Kaisu

OK.. so I was born 100 klicks south of the arctic circle and lived in Northern Ontario until I was 40. I did my paramedic ride time in Marinette Wisconsin during the coldest winter in recent memory. My tips.... The adrenalin is going and you are mostly in the ambulance, in patient residences or the ED. If you overdress you will sweat and if you sweat you will not be comfortable. In Marinette, the favorite EMS chair was directly in front of an air conditioner in the EMS room. Medics would sit in front of it in the middle of winter to cool down. The only time cold was a real issue for us was if we were out in the middle of the highway on an MVC. Even then, 10 minute maximum scene time is not going to expose you to a lot of cold. The big problem with cold is not for us but for our patients. I cannot tell you how often a sick person in their PJs is loaded onto the gurney and people get ready to take them out with one thin blanket. Put those layers on the patient. Several blankets and I would often "hood" a blanket for the patient's head. Do not dress in layers that are hard to remove under your uniform. A good set of thermal underwear, a couple of pairs of socks and a pair of thinsulate gloves work well. Be sure to get your boots a size larger so you have room for extra socks. A good hat is a must. Your outer gear needs to be your chief line of defense against the cold. I usually found that I had the big ole coat open. Good luck PS. it helps to be fat - I would retain old Milwaukee and twinkies.... kept me warm 8)

I am sorry to hear of this situation Ruff. I am a praying gal so that is what I will do. You stay strong and post often to let us know what is happening. Perhaps you can educate us as you learn about this. PS.. don't take those prognosis of life expectancy to heart. Your father in law is one in a million and there isn't that large a sample size of this illness to predict. My husband was diagnosed in 2000 with his lung condition and the average life expectancy is 10 years. He is almost 9 years out (in January) with NO loss of lung function since diagnoses. He will probably outlive me. (only the good die young)

tragic and unexpected... my thoughts and prayers are with her family, friends and coworkers.

Never heard of it before, looked it up .... Over the years, physicians have noted an association between asthma and sinusitis. In fact, 15% of patients with sinusitis also have asthma (as opposed to 5% of the normal population). An astounding 75% of severely asthmatic patients also have sinusitis. Additionally, asthmatic patients often report that their symptoms worsen when they develop sinusitis. Conversely, when the sinusitis is treated, the asthma improves. PS.. The reasons behind the association of asthma and sinusitis are similar to those suggested for the association between asthma and allergic rhinitis. The infected mucus from the sinuses may drain into the bronchial tubes, thereby causing bronchitis (sinobronchitis). The inflammation caused by the mucus may worsen asthma. The best evidence to date seems to support the idea of neural reflexes in the linings of the nose, sinuses, and airways. Sinusitis may activate a "sinobronchial reflex" and worsen asthma. Have you had asthma since childhood? Hope you are feeling better soon. PS.. pretty polite.. I was thinking pulled out of south of there..

You're right.. they should never have tazered him. They should have shot him.

I've had 3 or 4 different people tell me that part of the reason I had such a rough intro to my current service is because I was a woman and there are people who still believe women do not belong in this profession. I know that seems ridiculous in this time and age but there it is. I know that of 4 newbies (1 male and female each EMT and Medic), the males had a much easier time of it. There was instant acceptance because of the common ground of being guys. Do a headcount and you will find that in most services, men outnumber women. To claim that sexism is not an issue in EMS is being willfully ignorant. Sometime, we cannot afford to recognize the difficulties we face because we need the focus to cope with the more important issues. Further, I did my paramedic ride time in a service where the majority of medics were female. It was amazing. Several days after my intro to this, I was at another station that was the more typical configuration of male majority. I watched the interactions of the males with each other and the women standing off to one side. I was hit with the realization that the way it was for me at the female dominant service was the way it was for the guys all the time. I had a better understanding of the "brotherhood" thing they jabber on about. It's pretty nice if you can get it. Saying that you don't care if the partner is a man or a woman as long as they can lift is setting up a straw man. Why should advanced pre-hospital care providers need to lift? I know that the way things are currently set up, you gotta lift - but how hard would it be to set up things differently? To make medical knowledge and delivery of care more important than your ability to extricate or lift one of those ridiculously badly designed (read cheap) gurneys onto a box on wheels that is equally ridiculously badly designed is really putting the emphasis on the wrong thing. I can lift with the best of them and can outrun most of the fat ass*s I work with. They can get away with being fat and out of shape. I cannot because people will always wanna know if I can lift.

oh Matt - you sooooooo smart - and handsome toooooo

gee whilikers! that totally sucks. I am sorry to hear about your difficulties. People blessed with good health have no idea how lucky they are. I will be praying for you.

We all know that we need to treat the patient. Presentation, history, etc. are critical. I was trying to get a handle on what appeared to be a blanket statement by the medical director. The information I related to you was what was provided at the run review. I had a lot of questions after it and the type of discussion this has generated on this site was what I was looking for at the review. Thank you all for contributing. As a scared, inexperienced newbie thrown to the wolves, I have to stop trying to come up with a few simple "rules" about patient care and continue to try and learn and keep thinking. Thanks again.

Doc figured the guy would have died with 2 liters in him. Nothing would have helped in this specific instance. I just wanted to know what the right thing to do would have been in general.

OK - this I will buy. The doc took a reasonable position. Thank you so much for all your answers. BTW - the patient died in the ER.

This came up in run review the other day. It was not my patient, so unfortunately, I won't be able to answer your detailed questions. I was too intimidated (it being my first run review) to question the medical director about this. I would appreciate your comments tho - and if you think yes or no - please provide reasons. The patient was a late 50s professional truck driver. He called 911 for blood loss. EMS arrived to find him in the cab of his rig with blood and feces all over the interior. (estimated loss of 1.5 liters or so). The man had had black tarry stools and hemoemesis. He was feeling "pretty weak". BP was 98/60ish, HR of 95 (or so - he may have been slightly tachy at some point). 2 large bore IVs established and about 200 ml infused by the time they got to the hospital. Blood work done in ED - hemoglobin 8.2 The medical director had pulled this run because he felt medics should have put in at least 1L of fluid, and if they had pushed 2nd liter he would not have said a thing. My problem - would turning this patient's blood to kool-aid have helped at all? I mean, a hemoglobin of 4 would be useful how? The second point I have is wouldn't increasing the BP just make MORE blood run out of whereever it was running out of. I think a systolic of 98 is fine. Medics got out of the line of fire by stating that the line was wide open and it was a short transport but to me that begs the question. This is important to me because I want to know if I can trust my medical director. He is not the kind of guy I am comfortable with asking the question. I really appreciate your help.

guillaume barre

This is going to sound super-ridiculous but I feel a calling to this place. I am crazy enough and idealistic enough to believe I can make a difference here. At the risk of being maudlin, I think God wants me here and is protecting me. By the same token, never underestimate the capacity of the human heart for self deception. :? I am very tired. Just came off a 24 - ran at 2:00am for a 4 1/2 month old with respiratory distress and at 4:00 am a 17 year old passed out in a car in front of some guy's house. This was after the 13 year old injured in a rollover ATV accident. I have a rule to never make life changing decisions without proper rest, nutrition and exercise. I am going to hang in for my 24 tomorrow and then use my 4 days off to refresh and renew. I won't kid you - I am scared s**tless of that fatal mistake - the one that seriously harms someone. I am so green in the field but the one bright spot is my EMT partner. She has literally grown up with this service - her father is one of the shift supervisors and she has asked to be my permanent partner. While officially not done, unofficially she is scheduled every shift with me. It's kinda ironic - I am a 50 year old baby paramedic and she is 23 and seen and done it all...... Thank you again for listening. You don't know how much I appreciate bouncing stuff off you. I am expectantly waiting for you all to chime in and let me know what you think of this reasoning - or lack thereof.... :? PS.. I got shorted on my pay - 24 hours of overtime - (I did 160 hours in a two week period). Apparently this is a common occurrence here.

So I went in and talked to the medical director today. He flat out told me that the problem was NOT with me.. I got caught in the crossfire. He told me that he had attempted to get my superiors to do the correct thing with me and was being ignored. He says he was stressed out and he lost it. My immediate supervisor says that no matter what happens, he will give me glowing letters of recommendation and commendation. This is a tough, insular little redneck town and I am not ready to let them run me out. I ran on patients today (am on a 24) and was complimented by patient's family. My partner says the jerks can't handle the fact that I am from somewhere else and am better educated then they are. My immediate supervisor says the only thing they got to crab about is my lack of field experience and I am rectifying that every day. Thank you so much for your support. I am hanging in there until they all eat their words..... then I will leave... :twisted: PS.. while I was in the medical director's office my EMT partner was talking to the unit clerk. In barely concealed glee she stated that "I bet her cert is being pulled cause they weren't happy with her yesterday." When I confronted the UC about it she played dumb. such assholes.... PPS - my partner says these people are famous for running outsiders out of town and out of the job. She says it wasnt the smartest pick for the first place to work. Guess what - this gal wont be run out by anyone.. so thanks again for listening.

Well get that silly EMT to slow down on the ventilations. That wave form and the PCO2 indicate respiratory alkalosis. This will lead to muscle twitching, spasms, and weakness seizures, irregular heart beats, and tetany. The blister hmm - was this guy electrocuted? Did he grab a live wire?

OK - so I've been on the street for a month and a half. In that time, I've taken at least 100 patients to the ED. Day before yesterday, I was on the 4th call of the day - 3rd transport. No problems, no issues. I was feeling good about my job and life in general. (always a bad sign). We leave the hospital and my EMT partner says "We gotta go out of service." I say what? Go out of service. The ED doc and our medical director (who has never said one word to me) approached my partner and said "If she brings one more patient into my ED, I will yank Medical Direction". :shock: :shock: :shock: WTF I was scheduled for a 24 that day, 24 off and another 24 the next. Supervisors scrambling. Remember when I told you I was kicked loose with almost no training or backup? Well, it turns out that my superiors had not turned in my certs OR had me do a 12 hour ED shift that all new hires need to do. My day off turned into 12 hours in the ER yesterday and I am back on my 24 today - or at least I think so - no one has told me if I can run or not. I tell you, it gets harder and harder to focus on patient care around here. The same superior that had f***d up lectured me before my ER shift yesterday telling me that he doesn't care how may ER hours I have or how many ALS calls I have, whether I get to base out of the hospital or not depends on my performance in the ER. Further, at the end of that shift there was no paperwork defining criteria that I had met or not met or any other objective statement from anyone about the previous 12 hours, including nothing stating that I had even been there - :shock: :shock: :shock: :shock: :shock: Thanks for letting me rant. I will see if I am allowed to take care of patients today.

sliding down 'em

hmm... on a 20ish person, its not really likely that an arrhythmia caused the fall. So, if the fall caused the arrhythmia and the AED shocked it (thanks doc) then I'm thinking maybe commotio cordis. Be that as it may, is the patient being ventilated adequately? I would look after the ABCs, then check out the monitor. Also do a secondary trauma assessment, looking for injuries, especially to lungs (pneumo's etc) and abdomen and pelvis.

My current husband is 14 years older... when he graduated high school, I was 4. When he was fighting in Vietnam, I had just started 2nd grade....

I was 17 when I met my first husband. We married when I was 18. He was 43. Now that there is a chicken hawk - I don't care who you are.

You are correct about the BP - I was looking at 8/10 chest pain... which with uncontrolled aflutter I would consider ischemic chest pain... hence symptomatic.....

Girl With An Apple (This is a true story and you can find out more by Googling Herman Rosenblat. He was Bar Mitzvahed at age 75) August 1942. Piotrkow, Poland. The sky was gloomy that morning as we waited anxiously. All the men, women and children of Piotrkow's Jewish ghetto had been herded into a square. Word had gotten around that we were being moved. My father had only recently died from typhus, which had run rampant through the crowded ghetto. My greatest fear was that our family would be separated. 'Whatever you do,' Isidore, my eldest brother, whispered to me, 'don't tell them your age. Say you're sixteen. 'I was tall for a boy of 11, so I could pull it off. That way I might be deemed valuable as a worker. An SS man approached me, boots clicking against the cobblestones. He looked me up and down, and then asked my age. 'Sixteen,' I said. He directed me to the left, where my three brothers and other healthy young men already stood. My mother was motioned to the right with the other women, children, sick and elderly people. I whispered to Isidore, 'Why?' He didn't answer. I ran to Mama's side and said I wanted to stay with her. 'No, 'she said sternly. 'Get away. Don't be a nuisance. Go with your brothers.' She had never spoken so harshly before. But I understood: She was protecting me She loved me so much that, just this once, she pretended not to. It was the last I ever saw of her. My brothers and I were transported in a cattle car to Germany. We arrived at the Buchenwald concentration camp one night weeks later and were led into a crowded barrack. The next day, we were issued uniforms and identification numbers. 'Don't call me Herman anymore.' I said to my brothers. 'Call me 94983.' I was put to work in the camp's crematorium, loading the dead into a hand-cranked elevator. I, too, felt dead. Hardened, I had become a number. Soon, my brothers and I were sent to Schlieben, one of Buchenwald's sub-camps near Berlin. One morning I thought I heard my mother's voice.. 'Son,' she said softly but clearly, I am going to send you an angel.' Then I woke up. Just a dream. A beautiful dream. But in this place there could be no angels. There was only work. And hunger. And fear. A couple of days later, I was walking around the camp, around the barracks, near the barbed-wire fence where the guards could not easily see. I was alone. On the other side of the fence, I spotted someone: a little girl with light, almost luminous curls. She was half-hidden behind a birch tree. I glanced around to make sure no one saw me. I called to her softly in German 'Do you have something to eat?' She didn't understand. I inched closer to the fence and repeated the question in Polish. She stepped forward. I was thin and gaunt, with rags wrapped around my feet, but the girl looked unafraid. In her eyes, I saw life. She pulled an apple from her woolen jacket and threw it over the fence. I grabbed the fruit and, as I started to run away, I heard her say faintly, 'I'll see you tomorrow.' I returned to the same spot by the fence at the same time every day. She was always there with something for me to eat - a hunk of bread or, better yet, an apple. We didn't dare speak or linger. To be caught would mean death for us both. I didn't know anything about her, just a kind farm girl, except that she understood Polish. What was her name? Why was she risking her life for me? Hope was in such short supply, and this girl on the other side of the fence gave me some, as nourishing in its way as the bread and apples. Nearly seven months later, my brothers and I were crammed into a coal car and shipped to Theresienstadt camp in Czechoslovakia. 'Don't return,' I told the girl that day. 'We're leaving..' I turned toward the barracks and didn't look back, didn't even say good-bye to the little girl whose name I'd never learned, the girl with the apples. We were in Theresienstadt for three months. The war was winding down and Allied forces were closing in, yet my fate seemed sealed. On May 10, 1945, I was scheduled to die in the gas chamber at 10:00 AM. In the quiet of dawn, I tried to prepare myself. So many times death seemed ready to claim me, but somehow I'd survived. Now, it was over. I thought of my parents. At least, I thought, we will be reunited. But at 8 A.M. there was a commotion. I heard shouts, and saw people running every which way through camp. I caught up with my brothers. Russian troops had liberated the camp! The gates swung open. Everyone was running, so I did too. Amazingly, all of my brothers had survived; I'm not sure how. But I knew that the girl with the apples had been the key to my survival. In a place where evil seemed triumphant, one person's goodness had saved my life, had given me hope in a place where there was none. My mother had promised to send me an angel, and the angel had come. Eventually I made my way to England where I was sponsored by a Jewish charity, put up in a hostel with other boys who had survived the Holocaust and trained in electronics. Then I came to America, where my brother Sam had already moved I served in the U. S. Army during the Korean War, and returned to New York City after two years. By August 1957 I'd opened my own electronics repair shop.. I was starting to settle in. One day, my friend Sid who I knew from England called me. 'I've got a date. She's got a Polish friend. Let's double date.' A blind date? Nah, that wasn't for me. But Sid kept pestering me, and a few days later we headed up to the Bronx to pick up his date and her friend Roma. I had to admit, for a blind date this wasn't so bad. Roma was a nurse at a Bronx hospital. She was kind and smart. Beautiful, too, with swirling brown curls and green, almond-shaped eyes that sparkled with life. The four of us drove out to Coney Island. Roma was easy to talk to, easy to be with. Turned out she was wary of blind dates too! We were both just doing our friends a favor. We took a stroll on the boardwalk, enjoying the salty Atlantic breeze, and then had dinner by the shore. I couldn't remember having a better time. We piled back into Sid's car, Roma and I sharing the backseat. As European Jews who had survived the war, we were aware that much had been left unsaid between us. She broached the subject, 'Where were you,' she asked softly, 'during the war?' 'The camps,' I said. The terrible memories still vivid, the irreparable loss. I had tried to forget. But you can never forget. She nodded. 'My family was hiding on a farm in Germany, not far from Berlin,' she told me. 'My father knew a priest, and he got us Aryan papers.' I imagined how she must have suffered too, fear, a constant companion. And yet here we were both survivors, in a new world. 'There was a camp next to the farm.' Roma continued. 'I saw a boy there and I would throw him apples every day.' What an amazing coincidence that she had helped some other boy. 'What did he look like? I asked. 'He was tall, skinny, and hungry... I must have seen him every day for six months.' My heart was racing. I couldn't believe it. This couldn't be. 'Did he tell you one day not to come back because he was leaving Schlieben?' Roma looked at me in amazement. 'Yes!' 'That was me!' I was ready to burst with joy and awe, flooded with emotions. I couldn't believe it! My angel. 'I'm not letting you go.' I said to Roma. And in the back of the car on that blind date, I proposed to her. I didn't want to wait. 'You're crazy!' she said. But she invited me to meet her parents for Shabbat dinner the following week. There was so much I looked forward to learning about Roma, but the most important things I always knew: her steadfastness, her goodness. For many months, in the worst of circumstances, she had come to the fence and given me hope. Now that I'd found her again, I could never let her go. That day, she said yes. And I kept my word. After nearly 50 years of marriage, two children and three grandchildren, I have never let her go. Herman Rosenblat of Miami Beach, Florida This story is being made into a movie called The Fence. This e-mail is intended to reach 40 million people world-wide. Join us and be a link in the memorial chain and help us distribute it around the world.

Then that ED doc had no business giving you the business.... patient was symptomatic - that would be our protocol too...