ERDoc

Sounds to me like someone should have gone to jail.

LOL, touche!

Interesting idea, but I was thinking of something more epic.

I'm working on picking a theme song for when I bring the results (think a MLB pitcher coming out to the mound). I'll have it play over the hospital intercom when I enter the trauma bay. I'm going to have maintenance install a fan so that it blows my hair back when I walk in, too.

Shhh, don't tell my PAs that

PAs are just like any other provider. There are some awesome ones that I work with that I don't need to worry about and then there are some that make me pull my hair out and I never want to work with again.

You won't find any female bias from us here. The females we have here have already beat it out of us and put us in our place.

Pizza for the ER staff is usually mandatory (provided you get real pizza and not that thick cake-like crap). You may also want to update your profile, it says male.

This is no offense to you but you might have trouble finding a department that will allow a 15y/o female to ride with an all male crew. I was a member of a pretty progressive VAC and the youngest you could be to ride on calls was 16. In the event that you do get to do this, stay out of the way and look interested. Ask questions when it is appropriate but don't do it in a manner that makes it sound like you are second guessing the crew. Any good crew will ask about your level of knowledge. If they do, be honest and humble, "I only have first aid and CPR."

You just can't beat the smell of diesel exhaust in a garage in the middle of winter. Oh it takes me back every time I get a whiff of diesel.

What Ruff said as well as stress from the accident, head injury, brain tumor to name a few others.

They may be singing Kumbaya but they are still blaming the other guy.

It didn't appear that she was given any extra meds.

It's okay Mobey, you can admit that we do things bigger and better.

She's on a propofol drip with normal coags. As chbare said, this lady is on positive pressure ventilation so a tension pneumo is almost a guarantee. This lady requires a chest tube. A pigtail would be acceptable if your facility had them. So, the ICU accepts the pt and off she goes. As others have said, the moral of the story is to be gentle with the narcan, especially in people on chronic narcs. It may be funny to slam them just before they get to the ER to watch them puke all over the staff (I'm not saying that is what happened in this case) but you can also cause some real problems. There is no guarantee that this case would have turned out differently but something as simple as pushing a huge dose of narcan caused this poor woman to require intubation, a central line and a chest tube as well as a hugely expensive visit to the ICU billed to the generous taxpayers of the state.

So you Canadians use the NEXUS rules, developed in the US and not the Canadian C-Spine Rules, interesting. As for the urine, it sounds like chyluria but good luck finding much about it.

Not sure about the lawyers but the medical director happens to be a close friend of the treating physician so it has been passed along. Ruff, what is different with this pt than the ones that you have see "watch and wait"?

Labs are fine. Sats are now in the mid to upper 90s. No pneumothorax was seen on a poor chest xray prior to central line. The ptx is a small ptx in the right upper lung area.

The subclavian vein sits in close proximity to the lung (as well as a few other things). Sometimes an iatrogenic pneumothorax can be produced. Since you are working with Murphy today, you get the CT which shows no pneumonia or PE but does show a small pneumothorax. Does this pt need a needle decompression? Why or why not? Does she need a chest tube? Why or why not?

Did it look like actual white milk?

Sorry, I'm being vague. I know it is not EMS level stuff but what do you think is one of the most common adverse events with the insertion of a subclavian line? Let's let the people without hospital experience take a stab at it first. Hint, think of the anatomy.

Aw, come on now. You can't dump your responsibility on another provider. IO isn't an option since you cannot give contrast, nor can you through a foot or IJ. You drop in subclavian line that works well. What do you need to do next?

She is full code. Based on her lethargy and inability to remove the mask, she is not a BiPAP candidate. Her status is decreasing so the decision was made to intubate her. She is easily tubed with a 7.5 with no complications. The nurses are getting concerned because you have asked for a propofol drip and their IV seems to have infiltrated. They've had the best of the best of the best try for access and it has been unsuccessful. She was recently hospitalized so the admitting service will not take her without a CT angio thorax. What is your next step?

I'm curious if there is any country/locality that allows the EMS crew to say, "You don't have an emergency, you need to find a way to the hospital." And then provides true protection for them.

I'm not saying this is my case. I am just relaying the facts that I know. The medic skipped out when she heard the doc complaining about the pt being in withdrawal. He never got a chance to talk to her. A blood gas was drawn and her pCO2 was 79. I forgot to mention that she was just discharged from the hospital for pneumonia and resp failure secondary to COPD. She was not intubated on that last admission and her pCO2 is normally around 50. Stimulating her does not improve her status.