ERDoc

Here's emedicine, but I'll paraphrase (cut and paste the important parts) in case you can't open it over there: http://emedicine.medscape.com/article/1911303-overview Deep venous thrombosis (DVT) is a manifestation of venous thromboembolism (VTE). Although most DVT is occult and resolves spontaneously without complication, death from DVT-associated massive pulmonary embolism (PE) causes as many as 300,000 deaths annually in the United States. physical findings in DVT may include the following: Calf pain on dorsiflexion of the foot (Homans sign) A palpable, indurated, cordlike, tender subcutaneous venous segment Variable discoloration of the lower extremity Blanched appearance of the leg because of edema (relatively rare) Potential complications of DVT include the following: As many as 40% of patients have silent PE when symptomatic DVT is diagnosed[5] Paradoxic emboli (rare) Recurrent DVT Postthrombotic syndrome (PTS) Lower-extremity DVT is the most common venous thrombosis, with a prevalence of 1 case per 1000 population. In addition, it is the underlying source of 90% of acute PEs, which cause 25,000 deaths per year in the United States. Other than the immediate threat of PE, the risk of long-term major disability from postthrombotic syndrome is high. Over time, thrombus organization begins with the infiltration of inflammatory cells into the clot. This results in a fibroelastic intimal thickening at the site of thrombus attachment in most patients and a fibrous synechiae in up to 11%.[25] In many patients, this interaction between vessel wall and thrombus leads to valvular dysfunction and overall vein wall fibrosis. Histological examination of vein wall remodeling after venous thrombosis has demonstrated an imbalance in connective tissue matrix regulation and a loss of regulatory venous contractility that contributes to the development of chronic venous insufficiency.[26, 27] Some form of chronic venous insufficiency develops in 29-79% of patients with an acute DVT, while ulceration is noted in 4-6%.[28, 29] The risk has been reported to be 6 times greater in those patients with recurrent thrombosis.[30] Over a few months, most acute DVTs evolve to complete or partial recanalization, and collaterals develop (see the images below).[31, 32, 33, 34, 35, 36] Although blood flow may be restored, residual evidence of thrombus or stenosis is observed in half the patients after 1 year. Furthermore, the damage to the underlying valves and those compromised by peripheral dilation and insufficiency usually persists and may progress. Venous stasis, venous reflux, and chronic edema are common in patients who have had a large DVT.

I have to agree with the above Dwayne. Check out the thread by medicgirl. EDIT: Nevermind, you've already checked it out and commented on it.

<Bro Hug> Me too, man, me too.

WHAT????

I can't speak for the public health side but in the med school, you were a commissioned officer (O-1) with full pay and benefits, with certain expectations beyond med school.

The closest I ever came with NJROTC in high school and I was offered a commission with the US Navy when I was accepted to USUHS (military medical school in Bethesda, MD) but declined after reading the fine print. Both of my grandfathers served. One was in the US Army Air Corps but could never get overseas because of his asthma. The other faked his birth certificate to enter the Army at 17y/o and became a Ranger. He was at Pearl Harbor on Dec 7th and later ended up a Japanese POW. He never spoke of his service and refused to ever eat rice. My father-in-law was a Navy Corpsman (HM2) during Vietnam who was stationed with the USMC 1/13 and received 2 bronze stars and 2 purple hearts before being honorably discharged for combat wounds.

Hey, I'm a doctor. I have women throwing themselves at me. And then my alarm goes off and I wake up in the real world.

I joke, lol.

Once you are married there is very little body substance swapping, so it is a pretty effective form of BSI.

It looks like our friend didn't like the answers he got here or on that other EMS page (which were pretty much the same), so he took it to SDN.

And right here is an issue. GCS<8 was only meant to apply to head trauma. It was never meant to be used on medical pts. Unfortunately in all of medicine, especially in EMS, it has been used much wider and in circumstances where it wasn't meant to be used.

There is much more complexity to reading an EEG and EM docs are not trained in it. The only time we even look at an EEG is in medical school during our neuro rotation. I can get most information I need by examining the pt.

Crap, Mike beat me to the steroid psychosis. How about temporal lobe seizures.

He's obviously trolling, especially when you read his comment about cheating. The best thing to do at this point is to not respond to the stupidity and hopefully it will go away.

Yes, he did. Just a quick thought. Isn't BSI also called marriage?

Eh, I wouldn't put too much on the words of someone who has been in the field for less than a year and is an EMT in an ALS system, where the sick people are cared for by the ALS crews thankfully. Danny, you seem to be mixing things up. A good provider is one who can put their feelings aside during the call and does what they need to do. I will agree, someone who can't control themselves at the scene should probably consider a career change. Those who can put their feelings aside and deal with them after the call, in whatever way they need to are called human, those that have no feelings have no right to be in this field. When you grow up and the ink on your card is dry hopefully you will come to respect your pts and the position they are in. You may not think you need to have empathy and compassion in emergency medicine but the opposite is true. You are seeing people and their families at possibly the worst time of their lives or the end of their life. It is the time they need it the most and with your attitude you do nothing but take away what they need, you fail to treat your pt and their family properly. Don't want to believe me, the listen to a few stories from the people we are supposed to be caring for. I will get you started, though with your hero complex I suspect it is falling on deaf ears. http://www.goerie.com/article/20120504/LIFESTYLES07/305049943/Emergency-room-compassion-and-dignity

You've gotten answers from several people. I'm not sure what else you are looking for. The only prudent advice we can give you at this point is to contact your infection control officer, the CDC or OSHA.

You are looking for an answer to a theoretic question on a microscopic scale. We can sit here and argue both sides but there is no true good answer. The BEST answer is yes, you had blood on you that got near open wounds so, personally, until proven otherwise I would err on the side of caution and call it a possible exposure. You also have gotten the tone you have gotten because you asked the same thing on another website which many members are also members of. Did you think you were going to get a different answer?

Let the pissing match begin. It's funny how you conveniently missed the part about HepB and only commented on HepC. "Although percutaneous injuries are among the most efficient modes of HBV transmission, these exposures probably account for only a minority of HBV infections among HCP. In several investigations of nosocomial hepatitis B outbreaks, most infected HCP could not recall an overt percutaneous injury (27,28), although in some studies, up to one third of infected HCP recalled caring for a patient who was HBsAg-positive (29,30). In addition, HBV has been demonstrated to survive in dried blood at room temperature on environmental surfaces for at least 1 week (31). Thus, HBV infections that occur in HCP with no history of nonoccupational exposure or occupational percutaneous injury might have resulted from direct or indirect blood or body fluid exposures that inoculated HBV into cutaneous scratches, abrasions, burns, other lesions, or on mucosal surfaces (32--34). The potential for HBV transmission through contact with environmental surfaces has been demonstrated in investigations of HBV outbreaks among patients and staff of hemodialysis units (35--37)."

Wow. At my community shop, I cannot get an EEG. Sometimes I can beg for an emergent MRI between 10am and 3pm. Same for VQ scans, but not on Sat and Sun. I guess each hospital has it's niche. As you know from dealing with the system I am in, anything out of the ordinary gets shipped to the big house.

I think there is a difference between taking PPE seriously and making a blanket policy of using it on all pts. PPE should always be taken seriously, but it doesn't mean it needs to be used on all pts, it just needs to be used properly. I can't argue the logic of wearing it into a pt's house when you first arrive. We don't wear them on every pt in the hospital and no, there no magical disinfecting that occurs when an ambulance comes through the door. We practice appropriate infection control procedures, which means wash in, wash out. Several people on here have brought up MRSA. You all realize that we all have MRSA living on and in us since we are in the medical field as do our families, right? We all have our anecdotes that change the way we doing things, such as Ruff. I wouldn't blame someone who has had his experience from using gloves on all calls.

This pt is being transferred from an ER at a community hospital. There is no way in hell you are going to get an EEG. You'd be lucky if they could consult a neurologist in the next week.

EMS4LIFE, here is some guidelines from the CDC website. Read the section under "Definition of Health-Care Provider and Exposure", specifically read the second paragraph of that section. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm

I would definitely want to disinfect after a visit to that place.

Is it bad that I read that as, "I will disinfect my penis"?