ERDoc

Here we can recieve 12 leads (from those that carry them) and rhythm strips. They can send them by cell phone modulator or over an 800mHz radio.

Thu Jun 8, 6:45 PM ET ST. PETERS, Mo. - A woman angry that her new puppy had died pushed her way into a dog breeder's home and repeatedly hit her on the head with the dead Chihuahua, authorities said. The 33-year-old woman told police she had taken the puppy to a veterinarian, who said it was only 4 weeks old and needed to be returned to its mother. But before she could return the puppy, it died. Early Wednesday, the woman went to the breeder's home, pushed her way inside and began fighting with the breeder as she tried to make her way to the basement to get another puppy, police said. The breeder wrestled the woman out of her house to the front porch, where the woman then hit the breeder over the head numerous times with the dead puppy, the St. Louis Post-Dispatch reported, citing police. As the woman drove away, she waved the dead puppy out of the car's sunroof and yelled threats at the breeder, police said. She later called the breeder and threatened her and her family, according to court records. Police said they are considering felony burglary charges and misdemeanor assault charges. WTF :shock: :shock: :shock: :?: :?: :?:

So, trying to keep the original purpose of posting this thread, I added a little poll. Please take a moment to vote. Remember, the doctor is always right. 8)

Ace, I love the bunny.

There are a few in the past 4-5 years, but I can't think of them off of the top of my head. Anesthesia is always trying to prove that airway management is not something ER docs should be doing, so they love to try to prove it (and usually fail). 8)

Check out pubmed and do a search, there is a wealth of info. There was also another thread here somewhere that I gave links to several studies.

Must also have a huge distal AVM to cross back into the venous system. :wink:

I humbly apologise.

What's the anatomy that made this possible?

This would be true if it weren't for the fact that there are A LOT MORE than one paper. We recently had a journal club where we discussed this topic and there were three papers that showed prehospital intubation decreased survival in head trauma pts (and those are just the three that we reviewed). Take a look through pubmed, there are a lot more than one. Saying that this is a knee jerk reaction is a little off the mark.

Wait, it gets better. On their post-call the CC states, "Yeah it was a waste of time, he didn't make it." So, the medic working the console takes the times the meds were given. The pt got 2 rounds of epi and atropine. Then there is a 20 minute gap until arrival at the hospital. The excuse it that the CC was working on getting a line (and failed). :shock: :shock: :shock:

These were NOT paramedics, it was an EMT-CC. In NYS there is a big difference.

It was *******HIPPA******** Fire Department. 8)

Yes, this was an actual call that I took a little while ago. I posted it more to vent than for a real learning experience. This is an ALS crew (EMT-CC for you New Yorkers). CPR was started by the NH staff when they witnessed him collapse, 15 minutes prior to EMS contacting medical control. EMS: Oh, so I got asystole on the monitor. Should we stop CPR now?? Doc: No, let's avoid a wrongful death lawsuit and work this one to the ER.

EMS: The pt has been down about 15 minutes total now. They said they started CPR as soon as he went out. Yeah, he has lividity, his entire face was blue when we got here and now his hands are starting to turn blue. The only thing done is CPR. Can we terminate? Oh, you want to know what rhythm he's in? Hold on I have to put the monitor on him.

You are the doc at medical control when you receive a call for a field pronouncement. Your coversaton goes like this: EMS: We have a 77y/o male witnessed cardiac arrest. On my arrival the pt had lividity to his face. They were doing CPR and bagging the pt. His abd is distended. He has signs of not being viable. I want to stop CPR. Doc: So, the arrest was witnessed and CPR was started right away? EMS: Yup. The nurse said his face turned blue as soon as he went down. He now has lividity in both hands. Can I stop? So, what do you do?

Rid, what would you think of putting EMS under the oversight of ABEM (American Board of Emergency Medicine)? These are the people that set the standards for us to be board certified in EM.

Unless there is a reason not to, I always put at least a 7.5 in women and an 8.0 in men. Imagine trying to breath through a straw for a few days and you can appreciate what these pts feel. Also, in critical cases you want to be able to get as much oxygen as you can and blow off as much CO2 as you can. For peds I generally use the (16+age)/4.

The system here on Long Island is pretty bad too, though we do have ALS, but for the most part it is weekend warrior ALS. Pretty sad considering we are one of the largest volley systems in the country (both FD and EMS). Here is a link to a recent expose on the Fire and EMS service from one of the local papers. Be sure the check out the Taj Mahals that are being built to house the equipment. http://www.newsday.com/news/specials/nyf-i...0,3691882.story

Why is it that the less productive member of society you are, the more likely you are to survive a GSW/MVA/fall or other trauma? Why is it that the pts that come in c/o pelvic pain/abnl vag bleed are the ones that never take a shower (did you seriously not think you were going to need a pelvic exam)? Why do people call EMS/come to the ER if they don't want to do anything you tell them to get better? How can Some Dude and This Guy be such good masters-of-disguise? They are single handedly responsible for millions of violent assaults and have yet to be caught. Why is it that people have no clue that there is no cure for the common cold? Why is it that people feel the word 'Emergency' in EMS and ER is optional? Just a few points to ponder.

I think a lot of folks out there don't realize that Combitubes and LMAs are buck devices that are used until a definitive airway can be established. A definitive airway is a properly placed and secured ETT or a true surgical airway (Trach or cric, NOT a needle cric). It is only appropriate that if a basic has put a combitube in that the medic should attempt to get a definitive airway established. That EMT partner that was offended by it needs to realize that it is about proper pt care and not his precious little ego. I'm not sure about the role of LMAs in the prehospital setting, they seem to unstable to me. Like others have said, master proper BLS skills and there would not be a need for adjuncts, thus decreasing the risk to the pt (isn't this what it's all about?).

Don't feel bad, it happens inside the hospital also. A pt will c/o toe pain when the med student goes in, then abd pain when the resident goes in and finally chest pain when the attending goes in. When the admitting resident comes to see the pt, the pt will wonder why he is being admitted for toe pain.

Mictruition syncope can last quite a while from what one of our cardiolosists have said, but I didn't realize that it had been 5 hours so you are right not likely. Do not rule out sepsis in this case. Elderly people are not up on the latest textbooks, so they don't know how to present with typical symptoms. Though I think it is low on the ddx (especially with those BPs in the legs), don't take it off just yet. Let's get cultures. I think we need to continue trying to get IV access, when you get to the ER we'll drop a central line in.

Let's face it, the ddx on this case is huge, and we need to do a little workup, especially before we run to the OR. The first things we need to do as soon as the pt comes through the doors is a bedside US to look for free fluid in the abd and to look for an aneurysm and we need an EKG (she wouldn't be the first to present with atypical MI symptoms, it's pretty common in the elderly). Other things we would need to worry about (most of which people have already mentioned) are divertics, possibly with perforation (will need an upright chest xray), UTI (let's get a UA), appy or dissection (will need a CT), micturition syncope, as well as other less threatening things.

I don't know about the big city part or the "thousands of times," but I think what you are describing would do fine with Lido. I must admit that I have never used Amio outside of a cardiac arrest. For situations like the one you presented I would always use Lido (can't say I have any evidence for it, just the way I learned).