Amazing Call I Just Heard Dispatched

[JakeEMTP]

The fact that you would even have that image on your computer is disturbing. :shock:

It is really Mateos' residence. After being part of this board for as long as he has, I thought he might have taken that stuff down by now. Once a whacker, always a whacker.

[mshow00]

COBRA is in effect the same as EMTALA. Hospitals have to follow other wise very big fines and possible loss of Medicaid/Medicare http://www.medlaw.com/statute.htm

[firedoc5]

COBRA is in effect the same as EMTALA. Hospitals have to follow other wise very big fines and possible loss of Medicaid/Medicare http://www.medlaw.com/statute.htm

You beat me to the explanation of COBRA. It's a type of insurance that's very complicated and even harder to describe.

Our lady had her own phone. Even though she was in a nursing home, she had her own phone, TV, her own private nurse almost around the clock. Her nurse was usually there 8 a.m. to 10 p.m. When we would have to take her to the hosp. we had to take all of that with us including her wardrobe. When we complained about it the boss said to "do it", no matter what she wants. Evidently she was loaded, and paid everything in cash. Eventually when the hosptials got better TV's we stopped having to lug hers around.

[JPINFV]

There comes a point where there simply isn't enough room in the ambulance for all of the patient's stuff. That point lies well before I reach transporting TVs.

[firedoc5]

There comes a point where there simply isn't enough room in the ambulance for all of the patient's stuff. That point lies well before I reach transporting TVs.

When we knew it was her we were sure to take the type III rig. And whoever was in the back had to stand. It was a real pain in the a$$ to be sure.

[EMS49393]

I have run that call. In some inner city nursing homes, checking on patients is optional.

Thaimine for a diabetic in a nursing home? Yes, and I'll explain my defense... How many nursing home residents do you see that are actually well nourished? I don't see very many. Most of the patients I see in nursing homes are dehydrated and malnourished. Thiamine is also indicated in malnourishment, not just alcholics.

Lastly, COBRA is not insurance. It is a law created for several reasons. One point was to help people be able to continue their group coverage offered by their current or previous employer, if they qualify. Another part of the legislation was to protect people from being descriminated against, transferred to other facilities, guard against patient dumping, and make hospitals accountable for treating and not just transferring patients to other hospitals without a good reason, i.e. trauma, pediatric, etc. services.

I now return you to your regularly scheduled off-topic postings.

[spenac]

At one service we allow nothing larger than a purse, and they can only bring one. At my other service we might allow a suitcase. We do not transport all a persons possessions.

[firedoc5]

I have run that call. In some inner city nursing homes, checking on patients is optional.

Thaimine for a diabetic in a nursing home? Yes, and I'll explain my defense... How many nursing home residents do you see that are actually well nourished? I don't see very many. Most of the patients I see in nursing homes are dehydrated and malnourished. Thiamine is also indicated in malnourishment, not just alcholics.

Lastly, COBRA is not insurance. It is a law created for several reasons. One point was to help people be able to continue their group coverage offered by their current or previous employer, if they qualify. Another part of the legislation was to protect people from being descriminated against, transferred to other facilities, guard against patient dumping, and make hospitals accountable for treating and not just transferring patients to other hospitals without a good reason, i.e. trauma, pediatric, etc. services.

I now return you to your regularly scheduled off-topic postings.

I totally agree on the thiamine. You're right. All too often NH pts. are under-nourished.

I stand corrected on the COBRA. Right after I left the FD I had COBRA, and since it did seem confusing and very frustrating to me, I thought it was a type of insurance. Thanks for the explanation.

[mshow00]

Lastly, COBRA is not insurance. It is a law created for several reasons. One point was to help people be able to continue their group coverage offered by their current or previous employer, if they qualify. Another part of the legislation was to protect people from being descriminated against, transferred to other facilities, guard against patient dumping, and make hospitals accountable for treating and not just transferring patients to other hospitals without a good reason, i.e. trauma, pediatric, etc. services.

Yes, and because the pt feels they are not getting enough special attention does not qualify as a medically necessary transfer of care, hence the COBRA violation complete with fines and sanctions.

[tniuqs]

I have run that call. In some inner city nursing homes, checking on patients is optional.

Thaimine for a diabetic in a nursing home? Yes, and I'll explain my defense... How many nursing home residents do you see that are actually well nourished? I don't see very many. Most of the patients I see in nursing homes are dehydrated and malnourished. Thiamine is also indicated in malnourishment, not just alcholics.

First of why are you defending someone else ? I have been in many nursing homes that to an Awesome job of caring for the elderly, the assumption that all should be lumped into one catagory is not only folly but disrespectful. How in hell are we going to as a proffession recieve recognition if we slam and lump all into the same group, I just wonder what the LPNs and Caregivers say when the gods gift to paramedicine arses leave the building .... plant seeds, not burn crops if you see where I am going with this, don't forget you are judged too.

Interesting but the issue of pushing thiamine for nutritional issues is a bit beyond most Paramedic concerns, can one from a clinical observation diagnose malnourishment ... the primary reason for giving this medication is Wernicke-Korsakoff. As stated prior its not a bad thing to do but if you were going to go this step, why not give Mag Sulfate as well ? Most chronic malnourished suffer from hypomagnesemia, its the protocol monkey attitude that annoys myself to no end.

Wernicke-Korsakoff syndrome results from thiamine deficiency. It is generally agreed that Wernicke's encephalopathy results from severe acute deficiency of thiamine (Vitamin B1), whilst Korsakoff's psychosis is a chronic neurologic sequela after Wernicke's encephalopathy. The metabolically active form of thiamin is thiamin diphosphate which plays a major role as a cofactor Coenzyme in glucose metabolism. The enzymes which are dependent on thiamin diphosphate are associated with the TCA Cycle and catalyse the oxidation of pyruvate,alphaketoglutarate and branched chain amino acids. Thus, anything that encourages glucose metabolism will exacerbate an existing clinical or sub-clinical thiamine deficiency.

As stated above, Wernicke-Korsakoff in the United States is usually found in malnourished chronic alcoholics, though it is also found in patients who undergo prolonged intravenous (IV) therapy without (Vitamin B1) supplementation, gastric stapling or intensive care unit (ICU) stays. In some regions, physicians have observed thiamin deficiency brought about by severe malnutrition, particularly in diets consisting mainly of polished rice, which is thiamine deficient. The resulting nervous system ailment is called Beriberi. In individuals with sub-clinical thiamine deficiency, a large dose of glucose (either as sweet food etc or glucose infusion), can precipitate the onset of overt encephalopathy.

cheers