ERDoc

I wonder if this is his car.

WTF??? How do you go from a nose bleed to an abdominal aneurysm? (Asks the guy that coded and pronounced a nose bleed once)

Yeah, he got us. It's amazing how he turned a conversation about a D tank into one about marriage infidelity. I can't wait to see where the AED one goes, lol.

I'm not sure why. They work for me. Try them without the > http://www.emhealth.org/index.php/services/medical-services/emergency-care http://www.wkyt.com/news/headlines/Patients-Rights--224342991.html http://roguemedic.com/2013/09/two-children-abducted-by-ems-helicopter-for-one-laceration/ EDIT:I reposted them without the >, but it ended up there anyways. http://www.emhealth.org/index.php/services/medical-services/emergency-care http://www.wkyt.com/news/headlines/Patients-Rights--224342991.html http://roguemedic.com/2013/09/two-children-abducted-by-ems-helicopter-for-one-laceration/ Tried to post them using the link button. If that doesn't work then I have no idea.

There's a difference between cheating on your wife and trying something a little different with her consent. If you can't see that difference then it is a good thing you aren't married yet.

I don't think a kidnapping charge would ever hold up in court. A jury would just say he was doing what he thought was in the best interest of the kids (although, never underestimate a jury of US citizens). I agree Ruff, mom should not pay the bills. The only part that doesn't make sense to me is that the flight crew called for a second helicopter. I'm just baffled by the story from beginning to end. If the medic wasn't comfortable handling the pts (which is why I personally feel helicopters are called out so much) then he should have scooped and ran to the local facility. EDIT: Looking at the local facility's website, I would say they would have been more than prepared to handle these kids. http://www.emhealth.org/index.php/services/medical-services/emergency-care I think it is even more telling that the doctor at the peds facility who treated them even questioned why they were flown (according to the mother). And a follow up article: http://www.wkyt.com/news/headlines/Patients-Rights--224342991.html And an opinion piece by Rogue Medic: http://roguemedic.com/2013/09/two-children-abducted-by-ems-helicopter-for-one-laceration/

Any ER with a board certified doc would have been able to handle these kids. I obviously don't know the situation at the local hospital. Anyone that has been doing this for any amount of time knows when kids look sick and when they look well. There is nothing in this that says these kids looked sick. It sounds more to me like the medic on the scene freaked when he saw a bleeding scalp wound and panicked. HEMS is abused and we all know it and I think this was a perfect example.

You will probably need a physician's prescription/order, but I'm sure if you google oxygen therapy you can find some places. Whose license will you operating under when you use it?

"So grandma, what's going on today?"

Let's play Devil's Advocate for a second. Even if skull is visible, does that require a helicopter? Has this guy never seen a scalp lac? I must be a bad parent because I don't call 911 every time my kids get a bump to the head.

http://www.wkyt.com/home/headlines/Lincoln-Co-girls-put-on-AirEvac-flight-for-minor-injuries-despite-parents-wishes-224175611.html

There is one classic article that should be required reading for anyone looking to start using evidence based medicine: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/

Stop thinking logically Ruff, we're talking about management here.

That sucks for your friend. At least he saw the light and left. Those non-safety needles should not be allowed to be used anymore. I'm surprised OSHA or JHACO (not that they have say over EMS) haven't jumped on this yet.

If there is one thing medicine has taught me, killing people is hard. I had a woman once who got ROSC in the field after 30 minutes with an unknown downtime (don't ask). Ended up on an epi drip which we maxed out. Could only get her VS to 80/30 HR38. Talked with the family and decided to stop the epi. Two hours after stopping the epi, her vitals were still the same. This woman didn't seem to understand that she was dead. Finally she was asystolic after about 2.5 hours but her BP cuff went off and we got a pressure of 30/12. OK, turn the damn monitor off.

I don't know, I would question HONK. Usually with HONK, your glucose is much higher, think 600 (33.3) and up. There are also ketones in the urine so it's hard to say he's not ketotic. Usually with a chem profile you get a bicarb which would help differentiate this. The things that go against DKA are the age, this guy probably has type 2 DM, which is more likely to result in HONK. DKA is more likely in type 1. This guy may just be septic which can result in hyper or hypoglycemia.

Yes that counts. Why the hell is a nursing home sending a gout flare to the ER? There is nothing we can do that they can't do.

Gah! I can't stand hearing stories of douchy doctors. I would never fault someone for getting a sugar from a reliable method. What difference is 5% going to make? Is a sugar of 190 vs 200 going to change treatment, or a sugar of 50 vs 48? No. If I had to guess, this guy was probably IM trained. If you ever want to experience something that will make you want to pull every toenail off and pour alcohol over the wounds, round with the IM team once at your local academic center. They mentally masturbate for an hour over a potassium of 3.3 when normal is 3.5. How about we just give the 40 of KDur and move on to the next 30 pts we have to discuss for hours each!! Sorry about the sidetrack. Your response next time should be, "You are more than welcome to but good luck since it is in my protocols. Or you could check it your damn self." Then again, if you have to deal with Dr. Douche on a regular basis it may be better just to smile and wave and move on to something important.

I'm not trying to insult you in any way, Medicgirl, but when I hear someone say that something should be publishable I think double blinded, placebo controlled trials but I'm sure that is not what you professor actually wants. That is such a nebulous term that it almost means nothing without clarification (again, not aimed at you). Does he/she want something that could be published as an instructional/educational article in JEMS? As Ruff said, try doing it on something that is current. Right now the Washington Navy Yard is pretty current (still going on as I type). How about doing something on scene safety or responding to an MCI, including a static scene (aircraft accident that remains in 1 location) versus a dynamic scene (a shooting with the shooter still on the loose). Going a little further on that topic, the psychological effects such an incident has on first responders and victims and if you want to make it controversial, talk about CISD.

I think there are several parts to the OP's question that need to be answered/addressed separately. As for what you should do in regards to your future field, none of us can answer that but YOU need to figure out what it is you want to do. DO NOT try to go to RN and PA school. You are wasting one. If you want to be an RN, be an RN. If you want to be a PA, be a PA. Getting your EMT/Medic in addition to RN or EMT is a fine idea but will not get you much more in your current location. SBU staffs the SCPD helicopter and all of them are medics, no nurses. Your chances of getting on the helicopter depends on who you know and I can almost guarantee you will not get on it will DWI convictions. You will more than likely not be able to get a job with FDNY or any of the NYC hospital services. Some of the privates on the island might hire you with your convictions but since on LI EMTs are a penny a dozen, your chances are very slim. You also asked if you will be able to get your EMT cert. The answer is, most likely. Here is a link to the NYS EMS policy on certification for people with felony convictions. http://www.health.ny.gov/professionals/ems/policy/09-05.htm It says to refer to Part 800 which lists the specific felonies which are disqualifying, and surprisingly, DWI is not on there. You do need to let your instructor know that you have a felony conviction and then things will be assessed from there. Here is the Part 800 (search for the word 'conviction' on the page to get to the relevant part). http://www.health.ny.gov/professionals/ems/part800.htm Your best bet is to contact the state and find out what there process is. You should also talk to others at the 2 vollies you are with. There are probably a few that work for the privates and can tell you what their experience is. As others have said, it sounds like you need to get some help with your drinking problem. Do it as soon as possible.

It may not tell you everything shebtook but it will be a good start. Most overdoses now days are pretty much conservstive management, support airway and vitals until the drugs wear off. Obvious exceptions would be things like tylenol and aspirin, which we can get levels for. We are also narrowing our differential on this woman. Are we sure that this is an ingestion?

Even in the hospital, I'd support the airway and let the drugs work their way out of her system, while identifying the pills with micromedex and then changing treatment as needed. Obviously we would get a head CT, cxr, labs etc which may change things.

You're welcome. This is the way science works. This study may not change much but it raises some more questions that may lead to additional research that changes everything.

1 in 4 COPDers who are admitted MAY have a PE. I'm not overly impressed yet. Of the 1 in 4 that may have a PE, how many are clinically significant? I know the study doesn't address this but I don't think I would change practice yet. Maybe future studies based on this one would persuade me. I would guess that most of your COPDers are going to have positive d-dimers due to the infection/inflammation related to their disease. Personally, I think the PERC rules are useless and don't use them anymore (yeah, my n=1 may not mean much but to think I could have missed a healthy, productive 24 y/o with multiple PEs with infarcts makes me question the PERC criteria). I would almost argue that you can't use a d-dimer in COPDers either since their pretest probability is moderate to high and d-dimers are only useful in low pretest probability pts. I think it all comes down to clinical gestalt.

Any DVT is dangerous, it's just a matter of when. There is no way to predict when you will throw off a embolus and end up with a PE or, if you have a PFO (which most people are unaware they have) you can end up with a stroke. DVTs are not something to mess around with.