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I'm freaking out i know i know my stuff but, i also know that the national tests like to trick you i have a feeling ill be stuck with all the seizure, burns, and birth questions. Anything anyone can offer will be great agian i take my test 3:30 tomorrow the 26th of may wish me luck.

This came from the Amb. Assoc. of PA's weekly newsletter, thought it would be fun to share.

OK I'm go to make the title obsolete and say yes it was as this patients LOC changes dramatically about 15 mins after arriving at the ED. She was sitting up and conversing normally with no memory of the event. Initial dispatch @ 1am: 39 yo female unresponsive by the river at 601.... yadda yadda (The potential causes were going crazy in my mind!) In reality PT is in a nice RV/mobile home thing in a vacation park in bed with her husband standing there. (Pucker factor went way down!) The PT is "shaking"... looks like shivering. No major movements of the body just tremors all over. Her eyes are also moving rapidly and randomly in small movements. Seizure? Well for some reason I do a sternal rub and ask "Mam can you hear me?" and her eyes stop jerking around and stare right at me until I move away. I ask the husband about her medical history and he says (no joke): "She ate 15 packets of taco bell hot sauce for dinner". I reiterate the MEDICAL part of the question and get: "Thyroid problems and they think some medication of hers caused fluid to build up in her brain last year". He denies any history of seizures, stroke. but does say she has been feeling "sick" for a few days. He denies substance abuse and everything else I came up with. Vitals: (And yes I got these during the possible "seizure") GCS 9 (eyes wide open[4], no verbal noise at all[1], withdraws from pain [4]) HR 100 Sinus Tach no ectopy BP 166/88 RR 12 Sp02 100% on 02 (BLS on scene already had her on a NRB) BGL 96 (PT withdraws from pain during the stick, during the "seizure") Pupils reactive, same size, right size Skin PWD So I don't know what the heck is going on because on one side I have no history of seizures, she can look at me, no incontinence, no oral trauma, not hot/warm/cold, no magic wand... So maybe this is a stroke, poison/OD, or some metabolic thing to do with her thyroid and the cerebral edema. On the otherside she really looks like she is having a seizure and eventually wakes right up in the ED. So thankfully despite my lack of recognition I'm able to move the call quickly and get her into the ambulance and moving. This is where I notice her body is still "tremoring" but now her eyes have stopped going crazy and she is even moving her head alittle to respond to me. Eventually the tremoring/shivering stops (she didn't feel cold but I turned the heat on so maybe that had an effect). Still she counts as a GCS of maybe 11 if you say her head movement counts as normal motor/sensory. So like I said at the ED I go back into her room and she has no memory of the event or me and is conversing totally normal without any complaints. The MD initially thought some kind of ingestion or a bleed. But the common perception after she woke up was a seizure. What do you guys think? Did I really blow it and let a seizure go on (or repeat seizures) for close to 10 minutes? That's the amount of time it took before her eyes were no longer rapidly moving. I'm very frustrated by this call feel free to offer criticism I want to be better next time.

They do not trick you. Just do not try and read more into the question than is there. I would suggest that you do a brief review now then around 330 today put the books away and relax. If you do not know the material now you will not learn it by tomorrow. By cramming you are liable to actually confuse yourself. So go relax and enjoy the day.

For the life of me I can't figure out how you've managed to turn my comments into an assault on your religion?? I've never judged your religion other than to say that I don't share your Christian beliefs. I don't really see that as an attack. If I say that I love to have sex hanging from the rafters while while being spanked with a goth Barbie and pelted with eggs from the local midget wrestling club, and you reply that you don't, does that then imply that you don't share any other principles that I might have, and that you devalue me as a human? We can't then talk about evolution, cellular biology, our hopes and dreams for the future? (I hope not. Because midgets don't come cheap man....) Step back from the pulpit brother, no one is attacking you here. I was simply commenting on the way you chose to approach your love of your religion in this topic. I think it was a bit sideways. And I'd be more than happy to share my theories on life. Belief is too strong a word as I don't have a concrete belief system. I can't point to a book, or group of books and claim that they represent my thoughts, but have just a bunch of thoughts and feelings. I didn't believe that that type of exploration was what Matty was looking for in his thread. I'm not afraid to share them with you, there is nothing sacred or holy in my beliefs, nothing special about them at all likely, but they're certainly not secret. Dwayne

Idon't like rap but that was pretty dam good

I think one of the most ridiculous things we do is ask questions like this. It's just so anthropocentric. The centipede and the tree don't ask what the meaning of life is. That being said, I love the discussion. I think our job is to exist, evolve, and most importantly, obey the laws of nature. Every other species does, but somehow we think we are special and can reproduce indefinitely and manipulate our environment to an infinite extent. All creatures affect their environment, but not like we do. We are destroying the biodiversity of this planet while we continue to devolve. *Getting off soapbox.* One of the most important things I think we can all do is stop defining good and bad. We are so preoccupied with this inane activity, and hell, I do it too sometimes. But recently, when my grandma died, people expressed to me that they were sorry and how it was so "awful." I wasn't sure how to take it. I'll miss her, but she was 92 years old and suffering from late stage dementia. It wasn't GOOD, but neither can I say it was really bad. It just...is. Take a traffic jam as another example. If you sit there and think about how "bad" it is, you will miss seeing it for what it truly is and also miss the opportunity for either introspection, conversation, listening to music, or a million other things. There are so many things in life that we could take so much advantage of if we weren't so caught up in how abstractly good or bad they were. They are.

I thought that the first step was to find the hidden porn folder...

Maybe he's happily married? And yes there are some people like myself that are happily married. Perhaps despite what all seem to think he was wanting to be faithful and the supervisor by her continued actions created a hostile work environment. It actually annoys me how when we see the female be the aggressor everyone just laughs.

I fail to see where he disallowed dieties in the discussion, he simply asked that you back it up with a rational argument that didn't include 'because it just is.' Which you've failed to do. Then you should have shown him the respect to have played by his rules, right? And you rarely pass up an opportunity to make that point. I don't follow your beliefs brother, but I have respect for them. Unfortunately those that follow your beliefs, as here, often fail to show respect to those of other opinions. He didn't disallow your point of view, simply asked that you back it with logical, intelligent discussion as well. I for one would love to see you attempt to do so. Interesting discussion so far, by a bunch of interesting people. Thanks for the idea Matty! I'm still trying to find a point of view to argue... :-) Dwayne

Ruff, Eydawyn, thanks for joining in on the conversation. I would like all kinds of responses. There have been some interesting ones thus far. I will quote myself. Just to restate that I want those of the religious flavor to participate and I will not ignore the thought. Just as a disclaimer, I wanted it to be known that I was mostly looking for a non-religious answer, but*, I am willing to read the religious answers, I just ask for a some sustenance to back it up. Again, thanks for the replies Ruff, Eydawn. Please keep them coming folks. I like what I am reading so far. I will give some replies soon.

I think we need to see her pic before we pass judgment......

http://www.huffingtonpost.com/2010/05/03/gulf-oil-spill-photos-ani_n_560813.html And, you know what? I am sick of people who work in science completely rejecting science!!! How can you even justify interfering in this "God-planned circle" as an EMT? Obviously God planned for that person to die, how can you possibly interfere with his will?!?!? Global warming is a theory in the same respect that gravity is "just a theory."