Just Plain Ruff

I had a call that fell outside our standard procedures. One ambulance for entire county of 13500 or so. We covered 3/4 of the county and usually had 2 crews on during day but only one on at night. Had a 2nd ambulance service 17 miles away that covered the other 1/4 of the county. Got called to the nursing home for a patient who had fallen and hurt her ankle. She was pretty docile and was sleeping by the time we turned on to the street to take her to the ER. Call came in for a 2 year old choking 5 minutes away from where we were at the time. I made the decision to have the 2nd ambulance service start responding and we would respond also, with the patient in the back of the ambulance. We arrived and found a 2 year old in significant distress and then go unresponsive. Had swallowed a penny. Child on the way to arrest. Was able to visually see the penny and pulled it out with magill forceps. Began to breath for the patient with a BVM and he started to come around. My partner (EMT) was in the back with the sleeping patient. We waited for the other ambulance service to get there, they transported the child with what turned out to be a great outcome. Had we have followed SOP and waited for the other ambulance to get there, that child would be dead. I gave the penny back to the parents in a specimin jar.

Hey Hutsy, keep reading these scenarios. Very good scenario writers here.

So Dwayne, what might the bronchospam be caused by? Doesn't sound like she encountered an allergen in her home since she's been in the house for better part of the day? I know that you can not be allergice to a stimulus one time yet the next time you come into contact with that same stimulus you are allergic. (reminds me of a physiology experiment that I saw in paramedic school). I'm really leaning towards the PE over anything else but I'm open to the 'Bronchospasm' theory also.

I didn't see the mitral valve replacement in the history. Could the valve have malfunctioned or thrown it's own clot? It might just be me and my recollection but shouldn't she be on a blood thinner based on the heart valve replacement? My thought might be that the valve developed plaque on it/or an issue on it and it finally broke off going to her lung.

Well actually clots form over a period of time. Depending on her level of high cholesterol and her diet they can form over periods of months. My close friend many years ago had a huge clot in his left calf that they had to go in and put some type of clot busting drug directly on it which of course didn't work so they went in and stripped his vein in his calf. He said it hurt like a bitch having that happen. So she doesn't have a clot, what else could it be? You said chest pain, what is it's strength, is it off and on or is it constant? Is it tearing or just constant? We could have a musculoskeletal event that was triggered by her getting up and turning wrong.

Well first what makes me think blood clot is that she was sitting in a chair and she stood up and within moments she had the soa. The other would be her age. Do an exam on her legs, see if her calves are red or inflamed. Ask her if she has or has had any type of calf pain in the past week or recently. Does she sit for extended periods of time in that chair or any chair for extended periods of time. Does she have a family history of high cholesterol?

I just was notified of a new LinkedIn group for Combat Trauma Care. Here's the LInk to the group. Thought maybe some of you might be interested in it. Small group so far but there are a fair number of EMT City members who have this background. Could be a great place to network and share advice and ask questions. Her's the link http://www.linkedin.com/groups?gid=3990518&trk=hb_side_g Take Care

How long was she in the chair for? Did she sit there for a long period of time - 4-6 hours without getting up? Does she take blood thinners or has she ever had a PE or blood clot in the leg? I'm leaning towards a blood clot in her leg, breaking off and travelling to her lungs. That would explain most of the scenario. But maybe you have a different thing happening. Good scenario so far.

What was she doing prior to the event? Any pain on inspiration in any particular area of the chest?

Jeebus, how many scenes do you go to that start out safe but end up deadly? Prior to my retirement I was running about 5 calls a day 3 days a week. I can't remember the last time a call that started safe became deadly unless you are talking about a patient coding on me and then I don't think I needed the combat training but maybe I should get that 100+ hours of combat training so I can stave off those deadly calls. I'll bet that you go into scenes just itching to find some way to get to use your 100+ hours of combat training and all that pepper spray. I do carry a encoded radio that is a direct line to SAC command so if a scene does go deadly i can call in air and ground support to deal with the danger. It takes a couple of minutes to mobilize the attack forces but usually when I'm on a call they are already airborne and on the way even before I get to the scene of the call. I can always recall them. Thank GOD I haven't ever had to use them. Consider the paperwork I would have to fill out for a airstrike on a civilian target. I just get all clenched up when I think about that but at least I have the air and ground backup and all that pepper spray.

Count to 10. Take a deep breath, Then look at the scene. Then get out and look again. But honestly, this is a skill that's crafted over many calls. The first time you get injured at a scene or you miss something will be the last time that happens if I know you like I think I do. I found that I was in the same boat as you when I started as a medic. A mentor of mine said "dude, slow the F down and count to 10" I did that consistently over a couple of weeks and it began to be second nature. Remember the old adage, "it's not your emergency, it's theirs, don't make it your's or you are no help at all" told to me by the same mentor. I was on a scene as a new medic. We had a suicidal teen who left a note and he was hiding from us. WE split up my partner and I. My partner had a deputy with him. I did not. (stupid tax on this one). I searched the basement and the outside. I found the kid unconscious(so it appeared) in the garage that he had locked. I broke the window of the door, unlocked the door and went inside just after radioing that I found the kid in the unattached garage out back. Deputy and partner coming up behind me I entered the garage and bent down to check the patient and he went crazy, hitting and biting and scratching. I got hit in the face, my eye sustained a corneal abrasion that hurt like hell and I basically got whooped by this kid until the deputy and my partner who was about 350 pounds landed on him. they subdued him and I limped away with much pain. So I didn't follow my rules and wait for help, I didn't wait for my partner but as a new medic I was 10 feet tall and bullet proof. I found I was only 4 feet tall and definatley not bullet proof that day. That's when I realized that I had to do the counting exercise even in scenes where theres only one victim lying flat in a garage. I tell you this because that was the call that was my wake up call to really take my time and looking at all the aspects of the scene, there were knives, hammers, screwdrivers and many other deadly implements/weapons in that garage and luckily for me this kid only used his fists and feet and teeth. My guardian angel was over me that day.

I have seen some really nasty and outright disgusting things being said about Casey. There are many out there who if given the chance will kill her just because they think she deserves to die for killing her little girl which was never proven that she did. I had a somewhat heated argument with a guy at a local Little Ceasers pizza. He said if he saw her walking down the street he would get his gun from under his seat and kill her. I asked him why and he said, just because she got off doesn't make her innnocent of the killing. I asked him who made him executioner and he said "Little Caylee did, that's who" I told him he was crazy for thinking that and he proceeded to curse me and threaten me enough to the point where the manager at the pizza shop called the police. He was arrested for having a unlicensed handgun in his car. so YES Dwayne, this world has gone freaking nucking futts and some days I wish to have no part of it. But it is the world we live in and we must do everything we can to make it a better place for our kids and our kids kids. Casey has no place in the United States that she can be completely safe, no place where she can walk down the street without being the center of attention. Little Caylee is the one where the focus should be, who gets to mourn for this little girl who had absolutely NO say in her fate. That's the sad part. As for Nancy Grace and the media, they tried Casey, they convicted her and then they stirred up the pot and started to play executioner. Shame on them but can you really expect anything less from this group of people? Remember, if the american people didn't eat this shit up, they wouldn't exist. I for one do not watch any of the national networks basically because I'm busy running down a 2 year old and watching the Sprout network and changing dirty diapers. Just some penny wise comments from the peanut gallery.

You don't know what the repercussions would be? You have a patient you are transporting and you want to kick her out of the ambulance to respond to the dead guy. That is patient abandonment and that's a big No-No. Had you not have had her in the ambulance and the call came out, yes you probably could have explained to her that there was a higher priority call and you could have another ambulance to her in say 15 minutes but once she is in your ambulance you are out of luck trying to kick her out of the ambulance to handle a glory call that actually was a dead person. Didn't you learn about the legal effects in basic EMT Class that were reinforced in medic school if you are a medic. I didn't even read until now your statement of rules and regulations and if they stand in the way of patient care, screw-em. They are there for a reason, you better have a good reason why you broke the rules. Be careful with that thought process. I'm all for putting the patient first but I'm sure going to weigh the consequences of breaking the rules and whether or not they benefit the patient or not. To the Original poster: People die, every day. Unfortunately you have now had first hand experience with someone who didn't need a bambulance and it took you away from the major call. Either which way, you just deal with it, educating the patients who abuse the system and hope you make a difference when you do get that big call. The motorcycle driver was probably dead right there so your closer response time would probably have made not difference in that cyclist's fate. Maybe it would have, maybe not. Keep your chin up, keep your perspective and keep posting. Having the balls to come here and post your frustrations is good. Take care.

Actually let's discuss the coughing in your direction. Transported a patient a number of years ago from the VA to a nursing home. No info in the chart regarding his TB status. He was coughing inthe ambulance. I put a mask on him but it was too late. 3 months later got a letter from the VA regarding his TB Status. He was positive and contagious. I converted less than 3 months to the day later and the only documented patient that I came into contact with who had confirmed TB was this guy. I did not get TB but I am now a permanent converter and I have to get a chest X-ray each year for my yearly TB Screening. My partner also converted about 3 months after the transport also. 6 months worth of isoniazid, a permanent health department (state of missouri) record of my TB exposure and the inconvenience of having to go to the health department every week for my supply of Isoniazid. So maybe a cough in your direction should be an exposure? Maybe not but I for one say "if suspected then report".

I thnk that they are nearly there. Was talking to a fire fighter medic and he said that just as he thought, the old fat fire fighters who want nothing more to do with EMS are bitching and moaning about having to pull a shift on the ambulance. The ambulance is rapidly becoming the mode of punishment if you piss your captain off on a given day. Response times SUCK donkey balls, morale among the long time fire fighters is poor because they have to drive the ambulance on some shifts. The medics are working their asses off to cover open shifts and some days there are ambulances that are not staffed or there are fire trucks that go without a crew member. My friend told me that what could have been a great system has turned out to be a limp dick system where the old guard union members are dictating what happens on a day to day basis. On a totally different note - I called 911 the other day to come get my father because he was really sick. The two crew members arrived and were totally professional. They took care of him quite well, and I can't say I was unhappy in any measure. Response time was less than 7 minutes, scene time was less than 10 minutes and drive time to the hospital was less than 10 minutes. He was suffering from Erlichiosis and to be all honest, I called EMS to get him in to a room in the ER due to his inability to sit in a chair. KCFD - count me as a pleased customer.

When in doubt, report. Nuff said

What so you are pissed off that we didn't tell you how WONDERFUL a person you were to want to become an emt? It doesn't work that way. You asked advice on how to be an emt or whatever you asked and we told you that it would be no problem except for the driving issues. So here I go Thank you for deciding to save lives as an emt. I cannot wait till you become an EMT. We need to prepare for your awesomeness. Thank you for wanting to take the easy way out and the short cuts in order to be the best darn emt you can be. Why, because you are such a likeable fellow and a wonderful person. You will go far in this field and I hope that you will be the one to come save me when I have my big massive MI. Well now that I'm about to vomit in my soda bottle, here is some better advice. Go get your degree, get your emt and then move to medic and then work in the field. You will be about 23 when you graduate from all that if you choose the 4 year degree unless you quit school like you did in high school, oh yeah I forget, there were extensive circumstances requiring you to quit high school. By the time you have your medic you will also have a college degree, some more years of experience in life and I'll bet that you will become a DAMN good medic, but only if you decide to follow through and finish what you started. You yourself said "I'll stop at nothing" or something like that so put your money where your mouth is and do what you say you are going to do, and let's see what kind of emt you make. How was that for motivational speech? If you don't like the advice other than the sarcasm, then you don't deserve the help you are getting on this site.

All right jedi, if you won't stop until you are an EMT then why stop there? Why not take the next steps and get your EMT, then get your medic from a accredited college so you have a college degree along with it? You say you won't stop yet you only want to get your EMT? Then put your money where your mouth is and get the medic. Then you at the age of 20 or 21 can work in the back and not have to worry about insurance requirements that put 18 year olds at a distinct disadvantage in getting a driving job. Don't just do this half assed, do it to the point of YOU DON"T CARE WHAT IT TAKES!!!!!! You said it, we didn't.

He's got a bleed, stick a fork in him, he's done Sent from my SPH-D700 using Tapatalk

What is your budget. I have a program in mind but it might be too expensive, but i have been through it three times before and it is definately worth the fundage. What about sitting down with thevworst of the offenders to include the patient. Let the patient or family member tell you and the medic who treated them how they felt. Tel the medic thatbthis is their wake up call and their obnoxious behaviour needs to stop NOW.

So what are his psych meds he's taking? Does his wife take psych meds also that he might have gotten to also. What other medications do they both take that an overdose could give these types of symptoms. Normally in my experience on multiple drug overdoses, if the medication is in the house the person adds it to their list of stuff to put in their mouths. So IV, Oxygen, monitor. Transport Give narcan if protocols allow. How far is the hospital?

IPAD applications (will more than likely work on iphone and Ipod touch as well) All can be found on the APP Store. ECG for Ipad $0.99 Grays Anatomy Premium Edition $9.99 Labor and Contraction timer - free Medical Encyclopedia - Free Joslin Chest Atlas - $14.99 Medical Lab tests (tells you what the results mean of most lab tests) $2.99 Human Body 3D Anatomy - $2.99 What's My Rash (pictures of rashes and identifying points) Free X-rays - Free I can not vouch for any of these as how good they are because I have not downloaded any of these and don't have any money in my Apple account now that it's been hacked and 43.99 was drained from my Itunes gift card. Damn hackers Enjoy

Stroke exam? Kiwi already asked about the ticker Any recent history of bouts of confusion or showing signs of mental status changes on a increasing basis? What did he eat today? any chance he got into something outside like a allergen or something ingested? If he's in Australia any evidence of spider bite or snake/scorpion exposure?