JPINFV

Of course I've never figured out why medics even transport full arrests. The doctor at the hospital isn't going to be pushing any different drugs anyways. The patient that was last seen an hour ago and is warm and in asystole on arrival is dead. No amount of lights, sirens, or letters behind your name is going to change that. L/S transport of dead bodies puts the public at risk.

(or an expertly executed dialysis transfer :tongue:).

Ohh, but those F'ed up discharges are always full of trauma.

"Umm, can I get a DNR for your unstable hospice patient"

"Here you go" (signed Name, RN)

"Umm, thats no good, it needs to be signed by a doctor"

"But the patient is on hospice"

"Thats nice, but I would still need to turn around if the patient crashes"

"But the patient is on hospice"

:Begins beating head on the desk:

"Will this do?" (hands over a face sheet saying "DNR)

"Umm, no"

... 5 minutes later finally finds a DNR order in the chart. The hospital-wide DNR form can't be found

/Not the only time that this has happened at this hospital.

//Happy we lost half the contract to another local company.

do I bow now or after I catch my breath???? Paramedic attitudess will be the demise of our profession, so get as much praise as you can for your two years "ed"

How about get an education instead. Take an A/P and a neuro course at your local CC. You might learn something about all those wonderful things that the paramedics.

side note: we learnt about benzos and GABAa today in my neuro class. Finally starting to learn something useful in class...

So, pop a Valium and feel a little less stressed... Or take a class and learn how Valium works.

This is really frightening. EMT-J next thing we'll have is EMT-K (for kaopectate) EMT-L for Lidocaine, EMT-v for versed do you get the idea???

Dibs on EMT-G(od)

Once again JPINFV beat me to the Google button :x. So then EMT-Johnson is a basic with a penis extension, making up for their educational shortcomings. It's not their fault really. The Medical Director must be out of their mind to even jeopardize his/her license in such a way by even considering this lunacy. :roll:

Don't feel bad. I had it posted in the other thread and just copied it over...

Best that my google skills can come up with is "EMT-Johnson" (not joking, either...)

http://www.tjems.org/skillsdelineation.pdf

Well, if the internal defib keeps shocking I can think of two reasons why its doing it, both bad (the Pt either needs it, or its a malfunction).

In this case, use the EMT-B easy button. Phone a friend (i.e. either get a medic or get to a paramedic receiving center. What ever is closer).

1/4th a paramedic. 1/10 the cost?

The real question, is it worth NR? I questioned many states and even if you are NR they will not let you work in their state with there state cert., most cases they will let you challenge their exam but bottom line is you still have to hold their state card, NR or not.

California is, to the best of my knowledge, now a fully NR state at the basic level. They just recently phased out the state cert, so there are still a lot of basics that aren't national registry. You still need to get your local cert, but at least for my county, that's just a background check (live scan), a cert check (do you have NR? Do you have a CPR card?), and a check. Don't forget about getting your California Ambulance Driver Certificate. That is another Live Scan, a DOT physical, and a short, multiple choice, test based on a pamplet you buy (~$5) (its all test, no behind the wheel stuff).

Isn't the exception to "no beta blockers in this case" people who watch Grey's Anatomy (or The OC, but that is a local bias...)?

Best that my google skills can come up with is "EMT-Johnson" (not joking, either...)

http://www.tjems.org/skillsdelineation.pdf

WTF is an EMT-J?

An Orthodox Jew? :?

Wouldn't that be an EMT-OJ?

Or would an EMT-OJ be an EMT with a knife, a white ford bronco, and a bloody glove that's too small?

/remembers that chase

//Reconizes half the chase scenes at the start of Enemy of the State

Where are you working? Generally the ambulance should have all the supplies you will ever need.

As BLS, I'd be calling ALS to intercept due to the high blood pressure and general appearance, especially if further assessment can't rule out cardiac origin of the chest pain. Because of the limited assessment and treatment available to BLS, I wouldn't want to mess around onscene.

Yea, but thats the answer to just about every scenario. I got sick of posting that after the first time I posted.

(VS-eh, should we let this one walk? )

ABC

Ambulate before carry...

Does he normally use drugs at this location/enviroment? Has he ever had this combination before?

[we just covered addiction and tolerance in my neuro class...]

As with everyone else, a 12 lead would be nice.

Best bet pre-hospital would high-flow O2, rapid transport. Be prepared to control airway and give Narcan (titrated to effect) for when the cocaine wears off.

If it is an MI, give some nitro. Morphine should not be administered.

Any visual differences between legs? Equal pushes? On any medications?

C shouldn't too hard to acheive for the entry level, but it all depends on how well the course is taught. I can't speak to how much physiology there is in paramedic school, but learning how nitro works is going to be tough if its the first time the student has heard about MLCK. On the other hand, if the student gets any where close to a decent course (come on now, we talked about MLCK in a 10 week, 2.5 hr/week course at my university. I hope that paramedics get more then 25 hours of physio), then learning how their interventions work should be a lot easier. Without decent A&P, a simple fluid bolus to induce a Starling's effect becomes complicated (more fluid=more end diastolic volume[EDV]=muscle is stretched further=higher tension=higher stroke volume=higher MAP [if no change to peripheral resistance]). If a student has a good education in physio, the simple fluid bolus becomes more fluid=more EDV. Lidocaine just blocks Sodium channels and Narcan competes for receptor spots. Physio should fill in the rest.

Please if you are going to post or cite journals as well be sure they are pertinent to the case. This article was not for initial spinal precaution (s) , but eluded to the length of stay and having patients remain on LSB. Anyone that works in ER should know that removal of CID and LSB should occur ASAP (after clearance, preferred x-ray or CT) to prevent pressure sores, neuropathy, and other potential injuries.

The purpose of that study was to show that placing a person on a LSB was not a fully benign procedure. I acknowledged the limitation of the study to prehospital care in that post.

Well, I think that C-spine immobalization protocols are just sometimes to general. The biggest indications of a needed CSI for me are poor sensation/motor skills, visible damage, obvious MOI that is known to cause C-spine damage, head/neck trauma, etc. For example, if someone falls off a small ladder and hits a rock that breaks their arm (lets say he fell from 4 ft high) we would splint their arm. Obviously, this would be done after the proper examination. Let's just say the examination revels this patient to not have any other complaints or obvious problems besides the broken arm. On the other hand, some people could say well maybe this guy didn't show signs of internal nerve damage but it would be on the safe side to board him. That arguments is hard to counter because you can't prove them wrong or right. So most people would just say just to be careful board them.

Its about as hard to counter as saying every patient gets 15 LPM via NRB unless they can't stand the NRB. MOI isn't always the best predictor of c-spine injury. http://www.ncbi.nlm.nih.gov/entrez/query.f...p;dopt=Abstract

http://www.jtrauma.com/pt/re/jtrauma/abstr...9856144!8091!-1 (doesn't explicityly state that MOI shouldn't be used, it just doesn't utilize it, either).

Saying everyone gets a board would be like saying every trauma, reguardless of severity, should get a full body CAT scan just in case. Both sound ludicrious. Every prehospital provider (be it a EMT-B, EMT-I, EMT-P, PCP, ACP, CCP, or any other letters) who does something, "just in case" with out a clinical basis should be given a set of voodoo beads, just in case it might work.

Sure, the patient would probably deny back/neck pain, but he also has a destracting injury. Of course, without actually examining the patient it is a null argument. Not boarding any trauma and boarding every trauma is not an answer. There has to be a happy medium someplace that takes into account both the mechanism and the presentation. Blindly following protocol can be just as dangerous as making stuff up on the spot.

The term "skilled hands" in relations to a basic, as a general rule, should not be used in the same sentence. Any monkey can place a combitube, just as any monkey can hook up a pulse ox. It takes education and understanding (things some medics and most basics lack) to understand the what/when/how and limits of what is being done.

And if you think that basics are, in general, not lacking in education or understanding, I dare you to ask the majority of your basics what oxygen does. Afterall, it is our (me=EMT- main drug. Or do you hold basics to a different standard then medics? Would you accept a medic that doesn't know how lidocaine works (I picked lidocaine because it has a relatively easy mechanism when dealing with the nervious system)?

According to what most EMT schools are teaching these days, as long as you repeat the words "Scene safety BSI" aloud as you exit your ambulance, then everything will be just fine. No worries.

You mean that oxygen delivered at 15 LPM via NRB (which is actually a partial rebreather) won't make everyone better? :crybaby:

I think every patient that has been involved in ANY trauma where c-spine injury can NOT be SPECIFICALLY ruled out, should be treated with full spinal immobilization precautions. Depending on the age and health of each patient, it may take more force in some patients to fracture a cervical vertebrae. If the trauma is unwitnessed, c-spine precautions should be taken regardless of the incident. These are just my opinions, but it's better safe than sorry. You can't HURT a patient by protecting their c-spine, but you CAN if you don't treat them based on a "broken branch" theory.

Stay Safe

I will partially disagree. C-Spine is not a fully benign procedure. While, in general, the complications are not either seen or dealt with at the prehospital level, a patient should be monitored closely while on a long spine board.

[web:12cffaf812]http://emj.bmjjournals.com/cgi/reprint/18/1/51.pdf[/web:12cffaf812]

All traumas should be taken as a separate injury. A car accident with enough force to brake a limp should get a board and collar. The SNF patient that had an unwitnessed fall 4 hours ago, was up and walking around PTA and is A/Ox4, has PMSx4, no distracting injuries, and denies pain or tenderness of the posterior mid-line? No real need to. Different SNF patient with a mental disorder that fell the night before and has had a change in LOC from baseline per staff and is no longer ambulatory? Sure, board her up. As always, local protocols should be followed with a grain of salt.

You are called to the residence of a 72y/o female with upper lumbar back pain. She was in an MVA 2 days ago.

Have a nice day. :glasses5:

Ok, lets start with the basics.

ABC's, LOC, Skins, information about the accident, history of prior back pain/problems and primary medical hx.

I would argue that the LSB was a transfer device and not an immbolization device in this case. Since the patient was never fully immbolized, just transfered, there would be nothing to clear. Of course I would have used a breakaway instead (my company doesn't have scoops).

Devils advocate time here. Lets say that a paramedic could refuse transport and recommend that a person transport themselves. If the patients condition deteriorates because they are transporting themselves under a paramedic's recommendation, should the paramedic not be held liable?

True, but those procedures aren't necessarily done by the emergency physician. The procedure is done less frequently and spread out over more doctors. Whereas the trauma center has a larger number being placed and a specific group preforming the procedure.