ERDoc

I didn't think about out international membership when I said that, but I'm sure a simple google search will help for those that are curious enough. Not one of NYC's finer moments.

If so, my appologies. I always have trouble with internet sarcasm.

You are truly not helping any vollies by living up to the sterotype that it is the posts that support the vollies that have the worst English.

Again, it's hard to explain the colostomy without penetration. I'd be reaching, but maybe some sort of ischemic event from the renal failure?

D50 for a sugar of 560 is not going to do much, though it won't do any harm in his case. Diabetic coma and insulin shock are more laymans terms and don't really tell you what is going on. This kid is in DKA (new onset apparently). I would argue that at the scene you still cannot r/o trauma so you need to treat as such with aggressive airway management.

The spanking may have lead to rhabdomyolysis which might have necessitated the dialysis. Difficult to explain the colostomy unless there was a little Justin Volpe action involved.

If this guy is still seizing he needs hypertonic saline administered until the seizure stops. This guy is extremely sick and needs airway management and treatment right away. We can figure out the cause of the SIADH later, but it would be a good time to review the causes.

Just wait, I'm sure Dust will have something good to say about this. To the OP, seriously, spend less time volunteering and more time in a classroom. English classes would be a great start.

Perforation???? So, we have an unresponsive 26y/o with a few interesting interesting findings. I agree with aggressive airway management. I would get a finger stick and if he's not hypoglycemic (which we have established at this point) tube him right away. This guy may have suffered some unknown trauma, so let's not give him a chance to do something bad.

;)/

OK Anthony, justify a CT AND MRI. Your department head wants to know what you expect to gain by ordering both? What part of the body do you want image? Why are you getting lung biopsies? Which part of the lung are you getting a biopsy from? It's a pretty invasive procedure and shouldn't be taken lightly. PS-I'm not trying to bust your chops. I think it's great that you went out on a limb and gave your answer. Just trying to induce some more thought. Keep up the good work.

Yup, in jail for being illegally awesome.

Good points. Midclavicular line on the correct side. Make sure you are going to the top of the 3rd rib. If you get too close to the bottom of the 2nd you can hit the neurovascular bundle that resides there (A&P at its best).

What is the issue with the pool? As far as other ideas, depending on what his temp actually was, I'd go for double b/l chest tubes, NG lavage, peritoneal lavage, bladder irrigation among other things.

So? What's the problem with that? PS-Love the hat.

Oh man, this topic brings back some memories. I will admit it, I was a buff (whacker for those of you not from NY). I would go out with a couple of friends in one of our personal vehicles with a scanner. We'd hang out but when something "good," came across we'd head off and try to beat the FD/VAC to the scene. Yeah, looking back on it now it was a really stupid thing to do, but it sure was fun. Oh, to be 17 or 18 again.

Although I will leave the final sat to Asys, it sound to me like he was fine until the episode happened. If you are receiving pay for doing work then you are paid, albeit your pay sucked. If they were reimbursing you for the supplies you had to purchase, that is a different story. When I was a volunteer we did not receive any money. We were given our uniforms but had to return them when we left the company. We had to pay for our training but would get reimbursed if we passed and stayed with the company for a year. If you failed or if you left prior to being there a year you paid for the course. If you are being paid to do work, you are not a volunteer. So, if you weren't volunteering for the money (is that even possible), did you return the $5 per call that you got? If not, why not?

First, Asys said in his post that he took the rest of the day off. Second, if you are receiving a stipend then you are not doing it for "no pay" and are not volunteering (use whatever word you want but you are getting paid). Why can't someone get a paycheck for doing something be dedicated and have passion for the job? It seems to me that certain people are equating a paycheck with a lack of dedication or passion. In the end, does it matter who has more? Isn't the important thing who can provide better care (which we'll leave to the thousands of other threads that have been started)? I'd rather have a doctor with the personality of a loaf of bread but who is competent and up on his literature than a really friendly doctor who doesn't know what he is doing. The same goes for my choice of prehospital provider. Being friendly matters when you're playing gold (which I don't do by the way) not when you are making decisions that will affect people's lives and futures.

This was an arterial clot, so you do not need to worry about a PE or stroke. You need to worry about distal occlusion if a piece breaks off. Heparin is to prevent the clot from getting worse. The vascular surgeon can administer intraarterial tPA at a much lower dose than it were just administered through an IV. It is safer for the pt this way as they are at much less risk for bleeding. Also, depending on where the clot is they can pull part of the clot out (oversimplifcation here). In someone who is going to be undergoing a surgical procedure, the last thing you want to do is take away their ability to clot.

I think we can all see what this question was set up to do. I think both can be equally passionate. I started out as your typical volley buff, yeah, I placed a few orders with Galls, I'll admit it. However passion doesn't equal properly caring for people. I don't care how passionte you are for your job, if you don't have the education and knoledge you need to do it properly you are a risk to your patients. I also have issues with the person who said that volleys do it out of the goodness of their heart. I know plenty that do it for an ego boost. They wear their volley squad jackets 24/7 and expect to get special treatment because they are a volley. They pull their cars up and park in the fire zone and think it is ok because they have a sign on their front window that says they are a volley. These volleys also complain that they aren't getting a big enough LOSAP payment and their firehouses/ambulance HQs aren't big enough and don't have the 555 inch hi-def plasma TV that the next company has. How is expecting special treatment because you are a volunteer, doing it out of the goodness of your heart? I also have an issue with the statement that just because you get a paycheck, you don't have any passion for the job. I make a pretty good paycheck and I have passion for my job. I enjoy going to work everyday. I can't imagine myself doing anything else. If you are going to tell me that just because I make money doing what I enjoy that I do not have any passion, you need to come back to reality. Why else do we go into our chosen fields? We do it because it is something we love.

Nope. You are confusion morbidity and mortality. Mortality is death. Morbidity is basically injury.

I feel for ya dude. I had 1 that was 2mm and it sucked. Let's not even start talking about PCP for stones. I have enough trouble kicking the people out who are looking for their dilaudid fix.

I think those 200 hours might be better spent on a composition course. Do you want the ability to push meds with the education or are you against the meds altogether?

Just to keep things current, all of the terms being thrown around here are obsolete. The new term, recognized by international consenus, is drowning and then has modifiers such as death, with morbidity or without morbidity. Here is a link to the paper from the international body.

Not all kidney stones have blood either. Colic is the actual pain which is usually caused by a stone (though not always).