JPINFV

Lets start with the basics here. LOC, V/S (temp, BP, pul, resp rate [rate and quality where appropriate], rythum), recent sexual activity (patch doesn't rule out pregnancy), family hx of cancer, any other family history, drug use, try any new foods recently, blood in the vomit? [need information before developing a list of DDX]. DDX: Cancer (HPV), infection (skin signs, headache, nausea/vomiting). There isn't much to go on yet, but that would change. Tx: NRB 10LPM, bilateral axillary ice packs, forehead ice packs (hot, dry skin is never a good sign), IV with a large bag of NS (possible dehydration, plus relatively cold). BLS utilization would be as an organic blood pressure machine, this is a sick girl who needs ALS. Sure it's scatoma and not scotoma? I'm more then a little curious on how you know it's scatoma from checking her pupils (are the pupils a little bit more brown then normal?). 1. Its fun to work the patient like this. In real life, the patient probably needs more rx, studies, and tx then even the most progressive system can provide. This is happy land, though, with a complete lab and radiology department in your ambulance (unless I'm misreading the "every toy you could ever want" phrase). 2. You carry nothing. That's what the PD and basics are for 3. Everyone makes a differential dx, unless you're playing monkey see, monkey do. It might be as simple as, "the pt is hot, slightly confused, and pale, she might have an infection, so..." but it is still a DDX. The "but but but, we don't diagnose" needs to go in the same bin as "basics save paramedics" and "diesel bolus".

Well, I once did the "ball-point pen cric." Everything I ever needed to know, I learnt from ER /sarcasm

On another site I frequent (student ran BBS for school), there is a section called "AEF Vault" (AEF=initials of website). Threads of interest (be it humorous, off the wall, helpful, etc) are locked and moved there for easy reference. The only problem I see is getting people to read the threads before they post. (maybe unregistered visitors can only see that section...). Link:http://www.anteaterforum.com/forumdisplay.php?s=&f=31&page=1&pp=25&sort=lastpost&order=desc&daysprune=-1

Canada sucks. They don't have In-N-Out up there...

Just wondering, is there any drug, prehospital or not, that can lower a patients cortisol or Ca level, or increase the intracellular glucose level specifically in neurons?

Good site, but I'm disappointed that they don't have the throckmorton sign listed.

Actually, based off of his name and his country, it is more likely he is a primary care paramedic, and hence not an EMT, but your point is still valid for other people.

I would consider splinting, bandaging, stabilizing (trauma-wise, since basics can't really stabilize medical patients, unless the only thing they need is oxygen) to be urgent care. While important, I wouldn't call an arm Fx emergent. Glucagon is a recently dead horse that doesn't need to be revived. When talking about epi, are you talking about epi pens (for anaphylaxis)? Also, are you talking about preprescribed ("assisting" the patient)? Also, remember, your protocols and my protocols (following from that, scope of practice) is not the same. Better and more important are two different things. Is a doctor better then a nurse? Sure, that is why the doctor is in charge. Does this make nurses unimportant? No. There are not enough doctors going around to provide the day to day care (assessments, medications, etc) or do everything that needs to be done medically speaking in health care for doctors to do everything. Is a doctor better then a NP or PA? Are NPs or PAs unimportant because of that? Is a family practice doctor more or less important then an emergency medical doctor? I would say that there are a vast more bad basics then bad paramedics. The fact that a spectrum exists does not negate the fact that a paramedic can do a lot more for a patient then a basic alone could do. All the splinting in the world isn't going to help a patient with a MI (nitro, morphine, and aspirin will. Cath lab for the win, though). All of the levels have a niche to fill. It might be a small or less fun niche, but knowing your niche is half the battle. I guess you require all your doctors to have been a PA before being a MD/DO then? After all, if being half a professions is important, why isn't it seen more often? I guess you work for free then, or else you aren't that committed to the term "service." There are many more reasons to go into EMS then "service" That's because you can't fix brain dead.

Why restrains and LEO if the patient isn't DTO? Not all psych patients are violent. Not all psych patients need restrains. Just because they might have a pysch (or neuro. Psych disorders and Neuro disorders generally goes hand in hand[sup:567d8d070a]*[/sup:567d8d070a]) problem does not mean that they are not protected from false imprisonment. [sup:567d8d070a]*[/sup:567d8d070a]Suggested reading: The Man Who Mistook His Wife For A Hat : And Other Clinical Tales by Oliver Sacks

Another option would be to look at other courses in your area. The course I took (regional occupational program) was $120, including books (Brady Prehospital Emergency Care, 7th ed. including workbook). The biggest cost, by far for me, was getting certified (paying for NR, local cert, background check, etc) then the course. What Rid was getting at was to take CC courses to qualify for the loan if the EMT class won't do it for you. Classes in the basic sciences, as well as almost any other course (besides underwater basket weaving, but it sure is fun) would serve to make you a better provider in the end.

Sarcasm: 1. Hot, straight female partners that aren't dumb, dimwitted, or slutty (no sloppy seconds and no code 3 club, sorry) 2. Pneumatic tube systems between the local hospitals and their near by SNFs (say, any SNF within 2 miles) that can discharge the patient to the snf or deliver the patient to the ER from the SNF. 3. ER nurses who have attitudes more like ER doctors (ever notice how, at least BLS, when giving report to a doctor, that all they want in name, age, CC, and any important information (i.e. unwitness fall, pt moved pta to wheel chair, no change in LOC per staff), whereas nurses want everything (hx, allergies, PMD, etc). Serious: 1. Increased education standards being taught by people who know what they are talking about. Paramedics do not always make the best BLS instructors. No matter the level you are at, if you are giving [or "assisting"] a drug (no matter if it is prepresecribed or not [epi pens, nitro, etc]), you should at the very least know what it does, if not know the mechanism for it. Especially if it isn't preprescribed. 2. Elimination of fire based EMS for most of the country (nothing against FFs, but patient care and fighting fires are only related by being dispatched by 911 and having a vehicle with flashing lights and a siren). 3. Increased benefits to attract and keep qualified individuals who are more interested in medicine and patient care then playing with the lights and sirens or trying to get into the FD.

Ok, EMT-Bs are organic blood pressure machines...

Of course there is always the front seats of the ambulance.

I second DRG's. I got the el-cheapo Symphony one. The only time I've ever had a problem was if I didn't change the soft diaphragm (they're anti-microbial and the steth comes with 4 free ones, but it also comes with a traditional diaphragm that doesn't need to be replaced) when I was supposed to. After using the soft seal ear tips, I've found that my ear's won't stand the hard rubber ones that the standard steths comes with. Another link for DRG steths. http://allheart.com/newdrgitems.html edit: Has anyone used the DRG steths with the external sound reducing? How well does it work and is it worth the extra money over the Symphony?

Well, considering the following views expressed in this thread: as well as the overall feeling it seems that psych patients are a PD problem, not an EMS problem (sure, it might not be emergent, but I see nothing about medicine in the initials PD). My big problem is not with patients who are actively DTO. Slap those restraints right on or (if ALS) drug them up. DTS, though, is a whole 'nother ball game. Just because they were trying to slit their wrists 30 minutes ago (damn Emo music, rotting the brains of America's youth. When your child owns slip ons with a bunch of little skulls on the shoes, don't tell me there aren't any warning signs ), does not constitute them as a current risk to themselves. It definitely does not constitute them as a danger to others. Furthermore, a lot of psych patients are opportunistic, so here's an idea. Take your [your=everyone, not directed at a specific person] chrome plated hemostats out of your pocket and your trauma shears out of your holster and put them some place out of reach (like a cabinet or the front seat). Now there shouldn't be anything sharp in any sort of close proximity to the patient. Another great idea if you are starting to feel uncomfortable, but have not reached that threshold where restraints are needed, seat belt the patient with their arms inside the seat belts. It still ain't restraints, but will buy you time if you need to restrain.

All I can say is, "wow." I find it somewhat said that supposive medical professionals show such a lack of care for people with medical conditions. All psych patients go restrained? WTF? Sure, my safety and my crew's safety comes paramount, but that does not relieve me of my duty to treat my patients with dignity and use the least amount of restraint needed. Does a psych patient on an involuntary hold for "grave disability" really required physical or chemical restraints? Does every suicide patient really require hand cuffs? Any medical provider (and, regardless of the level of emergent-ness of the condition, we are all, still, prehospital providers) should have a darn good reason for using restraints. "Because I can" does not meet that criteria, in my opinion. At least locally, transporting patents in restraints is a large pain (as it rightfully should be). V/S q5 minutes. PMS checks q15 minutes. Unless PD can do chemical restraints, this statement is wrong. BLS can't do anything more then PD, though.

^ I would put that in my signature, but alas, it is too long.

I haven't had someone who needed transport yet, but I'm confident in my ability to paint a bright enough picture that the lawsuit for not calling would be greater then the lawsuit for calling (because anyone who needs care past a band aid is going to sue... :roll:)

Wow. This case is one of my worst fears about my summer job (per deim) at a local water park. Sure, 99.999% of the people walking into first aid are going to be cuts, bee stings, etc, but any need to call 911 has to be ran by the manager [who are, at most, only RC first aid certified) in charge at that time. The last thing that I want to be doing to arguing with a manager about the need for a heat stroke patient to go by ambulance and not POV to the hospital because the manager sees dollar signs.

Isn't there a growing trend in EM where the fast track (minor patients) is covered by midlevel (NP or PA) providers, and in these cases, the patient is normally not seen by an EMP?

But nothing says EMS Pimp better then a crome plated hemostat.

*Drafting letter to basic school requesting the addition of "crush syndrome"

10 more days before I can legally inhibit my NMDA receptors while activating my GABA(A) receptors... (Neuro final in 5 hours, including ETOH and Fetal EtOH syndrome... stupid 8 am finals...)

Umm, my post was directed at the person who posted the case report as their sole reason for why racemic epi is bad. Exactly, it is a SINGLE incidence where racemic epi MIGHT have had a bad reaction. Deciding if a drug is dangerous or not should not be decided on a case report, but on a study. There was an entire 5 minutes between your post and mine. It's safe to say that we were both writing our posts at the same time. Thus, my post was not directed at you. [cue short bus picture?] I've added a quote to that post for people who don't understand that conversations on message boards are not in real time...

Some one needs to know the difference between a case report and study.