becksdad

OOOOOPS!!!!! I think I just posted in the wrong thread. But there was a thread here somewhere in this forum where someone suggested that they got to take vitals and the only time they got to do "real" EMT work was when a code came in. I've seen that complaint before, and that's what my previous post was addressing! I must have this special gift for inspiring confidence when I don't even know which thread I'm posting in, huh?!......Sorry

I beg to differ with EMT's and Techs that consider vital signs a "menial" task. These are not just meaningless numbers that you write down and hand to a nurse. They are central to assessing your patient, and recognizing abnormal vitals can be paramount to your patients care. You also have the opportunity (actually the responsibility) to begin forming an initial impression of your patient as you begin vitals. You get to learn what "sick" looks like before you even put on a BP cuff. Tachypnea,diaphoresis, other skin conditions such as pallor or cyanosis, pupillary response are just some of the myriad thing you can recognize in the first seconds with a patient. These lead you to investigate further in keeping with the patients cheif complaint. It is also a time to begin good history taking, as this also provides important information about what the current problem is. Not just past medical history, but HPI (history of present illness/injury). Medication lists are important, and can greatly assist you with both past medical history and HPI, especially if you are dealing with a poor historian or there is a language barrier. All of this can be accomplished within minutes, and is of the utmost importance in where a physician will begin looking and testing him/her self. Also, this is the time to begin to gain a rapport with your patient. You can gain or loose trust very quickly depending on how you "size up" your patient. Some patients respond well to humor, others to a serious professional demeanor, etc., etc. So INMHO taking vital signs is one of the most important tasks in patient care, and ALWAYS involves more than just recording random numbers.

You make me laugh, Michael! Although that is just about what it looks like now! I just can't understand why my girlfriend insists on not sleeping with it!

However, Michael, I was able to save that blue teddy she was wearing. Still have it to this day...... If MaryJo were here, she would tell you thatI tried repeatedly to get her out. That's when the blue teddy ripped off........ yeah, that's the ticket!

aklandrews, we always called that one TACHYLORDIOSIS. Happens a lot after dey done fell out from not takin der peanutbutter balls (phenobarbital).

Agreed you did a good job not only assessing, but documenting. I will always maintain that good assessment and interpretation of findings is the whole basis for good patient care. Documentatation supports anything you did or did not do. So I don't get your Stuporvisors problem........ Big words? Too medical sounding? Perhaps they could provide some paper documents with the really WIDE lines and some big, fat crayons to write with.

Michael, that was a burning car we were talking about...... Sinking cars are an entirely different scenario. No fire, no burning desire....... At least not to do the right thing anyway. How ya been Michael?

I am truly amazed at the level of debate produced by the original question - which was ridiculously insufficient in content. Way too open-ended a question. But the debate has been good. First, it seems all agree that practice outside scope is nearly always a mistake, not to mention dangerous. I wouldn't want some rogue who makes all his/her own rules all the time practicing on me or my family. But there are circumstances...... One of the best examples I've seen here was where Ruffems spoke of reducing a dislocated knee with longstanding circulatory compromise. I have never been in a position where I felt I needed to manipulate a dislocated joint (except for my own toes). But faced with the same circumstance Ruff was faced with, would I have done the same thing? I think so. I would be uncomfortable and unsure of my ability, but I would try because I know that the patients limb is in imminent danger of being lost. As for the burning car scenario - IF I could get close enough, yeah, the leg would go and the patient would come out. But I think we need to remember that we are speaking of circumstances so incredibly unlikely, that protocols, SOP's, and scope of practice are practically useless. These are simply HUMAN circumstances being referenced, not just MEDICAL ones. That being said, I watch people practice outside certain "scopes of practice" every day. I work in an emergency dept. now, after several years on the road. In the ER, physicians order all diagnostics and treatments, nurses and techs carry out those orders. Do you think it really happens that way? Nurses routinely order tests and initiate treatments. Hell, even I order tests sometimes before a Doc has even seen a patient. Usually the physician is consulted before actually performing a test or treatment, and the physician NEARLY ALWAYS approves this. Of course, this is in a situation where the staff have all worked together for a long time, and a great level of trust and confidence exists. I know that this is an entirely different discussion than has been going on in the thread, but it kind of underlines how open ended and inflammatory the original question was, doesn't it? So, in my typically over-worded way, I guess I am agreeing with AKflightmedic, who so succinctly answered the original question ("would you work outside your scope of practice to save a life?"). Maybe. By the way, if I was the person caught in a burning car, tethered only by strands of tissue from a nearly amputated leg: I would rip the leg off myself, get the hell out of the car, use something to tourniquet my leg, gee, maybe I could even find some strands from the steel-belted tires and suture my own arteries closed. Then I would look for some help. That's what I would do in that outragously unlikely circumstance while folks sat around debating whether to save my ass or not. All tongue in cheek there, folks........ It's been a long time since I've been around the city, haven't had a computer for over a year now. I live in the stone age mostly....... but it's good to be back. Hi to all the folks I have missed.

Panda Bear, the most abundant jobs in ER's for EMT's & Medics are Tech positions. Responsibilities in these positions vary between geographical areas and facilities. There will be a great deal of non-glamorous tasks such as changing beds, stocking supplies, emptying trash, placing foleys, etc. But these things are required in nursing and EMS in the field also. Every position nearly everywhere includes tasks you may not like. Oh, well. But there is plenty of patient care, too. Assessing patients, wound/orthopedic care, blood draws, possibly I.V.s (depending on the facility), etc. I also know several Medics who do sedation in hospitals for procedures on pediatric patients. The list is nearly endless. But if you are in school now, the possibilities expand even further. Since you are interested in being a Paramedic, You could pursue Respiratory Therapist. RT's do probably the closest things that are attractive about field EMS. Where I work, RT's do not only updrafts, vents, and all things respiratory, but 12 lead EKG's, ABG's, and more. The whole medical field is wide open and in demand. If you are in school, the choices are almost endless. Again, good luck in your pursuit!

Panda Bear, AKflightmedic gave excellent advice. As Dwayne previously said, I lost a career in field EMS because I had a seizure while on duty. In Florida, you must remain seizure free for 5 years before you can work on emergency vehicles again. If you have a documented seizure disorder, I think this would disqualify you from field work. And if you think about it, it makes sense. Thank God I didn't seize while behind the wheel of the ambulance! Also, you probably know that strobe lights can induce seizures in those prone to them. At any rate, like AK said, there are so many alternatives to pursue, having a seizure disorder certainly doesn't bar you from a career in EMS. I now work in an ER, and it is as good an experience as I had in the field - just different in some ways. In a lot of ways, I have gained more experience in a shorter period of time because we deal with many patients at once, all day long. Good luck to you! If you really want to work in the medical field, I gaurantee you can regardless of having a seizure disorder.

I don't understand what you mean when you say that finding paid EMS work elsewhere would defeat the purpose of being an EMT there. What is the purpose? Beyond that, though, I think it will be very difficult to get and remain sharp without frequent patient contact. Training is fine as far as it goes, but training rarely takes into account the infinite variables of any situation. It is almost as if it remains only theory until you experience many similar situations first hand. Education is much more a key I believe. If it is within the realm of possibility for you, go to school. If you return to school to become a Paramedic, do the degree program instead of a tech school type curriculum. I gaurantee that you will be MUCH sharper after school (running no calls) than you would be running 11 calls in 10 months with only monthly VFD training sessions. Education, experience, and continued training are synergistic in developing a good provider. So if you really want to become a good provider, set yourself up in a situation where you can get all three.

Dwayne, I can't help but feel for the situation you find yourself in. But DO NOT, under any circumstance, diminish your standards and expectations! The vision you hold for EMS is what can help us progress. I can't help but think that Medics who offer smart-aleck responses to serious questions either don't know what they're talking about anyway, and/or they are afraid of someone else excelling and making them look bad. Hang in there, my man. I know you will find good Medics that will be good mentors, and knowing your judgement, I know you will choose your mentors well. As for your "preceptor" stating that no one should become a Medic the way you are doing it, I assume she means going straight from Basic to Paramedic. That's pure bullsh!t! I wish that I had done things the way you are doing it. Several years of experience as a Basic has done absolutely nothing to further my ability to be a good Medic. I could have gotten those same years of experience with the education you are gaining now. As it stands, I'm still a Basic. I'm with Dust on the idea of hiring you if it were an agency I was responsible for. Only I wouldn't fire your current preceptor right away. I would let you precept her and give her a chance to remedially train for excellence. With the attitude you describe, though, I doubt she would make it.

Respiratory Acidosis - Ok, I'm going to answer this only on what I have seen with this, so it won't be very in-depth. Hopefully someone will expand on it beyond anything I can say. It is a respiratory pattern characterized by very rapid, very deep inspirations and expirations (as opposed to the rapid, shallow respirations of hyperventilation). It is the body's attempt to blow off ketones (and maybe other acidic compounds?) trying to restore a Ph balance. After a better discussion of Respiratory Acidosis, how about: EPIGLOTTITIS

I think we need to take a great deal of responsibility for this lack of perceived professionalism ourselves. Ems as a whole in the U.S. is filled with people who perpetuate a negative perception. We have the whackers who simply get off on lights and sirens and "excitement". I know plenty of professionals in this field as well, and not a one of them is infatuated with any of this stuff. We have burned-out providers who bitch and moan about every single call, who attempt to talk patients out of going to the hospital with them - sometimes with disastrous results. We have providers who apparently don't have a clue as to how to assess different patients, or how to interpret assessment information. Lack of education? Let's talk about that next.... It's impossible to argue against increasing education. But many of us CHOOSE ignorance! EMT's who never want to learn anything beyond the basic 120 hour course. Providers who only meet the minimum CEU requirements in the easiest possible way. Hell, the agency I worked with for several years utilized an online CEU program for both Basics and Medics. When I did the Medic programs, every single question on the tests were BLS questions!!! Impossible to financially afford or have time for formal education? How about educating yourself? How about being interested enough in this profession to learn as much as you can? Even if the things you learn address issues that are beyond your scope of practice. It can only make you a better provider and patient advocate. And it will certainly make you better at assessing patients and communicating with other healthcare professionals. I really think that if we individually elevate ourselves, we will slowly begin to attract the caliber of people who will perpetuate professionalism. To a great extent it is up to us. As established providers, we need to promote all these things to newer people. Newer people - choose your mentors wisely! There are in fact many excellent, professional people within EMS. I wanted to say more, really, but I'm at work and need to go. But just a final thought: Regardless of anyone's perception, I consider myself a professional. I want professio0nal partners, and mostly I have had them. If you act and strive for professionalism, you are a professional. So do it.

Why does she take Prevacid? Was it originally prescribed in response to prior GI complaints? Or concomititantly with the ASA as prophylaxis?

So far, this is what I see as significant: Recent Hx of pneumonia, which is treated and resolving. Age of patient normal vital signs, no dyspnea completely non-tender left abdomen, sounds as if there is no guarding. pain is localized and severe, even to touch. considering the above, it seems very significant that the pain is described as off and on burning. Any skin changes in the affected area? I gots me an idear......

Hey, Eydawn - I would take the "freakishly large frontal lobes" comment as a compliment! Your posts always seem to indicate that you try to fully investigate any scenario you are involved in. You are very obviously quite cerebral in your approach to EMS, but seem to balance it with intuition based on knowledge and experience you have gained. That seems to address both the art and science of any type of medicine. So keep your freakishly large frontal lobes - they're an asset! ... By the way, I've seen quite a few dogs with only 3 legs... I mean feet... you said feet didn't you? I'm so confused!

As for the titles - who wants to be the "Dick of EMTCity"? We could have elections.....

How about bootleg Dextromethorphan? I understand it is sometimes sold via internet sites, referred to as DXM, in powder form. Some kids experiment with it as a supposed hallucinagen in megadoses. In large doses it acts as a dissociative anesthetic. Also, many forms of Dextromethorphan, both OTC and bootleg are combined with other active ingredients such as decongestants and/or antihistamines. There have been several fatalities through the idiotic use of this drug, including a double fatality in my neighborhood last year.

I have never been to a patients funeral either. Unless they were a personal friend, I can't imagine why I would attend. And I must agree with Asysin2leads that wearing a uniform (unless as part of a group to honor a colleague/brother/sister) would be extremely tacky.

I really like what Brentoli said about ears - so true! I would add eyes and noses, too, and by extension, our brains! Definitely a vital and underused piece of "equipment"! I've never been without a scoop or a stairchair - can't imagine not having them. Never seen the patient status lights, though. My vote goes with the KED. So many people around here are averse to using them, mostly for their own convenience (such as lunch not getting cold!). Ridiculous. By the time some responders half-arse immobilize a seated trauma patient, they could have properly placed a KED and done it right. About 2 weeks ago, I saw a patient from an MVC, seated upon arrival who was not KED'd. C/O neck/back pain. You all know the manipulation required to move a seated patient from a vehicle to a board to the stretcher. Well, this patient had fractures of C-1 and C-5. Fortunately, the fractures were stable, and patient experienced no compromise. LUCKY, LUCKY patient! But what if.....

In addition to ERDoc's comments as to the reality of hospital E.D. care, I would like to tell you about last night's visits to our E.D.: - An afebrile middle aged woman with a stuffy nose, whose C/C was "I have a cold." - A mother brought her young son in and stated "He has a mosquito bite." - A young couple came in and the young woman stated "I just found out I'm pregnant, and I want to make sure the baby is OK." - A family of 5 was involved in a very minor MVC (literally just a scratch on the rear bumper according to EMS). Dad wanted everyone "checked out" to make sure they were OK. Not one of the 5 had any complaint or sign of injury. - The perfectly healthy Baker Act patient sent to the facility for "medical clearance", and then held for over 11 hours because the Behavioral Health facility stalled on re-accepting the patient. Every one of those patients complained vociferously about the long wait for treatment and discharge. How many of those patients do you think will pay even one cent towards the diagnostics/teatment they did recieve? My bet is none. Yet, we also had a host of other patients with truly life threatening emergencies. And many, many more who truly needed medical attention, though not of a life threatening nature. And evey one of those patients will be billed an astronomical amount for their care. Hey, I don't have any answers, either. So it all seems like a pointless rant. But something is terribly wrong with the state of Emergency Medical care when we feel we must respond to a mosquito bite as if it is on the same level as an M.I. And then, if we don't, some lawyer gets involved. Hospitals end up practicing to avoid litigation instead of actually practicing emergency medicine.

Hey, I just started reading this thread tonight. ErDoc, I swear... I thought it was a woman!

Ok, ALS is 3 minutes out, hospital is 4 minutes away. Resps are 24, sustained heart rate at 140. 100% O2 in place - good. You think bed is covered in bloody feces (it's a very distinctive smell, dried or not). Patient drinking alcohol, known heroin addict. Not worried about heroin OD, his resps would be very slow to non-existent. So I'm back to G.I. bleed. I'm betting B.P. is low - get him supine - maybe strapped to backboard, get him downstairs on the board. I wouldn't waste any more time assessing or trying to treat anything on scene. You could be at the hospital within 60 seconds of ALS arrival on scene, so why wait? It would be an additional 4 minutes to get him to the hospital by waiting for ALS. If Fire has a Medic on scene, snag him to provide ALS care enroute to hospital (I.V., fluid bolus, 12 lead, even Narcan although that seems to be the least of this patients problems, etc., etc., etc.). Do any further assessments enroute. Be prepared for vomiting and ventilation assistance. In general, treat for shock, supportive care. Based on the info provided so far, the sooner this patient gets to definitive care the better. I don't see any advantage to waiting or continuing assessments that do not address ABC's. Whatever you can get in the way of further history or assessment info, fine, but get going. From what I see so far, that's how I would have run the call.

Well, since there was no mention of scene safety and you entered the residence to the second floor, I guess there's no problem there. But what is your initial impression of the patient as you approach? Level of conciousness/responsiveness/orientation? Respirations? Appearance of skin; diaphoretic? Pulse - rate, rhythm, quality? As well as information requested by vs-eh? And how does this impression fit in with the environment you describe (empty alcohol containers, blood and/or feces covering bed)? My first impression just from the limited verbal information is that the blood/feces could well be significant, especially if there is history of alcohol abuse. Any other clues in the environment as to pertinent history? Can wife or patient give you any further info quickly? Just based on that little bit, I'm thinking Fire would be real good to have on scene. Unless you and your partner want to carry the patient alone down from the second story, as well as equipment. It sounds like it may or may not be something pretty serious. I mean, I can get a mental image here of an alcoholic holed up in a dark bedroom, probably not eating or drinking much else, becoming dehydrated/hypotensive, maybe G.I. bleed, hell, maybe even hemmorhage of esophageal varices. Or maybe I just have a vivid imagination, and he really did just injure his leg. But this just sounds too much like one of those calls where dispatch information is way off base from the actual situation. I am curious to find out the answers to questions posed so far.