becksdad

OOOHH, DUST!.... P#ss*ng off the FD!!!!!...... but you are right about the neck/back pain thing. Very rare in kids, but anybody claims they got it, they're going with me. Unless refuse AMA.

Jeez, can we be sensitive, or what?!?All this over BP's? If someone is new, and trying to learn, "how do I take a blood pressure?' is a valid question. If someone is currently providing care at any level, shouldn't they know that 15 seconds on a radial pulse will give them approximate information as to BP, HR, rythim, quality? Its part of initial impression. And isn't a postural BP or Tilt test part of secondary assessment on syncopal, near syncopal, or hypotensive patients? (barring contraindications, such as trauma, suspected c-spine, etc?). Come on, this is really basic stuff. We need to get our ego's out of the way. And I'm not talking about the folks who have been doing this forever, and have WAY more education and experience than most of us. I don't care if Dust, and Rid, and AZCEP, and Asys, or anybody else has an ego the size of Jupiter. They have EXPERIENCE, they have knowledge to offer. I'll take it. Bash me all you want, if I can learn from you, OK. We need not shoot the messenger just because we don't like how the message is delivered! Translation - LIGHTEN THE HECK UP!!!

That was the perfect answer. Your turn.

Stiff man's disease - Moersch-Woltmann Syndrome, characterized by persistent rigidity & spasms of muscle. How about a patient c/o abdominal pain, and they tell you they have Marfan Syndrome?

Two peanuts were walking down the road, and one was a salted.

Interesting topic. Personally, I would have to agree with buckeye about most of these questions. I like to think that I am competent at my job. Been doing this for several years, have run several thousand calls, comfortable with equipment (KED, Hare, etc.), been on a few MCI's. I read, study, ask questions. We do monthly in-service training sessions, and credential before our Medical Director bi-annually. My regular partners trust me with operations and patient care, and I trust them. The highest compliment I have ever received is when my partner asks me "What do you think?" You see, I am an EMT-B. And we EMT's have kind of a bad rep - sometimes deserved, and mostly our own fault. So this topic just gave me a soapbox to stand on. Mediocrity seems to be epidemic, not just in EMS, but everywhere. We in EMS cannot afford to be mediocre - the nature of our job demands that we strive to be the best we can be. Would you let someone like you treat your mother? I know of EMT's who really think that it is their job to drive the ambulance and gather information. Period. And some of these same people haven't a clue as to the importance of information they gather. We need to be aware that chief complaints, vital signs and other assessments, histories, and meds all provide a more complete picture to direct any care we provide. And we really need to be able to interpret all this information accurately. It is NOT just the Paramedics job to interpret and treat patients based on presentation. What about the patient who initially presents priority 3, but begins to decline enroute to the hospital? Will we recognize the changes? Are we assessing and re-assessing? We should be. It is also our job as EMT's to be familiar with at least the fundamentals of ALS procedures and equipment. We should know how to apply a 12 lead, de-fib pads, etc. We should know approximate ETT sizes a particular patient might require, as well as all the equipment needed for intubation and where it is located. We should be familiar with ACLS protocols, what drugs are used, and where they are. We should be able to set up a nebulizer. All of these things and more ARE OUR JOB. We are PARTNERS with Paramedics.We do not have separate jobs - we are a team. Of course, this is assuming we are competent in BLS procedures and equipment. That is just a minimum requirement. But if we are content with meeting only minimum requirements, whose fault is it that EMT-B's have a generally poor reputation? It is incumbent upon us to change our own reputations. If we can be trusted to have a clean, well stocked truck, to communicate appropriately with our partners, to deal effectively with patients and families, maybe we can be trusted to become real partners. Maybe we can gain some CREDIBILITY. But its up to us. Sorry if I kind of got off the subject a bit. This is one of my pet peeves. I probably come off sounding really serious, but really I'm not. I have lots of fun at work. And there's always more to learn, so it stays interesting. No, I do not believe any one of us has mastered our chosen profession. Looking back on what I've written here, it might sound like I think I know it all, sorry if it comes off that way. I just think we need to elevate ourselves by taking our own initiative. Thanks for letting me rant.

Rid, I thought that was very well stated. I also think we've beaten this horse to death....

AZCEP, chbare, thank you both. Your comments pretty much supported our argument/questioning of why Valium (of all things) was given intranasally. This particular patient wasn't even seizing!

CH - Good point. Of course IV is always the preferred route, but we have recently used intranasal versed for seizures when IV access has been unsuccessful (usually on peds). It is pretty effective, with faster onset than rectal valium. Then again, I suppose the argument could be made that this could encourage mediocre IV skills. For some it may, but its a nice rescue tool when used judiciously. As for valium used this way, I have found nothing in any literature to indicate intranasal administration. There has been quite a bit of discussion among several of us involved with this particular call, and when my partner and I discovered the drug this patient received, and the route of administration, it was kind of a WTF? moment.

Asys, Dust, All other senior EMS providers- 1St- Asys, I hope I never have to work with anyone who puts together the 3 words "way cool badge"!! 2nd- Some of the best things I've learned so far have come from people who p*ss*ed me off by reaming me out! So I look forward to being beat up by you guys!! 3rd- To everyone who takes offense to straightforward criticism- lighten up yourselves!!! As long as you know its not your emergency, you can learn from everything!!!.......

Has anyone ever heard of using valium intranasally via an atomizer device? We use versed intranasally, and I've heard of narcan used this way also. My understanding is that valium is too viscous for proper atomization and absorption. But we inherited a patient a while ago from another agency that administered valium intranasally (and it wasn't very effective). They insist they have a protocol for this drug/route, but I have been unable to locate any information supporting this. Just curious....

Oh, yeah- forgot this one. Called for MVC, car vs. pedestrian, 7 y.o male, unresponsive. O/A, the 7 y.o. male was a cat.

Dispatched to a call for "patient salivating". O/A patient states she "swallowed" and is much better now. But for the rest of the month, whenever we had a patient c/o nausea, I would ask them if they had excessive salivation when nauseous, and then watch my partner trying not to laugh!!

Usually "the truck" or Medic(insert #), for a lot of calls, its called the "taxi" or the "big white taxi". But I like Tniuqs post: I'm gonna start calling it the "ecnalubma"!

Rush, I am generally very supportive of students. However, unless I'm reading your initial posts wrong, the spirit of where you are coming from SCARES me. You must realize that this field involves a whole lot more than just "helping people". First and foremost, any responder on scene or in a truck is responsible for the safety of everyone else - yourself, your partners, patients, bystanders, etc. Until you've been in potentially dangerous situations, you can't possibly know what this really means. Nothing personal, but I don't really want to trust my life or my partners to someone who is doing this as a part-time gig to get through college. As for helping people, you must also realize that even at BLS level care, it is possible to further injure or even kill someone. The scenarios where this can happen are so numerous I won't even illustrate. Competence in operations and skill in care/assessment comes through experience. Schooling is only the beginning, and it is unlikely that sufficient experience would be gained part-time while concentrating on college class load. PLEASE, re-evaluate motivation for the desire to get into EMS. I would never discourage anyone from this field who seems truly commited to becoming a good responder. But "Ricky Rescues" who want to indulge adrenaline rushes, or get off on lights and sirens, or fantasize about glory become liabilities to us all. I don't mean to sound negative or judgemental, but please realize the level of responsibilty involved, and potential consequences of every decision. I do wish you well, and hope that you make the right decisions.

Hey, Toy, I'm new to this site, but for what its worth it is a good thing that you have seen a negative aspect of people and attitudes within EMS. There are basically 2 ways to learn this stuff - 1)-what to do; and 2)what NOT to do. Yes, there are folks who are burnt out, who have bad habits, who treat patients poorly. And we all have days that we b*tch and moan about. But now that you've seen this, seek out EMT's and Medics who are really good at what they do. There are many excellent people doing this who will guide you along. Find medics who provide superior patient care, take pride in their work, their truck, their partners and themselves. Make your own commitment to be the best provider you can be, and hang around with like minded people. Learn about more than required to function as a Basic. If you can support/assist a Paramedic partner as he/she provides ALS care they will LOVE having you as a partner, and you will find in a short time you have many valuable mentors. If this field is for you, and you surround yourself with as many positive and skilled people as possible....well, its the best damn job in the world. Good luck to you!!! P.S.- Just remember we're all a little whacked in the head...look past our individual insanities OK?