Kaisu

you guys suck!

Rest in peace. My thoughts and prayers are with the family.

anyone willing to be a whore, a pimp, or a drug seller can certainly make money. I guess it all depends on what you want to be.

had one last week.... patient claimed spider bite - huge honkin' abscess - good post. I personally assume they all are MRSA positive.

Sigh - so many candles... so little cake Have a great one Teri

You are still pigs.. God love you and dont ever change

and if it is not an early beat, it is not a P anything... P means premature.... If it has a P wave, it is an aberrantly conducted P wave. (jeez - got into it with an ED physician over this the other day)

We had just started our new schedule. It's 48 hours on, 4 days off. The change has caused a lot of issues because we are a high call volume station, and a standup in the first 24 makes the second 24 less than fun. Earlier in the day, I had run on a chest pain. We had administered ASA and 3 nitro when the patient began experiencing sudden pain in the left arm. I had a fire department medic on the ambulance and I handed him the nitro for administration of the 4th dose and drew up morphine. Our medical director has a bugaboo about morphine. Although in our written protocols for use in chest pain, he has made it clear that he wants us to call for orders to administer it. I have had morphine for chest pain denied and learned my lesson. This lady was going to get it if she needed it. I was going to administer it and ask for forgiveness later. My guardian angels are on the case as the patient's pain responded immediately to the nitro. Transport time was short and I wound up wasting the morphine. I had the charge nurse witness the waste, filled out my documentation and took it to the pharmacy. It took them a long time to replace the drug but I finally got it. This is about 6 hours and several calls later. We get toned out for kidney stone pain. It's dark and the patient lives in the boonies. It took a while to find him. On arrival, he is doubled over on the floor of his residence, moaning in pain. We immediately assist/carry him to the ambulance and get moving. The patient's only medical history is hospitalization for treatment of kidney stones two months earlier. He is 35 years old, normotensive and takes no medications. He has no allergies. I immediately obtain IV access (O2 and monitor) and call for orders for morphine. (It is the only analgesic I carry. On a previous kidney stone patient, I had no option for pain as that patient had been allergic to morphine.) Med control asks me to call in on the cell. I do, and they ask for the patient's name. The medical director (on shift that night) checks the patient's history and then gives orders for 4mg of morphine. We carry morphine in 10mg/1ml vials and ampules. I pull out a 12ml syringe, attach a filter straw and draw up the morphine. The plunger draws hard - don't know why. I go to switch to a 14 gauge to draw up the saline. When I release the plunger, it pulls up into the barrel and shoots the morphine into the air. Crap!. In my surprise, I stick the 14 gauge into my thumb. Double crap!. Now I got a glove filling with blood (mine - hate that), no morphine in the syringe, and a patient moaning in pain. I pull up the second dose and administer 4 mg. The patient has immediate relief. I change gloves, we transport the patient and I get a nurse to witness the waste of the 6 mg. In pharmacy, things get very very slow. I wait and wait and wait. The pharmacy assistant comes to me and says "You know it looks a little funny - you waste 10mg earlier, now you've lost 10mg and wasted another 6. That's 30mg in one day and most paramedics never use it. Do you have an empty vial or something you can show us?" Tones are going off all over, all our crews are out, they need me to be in service and I am getting this bullshit. I get a little frustrated. "The ampule is in my sharps container, the vial is in the garbage" I tell her. I can tell that the staff is glad there is a glass wall between me and them because my BS tolerance is at an end. At that point, my supervisor shows up and wants to know what is going on? He takes it from there. The pharmacist is hard to understand because he is an East Indian gentleman with a very thick accent. Turns out he wants some sort of paperwork - not sure what but they make it up as they go along. An incident report signed by my supervisor and the medical director will be enough to replace the 10 mg. I lost. In the meantime, the 10 mg consisting of the 4 administered to the patient and the 6 witnessed wasteage can be replaced right away. My supervisor is happy because it means I can go into service. I am pissed off because it makes no sense. If I cannot be trusted with the 10 I wasted what makes them think that I can be trusted with the 10 used on the patient. Be that as it may, the pharmacist finally gives me 1 ampule. Supervisor is happy cause I can go back in service. He hands me a door card and a radio, (not sure why), I walk out the door and promptly drop the ampule on the floor, smashing it to pieces. Not as funny - large hispanic "gangsta" looking young man in the ED with a brachial artery bleed. This patient is mad at the world and makes waves. The ED doc in charge approaches the patient with a syringe and tells him it is pain medication. The patient allows him to administer it. It is sucs. The patient goes down and is intubated without amnesiatic or analgesic. I leave. When they told me it would not be like school, I didn't realize it would be this much not like school.

oops - EMTs only... so sorry - my entry deleted

check lung sounds... pneumo?

O2 high flow with NRB, immediate IV access, I/O if you cant get an IV, start with 20ml/kg fluid bolus- - recheck BP.

Hey y'all (just kidding, I still have diction. It kinda makes me stand apart from the crowd but heck, I'm used to it.) So we get this call for a domestic assault. This is in the valley, where they send us to rest at the rural low call volume station after we take our pounding in town. (that's the theory - last night we had a winter storm and were slammed with MVA's from midnight to shift change at 8:00am. Winter storms are a bugger at these elevations.) Be that as it may, we jump in the rig and are advised to stage at a location away from the scene until it is cleared by law enforcement. Paved roads end minutes into the response, and progressively deteriorate from gravel to washboard to big huge bumps. Rain on Christmas day has left huge puddles and mudholes. The rig is getting pretty dirty. We stage, wait for 5 minutes or so, are cancelled by sherrifs, then uncancelled and told to go in. We drive to the "residence" but cannot get into it. We are on tracks that would give ATV riders pause. A washout on the only access to the "home" forces us to park across a wash approximately half a mile out. We hike in, going down the gully, across the wash and up the other side. Thank God for my orthopedic surgeon. This is rough work for old lady knees. Rocks and cactus (and the rain slippery slopes) make it interesting. Fire goes in with us. Normally first response, we arrive together and hike in together. As first response, they get to carry the gear. There is NO way a gurney is going there so all my partner and I had to carry was our butts. It was enough. On arrival in proximity to the trailer, we are greeted approximately 100 yards from the tin box that is shelter for these people by the sherrif, the patient, the patient's son and what appears to be about a hundred dogs. The patient is 56 years old, appears 76 and with no visible tattoos still manages to have a pretty low tooth to tattoo ratio. She has visible swelling and bruising to the PIJ of the left little finger. The miscreant that caused this damage is nowhere to be found, taking off across the desert when the po po were summoned. The hair on the back of my neck is standing up. "Is your husband armed?" I ask her. "Nah, its locked up in the trailer" she replies. The sherrif assures me that two of his guys are out there looking for him and its all good. Those of you who think the desert is flat have never walked in it. There are so many dips, gullies and hollows that someone could be hiding 10 yards away and as long as they are quiet, you would never know they were there. The patient decides she wants to go to the hospital to get the finger xrayed and splinted. It seems like a good decision to me as the numerous vehicles dotting the "yard" all appear to be without vital working parts and even if operable, the wash out would prevent them from driving out. Before we leave, the patient wants to go into the trailer to get her purse, jacket, etc. She is smoking a filterless homemade, her fingers are black with tar and nicotine, and I am pretty sure this lady is going nowhere without her tobacco pouch and rolling papers. As the only ALS provider on the scene, even though this sure looks like an isolated minor injury, I have made patient contact and must follow her into the hovel. A blanket is hanging in the door way "to keep out the draft" she says. She moves it aside and like the 100s of dogs that ran out into the yard, we now have hundreds of cats scattering everywhere. The reek of cat urine almost overpowers me. Balls of cat hair fly in the air. The ill-fed progeny of the patient is running around looking for Ma's coat and Ma's purse and Ma's drug box (filthy thing... almost afraid to take it from him) and of course, Ma's tobacco and rolling papers. We spend another few minutes lamenting over the probable fate of the puppies out in the yard. I feel for the kid. His Dad just kicked the crap out of his mother, and it is pretty certain the puppies will be feeding the cyotes. Now begins the trek back across the desert, this time with patient in tow. It is slow going. Junior knows where the gully is not as steep and pretty soon starts leading us on a zigzag trek that probably takes twice as long as it should have. At one point, where the going gets pretty steep, I support/carry Ma. I had to get a little sharp with her to get her to drop the cigarette. We finally reach the side of the "road". Surprise - triple string barbed wire fence. Ma says - "now how are you going to get me over that?" The ambulance is only about 50 yards away - so close and yet so far. Did I mention it was cold cold cold? and that it was getting dark fast? There is an opening about 150 yards away. We head for that. The patient's son is on the cell phone. "Ma" he says, "David says we can stay at their house for as long as we need to." Ma shakes her head. "I can't stand the smell of his cologne" she demurs. "He starts spraying that Axe on himself and it almost makes me sick". I guess they have no friends or family willing to take them in that use Eau-de-cat piss. We get on the ambulance side of the wire, my partner backs the ambulance closer to us, the patient is transferred into the attendant's chair and Junior jumps into the passenger seat with the driver. The fire department medic sits down on one side of the patient and I sit on the other. I put O2 on Ma. The trek has her breathing pretty hard. I decide to wait for the heat to kick in before I start peeling layers off Ma and get a glucose stick - BGS 124. I uses about 3 alcohol preps to get a small clean spot on the finger for the lancet poke. In all fairness, that tin box she lives in would not provide any really good opportunities for personal hygene. She bleeds like a stuck pig. No anti-coagulants in her drug box. Hmm she says "I wonder why my blood is so thin?" I clean her up cause I sure don't want ANY of her bodily fluids on me. Things are nice and toasty now in the back of the rig. The fire department medic is waiting for vital signs to complete his paper work. I realize that everyone else on scene is standing out in the cold waiting for me. (even my partner would rather freeze than sit in the ambulance with Ma and her miasma). Every layer of clothing I peel off provides a new experience for my olfactory nerves. Vitals are assessed, the FD gets the little boxes on the form all filled out, and my partner, the ride along, the patient and I head for the hospital. The patient has a BP of 120/71, pulse rate of 120 and is satting at 98% on 4 lpm via nasal canula. Along with assorted other flotsam and jetsam, I had spied an O2 tank complete with regulator and cannula under the trailer. Ma disavows using it and mumbles something about some illness at sometime where someone needed it. Her lungs are clear and equal and she is moving good quantities of air, surprisingly so for the amount she apparantly smokes. I figure after that trek we are all a bit tachy, and decide to let her rest for a while before I assess her vitals again. I see no evidence of ETOH and she denies drinking that day. She says "social" drinker. Her pupils are quite constricted and there are serious prescription narcotics in her drug stash. I elicit a history of rheumatoid arthritis and degenerative bone disease. The patient is still tachycardic after 15 minutes of bouncing along the ruts. I find out that she drinks 2 to 3 liters of diet cola per day. "My diet cola and cigarettes are my two addictions" she cackles. We begin to talk about her life. She weeps about the fact that her husband is in all likelihood, going to go to jail. I am concerned for the boy. "He's got problems" she says. I tell her that living in the situation he is, he would be abnormal if he didn't have problems. Pretty blunt, but she responds to it. Crying more, she says that the boy has attempted suicide and that they now have a social worker. She states that the social worker has been paying weekly visits to the trailer and is due out again in a few days. I am astounded. "She has come to your home?" I clarify. "Oh yes" says Ma, "4 or 5 times now". I cannot believe that a child would be left by the state in that environment, but with the dearth of social services in this county, I guess there is literally no place for him to go. I get Ma talking about the incident. Dad had grabbed the boy by the throat and punched him. "Your son was hit?" I ask. "Does he need medical attention". "Aw no" she says dismissively "He's OK". I consider stopping the ambulance to examine the child, but he certainly appeared fine on the scene. I poke my head into the front and do a quick visual on the boy. I tell my partner that the child had been hit. He nods, having ascertained that while I was in the back with the mother. I decide to keep moving. My patient states that after the initial assault on the boy, she moved between them and pushed her husband away. That was when he dragged her across the room by the hair. The ensuing struggle resulted in her injury. "It's the damn booze" she wails. I find out that the police do not know the boy was hit. I also get the name of their social worker. We arrive at the hospital. The son is directed to the waiting room, Ma is sent to fast track. I advise the nurse of the assault on the boy. She is relieved when I tell her I will follow up with social services. (It takes tons of phone calls to get any kind of action on any social issue here.) The sheriff pulls up to the ED as we are getting our rig back together. I inform him of the fact that he has two domestic assault victims. At the station, I document all of this extensively, including the name of the social worker. I will give her a call on Monday. I will probably never know what happens to this family and I know this boy will be on my mind for a while. PS.. it took hours with all the doors open to air out the ambulance.

I do believe that I stated at the beginning of my post that I had no argument with the general content or the inferred meaning of Timmy's post. The blanket statement as it stands "EMS has absolutely no relationship with any form of funeral home" is in fact, blatantly incorrect. While you may see no reason to correct it, my nit-picking little brain has a problem with it. Saying there is NO relationship with funeral homes and EMS is blatantly incorrect in that same general sense. If we are talking about a very narrow range of relationships, I may grant that this is correct, but in the very short history of EMS, the funeral home connection has connotations that survive to this day - not to mention in the broader context of our societies (and by that I mean those that developed along Judeo-Christian lines,which includes Australia) view of death and dying. These attitudes inform us all, and I believe they have a direct impact on the OP's issue. just sayin'

While not having a quibble with the general gist of your posting, I must correct this statement. In fact, the early history of EMS is directly associated with funeral homes. Often, the only "ambulances" were those that belonged to funeral homes. They responded to scenes to take the "patient" to either the hospital of the funereal home. The first ambulances (the infamous "Caddies") were often converted hearses. I realize from your perspective that the late 60s/early 70s are in the dim mists of time, but for some of us oldsters, perhaps the EMS director him/herself, EMS will always be associated with the funeral homes. :wink:

Is EMS difficult on marriages? or are people that are attracted to EMS also poor marriage material? I'm asking because my third marriage is in trouble. I really don't think its just me, but with this track record I gotta look at the constant - me. Maybe I just pick badly? Any insights, suggestions, tips, etc would be greatly appreciated.

Dec. 23 ? A Christmas baby!!! Awwww.... Happy birthday sweetheart... Love ya always Me

Why? A picture is worth a thousand words. Would you like the first time someone actually sees this is in the field when they are responsible for the care of this patient? We had similar videos in PALs certification classes and I think they are invaluable. I think the OP posting of this is doing a service and I recommend all EMS providers (and possible any parent of a small child) view all of them.

I want to stay healthy and get stronger and keep learning... OH wait.... that's 3 wishes... Oh well, give me the first one and I'll take care of the other 2

I am an "old" rookie. I bring a lot to the job that the young bucks don't. I have emotional maturity and often am better able to handle the life experience aspects of the job. In general, young people tend to get shocked more by some of the stuff we see and often develop a cynical shell or a judgmental attitude in response to it. They also tend to get more emotional about things that, from my perspective, are really not a big deal. As long as I remain in good physical condition, my strength and reflexes are a match for theirs. I should not be in a leadership position tho and would refuse if asked. I need several years of seasoning on the job to have a clue about that stuff. I find myself in an informal position of leadership tho - with fellow workers more and more looking for my take on stuff. If forced to make an overall statement about things, I think that given a proper academic education, then the age of the provider is not significant. More important is emotional maturity, attitude, and good years in the field.

Yeah... I got that crap when I first started too..... Its remarkable how quickly the clumsiness goes away. That is just a question of practice. The thinking part tho - if you don't have it, it is very very very difficult (maybe impossible) to get it. I also got the the "don't beat yourself up - you'll never last in this business" BS when I critiqued each call. Also nonsense in my opinion. If I don't find something after each call that I can do better then I am being dishonest with myself or obtuse. Take care Wendy girl - you are about as far from a jerk as they make 'em.

LMAO - On the down side, he may know now tho.... does he troll the net?

People sometimes think I'm a jerk till they get to know me. I am physically imposing and very focused on the job at hand. I sometimes forget the social niceties. When they get to know me, they realize that I am a very nice person who only acts like a jerk sometimes. :wink: Seriously, I totally appreciate it when someone points out one of my errors. I LOVE the learning and I don't get my shorts in knot even if they do it in front of other people or non-tactfully. I forget that not everyone is like that.

thats wierd... because everyone knows paramedics are such a laid back bunch.. quite unwilling to be vocal and very amenable to authority. Can't understand why threads here go the way they go.

Likewise I'm sure.

What I was specifically referring to was your post defining three words in such a way as to appear to prove your point - being that practical jokes are always unprofessional and detrimental to the profession and our patients. Here.. let me demonstrate Note - definition from Merriem-Webster Practical joke - a joke involving something that is done rather than said; especially : a trick played on a person Now your definition of practical joke was 1. Something done for amusement to the detriment of someone else. This begs the question.. as the definition you selected assumes the position you take. It is the detriment portion that we are debating. That is the flaw in your argument. Respectfully Kaisu