ERDoc

Several people have said that palpating the abd can cause a problem. Can anyone cite any legitimate literature that confirms this?

Oops, I didn't mean to reference him. Sorry about bringing back those memories.

Whenever we have a welcome thread I always want to see someone be like that old crotchity guy that you see in the movies that just grunts unapprovingly when the new guy is introduced to the group. Then someone chimes in and says to ignore him, he's just old and crazy. And then he goes on a tangent about how in his day things were different and that, "these youngins today would never has survived out on the box like we did. Grrr."

You damn Canukistanians have to make everything so simple. You need to have a complex legal system that even experts in the field don't understand like your big brothers to the south have developed. It makes legal/ethical debates a lot more enjoyable.

Not to get too far off topic but sometimes you have to wonder if both parts of the country would be better off if the south had won the war. So to the OP questions, here are some additional resources: http://www.health.ny.gov/professionals/ems/policy/99-09.htm http://hvrs.comcastbiz.net/emtclass/EMTClassPDF/MedicalLegalEthicalissues.pdf Here is an interesting one that would have been a good one to find when we were talking about the guy who cut his leg off (Dwyane's thread I beleive): http://www.law.uh.edu/healthlaw/perspectives/HealthPolicy/990331Emergency.html

LOL. There are a few states where it is not statutory rape if you have intercourse with someone under 12, as long as they are your spouse.

Island, have you only worked in the northeast? Check out the statutory rape laws in some of the southern states. Scary shit. Check out the wording for Mississippi. http://aspe.hhs.gov/hsp/08/sr/statelaws/statelaws.shtml

In most, if not all, states a pregnant teenager is considered her own medical decision maker. Her engagement is irrelevant to anyone but the caterer. Exact laws vary from state to state but overall, you do not need parental consent to treat a pregnant minor. The legal definition of statutory rape also varies from state to state, so be careful there Island. You also bring up life threatening issues. The pregnant minor can refuse based on the same reasoning, however a nonpregnant minor CANNOT refuse treatment so you do not need to contact anyone for life threatening issues, it is called implied consent.

Don't say that too loud. Big brother is watching. Nevermind, we've said too much, go to ground. I'll bring the tinfoil hats to the prearranged meeting location.

I heard it happened in the cafeteria. Maybe she knew something that Monsanto didn't want going public.

Just to get the conspiracy theorists riled up, what does everyone think of the cause of death? I assume (a lot of that going on lately) that there was no autopsy so we will never really know. If the cause of death was listed as a heart attack, think of the up roar. "Defibrillators can save everyone!!!! She should have been saved!!!!! They killed her!!!!" Now, with a stroke it changes everything, "She was going to be a paraplegic anyway so maybe it is better this way. Next sensation story please!!!"

Agreed Mike, and the nurse is being left to hang by the corporation. This should be a lesson for EMS. Always cover YOUR ass and screw the company. They will not cover yours when the shit hits the fan.

Ruff, I think you are right on. This nurse is going to be the sacrificial lamb for the prolong-life-for-2-days-at-all-costs cause.

So now I just read the following from the daughter: "I never said I was fine with that," daughter Pamela Bayless told CNN Monday before hanging up the phone. "That was completely taken out of context, and I have no further comment." (http://www.cnn.com/2013/03/04/health/california-cpr-death/index.html?hpt=hp_t2) Sounds like the lawyers started talking $$$ with the family.

It's a little late in coming but I just wanted to post this. Joseph Iannuzzi Jr, lost his battle with cancer on Jan 17, 2013. He was a 30 year member of Shirley Community Ambulance, an ex-chief, an EMT with NYC EMS and eventually a NYS paramedic. He worked the console at Suffolk County, NY medical control at Stony Brook University for a number of years. He was a mentor when I was a volley CFR/EMT and later a good friend that helped me waste time when I was a resident and should have been seeing more patients in the department. RIP Joe. 1962-2013

I'm going to step on a soap box for a minute here. Dealing with these sort of situations is where EMS (and medicine honestly) falls short. We are not taught how to deescalate at situation unless you seek out such a course (although I think they are becoming more popular). I can't tell you how many times I have seen crews bring in agitated/drunk/high/violent pts and they just continue to poke the bear. They feel they have to be superior and one up the pt. This does nothing to help the situation and most time makes it worse (I am guilty of it too). I had an eye opening experince once that totally changed my methods. PD brings in a combative guy who is just a general asshole which isn't help by the alcohol in his system. He's kicking, screaming and spitting. EMS is yelling at him, the nurses are doing the same and I start to also. PD makes there way into the room and we step out. The officer looks at the guy and says to him, "Hey, these people are here to help. They don't want to hurt you and don't want to get hurt. Your problem isn't with them so cut them some slack and cooperate. OK?" The pt stops yelling and fighting and says, "OK." We all go back in the room with some apprehension but the pt is as calm and cooperative as could be and there is no more trouble. He even says sorry and thanks on the way out. Ever since that day I have tried the same type of approach and 9 times out of 10 it helps. Poking the bear and fighting with the pt over who has the bigger figurative penis will only get people hurt. I think this needs to be taught more.

Ruff, I see where you are coming from. I hadn't had a chance to actually listen to the call (only read transcripts). She does sound detached but maybe she is just one of those people with a flat affect or an IQ south of 70. It also sounded like she was trying to keep quiet, like she didn't want others to overhear the conversation. Someone mentioned that we shouldn't crucify the nurse or anyone else in this case without all info and I agree but sometimes it is a good mental exercise to go through even without all of the facts. It gets us thinking and may help out one day if we find ourselves in a similar situation. I think sysmet brings up a good point also (as usual). We have this Rescue 911-we-can-save-everyone mentality in the US. How would this go if it happened in Europe or one of the Asian cultures where death is respected and at times almost revered? I think it would have gone a lot differently.

Way to go Ruff! East coast in the house!!

The hospital is likely contacting whoever they have on the admitting papers. Next time she is admitted, make sure they have you as the contact person and encourage your sister to inform them of your status the next time they call her.

My mother worked at a nursing home and it was required that if you wanted to be a resident there you had to have a DNR. There were plenty of other facilities so it wasn't like they were being kept out of some place.

This isn't s healthcare facility, it's assisted living. They make it easier for elderly to live so that they can maintain their independence. Who said it was the family's decision? I would assume that this reasonable fit person made their own decision to enter the facility. If I'm 87 and I drop for whatever reason and one of you respond, promise me you will not do anything. If I am 87, I've lived a good life and would rather not have you beating on my frail, old fat ass. All I hope for is that my last though was of which nurse's ass I pinched last.

This could be a good topic, but is there any way to do it without continuing the free advertising?

Congrats grasshopper. Stick around this site and you will learn lots from some very smart people as well as from the rest of us.

So let's say that this woman did sign a form stating that no CPR was going to be performed. How is doing CPR acting as a pt advocate? If the pt signed such a form, she obviously does not want CPR so by performing CPR you are going against the pt's wishes and are therefore NOT acting as a pt advocate. The funny thing about medicine is that being a pt advocate doesn't mean being a hero.

I feel for this nurse. She was damned if she did and damned if she didn't. We see what happens when she didn't do CPR and if she did she may have lost her job. We can be a altruistic as we want and say that she should have done CPR regardless of the fall out, but how do we know that this woman isn't a single mom with some kids at home, living paycheck to paycheck? Now she's on the street because she did CPR on an 87 year old woman. I'm not going to judge her unless something more impressive comes out.