnboy, please note - Dwayne has never stated that he didn't deserve to be fired. In fact, in his first post in this thread, he cautioned Bieber about working outside of protocol, so your continued attacks on him are completely invalid. Again, until you can provide a post with accurate information, and refrain from name-calling, I will consider you a troll and nothing more.
  11. Clinical Judgment and Protocols

    I think I am going to ask admin to check your IP address.... your actions are very similar to another member here who tends to throw out supposed facts and then cannot support them with actual references. Your continued attacks on Dwayne are childish and unprofessional. Did Dwayne act outside of protocol? Probably.... did he have justification for it? Absolutely. Did he do more harm to the patient? Absolutely not. Did he get fired? Yup. Was the firing justified? Not in my opinion, as he had valid reasons for his actions. He didn't use the IO to be a cowboy... he did it because it was the right thing to do for that patient. If I or a member of my family were sick or injured, I would want a practitioner like Dwayne to respond, because he is NOT a cookbook medic who can't think outside the box, and who puts the care of his patient first. Dwayne has been very open about the fact that his care was aggressive. I would like you to explain how his actions were "wrong." Did he do more harm to the patient? Your comments of "you people" and "people like you" are emotionally based, not factually based, and show that you cannot support your claims with more than emotion. If you continue to post on this site, you will continue to be asked to back your claims with something factual. Twice I have asked you to provide references, and twice you have ignored my request and responded with replies that are completely opinion, not fact. I cannot treat your posts with the respect you think they should earn, when you cannot provide information to back up your claims. Based on your posts thus far, until I see an intelligent post from you, backed with actual evidence, I will assume you are a troll here for the sole purpose of annoying others. I am open-minded enough to change my opinion if I am shown evidence to prove me wrong.
  12. Clinical Judgment and Protocols

    Johnboy, This is what I have found so far (yes, Google is my friend): "Glucagon administered intranasally has been proven to raise blood glucose levels in volunteers. The effect of intranasal glucagon on blood glucose is similar to that seen after intramuscular administration for the first 15 minutes following administration." (Carstens, S. and I. Andersen (1994). "[intranasal glucagon in the treatment of hypoglycemia. A therapeutic possibility in the future]." Ugeskr Laeger 156(30): 4339-42.) "Glucagon in solution with a surfactant (deoxycholic acid 1% w/v) was administered by intranasal spray to 6 healthy fasting subjects and 6 insulin-dependent diabetics with insulin-induced hypoglycaemia. In the normal subjects, intranasal glucagon increased plasma glucose levels, with a dose-response effect. In the diabetic patients, plasma glucose levels showed a mean increase of 100% above nadir values in approximately 26 min in response to 7.5 mg intranasal glucagon; hypoglycaemic symptoms were relieved within about 7 min. These results suggest that intranasal glucagon is effective and may represent an alternative to parenteral glucagon or glucose or to oral sugar as the first-line treatment of hypoglycaemic episodes in insulin-dependent diabetics." (Freychet, L., S. W. Rizkalla, et al. (1988). "Effect of intranasal glucagon on blood glucose levels in healthy subjects and hypoglycaemic patients with insulin-dependent diabetes." Lancet 1(8599): 1364-6.) "We conclude that glucose recovery was significantly better after i.m. administration of glucagon than after intranasal administration. However, the differences between the incremental plasma glucose and the time for incremental plasma glucose to exceed 3 mmol.l-1 were not considered of major clinical importance." (Hvidberg, A., R. Djurup, et al. (1994). "Glucose recovery after intranasal glucagon during hypoglycaemia in man." Eur J Clin Pharmacol 46(1): 15-7.) "Intranasal glucagon raised blood glucose levels in patients with hypoglycemic episodes, although less effectively than intramuscular glucagon." (Pontiroli, A. E., A. Calderara, et al. (1989). "Intranasal glucagon as remedy for hypoglycemia. Studies in healthy subjects and type I diabetic patients." Diabetes Care 12(9): 604-8.) "There was no difference between nasal treatment with 2 mg ( and i.m. treatment ©, both being more effective than 1 mg (A) nasal treatment, P less than 0.1. BG continued to increase up to 10 mmol/l 90 min after i.m. glucagon administration, whereas it stabilized at a level of 4.6-6 mmol/l, 30-45 min after nasal administration. Eighty percent of the patients had side-effects to nasal administration - local irritation, rhinitis or sneezing." (Rosenfalck, A. M., I. Bendtson, et al. (1992). "Nasal glucagon in the treatment of hypoglycaemia in type 1 (insulin-dependent) diabetic patients." Diabetes Res Clin Pract 17(1): 43-50.) A 2006 article in EMSWorld calles nasal administration a milestone yet the references cited do not support it (http://www.emsworld.com/print/EMS-World/A-Milestone-Change-in-Practice/1$5165) and are based on versed and narcan intranasally, not glucagon. I have not found any research articles or studies dated in the past 5 years, even after reviewing more than 10 pages of Google hits. If it is the new standard, one would think that I should have found a recent study, or references to services using it in their protocols. So, again I will ask you, as I did in my previous post: Could you tell me a little more about using Glucagon IN, and what your protocol dosages and recommendations are? Please provide the references so I can follow up. If you are going to make the comment it is the standard now please provide the evidence to support it. I would love to read the research that supports this, and be able to bring it to my medical director. (Edited to bold segments only)
  13. Clinical Judgment and Protocols

    I was thinking the same as Fixnat... Glucagon generally takes at least 20 minutes to take effect, and my concern with this patient is that given her current situation, are we prepared to wait that 20 minutes, as that window for thrombolytic treatment closes if she is in fact having a CVA? Was Dwayne's treatment aggressive? Absolutely. Did he think outside the box? Absolutely! Did he do more harm to the patient? Absolutely not! This was a rare situation, which most of us will never encounter. Would I have done the same thing? I don't know, because I am not as smart as Dwayne is, and I may not have considered that option. In our protocols, thatg is a bit of a grey area, where using the IO would have been an option as long as I could have explained it to my medical director. Johnboy, I have never heard of using Glucagon IN (which I am assuming means intranasdally). So, tonight at work, I thought I would research it a bit. I looked in the 2010 CPS, and there is no mention of using Glucagon IN. The only recommendations are IM and in lower doses, IV. A direct quote from the CPS is "It is important that the patient be aroused as quickly as possible, because prolonged hypoglycemic reactions may result in cortical damage." I believe that in Dwayne's situation, he did exactly that. Could you tell me a little more about using Glucagon IN, and what your protocol dosages and recommendations are? Thanks!
  14. annie i know that your tougher than that ... you would not even need shears

  15. Dear.....

    A friend sent me this - enjoy! ************************* Dear Noah, We could have sworn you said the ark wasn't leaving till 5. Sincerely, Unicorns Dear Twilight fans, Please realize that because vampires are dead and have no blood pumping through them, they can never get an erection. Enjoy fantasizing about that. Sincerely, Logic Dear Icebergs, Sorry to hear about the global warming. Karma's a bitch. Sincerely, The Titanic Dear J.K. Rowling, Your books are entirely unrealistic.. I mean, a ginger kid with two friends? Sincerely, Anonymous Dear America, You produced Miley Cyrus. Bieber is your punishment. Sincerely, Canada Dear Yahoo, I've never heard anyone say, "I don't know, let's Yahoo! it..." just saying... Sincerely, Google Dear 2010, So I hear the best rapper is white and the president is black? WTF happened?! Sincerely, 1985 Dear Windshield Wipers, Can't touch this. Sincerely, That Little Triangle Dear Rose, There was definitely room on that Door for the both of us. Sincerely, Jack PS, you let go Dear girls who have been dumped, There are plenty of fish in the sea... Just kidding! They're all dead. Sincerely, BP Dear Saturn, I liked it, so I put a ring on it. Sincerely, God Dear Fox News, So far, no news about foxes. Sincerely, Unimpressed Dear jf;ldsfa/kvsmmklnn, Please lknvfdmv.xvn. Sincerely, Stevie Wonder Dear Nickleback, That's enough. Sincerely, The World Dear Skin-Colored Band Aids, Please make one for every skin color. Sincerely, Black people Dear Scissors, I feel your pain.....no one wants to run with me either. Sincerely, Sarah Palin Dear Mary, Just admit that you slept with someone else. This is getting out of hand. Sincerely, Joseph Dear Osama Bin Laden, Marco.... Sincerely, United States Dear World of Warcraft, Thank you for ensuring my son's virginity. Sincerely, Parents Everywhere Dear Anne Frank, Two can play this game.... Sincerely, Waldo Dear Batman, What was your power again? Sincerely, Superman Dear Customers, Yes, we ARE making fun of you in Vietnamese. Sincerely, Nail Salon Ladies Dear Global Warming, You're the best imaginary friend ever! Sincerely, Al Gore Dear Ugly People, You're welcome. Sincerely, Alcohol Dear Mr. Gump WTF are you talking about? There's a little diagram on the lid that tells you EXACTLY what you're gonna get.... Sincerely, Jenny Dear Katy Perry, I liked the kiss too. Sincerely, Justin Beiber Dear Haiti, Is it too early to ask what's shakin'? Sincerely, Seriously Going To Hell Dear Martin Luther King Jr. I have a dream within a dream within a dream within another dream.... What now? Sincerely, Leonardo Di Caprio Dear World, Please stop freaking out about 2012. Our calendars ends there because some Spanish d-bags invaded our country and we got a little busy ok? Sincerely, The Mayans Dear Snooki, GET BACK TO WORK! Sincerely, Willy Wonka Dear White People, Don't you just hate immigrants? Sincerely, Native Americans Dear iPhone, Please stop spellchecking all of my rude words into nice words. You piece of shut. Sincerely, Every iPhone User Dear Giant Spider on the Wall, Please die. Please die. Please die. Please die. CRAP! Where did you go? Sincerely, Terrified Dear Trash, At least you get picked up... Sincerely, The Girls of Jersey Shore Dear Man, It's cute, but can you pick up peanuts with it? Sincerely, Elephant Dear Dr. Phil, Look man, there's only room for one fake doctor in this world and I was here first. Sincerely, Dr. Pepper Dear Women, I can't read your mind so just tell me what's wrong or I am going to "Pretend" everything is fine Sincerely, Men Dear Women, Your shopping experience is of absolutely no interest to me! Sincerely, Men