ERDoc

Our local insurance giant did this to our group and it hurt. We fought and fought and finally got a compromise, but much than before. They are now beating all of the other local ER groups into submission and have told them that they will not get the compromise that we got because we are the biggest group in half the state. Medicine is not run by the providers, it is run by the for-profit insurance companies and the govt. As for Obamacare, our group is currently looking to see it's impact. The problem is that no one, even health care policy experts who mentally masturbate over this day after day, understand all of the repercussions. How will ACOs affect private companies like the ER groups or private EMS? I guess time will tell.

High was somewhere in the 1200s, low was 14 and still fully conscious, confirmed through multiple finger sticks and 3 lab draws from different sites (yeah, you could say we didn't believe it the first time).

Yup, looks like she is.

Thoughts and wishes to you Rich and to Momma B.

Pubmed reference FTW!!

AK, it's sad to see you go and I wish you the best of luck. I will also ask you to reconsider. There is no minimum post requirements so don't worry about how much or how little you contribute. Any contribution from someone with your experience is always welcome. You are not one of those that say, "We always did it this way so why change it." You recognize that medicine changes, even if you can't keep up with it. The newbies need someone like that to remind them that just because that is the way it was taught in EMT class doesn't mean it is still correct (or was correct when it was taught). I've had to cut back quite a bit but I still pop in from time to time. I don't know what I would do without an occasional dose of goat sex and Kiwiemergontology. Those of us that survived the Crotchity years share a bonding experience and are like family, lol. Seriously, please consider sticking around, even if it is only once a month.

Could be paroxysmal SVT or afib, reflux, pheochromocytoma, cardiac ischemia. Have I scared you enough to get you to a doctor? Workup would include EKG, Holter, bmp, troponin, TSH, 24 hour urine to start. I think a little pt education is in order to discuss the seriousness of any chest symptoms in a middle aged, life long smoker who knows better.

It's really hard to answer all of your questions without knowing this guys history (which I realize you are not privy to). All we can do at this point is guess. Hepatic encephalopathy is most commonly caused by liver cirrhosis, most commonly from drinking. Ammonia levels don't necessarily correlate with the degree of encephalopathy. I've seen people walking around with levels of 100+ and others who were obtunded with levels in the 70s.

One of the news networks is talking with a crane expert. He says those cranes are supposed to act like weather vanes in the wind and thinks something was set incorrectly when the crane was last used (his speculation of course). He seems to think that they will need to strap the broken part (of a lack of a better way to describe it) to the rest of the structure until they can erect a new crane to safely lower the damaged one.

I don't think it is one of those thing that is easy to get down, but I could be wrong. Those kind of cranes are attached to the building and take a long time to set up, I imagine they take even longer to take down.

Intraosseous. When you can't find a vein or need rapid access, you stick a needle into a marrow cavity.

You didn't kill her and you didn't try to do anything above what you know how to do. I would say everything was fine.

You've got to give her credit for creativity.

My condolences Arctic. At least it wasn't pericarditis.

Wait, Dwayne can still get erections?

Which part of NY are you from? The state has a LOSAP program. Suffolk County offers free tuition to VAC members. So just getting an errection getting to play with the lights and sirens isn't good enough for the young ones anymore?

I didn't mean to imply that you implied that. I was just putting a blanket statement out there that applies to EMS too. You can respond to a 18 week crackwhore who is drunk, high and smoking who goes into preterm labor and have her at the hospital within 5 minutes of calling 911. The fetus will die but everyone will be sued and there is a good chance it will be successful. In the US legal system dead baby=lottery ticket.

You will NEVER be able to win a dead baby case. It just won't happen. The best bet is to settle for as little as possible and be done with it.

I can't say why the OB went for the vaginal delivery first. A lot of times it is a judgement call, the reason why medicine is an art and not a science. The fact that the week before the mom was told she would need a c-section makes me question the decision, but without all of the facts, I can't really say. It's possible that the OB who told her she would need a c-section saw that the baby was big and would need a c-section if she went to term. Dwayne, the only reason I can think for your situation was the his head was compressing the cord during contractions and when she changed positions the position of the head or cord moved. Despite what the media and general public think, OBs don't like to rush people in for c-sections. It is higher risk to all involved. Having delivered several 14 weekers, both breathing and not, it is not an easy situation to deal with.

OK, this one has piqued my interests. Here is another article from NYT. http://www.nydailyne...ticle-1.1181731 First, they were being see by maternal fetal medicine (MFM), meaning it was a high risk pregnancy. They don't disclose the reason this was a high risk pregnancy to start with. Second, the baby's trunk was too large for delivery at 26 or so weeks so it would be considered large for gestational age (LGA). This may be related to gestational diabetes, which may be the cause of the MFM care. Third, the NYT article says that the pulling resulted in the head being seperated from cervical spine, implying an internal decapitation. There would be no reason for the arteries and veins to bleed at this point. The blood also shouldn't spurt towards the parents, it would spurt towards the providers. EDIT: OK, here is another one with a little more detail. http://www.courthousenews.com/2012/10/02/50841.htm So it says that the baby was decapitated in the delivery room but then it also say that the baby was surgically decapitated in the OR. Well, which is it? Something smells fishy here.

I don't even know what to say. How strong does the doctor and mom's pelvis have to be in order to rip off the head? This article just reeks of over-dramatization but that is usually what happens when you have lawyers and the press involved. If the baby's head is off, how the hell do you push it back in? It's hard enough to get it to go the way it is supposed to, but it must take even more work to get it to go the other way. There are just too many unanswered questions to really make any judgement but how the hell do you pull hard enough to decapitate someone by hand? EDIT: I'd be curious to know if the baby had any other injuries. If the doctor was pulling hard enough to pull of the head, surely both clavicles were fractured not to mention lots of other signs of trauma. If I had to come up with a viable scenario I would say the baby's first should was delivered and was too big to deliver the second. Bleeding is common during delivery and the parents are probably not used to the sight of blood. The placenta may have separated also leading to bleeding but would also result in death of the fetus. Fast forward to the OR and a c-section is being done and baby is dead or close to it. Head/shoulder is still stuck and nothing can be done before baby expires. Only was to get baby out at this point is to decapitate it. If anyone has read Learning to Play God by Robert Marion, he experienced something similar during his OB rotation as a med student I think.

Even with all of the bad, tasteless puns, the net result is the same.

I think we have a winner.

Holy mackerel. I never realized how horrible we are. Thanks for pointing this out Bill.

I hope he lived his life to the fullest. CARPe diem.