ERDoc

I think Dust pretty much sumed it up. If someone gives you the BS about needing experience before becoming a medic, ask them why doctors aren't PAs first.

Aye. But this is a specific condition. What does this unfortunate gentleman have?

Any saddle parasthesia? Incontinence? Reflexes?

What does the abd exam show?

I won't answer any of these things, I'll leave that to the field providers. If I were to get a call to RMA, I would speak with the pt and discuss my concerns (including diagnosis, but again, I'll leave that up to more debate) and tell him that if he doesn't come in there is a good chance he will die.

I think a better way for the OP to get the information he seeks would be to ask questions on the board. He will get a great deal of discussion with many opinions. A few things might come out that would not come up in a 1-on-1 conversation. Though, given his lack of response maybe NBC was trying to get a bite.

Any recent trauma (ie MVAs)? Any numbness or tingling?

Yes, it is possible for most doctors to make mistakes (ER docs do not make mistakes). Without a little more info it is hard to say. Did you have a glucose tolerance test? How far along are you?

EMT-CC is for critical care. It is the level between EMT and EMT-P in NYS.

I think I'll let this speak for itself. And this too.

Use the search function and you will find that this has been discussed ad nauseum.

Yeah it is. I've personally never seen that much pus.

OK, I admit it. I clicked. How can you not? It's like leaving a bank vault open with no cameras and no one else in the bank and saying, guard the money. Not that I would ever encourage stealing.

Nope. Joints don't hold that much stuff. The way they are milking it, the pus is coming from the thigh.

I don't have much experience with them, but I would expect to see much more tissue breakdown. This looks like a deep space infection without much tissue breakdown.

Stop thinking so concretely and focusing on the specific numbers. The more you do something the better you are at it. So a volley company is doing 5-6 calls per day. Are every one of those volley squad members on each call so that they can keep up their skills? Would you want to trust your life to a doctor that has only seen 3-4 patients per month for the last year and has not kept up on the journals? Here is one from a huge volley system. It shows that reguardless of certification level, they are poor at determining cardiac rhythms. I will admit that a problem with this study is that it does not compare the volleys vs paid. http://www.ncbi.nlm.nih.gov/sites/entrez?D...Pubmed_RVDocSum

So, what was the BP? Were there any other symptoms?

NREMT et al. I don't think people have a problem with the level of care provided by people who work in EMS and do the volley thing on the side. One of the biggest concerns is with the people who only volunteer. How do you become and stay a competent provider when yuo run 2 or 3 calls a month? How do you stay abreast of the latest research on ALS topics if you only run 1 ALS call per month. Yes, anyone can run through their protocals, but I think the point that people are trying to make by making a big push for education is that we can get rid of protocals if we have educated, experienced providers; providers that are able to think on their own and not depend on protocals to tell them what to do. We can all say we have seen bad things done by such and such provider of every level. Keep in mind that in some ERs you still have non-EM trained docs (IM, Fam Med, Surg). These are people who do not have the education and experience that should be required to work in an ER. I find it hard to believe an EM trained doc would wait 35 minutes before getting out the scalpel (though if this happened in an academic center I can see it happening as each person thinks they can do it beter than the person before).

My guess would be a diabetic, possibly with some neuropathy or a real high pain tolerance. Though, it could be someone with severe dementia.

OK, given those 2 scenarios given by stcommodore: Case 1: Theoretically should be fully immobilized. They have an AMS which makes you unable to assess for neuro deficits. Though, nothing will probably save this guy, the discussion is purely academic. However, scene is unsafe. As far as I am concerned scoop and run. Sorry dude, my life over yours (at least if you have any left). Case 2: Does not need a cervical collar. He is neurologically intact. No one is making jusdgements about a long board to keep the rest of the spine secure. There seems to be some confusion about what immobilization means. The c-collar only immobilizes the cervical spine. If you have a localized injury to the thoracic cord, a c-collar will do nothing to protect it. Reread what the PHTLS book says: In general, if a patient did not sustain definite neurologic injury at the moment that the trauma occurred, there is little concern for a spinal injury. This is because of the mechanism of injury and the kinematics associated with the force involved. Penetrating objects generally do not produce unstable spinal fractures as does blunt force injury because penetrating trauma produces little risk of unstable ligamentous or bony injury. Penetrating injuries do not cause unstable spinal fractures. Therefore there is no potential for cord damage following the injury due to the patient moving. Any cord damage is going to happen at the time of the injury and will manifest immediately. Interested in a little EBM, here is an article to review: http://www.ncbi.nlm.nih.gov/sites/entrez?D...Pubmed_RVDocSum There were 57,532 patients that were evaluated at the two trauma centers. Of those, 42.3% (24,336) were following blunt or penetrating assault. All of the penetrating injury patients with a cspine fracture or cervial spinal cord injury had some form of neurologic deficit on presentation. There was one blunt assault patient who presented without neuro deficit, but he had neck pain at the time of presentation. All patients with cervical spinal cord injury had a neuro deficit on presentation. Here is one more for you: http://www.ncbi.nlm.nih.gov/sites/entrez?D..._RVAbstractPlus Here is one that discusses putting the pt on a board: http://www.ncbi.nlm.nih.gov/sites/entrez?D..._RVAbstractPlus Here is one that I found interesting, though I'm not too sure how I feel about it yet: http://www.ncbi.nlm.nih.gov/sites/entrez?D..._RVAbstractPlus

I'm going to go clean my eyes with rubbing alcohol now. Note: do not try this at home

Yeah, those ER docs are nothing but a bunch of wanna be surgeons with ADD. Whiney bastards. Spenac, no bashing here. I've got mad respect of Timmy and mean absolutely no harm by it. I would be the first one to request that it be locked if it started to turn into something even remotely related to bashing.

Touche!

Says the 18y/o go go dancer.

That's just so wrong.