emt322632

Ugh I hate this topic... I had a discussion similiar to this with a probie once, wanting to know why we didn't respond priority to every call because after all "Dispatch could be wrong..." After I stared blankly at him for a few seconds I responded that it all boils down to safety. The safety of me, my crew, and all other drivers on the road, for it's not just our safety that we have to worry about, but the safety of all other drivers. We must respond with due regard, and if involved in an accident with an emergency vehicle, it would most likely be the responding ambulance/fire apparatus that was held liable for the incident. I can tell you for a fact that the vast majority of calls in New York State are BLS calls, : http://www.health.state.ny.us/nysdoh/ems/stat.htm I can't attest for all other states, but I'm betting the statistics are similar. Why put yourself at risk for a basic call? So...in short...if someone has a hangnail, I'm not responding priority...I refuse to. I refuse to put the lives of myself, my crew, and the other motorists in jeopardy because someone can't afford a bottle of Motrin or use their digits unaffected by a hangnail to call a taxi.

How about we ask the question, "What did you do that you didn't mean to do?" In other words, how did she attempt suicide...may clear some things up

Wow I guess I have it pretty good...I actually like my mother in law...my father in law on the other hand...what a putz... Seriously though, the officer definitely should have realized something was up when 2 hospital employees told him that there really was an emergency... Common sense....

I would have said CO poisoning but with your reading on the monitor I'm leaning away from that... Check out the BP and pulse, elevated BP and low pulse could indicate neurologic involvement (bleed) any s/sx of stroke? Patient favoring one arm over another which which to swing at you? :-) Do we have any other medical history besides his psych history? I could see the rationale for narcan here, while right now he's only altered with a patent airway, he could go even further under and lose the ability to maintain it on his own. Stop the drug (if there is one) from working and prevent him from possibly going further downhill.

Congratulations!!! May your little girl bring you and your wife years of happiness!!

If asked about a year ago what I felt about abortion, I would have said, "It's the woman's decision..." Now however, after having to deal with the issue and its potential outcomes, I'm much more on the pro-life side (save for the aforementioned instances of threat to mother and baby) Last year when my wife and I found out we were pregnant, we were so scared. The thought of abortion did cross our minds at first, until the very first ultrasound. Even though my daughter was the size of a peanut, I still had that special connection that only parents have with their children. We decided not to do it. 15 weeks later, we visited our doctor who told us our daughter had ventriculomegaly, which could mean a potentially serious complication or that she could simply need a shunt to drain CSF from her brain. We went to a specialist, and he laid out on the table that it could be 3 or 4 different things: 1) She would need a shunt, in which case there may be no inherent long term problems. 2) She could have a fatal genetic disorder. 3) She could have Down Syndrome. 4) The ventricles could return to normal and she could be fine... After saying all this, he also said we had a week to decide if we wanted to terminate the pregnancy. It all seemed unreal, here we were again at this decision. And still we couldn't do it...seeing her in the ultrasounds, she was her own person, and she was developing a personality!! Much of what I saw her do in the ultrasound, I see her do everyday now. We decided to keep her, even in the face of the unknown. Now, Olivia Marie is 5 months old, and even though she does have Down Syndrome, I wouldn't have it any other way. She has absolutely no physical health problems, and is just so damn cute and funny. She recently started smiling and laughing, and that is something that I will keep with me always, and can always brighten up my day. Looking back on all we went through, it seems like it was ages ago, and that I was a totally different person. I guess I was. As far as the thread (didn't mean to hijack I just started typing what was on my mind) this was a very sad case, and a heinous act. If they noticed the baby was breathing, they should have attempted all measures to save her. Period.

If the patient denied drug use, you have nothing else to go on unless you can run a tox screen in the back of the rig. All you had to go on was the patient's report that he had not used illegal drugs. If you found paraphenalia (crack pipe, burnt tin foil, the drug itself) that would be a different story. I think you did an excellent job of managing the patient as best you could. For them to say it was a reaction to the illegal drugs...well...yeah...I guess tachycardia could be considered a reaction, but to have the non-chalant attitude that "This is just a cocaine induced MI", is just worrisome in my opinion.

If you're waiting for changes in BP, HR and presentation, you're waiting too long... Back to the forum... Prior to going to nursing school I was very guilty of auscultating through clothes and not wanting patients to disrobe for an assessment. Now though, it's second nature, and really has to do with more confidence on my part. If I come across as a calm, cool and collected professional, I can gain the patient's trust and things will go alot smoother. My nursing instructor made a very good point, though it was in regard to bathing patients, never ask. I had problems with my patients saying they didn't want a bath, and she asked me how I presented it to them. I said "I ask them..." and she simply said don't ask, don't give them the option of not bathing. So now it's "When do you want to wash up?" So, instead of "Is it alright with you if I check your stomach and chest for injuries?" It's..." I need to check your stomach and chest for injuries..." I haven't had any problems since...

It looks to be sinus tach with ST depression and T wave inversion, possibly indicative of ischemia. See a few PVCs in their too, but too much of a wandering baseline and can't really tell from the photo if it's regular or not, could you scan it instead of photographing it?

I'm keeping that in the back of my head as well...The child definitely needs to be evaluated by a specialist, so if we don't have one at this hospital, let's get them to the nearest one. Meanwhile we can do a CT of the head, CBC, Chem Panel, Toxicology (just in case) U/A, and also double check for any signs of trauma while we're at it, expose the child if they aren't already and just take a peek to look for any bruises.

Completely agree...I'd rather be in front of the 8 ball than behind it...

Alright this little fella/lady could potentially be in serious trouble. Bulging fontanelle = increased ICP, and since mom had no prenatal care and baby has had no medical care, opens up a list of possibilities for complications (hydrocephaly, ventriculomegaly are tops right now...) IV access, if we can get a BP good let's do it...supplemental O2, may actually consider intubation to protect the airway if we want to get really agressive here...

What did the seizure look like? Full tonic-clonic activity or something else? Has the baby been sick at all, any underlying medical conditions that we need to know about? Any signs of trauma? Any other children to these parents with any health conditions? Was the birth uneventful (thinking if vac was used to assist delivery maybe just maybe something happened, it's a stretch but hey...) As others have said, vitals, blood sugar...how is the baby responding right now? Awake? Is he/she acting normally per the parents?

Well, let's get in the ambulance first When we get to the scene, how old is the patient, what exactly happened, did anyone witness the seizure, is there a history of them and how long did it last?