fireflymedic

I had this one pegged - female, child bearing age, always assume pregnant until proven otherwise. Plus she's giving the common I feel like I'm gonna poop (a common statement), intense intermittant abdominal pain, and the fact that she has some idea what's going on (this don't sound like it's her first rodeo with the locking the door). Glad mom and baby okay - thought this would be a bit more eventful though. Haven't had the curse/pleasure of delivering one yet outside of clinicals, and I'm hoping I never do ! Have come mighty close more than once though !

For those of you that have found the need to bash my statements above, I was simply updating the information. As you well stated, it does take months for a complete and thorough investigation to be completed and the cause of the crash may change. I was relaying information which I had received from someone I knew that was based there. It was not meant to be the final say by any means, nor did I try to relay it as such. I know usually my first question is what do they think happened? Although I didn't know personally the people involved in the crash, I have many friends who actively fly with AEL - two of which from that base - and I know fear goes into my heart each time I hear of one going down. I also have very close friends who fly with other companies, so it hits very close to home to hear of one going down. I admit I am ground based as I have when posting on other threads. However, I am actively involved in advocating for air safety. That being said, I REFUSE to openly bash or condemn a company when I do not know of their maintenance practices. If you notice, not one comment regarding that was placed in my post. Also, as far as insulting flightweb - there are legitimate conversations carried on there by those who are involved with flight and who's lives are the ones at stake. They have a right to raise the difficult questions and debate them. We would do well to shut up and listen to some of them. This is not the place to insult another site. This is a thread designed to honor those who were involved with the crash, and discussions such as this have disgraced them and the work they were trying to do. If you have a problem with someone's post, please either keep your opinion to yourself or PM them, that's what the button is for. Let's keep this thread open for the condolences to that crew, not an open pissing match.

It is confirmed that it was an air med helicopter from AEL (air evac lifeteam) and pilot, nurse and medic aboard were killed. I have friends that work that base, fortunately none were on that flight, but it is still a difficult thing. Always terrible to hear. My understanding from them is that the engine exploded mid air causing it to come down - the reason being unknown at this time. Names have not yet been released pending notification.

Ding, ding, ding good catch Medic 429- seratonin syndrome it is. Common in SSRI (selective seratonin uptake reinhibitors such as zoloft) within first few weeks of treatment or in possible cases of overdoses. Can also be caused at any time if combined with medications that are MAOI's, TCA's or those such as ultram, effexor, zofran, fentanyl. Can cause a variety of symptoms which may include tachycardia, vomiting, nausea, uncoordination, fever, heavy sweating, confusion, agitation, and in later stages, seizures and coma. For more info check out here - http://www.mayoclinic.com/health/serotonin-syndrome/DS00860

Medic 429 - you're onto something there....why don't you want to mix them? What can result? To the others - you're on the right track with the zoloft, but not quite there yet - there is NO infection in his system Firedoc - not stating he was crazy - family was making that complaint as he was a frequent complainer for mild problems, they thought this was no big deal initially

First off, you're an idiot for placing information about runs on your myspace, especially something that sensitive to an individual. As good as his intentions were (which I'm believing was more of a CYA motion, not true motives) he still crossed a line that shouldn't be crossed. As far as HIPPA, here's the problem with it. There is no real line to draw as to what can and can't be released. If he didn't release any more information than would have been or was released on the news, then he didn't violate it. Period, end of story. Now, the issue falls back on AMR policy as to whether he violated company policy which may be the case. If so, they have the authority to do with him as they please. At the state action level, it depends. We had an issue here with a guy that posted pics from a wreck that was fairly high profile and even though no patient information was released nor even the license plate shown, the guy's family (it was a fatality) sued for damages to the EMT who posted the pics saying it caused severe emotional distress. He was disciplined from his department, but didn't receive anything from the state level. Bottom line, it's not intelligent what he did, but no laws were actually broken, and unless AMR has a specific statement that you can't post pics from scenes up on personal sites, then really they are intruding where they shouldn't. The world has gotten so paranoid and sue happy it seems we are willing to go after anything and everything. Do I think the guy exercised bad judgement? Yeah probably, but should it cost him his job? Probably not. If it were here, I would have a discussion with him and rest of staff to prevent future occurrances and have something written up in company policy against posting information regarding runs on personal sites if I didn't want to deal with it. However, I do feel the woman is milking this a bit 'cause she can. The lines of HIPPA are quite blurred and there really are no HIPPA police so it's difficult to enforce. On another note - why is it AMR can't get it's act together? It seems they have been in trouble lately more than they've been out of trouble !

Okay, first let me clear up - not paraplegia weakness to lower extremities - pt can stand but not for long periods of time with extreme weakness. Typed without thinking and for lack of better phrase. Weakness was due to spinal issues and resulting urinary retention thus the foley cath. Didn't give complete info and for that I'm sorry. Now that is clarified.... Temp : 101.4 Monitor : sinus tach at 122 occasional PVC's Glucose : 115 Meds : appear to be appropriately taken Zoloft started three days ago, Glucophage started one month ago Urine : straw colored, normal output, no unusual odors Respirations : 12 and shallow Lungs : clear in all fields No history of thyroid or other medical issues other than spinal problems and urinary retention. Pt has vomited five times in last 2 hours small amounts of liquid. Last oral intake previous evening at 6 pm it is now 10 am. No flank, back (outside of normal daily pain pt experiences), or abdominal pain. Denies any alcohol or illicit drug use. Family informs you he occasionally takes Ultram for the back pain and they believe he took one earlier this morning with his other meds. Now give it a try

Hey, pt had stated that he did not have an inhaler and had not required the use of one for over 10 years, so was no longer an issue. Good running on this thread !

You are dispatched to a 42 year old male for symptoms of confusion and agitation. On arrival, you find the patient sweaty and nervously sitting on the couch. The patient's sister states he has been like this for the last hour and has also been vomiting. When you attempt to stand the patient to move him to the stretcher, you notice he is quite uncoordinated and feels quite warm. On taking vitals they are as follows: BP : 104/64 Pulse : 122 Resp : 12 Temp : 101.4 PMHX : depression, paraplegic, foley catheter present, diabetes Meds: zoloft, glucophage Allergies : penicillin What else would you like to know and what's going on with this fellow?

Well, your patient did indeed have a spontaneous pneumo which you all clued in on. However, it was due to marfan syndrome which was the zebra I was looking for (large face, long arms, long legs, thin build) which made him a prime candidate. The guy was 6'4 and 170 lbs. Perfect example. Darted him, showed some improvement - two days in hospital and he was home. Good call ya'll !

Okay, so you assess the guy and note the following : Lungs: diminished right side - no wheezing, crackles, rales noted Temp : 99.0 Monitor : sinus tach at 110 - no ectopy Heart sounds : normal Denies any nausea, vomiting, family hx of cardiac problems, and herbal or illicit drug use - states also no prescription meds. Also denies any hx of recent trauma. States has been inside most of the day playing his playstation and just went outside for a smoke and when he stood up he felt a pain in his side and had difficulty breathing which didn't resolve so he called you. No bruising or crepitus noted in the chest however, you do note that he has extremely large features for his build. Anything else you'd like to know?

You are called to the scene of a 21 year old male complaining of general unwell feeling. He states he was fine up until about twenty minutes ago when he started feeling lightheaded and had mild difficulty breathing. It is middle of winter, so he assumed it was just due to the cold air. He looks a little pale and diaphoretic. He is walking around and appears anxious speaking in three or four word sentences. Vitals are as follows: BP: 108/64 pulse : 110 resp : 24, shallow med hx : asthma since childhood but not symptomatic , smoker 1 pack day, drinks a beer daily, no illicit drug use - not on any meds what else would you like to know and where would you proceed from here? I promise there's a unique zebra in here !

By fire_911medic

I'm gonna go against the grain here a bit, but this is due to what I've personally seen and granted I came from a university based program that pushed you straight from basic to medic. In the experience I've seen and worked with, the medics which worked the street for a year or so prior to coming into medic school and continuing to work through had a better clinical experience during class and seemed to be more comfortable on a truck than those who came through with just the minimum ride time as a basic and working little bit during class until they started clinicals/ride time. However, that being said, I think the ones (IN GENERAL - no hard and fast rules here) that went straight through seemed to have a better grasp on concepts and book related knowledge as they were probably trying to grasp that to compensate for their lack of street experience. Either way, you definitely need some time on a truck before entering medic school - I personally did two years 1 with a transfer service, and 1 with a 911 only service best experience I got. Both were good solid services to work in and I learned good assessment skills, dealing with chronic diseases, and how to write a great PCR in the first, and the second let me get my feet wet in the trauma drama and the major medicals emergencies. Yes, I did have some bad habits follow me, as does everyone. Though I believe you develop some during your ride time no matter how great your preceptor. Minimum, I'd say get about 6 months experience prior to applying, Max I'd say two years. That's a pretty good time frame. More than two years, and you're really just burning time if medic is your final goal. That being said, there is nothing wrong with wanting to remain a basic, but understand that is a dying breed and soon I expect more to be demanded of them education wise or get out of the field. Though I've said before and I'll say again, I'd rather have a great basic than a mediocre medic as a partner anyday. Just go into it with a wide open mind and enjoy it ! Be safe and good luck !

Ruff - I beat ya to the PE idea lol - check my first post. Anyhow, good call as well - you hit it on the head with an ibuprofen OD. Kudos. On the other hand, I'm not sure I want RSI, I think I'd rather go DAI - I don't want paralytics to mask any further seizure activity and miss treating that. Just my opinion, but that's my thoughts. Of course you do have the option of short term paralytic, but I think DAI would most likely get the job done here just as well. Just somethin to think about.

EZ IO's are a great tool, but they are just that a tool among many others. I am preferable to the drills as opposed to the spring loaded. The sternal IO's just look evil, we've got 'em, but never placed one to my knowledge. However, I am with everybody else on infusing the lido - the drilling pain is rated about a two, but infusion about an 8 without lido so please use it, even if you think your patient is out. They're great if you absolutely can't get IV access. Only bad thing is the fracture issue, so a multi ortho trauma pt can be a pain and also the infusion rate without a pump or pressure bag is slow as all get out, but yeah, anything that can go IV can go IO.

Aight, that's it I'm on the ibuprofen OD wagon now - too many things fit and she's refusing to tell you whether she took anything or not. What do I see on the monitor? With her actively seizing, I'm taking control of airway as I expect the vomiting to come- DAI to prevent masking further seizure activity and control seizures with benzos - versed is benzo of choice for me. I'm gonna use versed 2-4 mg and fentanyl 50-100mcg to bring her down to tube. Do we see any hyperthermia here? Control any arhythmias - treat as presents. Could go either tachy which she is now, but with seizure activity may brady down. Drop an NG tube down her as well since we gave the charcoal which if this is ibuprofen OD certainly didn't hurt the situation. Blurry vision could be due to nystgmus. Watch her for kidney/liver issues, monitor urine output if long transport (ie in my case she wins a foley as well), be alert for metabolic acidosis especially with the seizure activity which may be a precursor to it. Let's definitely get fluids in this girl and try to flush some out and help preserve kidney function. She's headed for bad news if not already there....this one is sounding alot like my tylenol OD more and more....

I'm not gonna jump onto the OD bandwagon totally yet, however, it is a possibility to be considered though it's not quite fitting the total pic of a ibuprofen OD (yet) perhaps it's still early in the course though. If patient is allergic to asprin though, there is that concern with taking advil there may be a possible reaction to any ibuprofen product as well. Had an acetomenaphin OD not long ago that didn't quite fit the picture, but sure as day that was it. With suicidals you just never know. Treat symptoms - can she speak to me? If she can then find out how much (if any) advil was taken and if she is in fact allergic to asa. Either way, you're going to have to treat the breathing difficulty so go high flow O2 going, along with neb treatment to clear up those wheezes (a clear sign of lower airway constriction) and get that SPO2 up from 94%. With her BP what it is, she would tolerate a neb just fine without skyrocketing her BP and pulse at 108 (a little tachy, but not bad). With skin being cool and diaphoretic, this is sounding an awful lot like a med reaction of some sort (my guess is to the advil). Just to be certain we're not having an anxiety issue, any tetany in hands/feet? Feeling lightheaded? What meds is this girl on ? I'm going with this is a med reaction headed towards anaphylaxis if we don't do above interventions....that's my vote

Hey there, I had posted a comment regarding useless death in the line of duty deaths. I wanted to clarify something. First I meant senseless, not useless - I had been up way too long when posting that comment and misworded my comment, I am and will be eternally grateful for the soldiers out there fighting and others serving in Iraq. They have sacrificed seeing the births of their kids, their wifes, and their families to protect my freedom and for that I'm thankful. I have many friends and family that are currently in Iraq and various other areas surrounding there and would never insult what they are trying to do. I support our soldiers wholeheartedly, however I do believe one can support the soldiers without the war. And do I agree with the war? Absolutely not. Yes, I agreed initially when we were fighting it for the right reasons and the right people, but now it has progressed past that point and we are using the blanket of terrorism to go into areas we really have no business being. We aren't the world's babysitter. If I insulted you, my most sincere apologies. God bless you and all the others out there. I pray for your safety daily. Be safe and I hope this clarifies the error.

Okay, first things first - mom's freaking out so let your partner get ahold of her and try to get information so you can get the girl calmed down. Second, determine whether she's in severe, moderate, or mild distress. With that determined, figure out if it's anxiety related or a physical problem. Does she have a hx of respiratory illnesses? Any trauma to the chest? Any chronic illnesses? After going from that get baseline vitals, including lung sounds, skin signs, o2 Sat, meds list, and go from there. Right now differentials include asthma, COPD, CHF, chronic bronchitis exacerbations, possible anxiety issues, allergic reaction, chest trauma, pulmonary embolus, and then with the info you give, I'll have a better idea of how to treat this young lady.

We had a similar situation at a former department of mine - however ours was stolen by a former disgruntled employee who had a copy of station key made for personal use which none of us were aware of. Only one crew on at night, so was easy for them to get access to the keys which were right by the door. Stupid thing was, they stole it, then drove it and parked within a block of their house. We all had a good laugh over it, at least no harm was done to it, but needless to say now there is a pass key on the door. All well. Anyone brazen enough to pull a stunt like that, well, has more guts than most people I know. Good times, be safe. Oh, and one note on FDNY trucks - how'd they not lock themselves in or out? When we first got our FDNY reject trucks, I locked myself out too frequently and spent alot of time crawling through that dang little window or praying for someone for HQ to send me a key ! LOL, now THAT was a site !

I've sadly been involved in multiple ambulance related accidents, but never as the driver, but multiple times in the back - one with patient the rest just my partner and I. One was due to extremely icy roads, something we couldn't help, came down a hill and didn't have any traction, we were going slow but was only way out of the ER parking lot. We hit the bottom and couldn't make the extremely tight turn and jumped a curb ending up in a yard. Another was enroute to ER and were ran off the road by a coal truck coming around a blind curve and was halfway across the line. It was go in a ditch or go head on with the truck. We chose the ditch. No injuries to either one. Another involved us being rear ended stopped at a red light - partner had a good scrape on his knee. Our ambulance was hit HARD in a parking lot bending the frame. We were legally parked and nowhere near it when a drunk driver slammed into it. Worst one though was four years ago, we were T boned by another ambulance. Was with a brand new EMT partner (had his license two days so was really brand new !) He blew an intersection enroute to a call, and another ambulance was enroute to another call. They didn't see us until it was too late (and they did stop, then proceed) and we slammed into them. Some major injuries from that one. People need to use more sense driving an ambulance, it's not an ambulance, many people turn it into an assault vehicle.

Sporty - I know brady does a A&P for EMS that's actually pretty good. Might check into getting your hands on one - know they're pretty cheap through e campus and amazon.com

Hey, whoever told you that is right - the stupid question is the one not asked. The book is not the end all be all it's only the beginning. Now, as far as getting to know the heart better - an A & P course is a great idea. I'm currently working with my students about the heart and it's an area I'm passionate about so if you'd like to know anything, please PM and I'll do my best to answer your questions. Ask away as there is too much to cover in your questions than I have space to post here! Good luck and have fun out there. It's a great job !

MAST (after you knock the dust off of 'em and locate them) are actually respectable for stabilizing am isolated hip fracture. Used it several times for this method and seems to work quite nice. Mainly they aren't used so much because they weren't doing anything for the patient (though most didn't have 'em on long enough to really tell) but because ER docs were just cutting them in the ER and not proper deflating them. Just food for thought - good scenario and glad it was you not me buddy !