Mateo_1387

Dwayne, I hear ya on that one brother.

This was a call during my early days as a no0b paramedic, aw hell, what am I sayin', I'm still a no0b.

We were sent to a local store for an unresponsive person in the parking lot. Arrived on the scene to find a 30-40 year old male laying on the ground with apnea, cyanosis present, and still having a heart beat, slow, but regular. We immediately began BVM ventilations along with obtaining a history form the driver of the vehicle the patient was with. She reported a recent stent in prison, that he has some blood pressure problems, and that he has a brain aneurysm.

I thought BINGO ! Being a new paramedic I jumped to the conclusion that my patient had a ruptured aneurysm, since he suddenly became unresponsive, had bradycardia, and apnea. Feeling confident about the conclusion, I figured we had to secure an airway and proceeded to have the patient intubated. An attempt was made to intubate which produced a gag reflex. The patient started breathing on his own during the attempt so we opted to continue and use the BVM only. An IV was placed. My coworker, not a paramedic, suggested that we administer Narcan. The thought honestly had not crossed my mind.... Narcan was administered and within two minutes that patient was awake and chatting with us. I felt about 1 in. tall. Come to find out, in the midst of my excitement, the patient had a brain aneurysm, that was repaired. DUH. I learned an important lesson that day about the differential diagnosis. It was a great learning opportunity, and although not one of my better calls, one I cherish just because of the lesson learned. I guess the old saying goes, we're no better than our last call....

OK the DA is talking out his rear end.

"the legislature dropped it in their laps" is a cop out.

I plan on having the chat with the son soon, very soon.

It is my responsibility to tell the kids not the schools.

I thought it sounded like a cop out too. But, if he is a prosecutor of some sort, it might not entirely be his fault. I dunno.

Good luck with the son chat.

It is quite surprising the number of quality posts made on the subject so far. Thanks to all who have posted. Also, surprisingly, everyone seems to agree.

When I first read the article, I thought, what were they thinking? They seem to be falling backwards in time, in my opinion. It seems the basis of the law is that those under 18 are not legally allowed to have sex in Wisconsin. With the schools teaching how to use condoms and take birth control, they consider it to be contributing to the delinquency of minors, even thought the material is allowed to be taught, per Wisconsin law. The article also states that those 17 and older can be charged as an adult if having sex. It seems rather illogical to have to pay the ‘adult consequences’ yet be guilty solely based on being a juvenile.

Teaching kids to make proper life decisions is certainly necessary. Should it be taught at home? I certainly think so. Should it be taught in school? I definitely think so. As many children I presume do not learn about sex in the home environment, I feel it has to be picked up by the school systems. Society, as a whole, is relying more and more on the school systems to raise their child. Although I do not agree with the reliance on the school system to raise children, since we have thrust the responsibility on the school, I feel it should be taught. Of course, I would hope that the proper sex education today would yield more openness about sex, so the cycle of not teaching your own children about sex does not continue.

Further, I think the sex education should be focused on what we know to be true about sex. It should not focus on personal opinion or religion. Although I have a difficult time respecting personal opinions and religion, it is for the most part a right, and I believe should be taught in the home, if applicable, and not in the school.

I have to agree with AK that sex at a young age may not be healthy due to lack of life skills and an underdeveloped mentality, but it should be taught, just as children are taught about the consequences of using drugs. Although sex is going to happen at young ages, I think ethically, sex education should be taught in order to hopefully prevent the negative consequences of sex. Although the negative consequences of sex are not due to just ignorance, it is one step of the mixture that can be addressed, versus say, solving poverty (which the article references as a reason for increased teenage sex).

Thanks again to everyone that replied. Too bad we have no opposing opinions posted, as I learn just as much from them. I think these discussions help us all understand things a little bit better, at least I know it helps me. Thanks again.

Matt

A few of us were discussing this, and I wanted some opinions. I work in a very rural setting, minimum transport time is 60-80 minutes to an ER. Sometimes, you can't get an extra hand onboard during bad calls. So....if you're working an arrest alone, and you're just to tired to do more compressions, is pacing a feasability? Isn't it still going to circulate, providing you get capture?

Do I understand your question to be...

1, Can pacing replace CPR to circulate blood?

Or

2, Is it acceptable to pace during the cardiac arrest treatment sequence?

Number 2 has definitely been answered. I have the impression number 1 is your question, and, if it is, the answer is No. Pacing is not a substitute for CPR. It is possible to have 'capture' but have no heart beat. Without contraction of the heart, there is no circulation of the blood.

Matt.

http://news.yahoo.com/s/ap/us_sex_ed_wisconsin

So, what do you think?

prinzmetal's angina....?

That was my next conclusion too. Since the angiography is unremarkable, I assume we can rule out angina caused by atherosclerosis.

What does a coronary angiography show?

Matt,

Since you seem intent on picking apart my original post and analyzing it, let me do it for you, so that my meanings are clarified:

I didn't join this conversation to advocate corporal punishment, or to condemn those people that advocate it's use. My contribution was simply my observations and a statement of my views based on those observations. I'm not going to get into the whole 'judgement' scene, it's not my place to judge.

I am not intent on picking apart your post. I simply replied to certain sections of your post, inserted my thoughts and views, and asked you a few question (which are really for anyone to answer). I do not recall antagonizing you until part of the second post, where you started making assumptions about my first post.

You say you have observations, which the only one I have yet to see is that you have seen some kids who respond to raising of the voice and others that do not respond to spanking. What other observations are there?

I think you've misunderstood the entire content and intent of my post. At no time did I advocate using corporal punishment to discipline children. As a matter of fact, my posting was purely observational, and I intentionally left my personal feelings out it.

What have I misunderstood?

Your comment

“I've been on both ends of the corporal punishment scene. I've had one parent who was abusive with it, and another that only used it when nothing else seemed to be effective.I can say this about the the total way I was raised. I don't use drugs, I've never been to prison, I'm not an alcoholic and I've actually attempted to make something of my life.”

I interpret this as your evidence for corporal punishment. You grew up with it and it was incorporated into your totally raising. Since you seem to have grown up without those unhealthy things in your life (drugs and prison), you lead me to believe that corporal punishment, weather abusive or last ditch effort, had a positive effect on your future. You never mentioned that it did not help and in fact imply it was effective.

Did you leave your feeling out when you wrote “My views on coroporal punishment aside, I don't feel that it's a teacher/principal or other school official's job to discipline my child. As a parent, that is my RESPONSIBILITY.”? You even capitalized responsibility…

Were you not trying to invoke some feeling when you quoted “There's a quote attributed to George Carlin that goes something like this: "It doesn't take a whole village to raise a child. It DOES however, take parents to get off their lazy ass and actually give a damn!”?

By doing so, I merely pointed out that there are other methods available to discipline children. Furthermore, by not getting emotionally caught up in the debate, I beliveve I've given creedence to my observations.

I have seen no other mentions of alternative discipline except for raising your voice to show displeasure. Otherwise, I found nothing else in your post stating what tools we may be able to use as alternatives.

Also, not being emotional does not make your observation any more valid. In fact, what was your observation? I really could not find one.

I'm glad you think that we're making 'progress', but since I remained purely obeservational in the entire posting; how can you presume to know which side of the debate I'm advocating? It seems to me that you've already made up your mind that I advocate one method over the other, when in fact, I've remained entirely neutral.

I never accused you of taking a side (previously). We have had this discussion in the past, and if memory serves me correct, you do advocate spanking, just not entirely.

The Acetabulum, part of the Hip.

Q: The purpose of rotating venous tourniquets?

LOL, Heart failure with Left Ventricular Dysfunction, and Pulmonary Edema.... Very old school and I believe also proven not to be effective.

What are the names of the 4 specialized conduction pathways of the atria?

I am getting the impression from all the information being given so far that the gentleman has heart disease.

Walk with me here, please...

Patient present with hypertension, causing stress and probably some degree of ischemia on the heart.

The EKG shows left bundle branch block and strain pattern.

After the patient receives anti hypertensive agents, Metoprolol and Nitroglycerin, his symptoms of chest pain, Left Bundle Branch Block and Strain pattern disappear.

I am assuming the abnormal EKG finding for this patient is the lack of hypertrophy of the heart after the treatment is provided.

Although the coagulation panels are normal, this patient still has risk factors for clots, those being sedentary, overweight, and a smoker. I think pulmonary embolism could still be a possibility, even in the face of a normal coagulation panel, but sudden onset C/P, Shortness of Breath, and transient LBBB (seen during ischemia). Of course, for pulmonary embolism, the interesting EKG finding is the lack of tachycardia.

I think the treatment provided by the health care provider and the findings afterwards points more towards heart disease rather than pulmonary embolism.

Just my thoughts, eat me alive ! LOL

Matt.

I've seen kids that require no more 'discipline' than simply raising your voice to show displeasure, and I've seen kids that you can beat the hell out of, and it will change nothing.

So which method is 'better'?

This comment does not say much. What kind of environment did the kid live in to deserve to get the hell beat out of him/her?

I can agree with you that beating the hell out of a child will not change anything. Knee jerk reactions teach nothing productive. Beating the hell out of a kid is going to teach fear, pain, and teach that violence is a solution to most of life’s problems. Teaching a child how to handle situations in life in an effective manner goes a lot farther than striking a child and leaving them with no tools to handle life’s situations in the long run.

I've been on both ends of the corporal punishment scene. I've had one parent who was abusive with it, and another that only used it when nothing else seemed to be effective.

I can say this about the the total way I was raised. I don't use drugs, I've never been to prison, I'm not an alcoholic and I've actually attempted to make something of my life.

Drug users and alcoholics are not necessarily bad people. Everyone in prison is innocent, so I will not go there. Haha.

So, did spanking keep you from making decisions in your life that can be negative and unhealthy, or did having an understanding of how life works and how to handle situations prevent the negative and unhealthy in your life?

Where are smokers in your list of drug abusers and alcoholics? Are all smokers bad people too?

My views on coroporal punishment aside, I don't feel that it's a teacher/principal or other school official's job to discipline my child. As a parent, that is my RESPONSIBILITY.

So, when you get to be an old fart and your children decide to be responsible adults and take care of you in their home, is it ok for them to spank you when you do something wrong?

As a mechanic, I fill my toolbox with all the proper tools to effectively repair and maintain my vehicle. As a parent, I must do the same thing to be able to effectively raise and guide my child. As the mechanic might pass the toolbox onto his/her children, we must do the same with our 'parenting toolbox'.

Teaching your children violence to solve most of life’s issues seems like a worthless tool to pass along.

For those that advocate corporal punishment for all offenses, this is all that the child will have in their 'parenting toolbox', and the cycle continues.

I agree bro, we are getting somewhere. The tools a child needs are those which promote self improvement, and in my opinion, without the use of violence.

This reminds me of some parents that say ‘I made my child smoke a cigarette so they would be turned off to the idea of smoking’. Let us get this straight, you are going to make the child smoke, expose the kid to this ‘tool’, and then expect him not to use it (the tool, which is smoking). WTF?

It is like saying, I do not want my child to be violent, but I am going to be violent to scare the child into doing what I expect, and then expect them not to use violence…

It seems the knee jerk reaction of spanking teaches that it is ok to have knee jerk reactions to life situations.

My take on things…

Matt

Here's something else when it comes to respect. How about adults try modeling respect, including showing children respect? Sorry, but adults aren't owed extra special bonus respect because we've manage to not die nor does managing to not die entitle someone to lord over someone else because they're younger than 18. However, all too often people expect "respect" from children while being grade A A-holes.

Of course, since the kid is under 18, they are still earning their respect status through spankings and punishment... But, as arguments have been stated in the past on this site, why are we not spanking adults ? What makes kids so special that they get spanked, but not adults?

I look even more lowly upon those that think their kids deserve to be spanked, but only by them. By God if someone else spanks their child it is assault, but it is quite ok for the parent to spank? WTF?

Okay, let me then amend it to say that parents in general should not be in EMS. Not just mothers.

All of my best partners have been single males with no children. I stick with what works best for me.

I think we all suspected...

/humor

I am missing something... What is the point of this post? Is there a question or game we are supposed to participate in?

I see a case presentation with diagnosis and treatment already in place. What are we supposed to do?

Shoot, might as well. When you're hung like me it's likely an out patient procedure anyway, and I could use the free drinks on ladies' night!

Dwayne

Probably wouldn't be any different with a set of boobies, nobody looks at your face as it is...

Dwayne admits to hormone therapy after all, I KNEW he was going for that sex change operation !

Thanks folks for the Happy Birthday wishes ! I had a good one, better than I could have hoped for.

I voted that assessments are different with 'skill level'. It is really quite simple.

Education is honestly the difference between the assessments. Generally speaking, the more educated and/or more specialized the provider, the more detailed and conclusive an assessment should be. The more you know about how the human body works, the more you can suspect and assess for illnesses. Sure, the actual act of hands being placed on a patient may be similar between license levels, but the depth of the assessment will not be the same. How many Basics do you see perform assessments of the heart tones and cranial nerve exams? How many paramedics do you see perform assessments of tendon reflexes? The list can continue right on up the ladder. What is next, are we going to say that paramedics and nurses perform the same assessments?

Someone said it in another post, but it applies. How can you assess for something if you have no idea it even exists? The quality of the assessment is dependent on the depth of education.

Matty

Interesting case Wendy.

If I were on that call and with the information you provided, I would probably...

Check vital signs, temperature included, orthostatic blood pressure, listen to lung sounds and heart tones along with a physical exam, neurological exam, 12 lead, and of course explore the history to help guide us to a working differential or diagnosis.

Saying that her mind is sharp, her normal, does this mean during this incident she had some degree of altered mental status? Some things, based on the limited information I would be considering are infection, pulmonary embolism, stroke, heart arrhythmia, myocardial infarction, dehydration. These are just some things to consider. Being in the room with the patient may change the list.

Interesting replies by some.

Why are people getting their panties in a wad with this discussion? Comments like same ol' same ol', we have had this fight, nice to see nothing has changed, and the like are getting old. Folks, this is a tame conversation about differences of ALS/BLS providers. If we are going to have other folks learn from us, I think we should have more active discussions on these hot topics. This is not a knock out drag out like I have seen some other posts mirroring this topic.

I find it interesting that we have not only talked about ALS/BLS, but we have had others chime in with their perspective on how we should call ourselves, who should govern paramedics, education, and the like. I say this is a good thread.

Thanks folks.

Matty

But let me ask you this. If I am totally offended by anyone who practices that lifestyle. If it goes against my religious beliefs that marriage or a relationship is between a man and a woman and not a man/man or woman/woman then why should I not have the right not to hire someone of that lifestyle. Why don't I have the right to hire or not hire a gay or lesbian or a transvestite or transgendered person?

I mean it's still my company right? I should have the right to choose shouldn't I? I'm not taking government money or state money so I should not have to abide by their requirements right? IT's my company right?

If their lifestyle completely goes against my belief structure then I should not have to hire them even if they are more qualified than the next guy right?

What does it matter? When someone is applying for a job, is their sexual orientation a necessary question to determine if they are eligible for the job? What about their religious views? Does it really make a difference? (the only one I could think of in the circumstance is someone hired for a specific religious job). It comes down to being a human being and being qualified for the job, not the color of your skin, who you sleep with, or where you are from, or who you do/do not worship.

Yes (In reference to intent of palmin' breasts, lying and coercion)

You certainly have a point...but...

Intent looks good, but does not leave always favor outcomes. I am sure volly EMT's claim to have good intents when doing their jobs, but, when they malpractice, they are held responsible, good intent or not.

Not illogical at all. But as morals and ethics are something that for many of us are complex and confusing concepts, in those unusual moments when decisions have to be made using their application I'll not have time to explore those of my patient. I must use those that I've developed for myself and try to apply them in the best interest of my patient.

Interesting answer. I get the impression that if we follow our own morals and ethics then we are following a cowboy model of ethics and morals.

I am assuming, and maybe it is a wrong assumption, that this discussion is about lying to patients to compel them to the hospital. I then redirected it by replying to fireflymedic's post about the use of coercion. To clearly spell it out, what I was saying in my initial reply to your post is that using those tactics to promote your intent is poor form because the patient may not share your idea of what you think is best for them (the patient). This is my perspective.

I believe that in this instance that I've then covered my ass, but haven't advocated for my patient. In my opinion my moral and ethical obligation here is to make him better. I'm willing to bet that had I given the patient in my example this answer I would have caused his bullshit detector to redline. He knew his condition was serious, he knew he was in big trouble, and knowing how big exactly was going to effect his physiological response to treatment in some regards I believe. I could have given a more politically correct answer perhaps, but being politically correct was not my intention, getting him to the hospital alive was.

Why should we lie to dying patient's? Comfort level with the situation maybe? I bet this patient you described already knew he was in serious condition and was close to dying. You answered to him 'no worries brother, we are pushing it back, can't you feel it?'. What was the patient's reply to this? How do you think he took this response. Also, with him saying 'going.....to.....die', are you sure it was a question, or was it a statement?

I don't advocate lying as a general medical tool, but more so was attempting to debunk the idea of 'always' and 'never' as intelligent, useful language when discussing many things EMS related.

I get that. Finding exceptions to rules are fun.

Here again I'm not saying that this is a wrong answer in general, just wrong for me in the given situation. I could never ignore such a question and expect my patient to continue to trust me. Also, I believed these to likely be that last moments of his life...I didn't want them to be any more horrifying than they already were. The standard party line says I should have found a way to be honest. The human being in me felt that it was more important to be kind and productive. That was my moral/ethical intent when I lied to him. See? Perhaps this is off in the ditch, I'm not sure, that's why I love these debates.

I like these debates too.

Your lie may have had the best of intentions, yet he could very well have saw right through them. I probably would not ignore the question either. Honestly, I think if you patient was that sick, trust would not be the biggest deal in the world to him, survival would. I know this probably sounds like practicing psychology, but telling him the truth may better prepare him for death than giving false hopes of life. At the same time, giving him motivation to beat what could be imminent (death) is not the same as false hope.

Guess you never had a dying patient look you in the eye and ask, "Am I going to die ?" And what's the difference between lying to your boss (I am too sick to work today) or lying in your documentation to cover your butt versus lying to a patient. If you lie you lie.

What point you making about never having a dying patient ask 'Am I going to die?"

Sure, the components of a lie are the same, the effect it has varies though. Lying to your boss about being sick versus lying to your wife about where you were last night can have totally different effects.

I will be sure to give this topic some more thought and maybe can come back with something ever better.

Y'all have a good one.

Matty.

Isuprel rather

...

How often do you have the quiet to listen to heart tones? What do you do with the findings once you have them; do we introduce a new treatment based upon them or just write them down in a purely extrinsic exercise that will be repeated 20 minutes later in the ER?

Somebody, somewhere would find a way to screw up spending a lot of time on scene with a time critical cardiac patient trying to listen to heart sounds; I almost guarentee it.

It could be useful but IMHO it has limited benefit in the out of hospital setting with the current state of the system. It's kind of like saying well we want to measure if the patient hears better in one ear than the other.

So why Isuprel rather than Dopamine when they both have effects on heart rate?

...

I asked the questions first, where are my answers dude?

Honestly, I can make arguments for listening to heart tones and checking hearing, both can be of benefit to certain patient. I guess that is the difference between training and education.

Matty

Now he also need some inotropic support. If you have an ACE inhibitor that would be ideal but you may have to make do with dopamine if that is all you carry.

I am not following you about ACE inhibitors and inotropy. Could you please explain?

Dopamine could be out because of its chronotropic effect perhaps isporel or something else might do the trick however I think we are starting to get into tunnel vision of over-treating the patient.

Not following you either Kiwi. I cannot find the drug Isporel, which I assume is Isuprel. If that is the case I will say this...

You cannot use Dopamine for the chronotropic effects, but what about the chronotropic effects of Isuprel?

Heart sounds should have been taken but here at least they are not taught and while I agree it might be useful some sparky ambo would find some way to screw it up, kill somebody by blowing out thier scene time and it'd be taken away agian.

So, I am not getting this either. How can you screw up heart tones, then kill somebody with heart tones? How can listening to heart tones extend your scene time dramatically? How can they take away heart tones? Doesn't make much sense to me...