Kaisu

Everything you've stated in your first post tells me that you will be a real asset to this site. Welcome!

Dwayne you can't just shove a big spoonful in your mouth and mash down on it nilly willy... it takes a little finesse

I had a bowl a couple of months ago.. it was delicious

On calls where we have first response, we have often come upon resuscitation in process. When the effort is called in the field, we are told to record the call as a stabilization complete with PCR for billing. (nothing is as stable as dead ). Stabilizations are billable. PS.. there is no real pressure by the company to NOT call it a stabilization. Most of us report it as cancelled call - no transport and the company appears OK with that. Edited to add the PS

Damn... If I hadn't blown all my PTO time (and money) during my 3 month leave of absence, I would so go... just to find out once and for all who you are...

So.. I am dying to know, hatelilpeepees, why did you pick this handle?

I did not notice when you joined the forum. My reference to you as a newbie was based on your post count. You made the statement “Keep in mind, this patient has lost her atrial kick so having a degraded ejection fraction is not surprising” . It is difficult to ascertain exactly what you meant because your punctuation and formatting is rather poor. I interpreted this statement to mean that you felt a 34% ejection fraction is unsurprising to you based on loss of “atrial kick”. I was irritated in what I perceived as poor logic, as the patients EJ without the “atrial kick” was 61% prior to her developing heart failure. It irritated me because to me, it was extraneous statement with no contribution to make to the original question. I must admit to being irritated by the term “atrial kick”. I am generally irritated by attempts to simplify cardiology with catch phrases. Here in Arizona, I hear more than my fair share of them from medics. I was irritated at your statement “My suspicion is that she has mitral regurgitation to the degree that she can actually feel it “ primarily because she had mitral valve repair (with replacement valve) and in my mind, that had fixed that. Your second posting led me to research the recurrance of mitral valve issues after surgery and low and behold, I found that that is indeed a possiblility (albeit a low one), thus you educated me. That being the case, this patient with proven mitral valve regurgitation did not “feel it” as palpitations prior to the surgery. These palpitations are new. Your statement “Additionally, her heart failure is in both ventricles, so she probably has an enlarged heart creating a much larger surface area for the conduction, slowing conduction volicity, resulting in wider than normal qRs complexes “ irritated me because there is no evidence that this patient has both left and right heart failure and I found the explanation of enlarged heart creating wide complexes condescending. I would have thought that this is self evident to anyone with any understanding of cardiac pathophysiology. Your statement “Furthermore, palpatations are often mimicked by abarencies within the A-Fib, often from re-entry type pathways” irritated me because it is my understanding that this is what one of the most common causes of palpitations are. My original posting was trying to differentiate between this type of palpitation and the other main (and more dangerous type) ventricular re-entry pathways. I was irritated by your statement “ami is not a med i would choose since the side effects to this patient are by far greater risk than the benefits “ first because I have run into a strange and deep rooted prejudice against amiodarone here in Arizona. It seems to be based on old medics teaching new medics old stuff and a refusal to change. I have tried to trace this prejudice and think it may have something to do with the AZ heat and Amiodarones sensitivity to it. Needless to say, I have tried to counteract this to no avail. Secondly, I was irritated because the consensus among the MDs contributing to this thread was to avoid all medications in this case. Your followup to this statement to consider calcium channel blockers was extremely irritating to me as 1 – medications are contraindicated and 2 – the whole problem in the first place was the difficulty in determining whether this was atrial or not... thus going to a treatment based on the issue that was indetermined in the first place was irritating as hell (I'm getting irritated now :-) ) Your statement “Again that is making you read the ekg a bit closer “ was irritating it implied that I was not reading the ecg clearly, when I had made it clear that I could not obtain an ecg because the episode was over and second, earlier contributors in the thread make it pretty clear that even reading the ecg closely makes this a difficult differentiation. I referred to the thread as “dead” not based on how many days it had been inactive, but dead in the sense that there appeared to me very little to add to it. I perceived your post as one not adding an iota to my original question, and felt it was a post to show off a lot of cardiac terminology and little practical application to my question. I now appreciate that perhaps the world does not revolve around my naval, and that your post was helpful to others. In summary, I was irritated by your post. As for being an elite member, this is something that has been bestowed on me by the number of posts and should not be taken as an indication of the quality of my contributions. You can see that my reputation rating is pretty low, and that is because a lot of my posts are stupid one liners looking for a laugh. I very rarely make the effort to respond in as much detail to any post as I have to this one, and its only because you had the cojones to post the followup taking me to task for my rudeness. For my rudeness, I apologise. Edited to fix the freaking formatting... what gives with that anyway

Hello and welcome. What questions?

I was pretty open about who I was and what I was all about on this site. My login was my real name. I love this site and had found it invaluable when I was in school, on my first job. etc. I strove to be as honest as I could about calls, working conditions, co-workers, etc. I felt isolated in my job as I had been trained in a different state and was a total newcomer. I relied on you all to give me reality checks and honest feedback. To do this, I had to be honest and open and as detailed as required. I wasn't worried about backlash because I naively believed that anyone reading my posts in their entirety would appreciate that I was conscientious and while certainly far from supermedic, doing everything in my power to do a good job. A post about what I felt was a highhanded and unfair abuse of power landed me in hot water. I changed my name to reflect how I felt about what had happened to me (and perhaps that I bring this crap down on myself) and to disguise myself with plausible deniabilty for my co-workers and employers. (My avatar kinda destroys that, but I changed that only recently)

Not on the mouth....

Now that is an interesting statement. What was his ECG when he was conscious?

OK.. now I am going to work on the differential for delirium. was the patient in pain? Were CT scans of head, urinary tract performed? What did they show? has the patient untreated syphilis? Is the patient a long term alcoholic? Was a spinal puncture done? .. and I am not ruling out TIA/CVA.. just don't think it's likely based on the title of your post PS.. as far as I can tell, this is the differential Common causes: Dementia – nope – not long standing Pain – not sure – was the patient in pain Stroke/cerebrovascular accident and transient ischaemic attack – as suggested by your title, but unlikely because suggested by your title Myocardial infarction – normal 12 lead – still possible Acute systemic infection – patient afebrile Hypoglycaemia- nope BGL 94 Hyperglycaemia – nope – as above Hypoxia – I'm assuming because blood work was normal, arterial blood gases were too Hypercarbia - nope as above Acute urinary obstruction - possible Medication- or illicit drug-related – possible but not likely from your on scene assessment Alcoholic ketoacidosis – nope – blood work again Hepatic encephalopathy – nope – normal hepatic and renal numbers Renal failure – nope (blood work) Hypernatraemia – nope (blood work) Hyponatraemia – nope (blood work) Hypercalcaemia – nope (blood work) Meningitis/encephalitis – possible. Did the patient get spinal Brain tumour – possible – what did the CT show Post-ictal state – no seizure history – but possible new onset secondary to a lot of things Uncommon Traumatic head injury – any signs of trauma ? Adrenal crisis– nope (blood work) Thyrotoxicosis – nope (blood work) Myxoedema – nope (blood work) Brain abscess – possible – what did the CT show Neurosyphilis – has the patient untreated syphilis? Wernicke's encephalopathy – is he a long term alcoholic?

Hypertensive encepalopathy ? Did the delirium/stupor accompany rapid rise in BP, with increased LOC when BP was lower?

OK.. the next thing I would want to rule out is seizures. I once knew of the nicest nun you can imagine, except when she had these bizarre seizures where she came out with curses and swearing that made me blush (I KNOW!). After this activity, she reverted back to the sweet nun she was, with no recall of her colorful phrases and behavior.

blood values please. I know, I know, that is not available to us in the rig but I would want to rule out renal and/or hepatic failure, infection, etc I've seen some renal failure patients with high ammonia act pretty funky.

Thanks for playing I think the general consensus here is that treatment with ANY antiarhythmics is contra-indicated based on this patient's history. I refer you to the posts from the MDs. This is a patient that you DON'T mess around with, especially as the patient is asymptomatic during your contact time with them. Take them to the ED, where their treatment is probably limited to admission(possibly) and a cardiac consult(without a doubt) As a newbie to the forums, it would behoove you to read ALL of the posts in what is already a dead thread prior to posting.

I don't understand why just because a person is gay they get to be exempt from marriage. Hetero people have to suffer - Gay people should too.

Welcome to the site.

And pretty amazing to read about too! Thanks for that.

6'1" and 200lbs is not plumpkin sir.. 6'1" and 200lbs is pretty healthy.. and hot

Evidence both ways... AK refers to her as a sock puppet... the same day he says Ventmedic sock puppet is never far So.. possible troll ... however, trolling is a fine art and it is really hard to be fake stupid as opposed to real stupid.. I am of the opinion that this is real stupid.. So.. not a troll Almost painful need for admiration and attention unable to obtain legitimately - check So.. possible troll Unwilling and unable to bear self scrutiny and make an honest effort to gain competence - check Inconclusive... Peter Principal at work Enough information in posts that it is believable that this individual is in fact employed in pre-hospital emergency medicine (although questionable as to level of leadership claimed) - check so.. probably not troll (in that there is waaaaay to much to do in this field to engage in deliberate trolling) I would conclude not intentionally a troll.. but functioning in may ways as such

80% is what you put in your mouth....

Really appreciate the compliment... however.. to misquote Forrest Gump "smart is as smart does" - some days I feel about as smart as a bag of hammers

Work out 2x per week with weights - do almost no cardio at all. Really need to do cardio While fitness is an important factor in safety/injury prevention, I believe a bigger contributor to injuries is lack of familiarity with equipment. I was seriously hurt on the job because my partner had no formal training and very little experience with a new stretcher. He was a bigger than me moose of a young southern boy and could bench the stretcher with patient if required. What he didn't get is stabilizing a stretcher without a platform at the base on uneven ground is not the same as with one that has a platform at the base. It was instinctive on his part and was the wrong instinct for that stretcher. I miraculously escaped serious injury off the job when after 30 years of driving rear wheel vehicles in ice and snow I instinctively took my foot off the accelerator of a front wheel drive vehicle and rolled the mofo at 75mph. Wrong instinct. Anyway, didn't mean to hijack your thread in the third post. Gotta lay off the coffee.

I had emergency abdominal surgery a year and a half ago while on DRT deployment in Mississippi. (I hurt myself on the job). I faced the Physical Agility Test to get back. It took me a month 3 times per week to get ready for it. The doc signed off on it without even testing me. Less than a year later, a supervisor had abdominal surgery and the doc made him do the test. (He passed). I think the rules about PAT are selectively enforced and only required on hiring and after an injury. I am pretty sure messing with new guys is up there too.