ERDoc

Here Do you want everything handed to you? I expected better from you Michael.

Here is an interesting little article to go with an old topic. Enjoy.

You have learned well young padawan.

And we are slowly taking that away too. :twisted:

OK, be honest. How many people are scratching various parts of their body after reading the story?

I can't say for sure in this case, but surgeons are usually the last in and first out of the OR. He probably was never alone with the pt.

This shows a total ignorance of the issue. Do a little reseach and come back to have a worthwhile conversation. I agree with Ventmedic, we need to get EMS up to a national standard and not local standards. I also agree with the person that said that cost may be prohibitive. These machine can be pretty expensive (say $20k in some cases). I can also not see using them out of the ambulance. Keep them in the ambulance and use them once the pt is on board. I can see them having a place in EMS. Let's just look at the FAST exam (Focus Abdominal Sonography in Trauma, for those that were wondering). You pull up to a scene where a pt had had an abd trauma (MVA, kicked by a horse, whatever). They have good vitals because they are compensating for their bleed. You put the US on and find free fluid in Morrison's Pouch. Instead of taking the pt to your community hospital you will redirect to the trauma center. A negative US should not loosen up your pucker factor. The FAST exam looks at four spots where fluid commonly collects. Sometime the blood does not collect in these areas, so you still need to have a high index of suspicion. You can also use the FAST exam to assess a hypotensive pt with abd pain for free fluid. You can look at the Aorta to look for aneurysms. You can look for pericardial effusions and treat tamponade. OB is also another area you can use the US. You can have a pregnant woman who has not had her first appt yet. She develops pelvic pain and you, the astute medic, put the US on her and realize there is no fetus in the uterus. Where could it be? Could be an ectopic. This may also change where you take the pt and how quickly they get seen at your final destination. As to the comment about spending time with someone to perfect your technique, US is pretty easy to learn. As a physician I never spent any time with someone else other than my attendings. You learn them best by doing them and on the machine you are going to use. The quality of the machines that we use in the ER and that would be used in the field are much less than those used by the US techs. It would be like learning to drive a motorcycle by using a Suburban.

I almost used prehospital US use as my residency research project. I think there is some utility in it. I think the most useful purpose will be for FAST exams on trauma pts. It is nonivasive and pretty easy to use. Personally, I feel it would be a helpful tool in your toolbox.

Yup, things begin to move very, very slow when it goes on downtime for "upgrades"

I don't know spenac, I think a law suit and the emotional damage that was caused was a little much, but I think she might have a legitimate complain. I don't know if that was the best place to leave it. I can see not putting on her back since she is never going to see it, but at least put it up higher or on her arm. As far as that surgeon from NYC in 1999, I believe that the initials were in the woman's uterus where no one will ever see it (though I admit I could be wrong).

:lol:/ I LOVE CERNER :lol:/

Medicine in a constantly changing field. Everyone needs to keep up to date with the latest literature. I realize that this can be difficult in EMS because of the paucity of research but the field will not advance if you depend on your medical director to know the latest studies.

Is this hard abd voluntary or involuntary guarding? Are you able to say in this pt? Other than trying to get a line I don't think there is much you are going to be able to do for this pt in the field. Let's continuously reassess vitals and check neuro status. I don't think this is an obstruction, but would need more information to be sure.

:)/ Was any imaging done? I'd like to think they can at least do an abd film. I'm guessing CT is asking too much. A BM this morning does not r/o obstruction. The stool after the obstruction will still come out. Was any blood work done?

Only five times, huh. That's quaint. When they catch up to the 26 World Series wins the Yankees have seen, let me know, (not to mention the couple of World Series wins that other NY team has). I don't see your name on the Cowboys roster, so we know you are not a steer or a Cowboy. That leaves Admin and, well, you know.

I'd like to know what kind of workup was done at the transferring hospital. Jaundice is not typical of bowel obstruction, so was something missed? I'd also like to ask for an Australia to American medication translation dictionary (yeah, too lazy to Google).

You know what they say about the only two things that come from Texas? I don't think you are a steer so that only leaves one thing, lol. Bring on the war, the south could use a good whoopin' to remind them where they came from. Author note-please no one take this as serious. It is purely in good humor with spenac aka admin.

Not to make it a political statement, but no tall tales from a Texan?? Where are the WMDs?? Though I will give you credit, he is not a native Texan. I need to sneak around because you won't be up front and admit who you are.

Admini"s"trator="S"penac. That was quite a strech linking it to my R. Going through Google if found a reference that said that spenac is from an ancient Central American dialect and means one who runs a website. No, I will not divulge my source. I've even got your fellow Texans turing on you. Not bad for a guy from NY (thanks itku2er).

Easy there RichB. Some of the younger people on here are going to need to Google those names to have any idea what you are talking about. Thinking more about why it has to be spenac I have a few more ideas. 1. He works in a rural area and needs something to occupy the down time (weak but it supports all of my other theories). 2. He's from Texas and it would seem that the area giving us the most members is Texas. Probably because he spreads the news via word of mouth. Spenac-I said I'd be watching you. I'm on to you bro.

Hmmm...guilty of having some knowledge are we Richard B.???

Food for thought: http://www.ncbi.nlm.nih.gov/pubmed/9200808...Pubmed_RVDocSum http://www.ncbi.nlm.nih.gov/pubmed/9360565...ogdbfrom=pubmed http://www.ncbi.nlm.nih.gov/pubmed/1532245...ogdbfrom=pubmed

Too late.

Shane, I realize you've taken some criticism for the treatment but it would be helpful if you came back and explained what was going on. It might help us better understand why things went the way they did.

To the OP, since you are the one that is responsible, you are the one in charge. As others have said, be gracious and accept the assistance but tell them what to do. I'm sure you already know this, but besides not being able to confirm their title you also can't confirm their blood alcohol level. There is no need to be rude (I'm not saying you were). Just be courteous and if their help is not needed just say, "Thanks for the offer but we're good." Ruff, both of those stories suck. Good for you for sticking up for yourself and not letting inept providers get away with it. Those FFs obviously missed the class on sizing up a scene. Are you changing the stories though? Is it any cooincidence that you, "roll up" on these things? I'm betting you are a whacker with a scanner in your car and run to them when you hear them dispatched.