Leaderboard

I am very dedicated to my work. I wear Paramedic/EMS shirts every day, even when I'm not on duty. The EMS station is my second home, and my second family. It often seems as if my life revolves around the EMS department, but it means nothing compared to my little girl. I am normally a very friendly person, but if you hurt my little girl you will make me mad. I know my little girl is growing up, even if I don't like it. She seems to like you, so I'll tolerate you dating her, but here are a few things for you to think about while you're with her: First of all, I go into hostile situations to save people that I've never even seen before, you can't imagine how protective I am of my little girl. I once broke a man's sternum by accident while doing CPR to save his life. If that's how I help people what do you think I do when I'm pissed off? I know who investigates arson fires. They know exactly what clues to look for to prove it was arson, so they also know what not to look for should I mention anything... and I know where you live. I've worked more car accidents than you'll ever see, the sight of blood doesn't bother me one little bit. It's normal for me to IV catheters, Syringes, paralytics and extremely strong sedatives in my car.. Touch my little girl and me and you take a little ride. When my firefighter friends burn down a house for training, nobody ever looks in the closets. I use the jaws of life to tear doors off wrecked cars. They cut though solid metal like a hot knife through butter. So watch your paws or get the jaws. Sirens and air horns can really muffle the sounds of someone screaming. Most of my friends are cops, paramedics, or firefighters. WE ARE 911. If you make me mad who do you think you're going to call for help? I have access to explosives. I am well trained in emergency medicine. I know exactly which arteries are the easiest to sever and which ones bleed the most. (Remember the Medical training, IV catheters, Syringes and drugs!?!) Even though my little girl insists that you are a "nice guy" and not like most other guys, I know better. I was once your age, I know EXACTLY what you're thinking. Because of that I already have plenty of reasons to not like you. It wouldn't take much at all to push me over the edge, and I just stocked my med kit. So if you want to date my little girl you better keep these things in mind. Medics are protective by nature, and there is nothing we are more protective of than our little girls. Whenever you're alone with her, you better remember that someday you may be alone with me! (I modified this from "Dating a Firefighter's Daughter" I am having this printed on a nice paper and framed for both of my girls ) Race

"Ten Simple Rules for Dating My Daughter" Rule One: If you pull into my driveway and honk you'd better be delivering a package, because you're sure not picking anything up. Rule Two: You do not touch my daughter in front of me. You may glance at her, so long as you do not peer at anything below her neck. If you cannot keep your eyes or hands off of my daughter's body, I will remove them. Rule Three: I am aware that it is considered fashionable for boys of your age to wear their trousers so loosely that they appear to be falling off their hips. Please don't take this as an insult, but you and all of your friends are complete idiots. Still, I want to be fair and open minded about this issue, so I propose this compromise: You may come to the door with your underwear showing and your pants ten sizes too big, and I will not object. However, In order to ensure that your clothes do not, in fact, come off during the course of your date with my daughter, I will take my electric nail gun and fasten your trousers securely in place to your waist. Rule Four: I'm sure you've been told that in today's world, sex without utilizing a "barrier method" of some kind can kill you. Let me elaborate: when it comes to sex, I am the barrier, and I will kill you. Rule Five: In order for us to get to know each other, we should talk about sports, politics, and other issues of the day. Please do not do this. The only information I require from you is an indication of when you expect to have my daughter safely back at my house, and the only word I need from you on this subject is "early." Rule Six: I have no doubt you are a popular fellow, with many opportunities to date other girls. This is fine with me as long as it is okay with my daughter. Otherwise, once you have gone out with my little girl, you will continue to date no one but her until she is finished with you. If you make her cry, I will make you cry. Rule Seven: As you stand in my front hallway, waiting for my daughter to appear, and more than an hour goes by, do not sigh and fidget. If you want to be on time for the movie, you should not be dating. My daughter is putting on her makeup, a process that can take longer than painting the Golden Gate Bridge. Instead of just standing there, why don't you do something useful, like change the oil in my car? Rule Eight: The following places are not appropriate for a date with my daughter: Places where there are beds, sofas, or anything softer than a wooden stool. Places where there are no parents, policemen, or nuns within eyesight. Places where there is darkness. Places where there is dancing, holding hands, or happiness. Places where the ambient temperature is warm enough to induce my daughter to wear shorts, tank tops, midriff T-shirts, or anything other than overalls, a sweater, and a goose down parka zipped up to her throat. Movies with a strong romantic or sexual theme are to be avoided; movies which feature chainsaws are okay. Hockey games are okay. Old folks homes are better. Rule Nine: Do not lie to me. I may appear to be a pot-bellied, balding, middle-aged, dim-witted has-been. But on issues relating to my daughter, I am the all-knowing, merciless god of your universe. If I ask you where you are going and with whom, you have one chance to tell me the truth, the whole truth and nothing but the truth. I have a shotgun, a shovel, and five acres behind the house. Do not trifle with me. Rule Ten: Be afraid. Be very afraid. It takes very little for me to mistake the sound of your car in the driveway for a chopper coming in over a rice paddy outside of Hanoi. When my Agent Orange starts acting up, the voices in my head frequently tell me to clean the guns as I wait for you to bring my daughter home. As soon as you pull into the driveway you should exit your car with both hands in plain sight. Speak the perimeter password, announce in a clear voice that you have brought my daughter home safely and early, then return to your car. There is no need for you to come inside. The camouflaged face at the window is mine.

As soon as i don't doubt my ability to support her on my own financially. I can't take that big of a step without having my life all together and sorted out. Want to have a place of my own and to not struggle as bad with bills. When i get down on my knee i want her to know 100% that i am fully capable of supporting her. She's a great girl. i feel blessed everyday to have her in my life and a healthy relationship with her parents.

When are you going to do the right thing amd make her Mrs. Tyler_EMT?

Neurologically generated trismus is one of those "ominous" signs generally associated with brain-stem lesion. Meaning, it's one of the later signs to show up and only releases when the herniation is so complete that there's NO response moving through the brainstem, i.e. mega bad juju. What your trying to do with midazolam "snow" the patient enough to stop the trismus impulse. Which you can do with suffiecent quantities. Here's the issues with that though. 1) The EMS systems involved in this halfassedry typically never prescribe enough midaz to do it. We're talking 30+mgs at times. 2)That amount of midaz in a single bolus may do nasty things to a B/P. Cererbral Perfusion Pressure is calculated as MAP-ICP. This number typically runs 60+, but in situations of hypotension and increased ICP this can run too low to perfuse properly or even into negative numbers quickly (see Monroe-Kellie doctrine). 3)You've not performed one of the other functions of RSI, which is to "take out" the skeletal muscle involved in vommiting. This is the real reason anesthesia invented RSI for the non-NPO patient. Again, halfassedry has no place in RSI. For my money, surgical airway options are far more important than RSI. If you don't have them, get involved and lobby.

You mean you have never treated Martian butt lice? Now that we are done I think, I will confess that my thought process was more intuitive than intelligent or clinical knowledge based ( I am sure it was obvious). As soon as you were "banned" from the thread for having "insider knowledge" I knew it was going to be something that would be considered exotic for the civilized world. That really narrowed the scope for me. I was beginning to believe that my suspicions were going to be as wild as Barbarella booty bumps but decided to ride it out just to see where it would go. Thanks chbare, Great thread. It is my privilege to get to learn from all of you guys. edited to spell check intelligent

You know one of the things that I see that is so vital, though maybe not obvious to those that haven't been here forever, about this thread... I was going to jump into this thread just a a sentence early on and say, "Remember, this is Chris, try not to run down a bunch of psycho rabbit trails.." But it wasn't necessary. The respect for chbare as the person presenting the scenario was obvious. No one was looking for Martian butt lice, or some other crazy, far out explanation, because they know that that isn't educational and also that Chris doesn't have the tiny penis (or so rumor has it) that seems to create the need to post such 'stump the panel' crap. From the very beginning everyone was confident that this would be an issue within the likelihood of being something that they might someday see, and if not that at least the path would take them to places valuable for them... Man, I'm jealous of that. There is our rating system, which shows that if you cuss often enough you can get a lot of points, like me, and then there is the general show of respect for kindness, intelligence and simply being trustworthy, as we've seen here. I think that that is just too cool for school.. Good on you Chris. Dwayne

"Soylent green is people!!" If you have to Google that, you may not get it. Otherwise it's kind of funny... :-) Dwayne

Are you really accusing "the corporate medicine machine" of willfully killing people. What do they do with them? Sell their organs on the black market? They are responsible for their employees mistakes but don't encourage, endorse or promote them. It is true they should not, but you imply that the motivation for business it kill, kill, kill. It is a serious accusation. The kind of accusation that legally constitutes slander in a public forum. It's probably good none of them are watching or take your words to seriously. Of course you can have a lawsuit, with or without information. You can have a lawsuit for almost any reason at all like, let’s say, slander. Are you really accusing Dr.s of lying to patients’ next of kin to cover for a medic they might not even know? Are you saying that a ER doc would falsify documents to cover for anyone much less a person that may not even be a part of the same health system? Are you accusing ER doctors and medics of conspiring to commit fraud and dishonesty in reporting? Can you see how crazy that sounds? What you are doing sounds a lot like slander to me.

First off i am pretty sure Asys was making fun of me with what you quoted. Secondly, i am guessing you have never been involved in a lawsuit. I wish you the best of luck, not if but when you do. Race

P. vivax may be treated with quinine successfully, but QT prolongation is a concern. With P. falciparum and the region (Middle East/Asia), resistance to chloroquine is a concern. We can go many ways, but I would likely consider something like artemether and lumefantrine with yet another QTi precaution. I would not be adverse to treating with doxycycline if we believe this may be a case of severe malaria. Again, many potential options. The patient has no history of travel to any other country except Afghanistan over the past year. Flight layovers are also looked at, with the only layover being in Dubai, UAE. The patient somehow contracted malaria in Afghanistan. One of my microbiology professors contracted Dengue fever (bone break fever) when she was working on her doctorate in Costa Rica. From what she said, it's a pretty miserable ride. Edit for italics.

Intubation was not exactly prolific during the Crimean war.

Must be fact then. I stand corrected, was not aware you had so much hearsay at your disposal. (tongue in cheek sarcasm for those who are sarcasm-illiterate)

If you do not share the mistake, you cannot stop it. How many times has a medic given Atrovent instead of Proventil because of similar packaging that is hard to read ? I agree that errors need to go to a committee, and strategies should be implemented to make sure it does not happen again. I think he meant report to the family of the dead patient Doc

HURRRRK BLS BEFERR ALS AND THAR WASIS ONE TIME I WAS ONNA JOB AND THE GUY HAD THIS BLEED AND THE MEDIC WANTED TA START THE IV AND I WAS LIKE NOSIREEE YUZ GONNA TURN HIS BLOOD INTA KOOLAID SO I WAS LIKE LOOK AT THAT PARAGOD EMTS SAVE PARAMEDICS YEEEEEEEHAA!!!! And such.

Love it, Jake! The other thing I forgot to say is that we take to heart the "til death do us part". I'm the one who cooks for him and puts his vitamins in the little holder...

First, I think this suicide business needs to be put into context: The human body is a biological organism that is entirely built around survival. In fact, it's only been the past several thousand years where we had creatures on this planet that have been able to really think and ponder concepts that do not directly stem from "survival instinct" if you will. We in health care, who are also scientists in a sense should be keenly aware of just how important survival is. It's built into our nervous systems, we see in in the ability to clot, we recoginse it when we undergo physiological changes at high altitudes, we see it in the physiology of our patients who are experiencing various forms of shock. With that said, when a person is at a place where they are essentially overiding millions of years of evolution and natural selection based around survival, this should be considered profoundly abnormal. I know many people simply look at suicide as being a sin or a profoundly selfish act. However, a person has to be profoundly disturbed to overcome basic survival programming. Unfortunately, we often do not really appreciate the absolute seriousness of a person who is suicidal. If we can appreciate suicide for what it is, then we can appreciate how desperate and profoundly sick these patients are or were. We clearly appreciate the gravity of the situation when a patient has severe DKA, but often fail to appreciate that with people who are suicidal. With all of that said, we should also realise that mental illness is not a problem with the "soul." It is a real, tangable and potentially devistating problem that requires aggressive treatment just like the DKA patient mentioned above. Even after initial treatment, this is often something that will not go away. Just like insulin dependant diabetes, we understand that a life long battle will ensue. Also, just like diabetes where even compliant patients can end up with serious exacerbations such as DKA, we can expect people who struggle with depression and suicidal thoughts/ideation and the like to also experiences exacerbations in spite of treatment. Religion is a tricky subject. While I believe it can play a positive role in some cases, we need to put religion in to proper context when considering the physical world. Religion is not a particularly good mechanism for exerting control over the physical world in the sense that things can magically occur as a result of divine intervention. I could be wrong, but have not appreciated evidence to suggest my hypothesis is incorrect. However, religion can play a significant role in people who can use it to help make sense of "life" and esoteric questions that cannot be answered by science. Religion can give us faith, hope and fellowship. These are all potentially important and helpful. Religion is a good way for like minded people to get together and support one and other and hopefully support others who are not as like minded, but that is another topic and another discussion. Clearly, this can become perniscious in some cases, but can be very helpful and supportive for some people. I see religion as playing a role in helping people in certain situations, but it cannot get in the way of therapy that is based on observation and emperic experience within the physical world. It may sound like I am an atheist; however, many here know that is not the case at all. With that, we cannot let our faith based ideas encroach upon the emperically derived physical world. My best wishes and thoughts go out to people who struggle with these issues because I gather the struggles can be difficult and are life long.