ERDoc

:shock: :shock: :shock: Duck and cover newbie. You are right on one point, they are not trained to think on their feet, they are educated on how to do so. Browse through the forums and you will find what this means.

Meclizine first, then valium and benadryl if needed.

1. It's ERdoc. 2. NYS law says that anyone can walk up to a person and say, "Yup, he's dead." A physician or PA has to sign the death certificate. Your protocols are a different story. It basically depends on how much your medical director trusts your ability to do a proper assessment.

Wow, Mateo, thanks for bringing this one up. I guess I left you guys hanging, sorry about that. So, this patient has hyperkalemia from taking less lasix but still taking the same dose of KDur. She has EKG changes consistent with hyperkalemia so she needs to be treated as quickly as possible. Treatment would include albuterol, IV insulin, IV D50 and kayexalate. Normally you would also give calcium to stabilize the cardiac membrane, but this pt has an confounding issue. She is on Dig which increases intracellular calcium levels. Giving additional calcium will cause a stone heart leading to death. As someone said previously this is based on some older literature. Some small animal studies in more recent literature says it may be safe to give calcium, but who wants to end up as a case report. Although it is not available in the field, you can give digibind and hope for the best in cases of extremis.

The literature shows you are doing your pt a disservice. Toradol and a narcotic have been shown to provide better pain relief.

Since when did morphine cause diuresis?? If anything it has just the opposite affect and causes increased ADH production.

This has been discussed pretty extensively in the literature (I'll leave the literature search up to you). NEVER withold pain medications even in abd pain pts. Giving narcotics DOES NOT make your physical exam (or the physician's) less accurate. If fact, it has been shown to make it more accurate (again, I'll leave it to you to do the literature search). Toradol and morphine work pretty well together along with your antiemetic de jour. The way I approach kidney stones is to scan all first time stones with CT, UA and depending on how long the pain has been going on for I'll check a chemistry. In those with a history of stones that they have been able to pass on their own I'll skip the testing and treat the pain. Flomax has been shown to help move the stones along so they'll get a few days of it (though some recent studies are questioning this). Someone brought up migraines so let's talk about them a little. Narcotics are towards the bottom of the list. They are notorious for causing rebound migraines. Unfortunetly in my area anyone that mentions the word pain gets 2mg Dilaudid and 25mg of Phenergan. This is probably why we have so many seekers here (but that is for a whole other thread). For people with true migraines toradol, benadryl, compazine/phenergan +/- solumedrol usually does the trick. If they need more I will give an additional dose of benadryl, compazine and a small dose of morphine (about 2mg). I will also give large fluid boluses. There has been some promise in intranasal lidocaine or bupivicaine but more needs to be done.

The pilot was our most experienced pilot (Vietnam Vet). As of 5pm the ER was reopened. Elective surgeries tomorrow are cancelled but it is otherwise business as usual (except for getting transfers by helicopter).

This is one of the hospitals that I work at. The helicopter had a pilot and FAA offical on board and were practicing approaches. Both were able to get out before the fire started. The ER (the largest in most of Michigan and the only Level 1 in Western MI) was closed and several floors were evacuated. Most things have returned to normal now.

http://www.ncbi.nlm.nih.gov/pubmed/1505075...ogdbfrom=pubmed http://www.ncbi.nlm.nih.gov/pubmed/1698831...ogdbfrom=pubmed That last one is not limited ti trauma pts so it does not exactly answer the question being asked.

It is unprofessional attitudes/actions like this that keep EMS from being seen as part of the medical profession. Keep up the good work. Way to leave your partner hanging in the gallows. If being called a name hurts your feeling/ego then you have found the wrong career. As one of the veteran medics on here once said (though I don't remember who it was to give them proper credit), "Pull up your panties or turn in your card." Way to earn your respect and better your field. Firedoc, no we don't take Jerk 101. That would be the undergraduate class. We take Jerk 501. Seriously though, most doctors are not jerks. We are type A people and because of that we despise stupidity and incompetence, especially when it comes to the health and wellbeing of our patients. Unfortunetly, the US EMS system, as it is currently set up, breeds stupidity and incompetence. There are some great medics our there that deserve credit, but there are a lot more who shoot for the minimum and don't better themselves.

That must have been hilarious (unless you happen to be one of the nurses).

First of all, the nastiness started with the OP and the subsequent post berating and putting down the PA. Describing someone as a royal bimbo on her throne is not exactly positive is it? If you were here long enough you would know that I do not get involved in most of the little nit picking that goes on. I try to avoid those threads except when facts/knowledge need to be added (which is part of the reason I have not posted in a long time). If you wanted to avoid making this thread your personal bitch session you could have left out the part about the PA and still gotten your point across. It would probably go a little like this: I got called to a NH and went to check on a guy in cardiac arrest. The staff told me that he was blind, but in a blonde moment I checked the pupils. Silly me. See, positive and gets the point across while leaving out the negative, irrelevant parts and berating of another healthcare professional. I will agree with you on one point. The PA should have identified who she was. It does not matter if she was having a bad night, she should have identified herself. Saying something as simple as, "Hey guys. Thanks for coming so quick. I'm Mary the PA here tonight. I just pronounced Mr. Jones. Sorry to bother you." Once she has said that there is no reason for you to need any more info or for you to go to the bedside. Ambulances are not for corpses.

I would say the MagLite. It has many uses. You can use it to protect yourself from dogs or violent pts. You can use it to help you find that last drunk guy at the MVA that was thrown into the woods. You can use it to make sure you are not stepping in anything unpleasant when you are in the house/apartment that has no electricity at 3 am. Also makes a great learning tool for teaching FNGs how to play dodgeball (If you can dodge my MagLite, you can dodge a ball).

Something about this post just rubs me the wrong way. You sound like you have something personal (not professional) against this PA. Your description alone lacks in professionalism. She told you that she pronounced the pt and called you off. So she was being unprofessional? I just don't see it. As Richard B. said, check with your local jurisdiction as to who can pronounce. In NYS anyone can pronounce someone, but only a licensed physician can sign the death certificate (yes, there is a difference). It is not uncommon for a PA, or a nurse for that matter to pronounce someone. You do not need an EKG to declare death. Good clinical skills will suffice. Working in a healthcare facility (be it a hospital or NH), the rules are much different than they are in the field. There are probably plenty of good reasons that this guy was pronounced, you just may not have been aware of them. If you use lividity or rigor mortise as your criteria to pronounce, you will be working many useless codes in your career (but I have to give the benefit of the doubt, this may be what your protocols say). What is the big deal if he died in front of the nursing station? How many times have you walked into a NH to find several residents sleeping in front of the nursing station? Should they be checking pulses on everyone that sleeps? Seems a little overboard and rediculous. I have seen many NH disasters, but I don't see anything wrong with the case that you bring up (though you have more of the facts than I do). You sound like you have something personal against this particular PA or were offended by the fact that you were asked not to do anything after someone with higher authority pronounced the pt.

That's not going to happen until Suozzi or Levy lose a loved one who had to wait for the volleys to show up.

I will start by saying that I have not read through all of this discussion so if I am being redundant just tell me to shut up and read the thread. That being said, academia is no place for weapons. School shootings are not the plague the media is sensationalizing them to be. They make the news because they are so extreme and infrequent. If they were as commonplace as some talking heads are making them out to be we would not see them on the news everytime they happened. Just from unscientific observations (mad by myself) it seems like the countries that have to most gun control have the least amount of problems and those that don't have gun control have the most problems. Maybe this should tell us something.

I don't think the articles are conflicting. The sensationalized titles conflict, but if you pull apart the articles, they say the same thing. AEDs can work, but good CPR and EMS activation is just as good and costs less.

As a side note, the caduseus is a representation of Dracunculus medinensis or the Guinea worm. They are the longest nematodes and live under the skin in infected people. The way they were removed back in the day was to twist them around a stick and slowly turn the stick until the entire worm was out. The twisting of the worms on the stick is thought to be represented by the caduseus. Here is a picture.

Dude, you've got some cajones to come on to a site and, with only 7 posts, begin insulting veteran members and veteran providers. As I said in my previous post, search this site and you will find that this hass been discussed ad nauseum. As others have said, it is your unwillingness to see the flaws in the system that is holding back EMS. You can hardly call someone who has 110 hours of training, which required nothing more than a pulse to start, a professional. Having been an EMT for 10 years I can tell you that you don't know what you don't know. Let those that has the insight and vision make the changes to make this into a profession. True education comes from academia. It teaches you to think and not to follow a protocol designed for the weakest provider. Only when it takes a college education to become a provider will EMS even begin to be thought of as a profession. To think otherwise is ignorance and you are doing your pts a disservice. BV, I think we'd all like to know you credentials. It has been recurring theme here that those that think the way you do are the ones with the least credentials and experience.

I don't think I will ever be able to eat peeps again. Thanks JP.

OK, how do you resist with an opening like that? EDIT: OK, that was hot.

You absolutely can bag a conscious pts. However, there is no magic number. As long as they can adequately oxygenate and ventilate they will probably be fine on NRB (for now). It's a judgement call. If they are working to breathe and are cyanotic, it would probably be a good time to help them. I try to tell them when I am going to do a breath so that they can try to breathe in at the same time.

Use the search funtion, my friend. You will find out why you are about to get the responses that are coming next. I can sum it up for you in 3 words, education, education, education.

Where did he go to the bathroom?