ERDoc

WTF? With central lines, cutdowns have become a thing of the past. I remember learning them in the first month of residency but that was the last time.

That situation is not funny, but when you read it and picture a Monty Python-esque scene, it makes you chuckle.

I don't know where it came from but when I did the IFT thing in NY, we were told by a bunch of nurses at the sending hospitals (and it was from multiple hospitals) that we were not allowed to open/look at the transfer papers. I tried arguing it at first but it just led to a useless battle with the sending nurse. I learned to just smile politely and then open the chart in the ambulance.

Some crazy stories here. There is a reason the paralytics come with a red top. NEVER give someone on chronic opiates 2mg of IV narcan, NEVER. Never give narcan to someone who is walking around your scene, following commands but a little confused.

LOL.

So you've heard about my marriage, minus the breakup.

Does it count if you can lick the elbow of the person sitting next to you?

Ugly, I realize that you don't write your protocols and have to follow what you are told but your protocols suck. We don't need to go down the whole free radical pathway again as we have discussed it ad nauseum. No worries about the delay, we all have real lives so I totally understand. Again, it sounds like these are all problems with providers and not the equipment. Your equipment is only as good as the operator. There is only so much you can tell based on your (not specifically you Ugly, but a general, all-of-us type of 'you'). That is why we develop technologies and machines. They help us narrow down our diagnosis so we are not doing unnecessary harm by making the wrong diagnosis. Not all pts read the textbooks and common presentations are not always that common.

I want to nominate this for the TMI post of the year for 2013.

I once had a patient who was convinced that I was Jesus Christ. It's pretty funny since I look nothing like the modern day pictures of him and of all people in Christian, conservative, West Michigan, she picks the atheist in the group, lol.

You are completely missing the point. We are not talking about taking the easy way out of things. The examples you give are examples of piss poor providers and educators, not problems with the technology. You also missed my point about assessment. As for the AED not changing your treatment, yes it does. It defibrillates your pt when they need it. I highly doubt you can do that with your hands. Any provider who is using an AED should know why you do/do not shock. Again, you are arguing against the providers and not the technology. AEDs have become standard of care. I ask again, how do you assess if someone is getting enough oxygen? How do you decide when to give a chest pain or resp pt oxygen and how much? As for your story of the nurse in the hospital, I call total BS. Every nurse is taught and repeatedly made to take manual BPs. Hell, we are even made to do them in medical school.

You can't use the argument of the CO poisoning against the use of the technology, it is an argument against the abilities of the provider. Any provider who has access to a pulse ox should know that you can get falsely high readings. Without a pulse ox, how do you titrate your oxygen to your chest pain or stroke pts? A good exam can only tell you so much. How do you determine if the pt is not getting enough oxygen? EDIT: Saying an AED "has it's place" sounds a bit naive to me. An AED may not change the fact that you are going to be doing CPR but it will change the fact that you can convert your pt to a living, perfusing rhythm. Your CPR is at best 33% effective. You are correct, it may not be appropriate in every case of CPR, but without one you will not know if it is appropriate or not. How are you going to assess and treat the pt appropriately without a machine?

AEDs should be standard equipment on all ambulances that carry patients. Their benefits have been proven over and over. They may not be used often but they are one of the few things that actually will make a difference. As for the "treat the patient, not the machine," mantra, that is just used by people who don't understand how to use the machine properly. If the machine didn't serve a purpose, it wouldn't be created.

Overall, I don't think I would be worried about the gunman hiding. It seems like in all of the cases we hear about, the gunman is ready to die and will just keep shooting until that time comes. I see your point in a building like a school or large office building. Then I think about the situation in Aurora where it was a small building and a large area that is difficult to clear.

I realize that EMS is not going into a hot zone, but with so many of these situations, the zone is moving. There is a difference between the first responding officers going in immediately in vests and with weapons and EMS going in wearing their white button down shirts and khakis.. Unless EMS is given gear and a weapon, I think you are just creating more potential victims. Part of it comes back to the fractured nature of EMS in the US. Some form of tactical training is needed and I just don't see that being possible with so many volleys. Yes, there are many that would do it (I would have given my left lung to do it back in the day) but then there are those that shouldn't be in a scene like that. I guess if you are being called into an area that has been kind of cleared it wouldn't be so bad. I guess the only way to know is to do it and see what happens.

I can't see anything.

Please tell me this did not actually happen. I've thought about doing it many times but that is a whole other thread.

Not doing something different with each attempt at ETT placement. Doing the same thing over and over will give you the same results over and over.

Thank everyone. It has been really hard on my wife and every day it is a different emotion. In the end she will be fine (she's a tough cookie) but it's going to be a rocky road until then.

Pudding maybe, but definitely not applesauce.

Absolutely, and I'm sorry if I gave the impression otherwise. It is a matter of asking the right people at the right time.

Because they have to accomodate the lowest common denominator.

I agree with the above. No one is telling you to go outside of your protocols. In fact, we are telling you the exact opposite. You have to work inside your protocols. But understand the limits/errors with those protocols. Always question them but not in front of your pts. If you want to become a better provider, become friends with pubmed. EDIT: Also understand that a large proportion of EMS providers do not understand how research works and changes things, this is especially true in the volley systems.

You will learn that there are very few people who actually NEED all of the things you describe in your scenario. The whole idea of rapid extrication/KEDs/longboards is being questioned and most studies are showing more harm than good. As a college student, I assume you appreciate the idea of staying current with the literature. The problem is, in most EMS in the US, the instructors have no idea what the literature says and as a result the students learn even less. Do you mind if I ask what state you are in and are you a volley? As for the golden hour, here is a brief synopsis that you can provide for your instructors: http://www.jwatch.org/em201003120000003/2010/03/12/golden-hour-myth-or-reality I was in, shall we a say, a unique area when I did EMS. My instructors were more concerned with teaching us cool sayings like, "hot lights, cold steel" and sharing war stories than they were about teaching us that air goes in and out, blood goes round. There are exceptions, which is how most of us were able to pass.

I've seen it plenty of times. It happens in the hospital too. I've seen people out in the snow in their hospital gowns, IV pole in hand who were smoking.