ERDoc

Should we ban our alleged friend, Timmy, for saying the following: "Chuck Norris is gay." Before anyone get to upset, this is just a good natured joke to break up the monotony that exists in some of the more serious threads.

That sentence doesn't even make sense?? Chuck Norris and gay should never be found in the same sentence. It is one of the rules of English. It comes right after i before e, except after c.

:wink:

Anything he wants, including "negotiating" with guys named Craig who question his authority. PS- Chuck Norris eats one of these everyday for breakfast.

In theory they are volunteers. Most of their members are paid as cleaning staff or some other such title. They still collect tax money as a volunteer organization.

Nothing but the best for the volley departments on Long Island. You should see some of their firehouses.

At least you have a good reason. You could always become a member here. Check out those flack jackets and quads. Volley whackers if I ever saw one.

Bear with me Anthony as I try to answer your many (yet very good) questions. We immobilize in the kind of injuries you are talking about because they have the potential to injury the bony spine. Think a fracture of C1. While there is no neuro deficit now, if the pt is allowed to move that unstable fx the right way they can end up cutting the cord. So there may not be a neuro deficit, but that is because there is no injury to the cord yet. Think of the bony spine as a steel cylinder around the cord. A blunt injury will be able to easily disrupt the integrity of a large portion of that steel cycliner, thus making it unstable. As Dust said, there are very few reasons to immobilize the cspine in strictly blunt thoracic trauma (think a baseball bat to the back). It is all about how the forces are spread. In an injury from a fall or MVA you have these huge forces spread over a large portion of the spine. In a localized blunt trauma (baseball bat) or penetrating injury the forces can be severe, but they will be local. Thus, even if there is disruption of that steel cycliner in the thoracic region, the likelyhood of there being an issue in the cervical portion would be nil. U hope this is making sense. As for why we ask about pain, we have several clinical rules that we use to clear the cspine without radiologic evaluation. They are the NEXUS criteria and the Canadian Cspine Rules (they have been discussed here many times and can easily be Googled). They each have different, yet similar, criteria. One of which is that they cannot be influence by drugs or alcohol. That is why drunks take longer. One of the criteria that requires imaging is midline cervical tenderness. You can have neck pain and not get xrays as long as you meet the criteria. You are right that one of the other criteria is that they have no distracting injuries. Again, if you have a penetrating injury, if it has done enough damage to disrupt the integrity of the steel cylinder it will also damage the cord and you will have neuro deficits. Again, a penetrating injury is a local injury and will not affect the rest of the spine. I guess you could have the mysterious bullet that enters the spinal canal in the thoracic area and then take a northward turn and end up in the cervical canal. Something like that will do so much damage that you will have a neuro deficit. I hope I have been able to make this as clear as mud for you.

Debbie Gibson :downtown:

If you think about it, it makes sense. Why do we immobolize in blunt trauma? One reason is for neuro deficit which is a sign of cord injury. Another reason, in the absence of neuro deficit is for a potential unstable injury to the vertebral column that, if allowed to move would result in injury to the cord. In a penetrating injury why are we going to immobilize? If we have neuro deficit, that again is a sure sign of a cord injury. This can be caused by a knife or bullet which violates the vertebral column and directly injures the cord. A penetrating injury is not going to disrupt the vertebral column without causing damage to the cord inside, so if you have no neuro deficit there is no injury to the cord. EVERY penetrating injury that I have seen that has disrupted the spinal column has affected the cord and produced a neuro deficit. Also, if it is a thoracic injury, how is it going to affect the cervical cord? If you are not at risk for a cervical cord injury, why would you need to immobilize?

Where to start? A good number of RN and RT programs are bachelor degree programs. There are plenty of paramedic programs that do not require any college credits and even fewer that are bachelor degree programs. The ones where I came from required only a GED. In your scenario, leaving out the paramedic, there would be no question of who is in charge. The answer is no one and everyone. RNs and RTs are used to working in a setting where teamwork is valued and the team works together. There would be no pissing matches over who is higher and who has a bigger penis. They would focus on what needs to be done for the pt and not whose ego needs the biggest stroking. :roll: Honestly, without an ambulance or equipment all are pretty useless on a scene so does it really matter? Hell, even I'm pretty useless on a scene without the proper equipment. That being said, I guess I would rather have a paramedic on the scene because they are the most likely to have their trunk filled with buff gear. Thoracotomy tray please!!!

Part of the problem is there have been no good studies. It is hard to get IRB approval or volunteers for studies that start, "You will be bitten by a very large, deadly snake and we will try different things to see if you will live or die (we made no promises)." So much of what we do is based on anecdotal evidence and case studies. That being said, it seems like the best treatment in the field is to get the pt to the hospital as quick as you can and provide supportive treatment. That being said, here are a few articles from emedicine with references. My favorite part is in the coral snake envenomations under prehospital care. "If possible, take a digital photo of the snake from a safe distance." Hold on while I get my cell phone out to snap a picture of an already pissed off snake who is probably looking for someone else to take it out on. If you are lucky you will have Dr. Norris in your 5 spot. http://www.emedicine.com/emerg/index.shtml Scan down to the environmental section.

Amputation is for wusses. Dr. Chuck Norris would do it Mobey's way with no PPE or anesthesia.

To which the flight crew should respond, "You called us to turn over pt care to someone of equal or higher training. We are assuming care for this pt. It is our responsibility to do our own assessment to properly care for the pt and fix the things that you missed. Thanks for thinking you are able to tell us how to do our job."

Yeah, those 2 are pretty scary, but can you beat this?

I think this pimp has the ultimate control on scene, but I gotta say, Dogma was an awesome movie.

I would start by finding someone who knows the area well and then try to find a helicopter with FLIR. Otherwise, put the ME on standby because cliff+drunk friend=bad outcome.

The main flight service where I am at uses an MD/RN crew.

I don't see a spot for 2 radios and 3 pagers.

I agree with Timmy, teamwork is a wonderful thing. In the end it should be the RN calling the shots since he/she is the one that is going to be doing the transporting.

That's not so easy to do when you are the medical director for about 2000 EMTs and 750 paramedics.

If your goal is to become a doctor, skip all of the other stuff. Focus on your academics and getting involved with research. They are what will get you in. Don't worry about how much patient care experience you have, it will not matter. Working 80-100 hour weeks for 5+ years will provide you with plenty of experience. That's why it is called school. If you want to know what it entails to get there, see the other thread. Yeah, and what 'Zilla said.

Look at it from a medical director's point of view. You are relying on a large number of people (most of whom you have never met) that are working under your medical license to be able to judge what is and is not an emergency. With the system the way it is now, you will not see that happen very soon. Think of some of the people you work with and decide if you would trust them with your license. I think a more likely approach is to allow the crews to call medical control and get permission to refuse transport.

'Zilla brings up a few good points (as usual). Most premeds who are EMTs are EMTs to get into medical school. My experience was a little different. It was my EMT experience that made me decide to go to medical school. I think that set me apart from some of the others. Admission committees know who are EMTs just to put it on their application. In a large portion of my interviews I was asked a lot of questions about my EMS experience and the interviewers seemed generally interested. Maybe it was a way for them to pick my brain apart and see how real my EMS experience was, but who knows. I also used my EMT to make some money to support my family during undergrad.

If the embolism occurs superior to the visible portion of the jugular, then it is not a PE. Most PEs are small and occur in the periphery of the lung. You can get a massive saddle embolus (embolism that blocks where the pulmonary artery branches into the left and right arteries) that will cause significant hemodynamic compromise. Most smaller PEs will only cause right heart strain and not full failure, so you would not expect to see JVD.