ERDoc

Oh wait, it gets better. So, you attempt to control one of the worst cases of withdrawal you have ever seen with multiple small doses of morphine and ativan. You run a fine balance. Nurses are having difficulty getting peripheral access and you have a 22 in the left AC that is sketchy. The pt begins to tire and drop her sats. What do you do now for access and airway control?

So, the pt is given 2mg IV narcan and almost immediately wakes up but is agitated, combative, diaphoretic, pupils are dilated. HR 140s, BP 178/105. She is brought to the ER with lights and sirens, hands and feet in restraints. You are now the physician in the ER. What do you do?

Would anyone hit this woman with 2mg IV narcan?

This is not one of those scenarios with a hidden twist. I just want to know what you would do. You are called to the local nursing home for a pt that is unresponsive. Upon your arrival the nurse tells you that half an hour ago the pt was fine. She was given her normal dose of methadone for her chronic pain. 30 minutes later they find her unresponsive with snoring respirations. On your exam she has b/l constricted pupils, stable airway but sats in the mid 80s, RR 8. You have IV access, blood sugar is 123. She is not responsive but withdraws when you poke her with the IV and do the finger stick. You decide this is due to the effect of narcotics (which it is). What is your next step?

I think it is a good thing for a new person to necrobump. They bring in a new view/perspective. Who knows, maybe it will bring on a new discussion that would not have been had if it weren't for the bump. Maybe the literature has changed since the thread died and new things can be discussed.

Before I moved to Michigan I would have had to ask what snow was, lol. Yeah, wilderness is nice but you can't beat sitting on a beach in the Hamptons, checking out the locals..er..scenery.

Anything north of the Bronx is upstate. I love upstate, it's where my family is from and I spent many vacations up there. And that fish was caught off the shore of Plum Island.

I don't personally subscribe but I might be able to get it for you. Send me the article info.

Good point but for me it wasn't worth it. The only escape routes were to New Jersey. I'd rather die in the flames on the water.

Maybe that came of worse than it was meant to. I have the utmost respect for FFs when it comes to firefighting and rescue ops. When I see flames, I am running OUT of the building. My dig isn't even at the FFs themselves (except for the douchey ones that further the stereotype), it's more at the system that has developed where providing medical care to the sick and injured is see as less valuable than saving their property and belongings.

He's a New Yorker, what's not to like? Unless he's from upstate, then there is lots not to like.

I don't know if I would consider 'Big'uns' as catalogue.

Maybe we shouldn't ruin this young and vulnerable person yet. NEVER speak of EMS with firemonkeys. You will get blank stares and the occasional, yeah we did that but just so we could get promoted to firefighter.

I could never afford one of those. Remember, I was on Long Island so I had to be prepared for bad water scenes. I had the naval pack which, instead of a harrier, had a destroyer and for quick escapes, a cruiser.

Ruff is right. You best bet is to ask someone local to you. EMS is a very fragmented field with different requirements for different areas. We have representatives from many countries, each with its own way of doing things. It's always nice to have a new, interested person post here, so since you put the effort into coming here and asking, I will answer your questions based on my experiences. 1. When I was in college, I wanted to be a doctor and I majored in Biochemistry. 2. To be an EMT where I was one (New York State in the early 1990s) all you needed to do to become an EMT was have a pulse (breathing was optional) and pay for the class. The class was a 100 hour course with 10 hours of ER observation time. 3. No previous experiences were essential. It would be helpful to have a basic understanding of anatomy prior to class. 4. I didn't prepare myself. A friend convinced me to join to local volunteer EMS squad. 5. There is no such thing as a typical week. It all depends on where you are. When I was a volley, we had pagers so we could respond when there was a call. When I worked for a private service, we mostly did renal roundup, hospital discharges/transfers and nursing home transports. You'd sit in the ambulance until you got a call. 6. Staying calm and driving safe. Being able to talk to people is also a little important 7. The toughest problem was management. When you work for a private you are there to make money and if you are not doing that, they are not happy. You also had to get used to not getting off on time. 8. Back then I was a buff, so I got my kicks off trauma and sick people. This is not accurate now. 9. Putting up with the non-medical crap will burn you out. 10. All of your past experiences will make you what you are now. You experiences as a young EMT will provide a learning process that will shape you as an older EMT or medic. 11. Yes, I went to medical school to get away from the badge bunnies. Nothing turns a girl off like student loans. 12. I can't really answer this. 13. For the private I worked for we had a set uniform. It was just like any other job as far as time off. For the volley, you had to wear something that had the VAC's name/logo and had to wear pants and closed footwear. 14. Like I said before, to become an EMT in my situation/location all you had to do was have a pulse and pay the fee. 15. Yes, but I wanted more which is why I went to medical school. 16. Pros-a job you will love to do, satisfying to help people Cons-many people are not thankful for what you do, pay sucks 17. A typical day is spent taking people to the hospital 18. No skills necessary but you should be able to talk to people. 19. None 22. EMTs are a dime a dozen but it is easy to enter the field since turnover is high but there are some more competitive jobs 24. Until we can eliminate alcohol, drugs and stupidity there will always be a job

I needed that laugh for that day. Thanks for the necrobump. I packed a jumpbag when I first became a CFR and then EMT back in 1992. It has all sorts of stuff like trauma dressings, glucose, BP cuffs, hand operated suction, oxygen regulator (no tank though). I even had an MCI kit. Nowadays the most important thing I keep stocked is my cell phone so I can call 911 to get someone that can do something for the pt. I do still have a fully stocked jumpbag although it still contains the same exact equipment I put in it back in 1992. I grabbed one of the 4X4s when one of my kids scraped their knee and after I opened the package, the gauze crumbled in my hand. It might be time to take that bag out of service but then where would I keep my RPG launcher for those scenes that go bad?

A little off topic, but: http://www.snopes.com/business/genius/spacepen.asp And eventually the Russians switched also.

It's just the way you made it sound. Like I said, I wasn't trying to start a fight, just asking a serious question. There are plenty of services out there that would insist you take the broken equipment if it is still "useable".

"OK ma'am. I'm going to need you to do what I do. We are going to slide down the remaining 7 flights on out butts. My partner will be holding you O2 take, IV bag and cardiac monitor." EDIT: From what he describes, it sounds like an acceptable work-around but you know if something happens, even if it has nothing to do with the broken equipment, it will be cited in the lawsuit as the source of the problem. He's in NYC so you know it will be a lawsuit.

My guess would be that they have higher expectations of us in the ER. Personally, I hardly ever call for a helicopter. We are close enough to the big hospital that there is not much difference between ground and air time if there is an ambulance available. The only thing that changes my choice of transportation method is level of care needed by the pt, but our helicopters are staffed with a doc and a nurse.

I couldn't have said it better. I give and she takes.

I'm not trying to put you down but just wanted to ask if the equipment is broken, why are you not putting it out of service?

Well, Capt, technically you did xray right through it. He never said you'd be able to see anything, lol. Just out of personal curiosity, what was his reaction to the xray? I'll admit, I get a sick sense of satisfaction when I can stump or make look foolish one of the device or drug reps. I can't get free stuff from them anymore so I might as well get something out of the interaction, lol. Personally, most of time I just remove the splints so I can see what the injury looks like to decide on needed resources, especially at the rural place where I can't just call the ortho resident.

That is so true, you have no idea. I don't know where some of these people came up with the money for their lights. I have seem some real crazy videos on youtube of light set up in POVs that would make any volley ambulance jealous.

I've been lucky in that the 2 places I've worked have had not for profit HEMS. In NY, the HEMS service was provided by the county police dept and have a paramedic from the academic center to provide care. You can bet your ass that the PD kept the helicopters in perfect shape and were overly cautious about weather conditions. In MI, the HEMS is run by the large hospital system in the area. They are a not for profit organization and safety is of prime importance. Neither one would question the need for a helicopter from the field. They would assume that since the ground people are with the pt, they know what is going on. Calling the helicopter from an outlying hospital here in MI, they do start to question if it necessary.