scubanurse

and they keep getting it until they are pain free or not breathing.

JW

I like!

Everywhere I have run a code has used EKG waveform during CPR and the presence of a femoral pulse...

I know I'm new and blond, but how does ETCO2 tell you CPR is being performed adequately? I thought that was used to determine if ventilation were adequate? And yes, ventilation is one part of CPR... is there another use for it?

I am curious to see these studies about the femoral pulse checks in CPR... I would think that if a femoral pulse is present, adequate perfusion to the brain was occurring?

Being another product of the almighty MIEMMS organization... I think you are misinterpreting the Trauma decision tree. From what I gathered, the patient was just bleeding from the back of the head and had no obvious sings of a skull fracture. The hip injury is not a reason to fly out or even begin to call this a category A trauma. The protocol states 2 or more proximal long bone fractures. a Hip fracture you could argue is a long bone fracture but personally I would say that's stretching it, and since it was only affecting one side it doesn't meet the protocol regardless.

Like others have said, you need to bring this up with the crew chief and your ems duty officer/chief. I don't know what county you are in, but you should have an officer (Lt and above) who is in charge of EMS operations. Talk with them, you need to hear the crew chiefs side of the story and understand the reasoning behind her decision to not follow the protocol. In my book there is no excuse for not doing at least a rapid trauma. Even when I had a priority PIC in front of a Level 2 trauma center, I still did a rapid trauma. She could have missed a life threatening injury by not doing one.

Another question...not meant to intrude or anything, but why did you listen to her? If I were in that situation, and I can tend to be bullheaded and stubborn, I would have said, nope, I'm going to do an assessment and we can discuss this later. If I had been a supervisor on that call and witnessed you laying down in front of her and disregarding protocol yourself, I would have had issues with your behavior as well.

Hahahaha...how long are the kanye jokes going to go on though? It could be applied to everything and it seems everyone is.

Congrats again!

link no worky

Congrats! That really is a beautiful name for what I am sure is a beautiful little girl!

Good luck! I pray that things go smoothly and safely

Congrats!!!

wow... that's really funny!

HAPPY BIRTHDAY!

All of the above... sometimes even in class!

That's funny!

HAPPY BIRTHDAY!!!!

And for the record Kate; I think your thoughts are worth way more than two cents...

Dwayne

Aww thanks! Maybe $0.03? woohoo! I feel special now.

On the topic though, an EJ is a pretty common (at least for me) Peripheral IV site with minimal complications associated with it if done properly and as trained. Maybe it is your training that is the issue here? We learned EJ's in a full class session and had to practice them in clinicals. EJ is usually one of my first sites I look at in a code due to the fact that I'm usually at the head anyways, and an AC access just doesn't cut it when you have 3 big FF's clunking around the patient and can pull the line easily. I prefer EJ any day to an IO, but I also know when the situation is appropriate to do both.

Aaron brings up a good point in that if the patients head is conveniently rolled laterally and I see a honkin EJ sticking up at me...I would consider one attempt only if the patients airway is also cleared and they are breathing adequately.

Rome-- If you think an EJ has more aftercare/risk than an IO I suggest you go try having one of each. An IO is drilled in to the bone and the people I have talked to who have seen the site 12-24 hours after removal, say the patient had site discomfort whereas an EJ feels like none other than a peripheral IV...

Have a fantastic week y'all and be safe.

Kate

I think all have valid points based on our own experiences, outcomes and training. In a situation like this, it is hard to develop a formalized opinion on what method I would choose, as I do not have a live patient in front of me to help me decide based on the numerous observations that can be made of a patient. Personally, I would probably go for the IO as it is quicker and in my experience (although limited) more reliable. I would want access ASAP to give fluids and medication if necessary.

On the topic of c-spine precaution, if the patient has a high cervical fracture then movement could end life. So as Dwayne put it, Life over Limb and by maintaining a neutral alignment on the c-spine, I could very well be preserving life.

Just my $.02 for what it's worth

I'd rather take 2 weeks off than up to 6 mo for surgery... I really hope PT does the trick for you! Let me know if I can be of any help and good luck!

If they alert and oriented, they can make their own judgment. If they are not, they cannot make that call for themselves. If they refuse transport, I'd have at least medical command back me up, and most likely call the police in since this person shouldn't be out walking around and driving.

i second that... but that dude had a GCS of 14, and was alert and oriented so I'd probably (probably because I was not there to make the call based on instinct and gut feeling) let him sign the refusal... would be nice to have PD there to witness though if possible.

Since your shoulder is "only" a grade 1 tear, I would say rest it, do some PT and see how it feels. As the recipient of 4 major shoulder surgeries, I can tell you, they suck big time. They are one of the most painful too. I have had multiple AC joint injuries and most healed in time and were back to normal where I could work and even rock climb and kayak on them. Listen to the orthopedic surgeon though, but keep in mind most ortho's just want to cut to solve the problem so do not be afraid to look for a second opinion. Depending where geographically you are, I might have some good recommendations for ortho docs.

Best of luck to you and let me know if I can be any more help!

Try warming it up...

We still do EJ's in patients who have poor vascular access due to burns, dialysis shunts, trauma to the arms etc because an EJ is a different site, which may not be affected by the reasons another peripheral IV site would be. Also, here we can only use an IO in a last effort for access where sometimes an EJ would be more appropriate.

And humeral IO would be best in that situation for all the reasons listed above.

I hope that makes sense? COld medicine may be getting to my head.

That is wicked! I'm going to do that next time!

Congrats on the "save" and welcome to the city Dar

Good for you for taking an A&P course! Really it will benefit you greatly if you choose EMS. I had been in EMS for 3 years when I took the course and I had been working in a suburban 9-1-1 system running about 400+ calls a year and I had just finished my EMT-I/99 course when I took WEMT.

NOLS has a great section called WMI or Wilderness Medicine Institute and their website provides a pretty good description of all that is required for each of the wilderness levels.

http://www.nols.edu/wmi/courses/wemt.shtml is the link for the WEMT course description.

Good luck with A&P and welcome to the city!

I have done NOLS and it is excellent. You learn more skills on how to adapt and overcome and use what you have to make do. LIke the previous poster said, you have to instruct others on how to assist you. My only recommendation is that before you take this course, know WHY you want to take it and what you hope to get out of it. If you are in the wilderness a lot and hiking or leading others than it is a good course to take. But for the average Joe... it will be a waste of money and time. Also be very proficient in your skills as a basic first. The course I took there were brand new EMT-B where most had very little if any "real world" experience as a street EMT and it was noticeable to the more experienced providers as their assesment skills and general knowledge with how things work, and a few of us got annoyed with the slow pace that we had to move at and constantly having to go over basic skills with them. PM me if you have any questions. I am looking into getting a summer internship with NOLS or Outward Bound with teaching and will be happy to give you any more advice that I can.

best of luck,

Kate

September 26, at 8:14 pm

I cam across this video about how unsafe it is to text while driving. It is being shown to high school kids in Wales apparently...pretty good video with close-up of mechanism etc...

http://www.engadget.com/2009/08/16/wales-p...film-about-the/