ERDoc

Most ER docs are not hospital employees. There are some, but there are others who are independent contractors who must incorporate themselves and are considered their own company. There are others who work for a group that staffs one or more ERs who can ultimately become a partner or shareholder in the group and share the profits. Like I said, I am basing my observations on a purely nonscientific method. Most of the docs where I trained (LI, NY) reguardless of their specialty despised conservatives. I thought that was just because I was in NY, but after being in one of the more conservative parts of MI for about a year, most of the docs I run into are more liberal leaning(I haven't had much time to talk to docs from other specialties however). Most of the ER docs that I know who are conservatives are generally older (nearing retirement) and seem to be so out of touch with the patients that their care is questionable.

After reading a few threads recently I was curious to see which way everyone swings (politically speaking). Just from some very nonscientific observations it seems like more people in EMS are conservative while it seems most physicians are liberal. I would think it would be the other way around. Feel free to comment, but don't feel obliagted. Let's try to keep it clean and friendly. I realize I've lit a very short match in a room full of gunpowder, but I believe in you guys.

The only movie of his I have seen was Roger and Me. I thought it was a really good movie, though it has been a few years since I have seen it. I still want to see the others. You better believe I will be seeing this one. I love the commercial where they have Bush saying something about OB/GYNs not being able to practice thier love with their patients. I don't know the full context, but the sound bite sure is funny.

Whit, I'm not sure what you mean by a circumflexion so I cannot comment on that. It is very rare for kids, especially this young, to end up with cervical injuries. Their bones are mostly cartillagenous at this point and can take quite a hit without any problems. Accicents that result in any form of injury are usually fatal. This is true in healthy kids. If a kid has some sort of underlying bone problem (ie osteogenesis imperfecta) then this does not hold true. Obviously I cannot comment on this kid, but I also said extremely rare (not impossible). Using the NEXUS rules, it does not sound like you can clear this kid (language barrier, can a 2 year old really tell you about midline tenderness?). Not sure where this kid falls on the CCS rules as I am not as familiar with them. Also keep in mind that not all cspine fxs are unstable (not that you can tell that in the field). I learned that this past week. We had a 24y/o who was running in some shallow water and though it would be a good idea to dive head first into the water. Imagine his surprise when a bunch of rocks jumped in his way and he hit them with the top of his head. This was at 0230 (yes, alcohol was involved). He came in about 14 hours later because the pain had not gone away. CT scan shows a Jeffersonian fx of C1. The fracture points were both to the posterior arch. Called the ortho guys and they slap Miami J collar on him and send him home. I was alittle upset to say the least. So, I did some reading and any C1 fx that occurs behind the lateral masses is stable. This kid will be in the collar for 3 months, but it beats a halo for 6 months.

Sure about that? Want to hang your hat on that without a physical exam or EKG? I think we need a lot more info. DDx at this time includes COPD, MI, PE, CHF, pneumonia, pericardial effusion/tamponade, dissection just to name a few.

If you are going to put a collar on someone, you should have them on a board. As Dust said, there have been no studies that show a ride in an ambulance on a backboard cause decubs, but there also no studies showing that it doesn't. There is simply a lack of studies. If they get to the ER and are left on the board for some time, then yes they may develop them (this has been documented). That's why the pt should be taken off the board as soon as they get to the ER. As for SCIWORA, they should be boarded and collared. Pts with SCIWORA have a neurologic deficit of some kind so. Based on both c-spine rules, they should be boarded and collared. It doesn't matter if they have midline tenderness or not. This is usually a problem with kids (very rare in adults) and as the name implies there will be no abnormalities seem on radiologic imaging.

There is absolutely no reason not to give pain meds to someone with pancreatitis. You are confusing this with pt with bile duct stones. Morphine has been accused of casuing spasm of the sphincter of Oddi and has been thought to cause problems in common bile duct stones. In the age of ERCP this is really not an issue. You are only doing your pts a disservice if you are not treating their pain. The only true contraindications for morphine are hemodynamic instability and morphine allergy. In someone with ileus you need to be cautious, but you also need to treat the pts pain. Like I said, to withhold pain meds from someone in pain is criminal.

OK, three pages of really sh!tty puns. I think we have truly hit bottom. As I said before, we should put this hole thing to an end.

Check out the scenario on the 9y/o girl that was thrown off of an ATV. I posted the NEXUS criteria and a link to the CCS rules (as well as a study comparing the 2 sets).

Let's look at the NEXUS criteria: No midline cervical tenderness No focal neurologic deficit Normal alertness No intoxication No painful, distracting injury that might make them ignore their neck pain So, from what we were given in the original post, I think we can assume #1-4 are negative. The gray area is the last criterion. Does this girl have a distracting injury? We might need a little more description of the elbow. Was she in a lot of pain? How do you determine what is a distracting injury? I'll let you come up with your own opinions on that. Before I can say board or no board, I would need a little more info about the accident. Also keep in mind that the NEXUS criteria were developed and validated on an adult population, though a few smaller studies seem to confirm the validity of the NEXUS criteria in children. Here is what the original study designers considered a distracting injury: "Any condition that, in the examiner's judgement could be producing enough pain so as to distract the patient from another, particularly cervical, injury. Such injuries may include a long bone fracture, a visceral injury; a significant laceration, degloving injury or crush injury; large burns; or any other injury causing acute functional impairment." According to the CCS rules, this pt should be boarded. It is difficult to post the CCS rules because they are a little complex, so here is a link to a visual guide: http://www.aapsga.org/ajcm/2006/fall/pdf/a...6-article03.pdf According to the first box, this is a significant MOI (a collision involving a motorized recreational vehicle) so this pt should be boarded and get xrayed. This is one of those cases that shows the discrepancy between the 2 rules.

No disrespect meant towards you. I was just making a general statement, not specifically towards you. Sorry about the confusion.

Resp distress has more causes than just the lungs. The heart is also a major cause, so a 12 lead is in order. Obviously you need to use your clinical judgement as with everything else.

You crack me up.

We should put this HOLE thing to an END before it goes too far.

Eric, people don't have a problem for medics who work for the FD per se. The problem is with the people who become medics just to become a FF. These people don't really care about the pt or the job and are only doing it as a stepping stone to ride the big red trucks. Unfortunetly in some areas EMS is controlled by the FD. I say unfortunetly because in many cases EMS is treated as a second rate part of the FD and doesn't get the funding/equipment/staff that it truly needs. The FD should stick with the fire fighting and EMS should be it's own seperate department.

I find it hard to believe that any government building would have very comfortable TP. Maybe this chick was into S&M and wanted something that was rough! :shock:

The best part has to be the first comment by Chief Walker. Even the police chief can't keep a straight face. MARSHALLTOWN, Iowa - Police blame a woman named Butts for stealing toilet paper from a central Iowa courthouse, and while they're chuckling, the theft charge could put her in prison. "She's facing potentially three years of incarceration for three rolls of toilet paper," Chief Lon Walker said, stifling a laugh as he talked to KCCI-TV about Suzanne Marie Butts. "See, I can't say it with a straight face." Workers had noticed the rolls disappearing from the Marshall County Courthouse much faster than usual, Walker said. Butts, 38, was caught last week after an employee saw her taking three rolls of two-ply tissue from a storage closet, Walker said. Butts insisted it was the first time she'd pilfered toilet paper, but she declined to answer further questions on her attorney's advice. The fifth-degree theft charge, a misdemeanor, normally carries a sentence of less than a year in jail. But Butts could face more time if convicted under the state's habitual offender law because she has prior theft convictions. Walker did not know why Butts was at the courthouse, but said that she did not work there.

Birth, the one thing that will happen reguardless of how good or bad your crew is.

Great case. This is a good example where you can see the anatomy on the EKG.

As a newbie, I will not deduct any points (others may not be so kind). When you make a statement like that you need evidence to back up your claim. Sorry to jump on you right from the start. Welcome to the city. Dust, what do you mean Rescue 911 is not a source of information. I thought it was THE source. Shatner is like a god. I even have a shrine to him in my basement. My life feels so empty and meaningless now.

And just to help them up their hits: http://www.mifd.org/ Remember, Chief Carl and his 17 volunteers are ready to help (man, sometimes it is just to easy).

In the system I grew up in, we were vollies and PD would respond to all scenes (no FD thankfully). It was pretty clear in NYS that any suicide or intox was incapable of refusing. If you had a problem, you called medical control and they were to talk to the person as assess if they had the capacity to refuse. If they did not have the capacity, you had to transport. It became a problem at some point because the police would not assist in forcing the pt to go. One too many unlawful imprisonment lawsuits and a memo came out saying that they were not to assist except in the case of a violent pt. So the jolly vollies were left on their own trying to get a pt to go. Kind of ironic. They were the ones least capable of dealing with it and they were the ones that had it dumped on them. Glad I started working the other side of medical control.

I recommend Henry and Stapleton. Sure it's outdated, but the author was a mentor of mine so I am compelled to recommend it.

One of the best episodes is the one where Peter sues his doctor for molesting him after he gave Peter a prostate exam. Peter had the whole town turned against this doctor.