Kaisu

Yeah... that is one beautiful tatoo...

Egos egos egos... I am having a similiar problem with an RN (I run Critical Care Transport and we are a team comprised of EMTB, EMTP (me) and an RN) and I see it in the field with fire medics, transport medics, etc etc often. I think it stems from the fact that EMS can be damned scary. The more medicine I learn, the more I despair of ever getting a handle on it. Patients don't read the text books and even if we memorize every text in the field, we will come to that chasm in medicine of "we really don't know." If you don't have a little pucker factor on every call, then you are ignorant. So the EMS conundrum - we are expected to deal with the situation, whatever it is, yet we are often working in the dark. A lot of take charge types cannot cope with it emotionally. Somebody running around acting like they know everything and can dismiss the eyes, ears and brains of other professionals on the scene is somebody riding for a fall. It will bite them in the ass. Unfortunately, these types often harden in their stupidity as opposed to changing for the better, and tragically, someone might have to die first. So what to do... I never get in a pissing match in front of patients or the public. I eat crow, unless actions will harm the patient, in which case I intervene firmly, and swiftly. In your case, I would assume this medic had taken control of the scene, was a higher level of care and you really had no voice in what happened next. Write it up man. Write it up the way you told it here. Make sure you make it clear that you are acting out of concern for your patient (and future patients). It is just as much your responsibility as good care on the scene. You are advocating for your patient and that is your job. Good luck to you. PS.. you did the right thing for your patient. All the brilliance in the world will not trump being thorough and correct and doing a top notch job on each and every call.(much harder than it sounds). That consistency week after week and year after year is what makes a professional. At the end of the day, you can take pride in that. edited to add PS

I do have a surgical airway option, however, I would push the obstruction into the bronchi with the tube before I attempt a crike. This is under the general principal of doing the least risky procedures first and escalating if required. By the same token, there is not a lot of time to ponder these options. I would move through them as quickly as possible. I would leave the tube unless ETCO2 is unacceptable. It is possible to plug the tube and the murphy eye does not generally provide adequate ventilation.

Don't sweat it. I spent an hour on the stationary bike per day. - no resistance. It was awesome. The knee that moves is the knee that heals... big plus.. no weight gain.. actually weight loss... due to the bike. I saw a physiotherapist for about 3 weeks. It was difficult for me to get to it (45 minutes away) and I took over the rehab process on my own. I am motivated and educated about my body. I don't recommend everyone do without a PT, but my knee is great. I love the way your surgeon thinks and I think he is right on the money. The hamstring is the natural ally of the ACL. Over developed quads with underdeveloped hamstrings are one of the predispositions to ACL rupture. Why disrupt the hamstring? The other benefit of the patella graft - bone to bone at both fixation ends. The allograft is a nightmare. Adds about 10K to the cost of the surgery and you have NO guarantee where that graft came from. Google "body parts ring" to see what I mean. It has a higher failure rate than the patella also. I have no issues with kneeling or tendinitis. There is a reason it is the gold standard. Trust your gut. Good luck!

Are you a new EMT? If you are, the big agency is the way to go.. strictly for the call volume. I run 10 times the calls at my big agency than others do at the smaller ones and that experience is totally the way to go. As you noted, call volumes mean standup 48s happen. It is exhausting but it is amazing what you learn you can do. I think if you are new, you will always wonder if you could have hacked it at the high volume place.. but maybe that's just my own particular brand of crazy.

I tore my ACL during a flying side kick at a heavy bag.. went down like a rock! I spent about 3 weeks rehabbing the knee to get range of motion and strenght, then had the patellar autograft. I had a CPM (continuous passive motion) machine for 24 hours following surgery and my first rehab 48 hours after surgery. It took me about 6 months to be fully functional; however, my knee was not 100% until approximately 13 months post surgery. ACL recovery is a marathon, not a sprint. I found this site to be an invaluable source of encouragement, information and support. Knee Guru Good luck!

1. What aspects of being an EMT/Paramedic are you most passionate about? Are they the same things you THOUGHT you'd be passionate about when you started? Patient care and medicine.. its what I wanted and it is still what drives me. 2. If you changed careers- do you regret leaving your "stable" job for something more tumultuous? Was working in EMS as rewarding as you had hoped it would be? Working EMS is totally rewarding to me. I do not regret leaving my old job. For me, it is everything I dreamed of and then some 3. Do a lot of people burn out? Yes 4. For the married folk out there- how has working in EMS challenged or strengthened your marriage? My husband and I are not trying to have kids anytime soon, but I imagine things will still change if I'm switching into such a demanding line of work. Will widen the cracks in any marriage. Very difficult to have a family with the long hours, arduous shifts and high levels of stress. 5. Am I crazy? I don't know, but it really helps in this job.

As an aside AK - your signature line "don't pray in our school and I won't think in your church" betrays a lack of biblical understanding and an ignorance of some of the best thinking in Western thought on theological matters. To make this as fundamentalist as I can, I refer you to 1 Thessalonians 5:21 (New International Version) which states "Test everything. Hold on to the good." This injunction specifically refers to spiritual matters, but is a good philosophy for everything and is more congruent with what I know about you than your signature line. I am surprised at you and in general, the uniformed populace which makes the totally unfounded assumption that faith = stupid.

And your ass glows!!!

What is wrong with these people? Is there a culture at this shop that promotes or protects the idea that this type of behavior is acceptable? It makes me want to weep.

I negated the positive on jeepluv77's posting not because I object to anything on the posting. I did it because on an educational and professional EMS site, I have a real problem with people earning reputation posts for funny stuff. Just a personal pet peeve and I truly hope it is not taken personally. PS.. my other pet peeve is people who negate and run.. thus the explanation. respectfully cm

Extensive background check required for my current job, including background, criminal and credit checks. They contacted my high school, which I attended 30 years ago and out of state checks everywhere I had lived, including Canada. It made me happy, because I knew my colleagues and co-workers had gone through the same process. I felt good knowing I was going to be keeping good company.

LOL... makes me reconsider my decision to have nothing to do with fire...

Sounds like an awesome outcome and outstanding work by everyone involved. Good story... thanks for sharing it.

I have been extremely privileged to experience a lot of life. My life started pretty badly... the out of body stuff... disassociation... kids are good at it. Our brains don't know at that age what's possible and what isn't and getting out of the body to a safe spot near the ceiling is a damned creative way to escape something unbearable. That being said, after being through more shit (and more joy and happiness) in one lifetime than many can claim in several, I have come to an unshakable knowledge that God is good. I feel loved beyond measure, protected in every way possible and more grateful than I can say for my life. What happens after? I really don't know, but I do know that it will be good and when my time comes, I will meet it the way I meet life... with joy and expectation and the thrill of the adventure. God bless you all

Thanks so much for the intelligent responses. You folks are invaluable to me... Re the dosages.. I carry 2 mg, when I have acls 1st response (50% of the time) they have 2 mg in their box too. RN Emergency field guide suggests 3 - 5 mg dosage... thus doable in this situation. On the calcium channel thing... very interesting. We don't carry insulin and I don't know of any EMS service that does (not that they may not be out there) so my option is all the CaCl I could throw at them and beat feet to the ED. Thank you again for the answers.

I have a question for you. Working a full arrest and thinking about the Hs and Ts.. in this case, I have good reason to suspect a beta blocker overdose. As far as I know, epi/atropin is not going to do much to a heart thats od'd on beta blockers. Given that peripheral circulation is going to be compromised in a big way, what do you think about administering glucagon IV? Dose? Your input is much appreciated. edited to add glucagon instead of the word antidote

Do all the stuff in vegas that you are planning... EXCEPT DO NOT GET MARRIED!!! If you insist... congratulations and best wishes

then we are in general agreement. Thanks again for the responses.

and if that takes 5 doses in the COPD'r?

ok... follow you so far... what about peak therapeutic levels? wouldn't repeated dosages increase levels and at what level is the best efficacy for that specific patient? (btw.. appreciate you responding. Thanks for letting me pick your brain.)

For all patients? In all circumstances? Please explain why.

Is the patient febrile? Absent lung sounds on the left base, sweating, and high blood sugar suggests BGL pneumonia.

hmmm... BGL of 234 mg/dl. Does this patient have a history of diabetes?