Mateo_1387

I think we should be thinking about the children ! Lets start sterilizing all confirmed HIV patients and patients with high potential to contract the disease. Easy to say when it is not your penis. I'd also beg to differ about sensitivity. Although performance and pleasure are still achievable, it is still going to be different. Fine and dandy, but it still needs to be the decision of the adult male. More than a half-centimeter. Me too, if the consenting adults wants it. Sounds good, let the decision be up to the adult in question. Damn Skippy!

LOL. I am sure they can.

That may be. Condoms were just a suggestion to prevent an invasive procedure. I still say circumcision needs to be the decision of the adult male. It is not right to force that decision on a male when he will have to live with it for the rest of his life.

Condoms are effective to prevent the spread of HIV, HPV, and HSV-2, yet condoms require no cutting or altercation of a defenseless infant.

Is there a link for this source? Has there only been one study done to determine the effectiveness of pulse checks during CPR. I am thinking it is not a bad thing to do, even though it is not a definitive assessment tool. It is like listening to breath sounds. You have patients just starting to develop pulmonary edema, yet they have clear breath sounds. Although just listening to breath sounds is not definitive in this case, listening to breath sounds may still add to the bigger picture. This is how I am viewing the pulse checks.

I have been lucky to not make a medication error as of yet. Hopefully, it will not happen either. The service I am currently with does not have a set way to report medication errors. If I did make an error, I would document it and pass it along to the nurse. In the service I used to work with, they required that as soon as you realized you did something wrong, that you immediately call up the Medical Director to report it. The reasoning behind this is because the medical director needs to know immediately what happened so that he could discuss with the patient's physician the issue. Of course, it is also required to document the error. The old service expected everyone to report their errors and made sure to let everyone know that reporting did not mean they were going to get 'fried' by administration. They would however, if it were a major problem, recommend some remedial training that was supposed to work in a positive manner, and not a negative one. Of course if the issue persisted, they would of course address the best way to correct the problem.

Baby Hannah should have received an award for her breakfast defeat too !

Maturity definitely is vital to the business. Nothing worse than a bunch of old experienced medics laughing and carrying on in front of patient's and their families... Life experience can be beneficial, but it is not everything when working on an ambulance. Most EMS folk I know have 'life experience' that exceeds mine, but I still would not trust them to work on my dog. By life experience, do you really mean EMT-B experience? I am confused on your point here. Maturity is not necessary to know when to push a drug or to perform an intervention. But I am sure that most intelligent providers are probably also mature. Just saying they are not dependent of one another. Also, experience, in my opinion is not always necessary to know when to perform an intervention. I am a no0b paramedic and do no have the experience some providers have. Yet there are many interventions I perform that other paramedics would not even consider. Experience, I believe, helps a provider to be more comfortable with their intervention, and picking up on the very minute things that happen on a scene. Again, the point is that experience is not dependent upon a competent provider, as we have all seen providers with years upon years of experience, yet they suck as a provider. She is probably a better provider today because she gained that skill after having a better education foundation than the average EMT-B. She did no learn the bad habits as an EMT-B, and then later have to break those bad habits when she became a paramedic. I agree with the first three sentences. There definitely are changes in the mindset of someone 18 vs 22. I just do not like the idea that because someone is young, they are not capable. You can still be old and not experienced in the ways of EMS. Releasing anyone of any age to treat patients, when they are not capable, is a recipe for disaster. Releasing a dual medic truck, with two 22 year old providers who are capable would not be a recipe for disaster. This is being sensitive to the situation, not generalizing that young=inexperienced exclusively. Good idea.

Probably some of Jake's (JakeEMTP) folks. I guess just another one of NC's finest.

I am seeing sinus tach with biventricular hypertrophy and biventricular strain pattern.

Thanks Doc, but why can't it be arrhythmia with PAC's. Take a look at the XII lead, there are clearly what appear to be round upright p-waves. I was under the impression that WAP and MAT all have different P-wave morphologies as well as varying PRI. The rhythms he showed us have Complexes that are regular, as well as some that are premature and late with varying p-wave morphologies.

The underlying rhythm appears to originate from the sinus node. There also appear to be ectopic atrial contractions. This may be why it looks like WAP or MAT. Take a look at the XII lead. There are plenty of similar p-waves, and the occasional biphasic and inverted p-wave, indicative of ectopic atrial contractions. I am sticking with my guns, I think it is more of a sinus arrhythmia, or even a sinus block (meaning the ectopic atrial contractions may be compensatory). Does this person have sick sinus syndrome?

I disagree with MAT or WAP. Although the rhythm is irregular, the PR interval remains the same. I think you are dealing with sinus arrhythmia along with an ectopic beat. Here is why: PRI remains the same. R-RI at times is regular, then becomes irregular. (except one) a p-wave for every QRS. QRS for every p-wave. P-waves are round and upright. (not different morphologies as is WAP or MAT)

I did not see where it was confirmed if she was beat or not by her parents. Just a thought, but I wonder what statistics would show, of prisoners, if questioned whether they were beat or not as children. I would bet yes, as beatings are the most common form of punishment as children.

Aw Hell. I flubbed. You are correct. I was meaning to talk about vitamin K. Thanks for clearing it up !

Spenac, I do not know of any specific ECG findings that say 'drug abuse.' There are however street drugs that do affect the heart. Drugs that are stimulants can affect the heart rate, contractility force, and increase oxygen demand. Depending on the health level of the patient, these drugs may affect how the heart reacts to the drugs. Cocaine, for example, can cause an increase in HR, increased oxygen demand, and an increased contractility force, and cause arterial spasm. A patient, who OD's on say cocaine, may show symptoms of heart problems. The effect of cocaine on the heart can cause the same effect as say a thrombus in the heart, which is ischemia. A history may clue you in to suspect something such as a drug induced AMI. There has been a problem lately in NC with some cocaine being cut with a veterinary grade drug called Clenbuterol. Its effects are similar to albuterol and ephedrine. These patients would present with a 'high' unlike their others, with tachycardia, and anxiety. The albuterol effects would push potassium into the cells, causing the patient to become hypokalemic. Standardized treatment with Sodium Bicarbonate is not advised with these patients. More information can be found at http://www.jems.com/news_and_articles/tips...l_outbreak.html Any more specifics on the XII leads you ran? Did you have any changes on the XII lead and patient condition with your treatments?

I would not say that it is necessary to monitor the glucose closely, unless under special circumstances you deem it necessary. I threw it out there to invoke some thinking about the metabolic effects of Solu Medrol. For example, Solu Medrol can increase glucose levels. Typically, patients can present with multiple problems. Although there may be an acute inflammation problem, the patient may have secondary metabolic problems, such as diabetes. It is just something more to add to the mix.

I am going to go ahead and start surgery. Go ahead and relieve the pressure in the brain to improve circulation and decrease swelling. My 15 day Spenac paramedic class went over Pediatric neural surgery for all of 1/2 hour, so I am adequately prepared for such. Plus, I stayed in a Holiday Inn last night. On a serious note, the potassium is slightly low. Being born at home, it is doubtful the baby received a K+ shot. Potassium could be causing her to not have adequate blood clotting, leading to extended bleeding.

Attitude is everything. It is sad to see EMS providers that cannot show simple respect to another person. Patients calling for help should not have to hear things such as "why is THIS pain different now at 3am than it was 7pm LAST night?" Too many people are short winded with patients, tell them how it is 'gonna be', and usually plain dicks to patients. Why do you think this attitude shows? I say due to burn out. I have noticed in my short time that patients are much easier to work with when they are shown a bit of respect. The other reason I think certain EMS providers have an attitude about their patients is because they do not possess enough medical education. So many times I run to nursing homes, frequent fliers, and the like to find sick patients where my partner is saying "they should have sent a convalescent ambulance to transport." I usually end up having to take the call because the patient is in pain and deserve pain meds, they are dehydrated and need fluid, their breathing is not normal and I suspect other medical emergencies. It is the difference between appreciating what the patients’ problem is rather than thinking about going back to bed. As far as ass kissing patients, you need to take a step back. If you do not like your company's 'you call we haul' method, then go find a better EMS agency to work for.

Does anyone give it for pneumonia? How about Pulmonary Edema? Does anyone check blood sugars before giving the drug?

Chest decompression. Duh !

LOL. That brought a smile to my face. And to fix your problem, start transporting to Mexico !

AHA recommends codes be worked on scene because they do have a better chance of ROSC than a code being worked in an ambulance. Next time that fellow comes in to 'hang out' with you, let him know just how lucky he was, as chances were very much against him being worked in the back of an ambulance. You already admit to allowing family to ride in certain situations. So why do you discriminate? I have to agree that justification needs to be met as to why you may deny someone to ride, such as a rider being hysterical. I get the impression your risk management dept. is not very savvy in your area. If so, that is a shame. Either way, you should be able to treat a patient's physical harms as well as support their emotional needs. We can drop the tatts deal. You do not get it anyways. I am not comparing tatts to riders, but rather the regulation of stress inducers.

What exactly is a hospital problem? Do you not consider EMS an extension of the hospital? I do, and as such, I administer care along the same lines as the hospital. Parents will want to be with their children as well as children of older parents may wish to be with their parents as they receive medical care. With family present, it will help to calm our patients and keep their emotional needs in check. Especially with dying patients, I firmly believe loved ones should be near by. I realize in an ambulance, it is not practical to transport the whole family. Transporting a caregiver for an older adult, or both parents, may be needed, as the ride to the hospital may be the patient's last. We, as medical professionals are not just there for the patient, but we are also there to satisfy the family. When we piss off the family, or do not perform to their wishes, whatever the family says will help give us an even bigger black eye. Cynical_as_hell, your second to last sentence ( "So what if their feelings get hurt or they get offended, at least you will still have a job." ) is disturbing. I sense no compassion at all. One thing I have noticed that EMS lacks a lot of is compassion for the other person. Too many times we come across as dickheads to everyone. Something we all need to work on to give EMS a good name. Spenac, when you ride your 90-mile trip to the hospital, with the family following behind, you are not allowing them any participation. 90 miles is a long time for the patient to die. You may be the last person that is with that patient when they die, but you will not replace the comfort a patient may feel by dieing with a family member by their side. Also, as a parent, I will want to be with my child when they are given medical care, not in the front seat. When you separate children and parents, I think you are asking for trouble. Many times parents have rode in the back and helped to calm their children down. I thought the reference to tattoos was clear, but I will try again to explain. Many people call for the regulation of tattoos in EMS because they say tattoos will cause undue stress on another individual (which I think is bogus). Companies may regulate tattoos. Not a big deal, in my opinion. On the flip side, some say no family in the back of the ambulance, disregarding any stress it may cause your patient. I find it problematic regulating the emotional bonds of family. The point is why regulate one cause of patient stress while ignoring the other?

Welcome to the City ! Great introduction post, keep up the quality !