ERDoc

ERDoc for president in 08!!!! I don't even have the tax problems. I will admit that I didn't help any Chernobyl victims (mostly because I was still in elementary school at the time). Though, I did stay at a Holiday Inn Express once.

I hear Chuck Norris wears them too. Rumor has it Bruce Lee was burried in them.

I would love to, but I think I'm a little too young for that yet. At least that's what the voices tell me :wink:

:x DON"T EVER SAY THAT WORD! THE VOICES WILL MAKE ME DO BAD THINGS TO YOU! :x

This whole "by the book thing reminds me of a noob back in my EMS days." She was a fresh EMT (card was still wet) who took the class through the local community college and joined the vollies after the class. She had been riding for about 2 weeks when we get a maternity call. As we jump in the ambulance she starts freaking out saying that we need to get a textbook so that we do it right. It was a good laugh. This was the same girl that when we told her to jump on the bottom rail of the strecher and continue CPR as we wheel the pt into the ER decides to jump all the way up on the strecher, straddle this dead 80 y/o 350lb guy and continue CPR. You should have seen the ER staffs faces. Priceless. Yes Dust, she was hot.

Gotta agree with Rid. This is on a case by case basis. Sdowler, I'm not exactly sure what you are trying to get at.

Touche.

I think it was an exgirlfriend. Sorry Speedy, couldn't resist.

I got to admit, I'm a little surprised you missed that too. -10!

I think something that might help in the ER was if we were given the ability to tell the pt, "I'm sorry, but that is not an emergency. You will have to see your doctor." No hospital is going to allow this because it looks bad. Pt satisfaction before pt care.

I have to agree with you Whit. I have never seen a traumatic arrest survive. My guy on the motorcycle never actually arrested. I think what the studies are showing is that maybe we need to rethink what our definition of "obvious signs incompatable with life," is. Sure decapitation is dead. Decomposition is dead. If you have someone crushed in a car without a pulse and it is going to take 15 minutes to cut the car away, they're dead. I'm curious how many traumatic arrests are actually medical arrests that just get into an accident. Maybe cross clamping someone's aorta in the field will improve outcomes for traumatic arrests? Who are we going to trust to do this? Just a few random thoughts I've had since reading these articles.

If your pt is showing signs of decomposition, I don't think lights and sirens are going to help much. I think you may also have more problems than the femur fx.

I see we are all well educated and well prepared to treat hypoethanolemic pts.

I would have to disagree. Most MDs, at least ER docs and surgeons, recognize the futility of resuscitation in these cases. Residents are not likely to try new procedures without oversite of an attending. They may be gungho in the ER, but put them by theirself and they are not as quick to jump for the scalpel due to their inexperience with the procedures. Whatever they can put off to the ER they probably will. There was an article in Annal of EM in 2006 that showed we may be missing some people who will survive a traumatic arrest. http://www.ncbi.nlm.nih.gov/sites/entrez?D...Pubmed_RVDocSum

Whit, this study or a similar one may change that policy (which is why we do studies). If HEMS with an MD can improve outcome then there may be a change in the way we practice. I took care of a guy in residency who made me reconsider what I felt was a hopeless resuscitation and my feelings on what is considered a bad outcome. I was oncall in the surgical ICU and they helicopter a guy in who was in a high speed motorcycle MVA. He was wearing a helmet. He ended up with an intracranial hemorrhage and a severely elevated ICP. Add to that his flail chest and pneumothorax. He went to the OR prior to sending the evening with me. The neurosurgeon removed a flap of skull, put in a drain and ICP monitor. The guy was on a mannitol drip, intubated and had a chest tube in both sides. The swelling in his brain was so bad that you could see the swelling coming out of the area where the flap had been taken out. His ICP was sky high through the night, to the point where the neurosurgeon stayed in the ICU with me. There was nothing we could do to get his ICP down and the swelling from the flap was getting larger. He went back to the OR and they removed another piece of skull. This one looked the same as the first and didn't help with the ICP. The neurosurgeon talked with the family the next morning and told them that it was pretty much hopeless and they should start making funeral arrangements. He told them that if this guy was to survive he would basically be a vegetable. The following day the next neurosurgeon came on service, who dealt primarily with pediatrics (don't ask how that happened). He told the family that everything was going to be fine :shock: . I left the ICU while he was still there and never heard what happened to him. A few months later I'm back in the ER and I pickup the guys chart. He is here because he had a seizure while in rehab. He survived, though he will never be the same. He will probably never be able to walk again. He can talk, but with great difficulty (think severe stroke victim). He was a police officer and would never be able to work again or ride a motorcycle. I asked him how he was dealing with everything. He said he was so thankful that he survived. He said that it sucked that he would never walk again and had trouble talking, but he was alive and able to see his girlfriend again. They were planning on getting married once he was up to it. He said he never regretted surviving the accident, despite the degree of disability he has. Made me rethink what it meant to have a severe disability.

We are missing a few things from this study. What is their definition of BLS. It looks like they have nurses on the ground, so can they perform IVs? What is their definition of severe disability? Severe may mean something different to me than it means to you. We also need to be careful about the conclusions we draw. Was is the skills provided at the scene? Was it the decreased transport time and quicker time to the OR? Hard to say from this abstract.

Oops. I didn't realize that. Wooks wike I made a big mistake. I hope I haven't broken the waw.

Wook a wittle harder Kyle. It might make you waugh.

There is one downside to a 0 wait time. It means I have to work harder. Damn.

Personal experience?

Things Found Only in America 1. Only in America......can a pizza get to your house faster than an ambulance. 2. Only in America......are there handicap parking places in front of a skating rink. 3. Only in America......do drugstores make the sick walk all the way to the back of the store to get their prescriptions while healthy people can buy cigarettes at the front. 4. Only in America......do people order double cheese burgers, large fries, and a diet Coke. 5. Only in America......do banks leave both doors to the vault open and then chain the pens to the counters. 6. Only in America......do we leave cars worth thousands of dollars in the driveway and put our useless junk in the garage. 7. Only in America......do we use answering machines to screen calls and then have call waiting so we won't miss a call from someone we didn't want to talk to in the first place. 8. Only in America......do we buy hot dogs in packages of ten and buns in packages of eight. 9. Only in America......do we use the word 'politics' to describe the process so well: Poli' in Latin meaning 'many' and 'tics' meaning 'bloodsucking creatures'. 10. Only in America......do they have drive-up ATM machines with Braille lettering. Man I love this country.

Doh! I just got it (I first read it just after you posted it). OK, I'm a little slow on the uptake.

Careful, you are comparing Volts to Joules. They are measures of different things. They are related to resistance in a way that I cannot remember after all of these years.

First off, welcome to EMS and medicine. You will quickly learn that in medicine, very few pts read the textbook. The elderly lady with the RUQ pain, nope it's not her gallbladder, she's having an MI. There is very little in medicine that is black or white. Your protocols are guidelines that have been established (hopefully on the latest available evidence) to direct you on how to treat a pt. Not every pt will fit your protocols. Education is the most important aspect of medicine, but experience is a close second. As you gain experience you will begin to recognize the gray areas and how to deal with them. As a newbie it is best to use what you have learned, but as you gain experience you will see where there are variations.