becksdad

Eydawn, the attitude you display, the acceptance of your own limitations, and the desire to improve already make you an excellent provider! You are the kind of person I would want to run on a member of my family. We don't often compliment or give kudos to each other, but I wish that I had your attitude and professionalism when I was 20 years old. As it is now, I'm already an old fart, and will never reach the competency level that was possible had I had my stuff together when I was younger! But today is today and yesterday is gone. Just keep doing what you're doing!

I think the reason that Glucagon is not, and should not be an option for BLS providers is that it causes the liver to dump all of its glucose stored (if any), and then the entire body is depleted of any reserve fuel. At least that's my oversimplified understanding of its mechanism of action. Now watcha gonna do if it doesn't work? Bad juju. Very bad. Now you're going to be screaming through town L&S with a patient you can do nothing for. With the knowledge that you may have caused that situation. Please, anyone correct me if I'm wrong.

Congratulations on the job offer!! What an exciting time for you! All of the above advice is great. All of the advice from posts about students and ride time is applicable, also. As well as showing enthusiasm and doing things - watch. Everyone has a lesson to offer. Some of these lessons could possibly be what not to do or how not to be. Use common sense. As you watch and get to know the Medics you work with, choose wisely your mentors. We all have mentors - people whose knowledge, skill, and demeanor we want to emulate. The learning is just beginning, and it lasts a lifetime. Remain a student, but be comfortable and confident in those things you do know. And finally, realize that you also are a teacher. No matter where you are within EMS. You might be the only, or the first, EMT someone sees. Make sure they are left with a good impression of a professional within the medical community. Again, congratulations!!! Have fun.....

So following the Snickers bar anectdote (great story!), logic would dictate that a tube full of instant glucose administered in a like manner would have dramatic positive effect..... Seriously, though, I've always thought that oral glucose is a monumental waste of time. I wouldn't stuff anything into the mouth of an un-or-semi-conscious patient. Time for D-50, or Glucagon if unsuccessful at IV access. No matter what, they still have to eat something. So if they're awake enough to gobble on some orange pasty crap, why not just get a nice glass of OJ, or a peanut butter and jelly sandwich, or something? Seems to me the boost in BGL is better and longer lasting from real nutrition anyway. Just my $0.02. .... I've always wanted to say that.... "my $0.02." Never said that before. "Just my $0.02". ...there, I said it again. Man, I'm in a smart-aleck mood today.

Eye due undurstand yur poiwnt, but eye would hait too sea a pee-see-are ritten liik this.

Asysin2leads comparing himself to Mary Poppins: Priceless!!!!!!

Sounds like a real Boy Scout.... It'd be a shame to lose one such as this.

HaHa back atcha! I was going to make the same M*A*S*H comment! Dust - did you really mean to say that the entire camp is a quarter mile HIGH?

Pumpkin!!!!! I love it!!!!! Pajama Party!!!!! Hahahahahahaha!!!!!! Shira - don't take it personally...... LauraAnne - you're my new favorite newcomer to the site! Not because of the catfight quality of your last post, but because of your not-so-subtle implications and expectations of professionalism within our own ranks. Of course, catfights are fun, too!!

Addictions are a HUGE problem everywhere, I think. This poses a challenge to us as EMS providers because it is so prevalent, especially poly-pharmaceutical abuse. The most wasted person I have ever seen presented to our ER a few weeks ago. He had a BA in the low 500's, and EMS brought with them 3 empty Rx vials - Percocet 10's #30 ( not 5's, 10's ), Diazepam 5's #30, and Ambien 10's #20. All dated within the last 3 days. According to "significant others", this patient had consumed all of these himself, as well as 2 GALLONS of Vodka in the last 48 hours. This patient was initially found face down in a pool of coffee-ground emesis, and was covered in bloody vomit from chin to waist. Believe it or not, this person could tell you his name, birthdate, the year, the date, the current president, where he was, and what happened. Once you translated through the gibberish talk and unfocused eyes, that is. Amazing. It must be a full-time job to develop that kind of tolerance. Just as a footnote, this patient did NOT have esophageal varices, the entire time he was in the ER his V/S remained WNL (R/R between 14-18, P=in the 80's, and BP in the 130's systolic). Temp. just a little low initially (around 97.0). Again, amazing. A few days later he walked out of the hospital under his own power, entering an in-patient treatment program. I do not volunteer this story as anything like one-upmanship, but to raise awareness of the immense problem of poly-addiction, and the true medical emergencies that this can present.

Man, I haven't seen sirens or heard strobe lights since the 70's! Do they still look and sound the same?

Funny stuff right there! Would Dr. Samuel Shem happen to be Professor Emeritus at BMJ (Best Medical Journal)?

Once, when it wouldn't start, I called it a "M@th*rpl-ck!ng Beotch Ho!" and slapped it upside the dashboard. * I know.... I keep raising the bar of professionalism for all of us. Forgive me a moment of weak smartaleckness....

WARNING: THIS POST WILL LIKELY RANT AND RAVE AND OFFER NO ACCEPTABLE SOLUTION TO ANYTHING! Docomd600, I am originally from Maryland also, and my introduction to EMS was in that state. I see from your post that the county you work in is combination career/volunteer - from that I can guess that you are in one of 2 counties that border Baltimore City. To my knowledge, the other counties are entirely volunteer, and I used to live in one of them. I would like to tell folks about my own experience and observations in this county volunteer system since members of this board have been graciously tolerant of my other tirades. Back in the mid-90's, the volunteer FD had impressive looking apparatus. The particular station that I was involved with had 3 ambulances and many more pieces of fire equipment - engines, trucks, pumpers, brush trucks, etc. And that was just one station of many dotted throughout the county. They were all late model vehicles. This period of time was also my personal introduction to the Whacker. The parking lot was filled with personal vehicles sporting lightbars, strobes, reflective striping, window stickers, and custom license plates. Members considered cornerstones of the organization had nicknames like "Bubba", "Red", and "Bucky". (Real nicknames that I remember). Standard issue uniforms included baseball caps and cans of Skoal. 911 calls were answered by people flying down the road since they had to hastily leave their lawn cuttin' business (sorry - landscape design service). Despite the investment in large, new ambulances, EMS was quite the bastard step-child of the volunteer FD. There were arguments and debates over who would have to cover the Medic truck - mostly by people not wanting to do it. FIRE was the big ticket baby! Everybody wanted FIRE. The rare CEU class or Medical QA meetings were so lightly attended that there would be leftovers from a dozen donuts. But let 'em get ahold of an old barn to burn and half the county was in!!! I remember being at a CPR recert class there when a fire call was toned out. My God! Even though there were sufficient people covering the trucks, most of the folks in the class (including the instructor) got real bug-eyed, started quivering, and ran, literally RAN at full speed, to throw on some turn-out gear and not miss the truck pulling out! I looked over at the other guy left sitting there (like WTF?), and we both just busted out laughing!! It has been about 10 years now since my brief involvement with that particular organization. When I go back to Maryland to visit family, I see that they now have a brand new, multi-story, multi-million dollar station that covers an entire square city block. I think there are 6 bays, new vehicles, and the same light bars, strobes, etc. on the POV's in the parking lot. From the local media, it seems inside the station there are private sleeping quarters, classrooms, media center, fully equipped commercial grade kitchen, etc. Other stations throughout the county are following the lead of this flagship. THIS ENTIRE COUNTY REMAINS COMPLETELY VOLUNTEER - NOT ONE PROFESSIONAL, CAREER MINDED INDIVIDUAL RESPONDS TO EMERGENCY MEDICAL CALLS!!!!!!!!!!! And yet, professional, educated masters of Emergency Medicine still do not have bunks, stoves, or even chairs to sit in!!! Many, like Asysin2leads I imagine, must stage in their vehicles for entire shifts, without benefit of even a bathroom!! Unless they're in an extended cab vehicle, they can't even recline their seats to take some pressure off their backs. I cannot even begin to express the utter shame we should feel as a nation that re-creates the conditions described above in state after state, county after county. I know that complaining about something is useless without offering alternative solutions. I have none. I really wish I did. Maybe a start would be to proclaim as publicly as we can the reality of EMS throughout this country. I am certain the same holds true in other nations as well. I really don't think the public has a clue. If they did, maybe they would begin to take the kind of pride in Emergency Medical Responders that is currently reserved for "Bubba" and his big red fire truck. *no disrespect meant towards any professional firefighters or landscapers.

Off the wall topics, obscure diseases and such are interesting, no doubt, but my suggestion for the first paper, "Pathophysiology of a Disease", would be to impress your instructor with a thoroughly researched paper on a disease that we commonly see and affects many people. For example, Diabetes, Artherosclerosis, Hypertension. These 3 diseases are not only widespread, but they have diverse effects on multiple organ systems, and there is an almost limitless depth of information to learn about. I would bet that a well planned dissertation concerning etiology, sequalae, treatment, prognoses, etc. would not only impress your instructor, but would give you an armament of knowledge that will be useful to you throughout your career.

Oh, Lord! Scratrat touched on what I think was the main problem with this call. Actually it is 3 problems, and they are: scene safety, scene safety, and scene safety. First, this crew runs to a "known crack house" met at the door by a "15" year old intoxicated girl trying to refuse entry. There is violence threatened. There is no LE. Not only does the crew attempt entry into the house without it being secured, but they managed to talk their way in despite obvious danger and despite having no LE on scene. Once inside, everyone there appears intoxicated, more threatened violence, patient alternating between unresponsiveness and violent behavior. And then.... according to the account given, this patient somehow must have been removed from the house.... only to be brought back into the house!!!! WTF!?!? Then, to top it all off, the 2 partners split up so one could go back into the house again and try to get a history on the patient. Never lose sight of your partner!!!! And why REPEATEDLY and DELIBERATELY insert yourself and/or your partner into dangerous situations? I don't get it. This was sheer lunacy! I know your post was actually trying to address a question of transport vs. refusal for intoxicated persons, but nothing trumps my safety or my partners safety. And from what was said about this call, the entire thing is a glaring example of disregard for anyones safety. As for the question about refusals by intoxicated persons: usually they go with us. Most times, they are a danger to themselves or others, and states of intoxication render them incompetent to make intelligent decisions. For those resistant to a nice ride to the hospital, LE can be fairly persuasive. Failling to obtain consent is still not a problem - there's always the Baker and Marchmann Acts. Speaking of Baker Act - I think those 2 partners you told us about would qualify as recipients. They definitely placed not only themselves, but others in danger!!!........ sorry, I just had to get another one in

As one who is an EMT-B, I would like to see discussions take on a different focus. I think we need to get away from "skills" per se, and focus on 2 things: Assessment and Education. It just doesn't matter what we are able to do to people if we don't know why we are doing it. I, too, went through a period where I was enamored of learning new "skills", and honestly, I don't think I have ever seen an "ALS skill" that I couldn't master in a fairly short time. But the ability to perform an intervention means absolutely nothing without good assessment. You can't decide what to do until you know why you are doing it. And with all the variables that thorough assessment entails, the knowledge of human anatomy and physiology, awareness of consequences of interventions..... it seems to me that there is quite enough to learn there to keep us occupied for a long, long time. I think great assessment skills are the result of 2 things: Education and Experience. To me, the mark of an excellent provider is in the ability to thoroughly and accurately assess patients. It is incumbent upon us to become educated and to practice all of the knowledge we accumulate towards improving our asessment capabilities. As EMT's, we need to decide the direction to focus on. I would much rather give report to an Emergency Physician providing detailed assessment information, which will assist the physician with his own assessment and treatment decisions, than to exclaim "I started 2 IV's for you!" (and then expect them to be impressed).

Hey Michael! I said "lots of stories, very few true". If you don't jump on that one, I'll know Teddy is dead.

I don't believe that 95% you were told, Wannabe. I also don't necessarily believe that increased opportunity equals increased infidelity. No matter where you are or what you do, if that is what you are looking for, you will find it. In that respect, I don't think EMS is any different than any other occupation. Perhaps I have been very fortunate, but the majority of my regular partners have been mature, commited people, both professionally and personally. Call me naiive, but 95% sounds a lot like boys high school locker-room talk - lots of stories, very few true.

Welcome, Doc! We are so glad to have you here! The quality of this board just keeps improving, and I hope you stay to continue the trend. Us newbies need it.

We have Duoneb that we usually use after albuterol alone, or with a patient who has obtained no little or no relief with MDI or a home nebulizer. It often (but not always) makes a big difference. We also use Solumedrol that helps a lot, but later rather than sooner.

Never say never, but I don't see burning out ahead of me. There is always more to learn, new experiences, new avenues to explore. It's the most entertaining thing I've ever done as an occupation. I take emergency medicine seriously, but it's not my entire life (which I think is a big key). I'm also a husband, father, friend, neighbor, brother, son, student, etc., etc. Medicine fascinates me. I hope it continues to do so for a long time.

Last time I broke a window was when my Dad showed me how to make a slingshot. I was 11.

I carry a combitube. I like to inflate the cuff and tell people it's a tamponade device for lower G.I. bleeds.

Dustdevil wrote: "Once a provider is educated, it becomes painfully obvious how absurd this popular misconception is. And then the craving for protocol is replaced by a hunger for knowledge and understanding. And once you have that knowledge and understanding, you no longer need protocol because now you know what to do." THAT'S IT RIGHT THERE!!!!!! A MILLION WORDS TRYING TO SAY THE SAME THING, AND THERE IT IS!!!!!!