fallout

I would call 911 for the old lady using my cell phone with the vague description "there is an old lady who looks sick at a bus stop" and not say where and then not answer on callback. I would take my best friend and ditch the woman of my dreams because sooner or later she will turn out to be insane..or I will drive her insane...or something.

I have been there. It happens to us all. I still remember my first pediatric DOS and it has been over a year since the day. And yes, death does overwhelm me. I DOSed my neighbor and literally moved from the apartment because of it. My personal coping technique is to run a strenuous workout. The memories all flood back but in some weird way they motivate me to push my hardest and at the end I seem to be at peace with it all. You are not alone in it all.

Then the evil surgery resident said "You have the ring and I see that your schwartz is as big as mine."

As a general rule I only touch patients as necessary to do my job. I guess this is a side effect of working where most of my patient population has never heard of a bar of soap. In rape cases I like to keep contact to a minimum to avoid interfering with evidence. I have treated two rape patients. The first could not talk as the result of a TBI. The second was in a catatonic state. She would just stare straight ahead with absolutely no reaction. I was basically talking at her for the entire call. "I am taking your vital signs." or "I am starting an IV now." etc. It felt weird but I have no illusions about being a counselor of any sort. I just speaking in calm voice tones and listen. People will talk if they want to.

I would guess you have a case of people making formaldehyde and weed. That is how all the ones i have encountered tend to present. Occasionally they will just go crazy like someone on PCP. I had one break out of leather restraints and charge the ER staff. Be careful if they are making "fry" as they will become combative.

I would love to have that test. My system has short transport but the area is very urban. Everybody has "gots the chests pains." Every shift I am presented with the asymptomatic, vital signs stable, 12-lead unremarkable chest pain patient. Consequently, the ER is very skeptical when you call a STEMI. I can't blame them entirely, medic mill + ton of non-cardiac chest pain and no one wants to call an inappropriate cath lab activation. If I was able to say "I have a positive saliva test," it would drill the message home to the ER staff that much better.

I would disagree on the grounds that the gag reflex is just that, a reflex. A reflex never involves the brain. The signal travels down one nerve, the afferent nerve, to the spinal cord where the efferent nerve transmits a signal to the affected body part to react. Even while someone is paralyzed, the signals are still being sent through the nervous system. Since the one of the efferent nerves of the gag reflex is the vagus nerve, bradycardia and hypotension are a significant risk in intubation scenarios. Searching for "gag reflex arc" on google can tell you more as I am not the most knowledge about neurology.

That is where it gets a little confusing. She briefly improved to GCS of 6 for a period of maybe one minute. She made a weak attempt to grab the BVM from my partner. This was prior to any medication administration. From that point on, GCS 3. I tried everything I could think of, hand drop hit her in the face, painful stimuli to nail bed, sternal rub, etc. I guess that is the practice of medicine. Knowing what the rules are and then choosing to break those rules for the given situation you are in.

I was in a situation about six months ago where I did a RSI without any sedation. It was a tough decision that I didn't like but I felt between a rock and a hard place. The call was a suicide attempt overdose on an entire bottle of Ambien and entire bottle of Darvocet(I think? some narcotic pain control med). On arrival the patient was cyanotic, GCS 3, breathing 4 a minute. The vital signs were rate of sinus bradycardia at 50 bpm and blood pressure of 80/40. We started BVM ventilation and attempted to place an OPA which resulted in the patient gagging. Unfortunately my service only carries Versed as a sedation agent. I didn't feel comfortable administering versed with that heart rate and blood pressure. After five minutes of BVM ventilation she completely stopped any respiratory effort. The patient had very weak gag response at that point. I made the decision to withhold versed at the time of intubation and used anectine only. Perhaps if we carried etomidate I would have administered that because of the shorter duration. Eventually after the airway was established the heart rate and blood pressure improved and I was able to sedate the patient with versed. To this day I wonder if that was the right decision and if the patient experienced mental trauma as a result of the intubation. I would appreciate people expressing their opinion on whether my treatment was appropriate.

I am not a nutritionist, but from someone who is training for a half-marathon your eating habits are not good for someone who is exercising at the level you are. Primarily, I see some problems with not eating enough carbohydrates. I am not trying to insult or demean you, I am just being honest to try and keep you from causing further harm to yourself. There is a wealth of information on the internet by people with degrees in nutrition and/or kinesiology. runnersworld.com under the nutrition tab and bodybuilding.com (http://bodybuilding.com/fun/bbmainnut.htm) have good information about eating for the physically active. None of this replaces speaking to a nutritionist but being an educated patient is never a bad thing. As for exercise, I run three days a week and spend two days doing cross training, be it free weights, resistance training or alternate forms of cardio. The other two days I purposely avoid doing any major exercise. I may do an easy jog to relax or some stretching. Nothing says you have to exercise every day. Often that can be counter-productive. In closing, I commend your discipline to maintain your current routine, but it might be time to use that discipline to make your exercise and nutrition make your more healthy.

Mine was a three month period of slowly realizing there are some glaring issues with EMS that really couldn't be fixed on the paramedic level. One was the fact, at least where I work, who is protocol certified and who is not is largely a popularity contest. I have seen barely competent medics be certified while those who quietly do a great job of assessment and treatment fall by the wayside. Second, the day my service put 12-leads on the ambulance, there was a furious argument among the staff. 12-lead is really the standard of cardiac care these days. It got to the point one of senior members of the service removed all the 12-lead cables because we "weren't trained in them." We had just had a class on 12-lead EKG interpretation. The final blow was a murder scene I worked. My supervisor inappropriately field terminated the patient despite me quoting the protocol at her on scene and why this patient had to be worked under our protocols. There were also some greater ethical problems that occurred in relation to that scene. I documented in all in writing to our administration and the whole fiasco was swept under the rug. My two years experience of EMS have made me aware of problems that will only be corrected by good medical and administrative leadership. I knew that if I stayed a career medic I would grow extremely frustrated and burnt out from trying to fix it from the bottom up. So, I decided to put in the educational time and effort and earn the right to advocate for EMS from the top down.

I am in Texas, Greater Houston Area. Our emergency planners are making their decision at 1130 today. If we evacuate, it is going to be a long few days.

After reading everything, I would be inclined to believe that this child has undiagnosed neonatal hypoglycemia. Now, why the kid has that? Endocrine disorder? First-time parents not aware of how to properly feed a child?

I frequently go back in as "no EMS care" required off of MVCs. Namely, we get tons of bystander calls on every little fender-bender. So, we arrive on scene and the people state "I don't need an ambulance" and "I just want to make a police report." To me they were never patients. They didn't want my services and I can't really thrust my services on them. It is one thing if it was just a documentation issue, but we also send people a $50 response bill when they do not want our services. Now, if we get there and they have a complaint or mechanism is suggestive of potential injury, then it becomes a patient refusal.

I am curious about rates on dextrose drips. I work for a service that still cares D5 and I routinely hang D5 on patients whose blood sugar I am fighting the increase and drop battle on. We don't have a protocol for that, but it seems logical.

Returning the patient to the residence is a bit harsh. I was in that situation, had a swirling the drain patient with a DNR that the family wanted transported to the ER. I tried to explain the only treatment option we had was intubation, which was not possible because of the DNR. The family still wanted transport. Regardless, the patient went into cardiac arrest three minutes into the transport. I took that patient to the ER. As a general rule though, I don't transport cardiac arrests that have not resuscitated if I can avoid it. If they are dead on scene, I break the news to the family and leave it at that. I help them get in touch with a funeral home, chaplain, etc. but under no circumstances is that body going to the ER in my ambulance. Frankly, it is another bill on a family that is about to take a huge expense financially. For reasons of protocol, I do get stuck into transporting cardiac arrests if they do not fit our field termination guidelines. However, when I transport a cardiac arrest, everyone at the ER knows the patient is not going to resuscitate and that I am bound by medical control to transport.

No, retaking basic would be a waste of your time and money. I say this because the paramedic material covers the basic material plus going further in depth into various diseases processes and treatment. In addition, paramedic class is about learning to think like an ALS provider, so a semester of relearning to think like a BLS provider is not beneficial. If there is some information that you are uncomfortable with from BLS class, reread those portions of the text to solidify the knowledge.

Heard on the PD channel during gay pride week: All units, attempt to locate a male...uh...female...uh... shemale wearing a white dress in the vicinity of the undercurrent bar in connection with theft of a purse. Another gem: 369 headquarters, clear the main, have an evading driver. 2 minutes clear.. resume normal on the main, he wasn't evading, just a retarded driver. And, another PD call: Respond to 69 and Wall on an undesirable. Caller advises, Ray Charles, black male is on location throwing beer bottles at people's head. No, not the blind ray charles.

I've never been a fan of the phrase MICU for the standard paramedic-staffed ambulance. Generally, in an intensive care unit, critical care or intensive care medicine is practiced. In the ambulance, we do not practice critical care medicine. It could be said it is appropriate to put MICU on the side of ambulances that do genuine critical care transfers. But, sticking on the side of the standard emergency ambulance does not make sense to me. We are in effect, stealing another discipline's terminology. Even more heinous is that terminology does not describe out function accurately. In the ambulance, we are most closely affiliated with emergency medicine. We rapidly assess nature of complaints and determine severity, then treat accordingly and the mean time, get them to an emergency department. So, we aren't a MICU. We aren't an emergency department. We lack the resources for definitive diagnosis that an emergency department has. The term ambulance has some connotations that aren't exactly flattering to EMS. So, ambulance is no longer a good term to describe our vehicles. I have not come up with a good term for what to put on our vehicles. I have considered medical emergency response, but is is somewhat wordy, though accurate. In fact, everything I can think of is a mouthful. Any other ideas our there?

The issue with the AMR "training," at least as I remember it, was that is isn't about making you a better medic/emt/whatever. It's all corporate policy and that type of BS. No medical training involved.

It was a statement regarding the ill choice of the phrase "Air force above all." A common phrase for the German nation was "Germany above all." In general, that was an expression of uniting the states of Germany into one nation. Germany was similar to the Greek city states for a significant part of their history. Then, one Adolf Hitler came along and perverted it to mean Germany had the right to pillage other nations, enslave people based on religion and ethnicity, etc. I just found the air force's choice of slogan darkly comic.

Ah yes.. Air Force über alles. Soon to corralling all the American jews into ghettos, then bombing them..or some much D:

Another technique for practicing assessment is to find someone in your class and ask them to pretend to be a patient. It does not have to be some life threatening or emergent situation. The point of the exercise is to aid you in building a systemic method of patient assessment. The SAMPLE and OPQRST pnemonics are a useful beginning, but be careful not let those pnemonics limit your assessment. My personal method goes something like this. Hi, I'm <your name here>, what is going on today? That will usually illicit some response such as "I have been vomiting for the last week." Then, start asking questions and performing physical exams that will aid in narrowing down the origin of why they might be vomiting. This would include the OPQRST. Generally I do my past medical history after the history of the current illness. This would include the SAMPLE. Some medics believe that assessment and history taking is all about them talking to the patient. I believe that not to be the truth. I prefer to listen and ask questions that guide the assessment towards narrowing down what disease process the patient is experiencing. I find that the patient tends to give way more detail that way. As others have stated, quality assessment comes from education, practice and experience.

Well, I went back in time, told Hitler his painting's didn't suck and that he should be an artist. I also kept him from going to Vienna or reading any publications by Jews. Really, it was quite a disaster averted without the bloodshed.

I worked for a private transport system where I was frequently handed physician certification statements that were utterly not the truth. I always documented what I actually saw about the patient. The truth is, when the fraud search comes through, who is going to defend you? Certainly not the boss who ordered you to change the run report. He is going to be on the next flight to some non-extradition country with his ill gotten gains.