Mateo_1387

Well, I hope she uses the money for charity, and not her own personal use if her only 'interest' is in discouraging the surgeon. I would think that doing a lot of complaining to the hospital would give him enough "discouragement" from doing it again than the trouble to sue the doctor. As far as someone other than a doctor putting a temporary tattoo on a patient to "cheer" them up, I would say get patient permission first. They said the surgeon does not deny it. They did not say he admitted it. They also said that he has placed 'washable marks' on other patients. Maybe it is just lingo, and I am reading into it too much, or maybe it is going to be difficult to prove. Was it the best decision on the part of the surgeon? Probably not. Was there harm intended? I doubt it. That is why I think it is just a lawsuit for money. Just an opinion though.

This is coming from new skool Should "old school" ways of doing things change with up-to-date treatments? I would say that old school treatments should change with up-to-date treatments. There is a lot of research being done today about how our treatments affect the patient's whole hospital stay. If our "old school" treatments are not cutting it, then they need to change. Old school techniques are another story. The experience that old schoolers have with scene management, driving, patient interaction, and tips to facilitate certain procedures is awesome. Experience is just not something that you can get by education alone. I will say however, there may always be some rare situation where old school treatment may be necessary. For instance, placing a psychotic patient prone. I am not saying that I advocate it, but you just never know. There may always be a time where it may be necessary. I always keep that in the back of my head. Are the newer medics and EMTs coming in to the field with more knowledge base? I would say overall yes. Of course this also depends on the type of program the new medic graduated from. Back home, the medics coming from that community college are more often than not undereducated to be paramedics. I was telling people that there is a program there allowing intermediates to take a medic class that has only 56 days of class, at 8 hours each day. Typically they are in class less than 8 hours a day. We are talking 56 days of class! Can you say undereducated? On the other hand, you go two counties west, and you find medics who graduate from a 2-year program who have an extensive knowledge base. These graduates typically only have street experience from their clinical rotations, but they are educated to be paramedics. The differences between the two schools are 1) education and 2) experience. It should take the educated paramedic far less time to be a competent self-standing medic, than say the undereducated paramedic. Where the educated medic did most of his learning in class, his biggest goal now is to get experience. The undereducated medic ends up having to play catch-up in the field with sick patients, plus gain the experience. This leads me to answer the original question. I think that new medics with a degree in general have a larger knowledge base entering the field than the old school medic when he/she entered the field. The old school medic has the experience, which makes the two situations similar. The point I want to make is that I think it will generally take less time for the new educated medic to become a competent self-standing medic than it did for the old school medic. Remember these are just my observations from the field coming from a new medic in my area. Back home, the medics are stale. What I mean is they are old school and most choose not to be up to date. I would much rather have green medics with a degree to care for me than the old school medic back home. There are some medics who I know would be considered of “old school” origins who are changing very well with the times. Their knowledge base is amazing. They are able to take what I learned in school and expand my medical knowledge base. They exemplify what is expected of a paramedic. I only know a handful like that, but we need to have more paramedics act as they do. They are definitely a minority. The medics I talk of had to educate themselves many years after they became "certified." They all have similar backgrounds with inadequate paramedic training. Each of them went on to obtain EMS degrees, and they continually learn about the new. Those are the "old school" paramedics I want to learn from. Their years of experience and education are admirable. Those are the medics that would take many years of experience and continual learning for me, or most people, to surpass. They have a lot to teach, and I have a lot to learn from them. Most old school paramedics I know though know enough just enough to stay afloat. I have no interest in learning from them. Can we and/or should we try to learn from each other? I say there are qualities in both we can learn from to make ourselves the best paramedic we can be. What do you want to learn from the other generation? It depends on who I am learning from. The educated medic of “old school” origins I want to ride with so I can pick their brains, and learn all that they know. The old school medic who knows just enough to stay afloat, I have not interest to learn from. It is not that they do not have “anything” to teach. It has to do with the mindset of the person. What is your over all perception of the other generation? I know an equal number of “good” old school medics, and I know an equal number of “bad” old school medics. I only know a handful of experienced “old school new thinking” medics. So, my perception of the “other generation” is divided. How do we make change to better understand each other? This is a good question to ask. It is easy to point everything out, but there needs to be work to fix the problem. I think there are a few things that would help each generation to understand the other. First of all, I think everyone should work to be on the same level. It is very important for our profession to get educated, be educated, and stay educated. On another level, we do not need to divide EMS within, as we do with other medical professions. For example, so many people in EMS keep RN’s and Paramedics professionally divided. The atmosphere of cooperation is not there. I also see that as a problem within our own profession. The old school and new school generations end up dividing themselves. So, I think the atmosphere of EMS should be to strive to be professional and cooperative.

If the motive behind suing is not money, then why do it?

Don't talk about my lovechild's mama like that ! On a serious note, I wonder how far up the panty line was. They did not say, but maybe it was placed below the panty line near one of her hips. Also, some things to consider. The patient had the surgery on her back. She was probably placed on her back after she was intubated and had a foley placed. So access to her front did happen. Something else, they blame the surgeon for the deed. What proof do they have. Nobody saw the surgeon place the temporary tattoo. It will be difficult to prove, I would think.

You want to make D10. The drug is for the neonate patient, so we are talking about a very small amount of the drug. I also am assuming that you protocol wants you to give the neonate 1-2cc's of D10 per Kg. So again, we are talking about a low volume bolus. AZCEP's methods work fine, but I am just giving you my method in case your company does not buy 250ml bags. Pull 4cc of D50 into a 20cc syringe. Then pull 16cc's of saline to dilute. This puts 2 grams in 20 cc's, and gives you a 10% solution. This amount should be just slightly more than adequate to administer to a neonate.

Maybe not........ [spoil:70aa6d8c14][/spoil:70aa6d8c14]

It could be.......the "admi" is still functional

Ruff, after that last comment, you're always going to stand in the "short" line at the airport !

I do not see a problem with waiting for a 12 lead. We determined that part of a proper assessment includes a 12 lead ecg. The person calling for an MI is not going to hurt anymore if the aspirin is delayed another 5 minutes, to perform a thorough assessment. There is always the possibility that you find indications on the 12 lead that would rule out an MI. Most MI patients also call for EMS long after the MI has started, so another few minutes for Aspirin administration can wait for a proper assessment.

I do not remember saying it, but thanks for posting the scenario. Just out of curiosity, when you did the DAI, did you use 100mg of lidocaine? As for the BP on the herniation patient, the information I have is from the 5th edition BTLS book by Dr. John Campbell. In the book, he says (I am paraphrasing), that a traumatic brain injury (TBI) rarely present with hypotension. When hypotension is present, it is usually caused by hemorrhagic or neurogenic shock. According to Dr. Campbell, the TBI patient cannot tolerate hypotension. Farther, an instance of hypotension, meaning a systolic pressure below 90, can increase the mortality rate by 150%. Hypotension in children with a TBI has an even higher mortality rate. Dr. Campbell recommends that the pressure be kept between 110-120 systolic, and the Cerebral Perfusion Pressure (CPP) be kept above 60mmHg.

As far as DAI is concerned, I guess I have heard of it, I was not familiar with the lingo. I was taught that for trauma, a MAP of 60 is fine, but for a head bleed, the MAP needs to be higher to maintain CPP, because with Hypotension, plus herniation, the CPP cannot maintain at a lower pressure. I was just talking more about it to see if maybe there is some literature/studies done on the subject.

Cool. As for the blood pressure, I was taught that it is prudent to have the blood pressure about 110-120 to keep up cerebral perfusion pressure. My number may be too high, but that is what I remember from school. Maybe someone can chime in and maybe give a small lesson on this subject. I am familiar with RSI, but what is DAI?

I would have to go for comfort. I did many shifts in the hospital, and because I was not in comfortable shoes, I was looking for time/places to sit. As for the safety of the crocs, I do not see where the problem is with them. They would be easy to clean, the are all one piece with no fabric. With shoes/boots, they have fabric which can soak in an fluids. The rest of a uniform is fabric, and if fluids get on the uniform, we just change uniforms and wash off. Also, if I remember right, there is a line of crocs made for health care workers, that do not have the holes in them.

Nah, the reception on the TV has not cleared up yet.

Just a first impression, but it looks like the patient is herniating due to intercranial bleed. Maybe from a hemorrhagic stroke, or maybe due to trauma, since the door is off the hinges. RSI IV O2 keep the blood pressure above 110 systolic Hyperventilate Sit the patient up Rapid transport to appropriate neurological facility.

This is the exact one that I sent to Ruffems' email. This semester hours and tuition rates are based on the North Carolina Community College standard. Semester 1: EMT- Basic- 3hrs Emergency vehicle operation and Introduction to EMS- 3hrs ( this is to include the history of EMS, issues concerning EMS, the role of EMS now and in the future) Pharmacology 1- 2hrs Pathophysiology- 4hrs (3hrs lecture, 1 hr lab) Semester 2: Pharmacology 2- 2hrs Advanced Airway Management- 2hrs Clinical Practicum 1- 2hrs Introduction to Paramedic Care- 3hrs (this would be the class that is like an intermediate class, introduction to patient care at an ALS level.) Cardiology 1- 4hrs Semester 3: Summer Cardiology2- 4hrs Maternal-Child Emergency Care- 3hrs Clinical Practicum 2- 3hrs Semester 4: Legal and Legislative aspects to EMS- 2hrs Advanced Medical Emergencies- 3hrs Advanced Patient Assessment- 2hrs Rescue Scene Management- 2hrs Clinical Practicum 3- 3hrs Semester 5: Advanced Trauma Emergencies- 2hrs EMS Management- 2hrs Lifespan Emergencies- 3hrs EMS Instructor Methodology- 2hrs Clinical Practicum 4- 3hrs Semester 6: Special Needs patients- 2hrs EMS Capstone- 2hrs Clinical Practicum 5- 3hrs Prerequisites: Courses to be included. Microbiology- 4hrs (3 hrs lecture, 1hr lab) General Chemistry- 4hrs (3 hrs lecture, 1hr lab) General Psychology- 3hrs Developmental Psychology- 3hrs General College Algebra- 3hrs General College English- 3hrs Anatomy and Physiology 1 and 2- 4hrs each (3 hrs lecture, 1hr lab) Professional Research and Reporting- 3hrs Special notes about courses and the semester schedule. The Clinical Practicum classes will be specially designed. Clinical will be one day a week for 10 hours during a normal semester, and 12 during the summer. Practicum 1 - This will include mostly hospital time. Time in emergency rooms to get students used to seeing patients, interviewing, and beginning to perform skills. Practicum 2 - This will incorporate more ambulance riding. Also the patient will visit the Adult ED and Surgical ICU. Practicum 3 - This will incorporate some ambulance riding time. The student will start a new clinical site in a pediatric ED and Pediatric ICU/Neonatal ICU to complement the classes of the summer semester. Practicum 4 - This will be mostly be ambulance riding time. Also Mobile ICU transporting sites will be used or clinical locations. Practicum 5 - This clinical will be mostly ambulance riding time. This time will be at different agencies to give the student access to other system designs, protocols, and equipment usage. By this stage of school the student should be viewing a place for employment, and multiple agencies exposes students to agency, and agencies to possible future employees. Practicum 6 - This clinical will be all ambulance ride time. The time riding will be with limited preceptors to fine tune the students skills. EMS instructor methodology notes: This class is not designed to prepare the student to be an EMS educator. This class is more designed to prepare the student to deal with other students that may ride with them. This class also helps the student to prepare media for the general public. This class prepares the student to teach community classes such as CPR. Rescue Scene Management: This class will be to teach students to deal with different types of scenes and their safety on the scenes. They include Multi Casualty Scenes, Fire Scenes, and Rescue Scenes. This class is not to teach the student to be a rescue technician or a firefighter, but rather to expose student to what will happens at the scenes, and how their involvement impacts the scene. The courses are designed to be an acceptable workload on the students. They are around 12 semester hours for normal semester, and 9 or less for the summer. The total semester hours for the degree ( not including prerequisites ) is 66. At the NC Community College tuition rate of $42/semester hour the full two years of study will cost $2,772.

It is true. It may only be 2 inches long, but most of the women still cannot handle me. They say the 12 inch circumference is just too much to handle. Thats a good question. They just don't make raincoats in my size :wink:

:takes JPINFV's place on the soap box: I would say generally what you stated above is true. I am not trying to nit pick, but your logic of psychiatry being medical, there are psychiatric emergencies, therefore emergency being in EMS automatically makes them our patient. I do not see where keeping peace and order is in the job description of Paramedic, so if a patient is violent (threatens my life, physically Fighting me, no combative due to a medical problem (there are some exceptions)) then they can go with the police department. Again, the goal is to go home every night. I hope this does offend you, it is just something I felt should be said. :steps off the soapbox, then slips and falls: :shock:

Figure out who Admin is and his/her other identities

Can there also be a judge with lower standards, just to keep the minority happy?

To the OP, this is a good topic to discuss ! I think it really depends on the call as to how to handle the violent psych patient. First and foremost is that I have a goal everyday, and that is to go home alive. That being said, if I have a patient that is threatening to kill me and rape my partner, then I am leaving the scene, and the police department can take care of the person. If someone can look at me and verbally threaten my partner and I, then they should be safe enough to go with the police. Now, lets say you have a drunk patient that is wanting to fight. The people around say that they downed a bunch of pills. Would you still fight and restrain the patient? I probably would not. Again, if I have a patient that is going to fight the living daylights out of me, then I will probably let the police department handle the patient. The police will be able to take the patient to a hospital to get treatment based on the scenario above. The fact is that if a patient is going to fight, you will have a very difficult time treating them and your life is in danger. You might ask, well what happens if the person dies because you did not treat them because of the pills they took? First you have to ask this, how do you know if they really took pills? Patients do lie. Is it worth risking your health over someone wanting to fight, when they could just be lying to you? You can always follow the police to the hospital if something does happen to the patient. The pills may take some time before they metabolize in the body, so them riding with the police because of they decide not to cooperate may be fine. If the patient does become worse off, you can always follow until it happens. Then there will be those times that you have a strong inclination that the patient has a serious medical related problem and is fighting with you. Some examples could be hypoglycemia, head injury, hypoxia, hypovolemia, electrolyte imbalances, neurotransmitter imbalances. The head injury example, it probably would not be wrong to restrain your patient. Using physical force can be an option, but you should be careful when doing so. This would be a good case to restrain the patient chemically. For the hypoglycemic, it may not be a bad idea to restrain long enough for the patient to get tired, and then start your IV glucose, or maybe even glucagon. This is of course dependent on the situation. Not all psychiatric patients need to be treated by EMS. There should be a call for judgment with these patients. A schizophrenic patient may need psychiatric treatment, but when he threatens your partner, acts very violent, and uncontrollable, this may very well be a police issue. This may mean that the PD takes the patient to a hospital, or maybe this mean that they hold the patient down, and you give a medication for chemical restraints so that you may treat other medical conditions the patient has. You have a patient who has a head injury and he fights your efforts to help him and you come to the quick decision to restrain the patient. You would want to use a chemical restraint in conjunction with a physical restraint. After you administer a chemical restraint to chill out the patient, I would recommend you place physical restraints at each extremity. When you tie the restraints, you need the restraint around the extremity as close to the tie off point as you can. Tying the patient's extremity as close to the tie off point as possible makes it very difficult for them to move that extremity under straps and such. Tie one arm in an L shape above the head, and the other arm towards the lower extremities. The arm placement gives less power to the patient to use core muscles to aid in escaping. It is ideal to place the patient on a backboard and restrain, this way you can move the patient easily. When you place restraints on a stretcher, in order to move the patient you have to remove the restraints, which could lead to problems. While on the backboard, strap down the torso, the hips, the thighs and the lower legs. Taping the head down may be necessary if the patient bangs their head against the backboard. Make sure that the pockets are empty because there is the possibility they can reach in and use something to their advantage. Of course, hopefully if a patient is able to use reasoning that they can escape by reaching into their pocket for a tool, then police probably should be transporting. Also when you are working on a take down, make sure everyone involved knows what they are to do in the take down.

What happened to buddha?

testaccount.....I should have known :?

:evil: grrrrr

Well, I actually thought that one person on the list was admin. I really wanted it to be serious. I wanted to see if people maybe agreed with me, and also to get some discussion going. I figured if the person I thought as admin turned out not to be, then it would be fun to have an honorary position, however silly it really may be. Anyways, Thanks all for the participation. I guess it will remain a mystery, until someone leaks out the identity of admin.... :evil: If I fill the gas tank, will you tell me?