Just Plain Ruff

On a routine car stop in Tampa while trying to arrest a subject two Tampa Florida police officers were shot. 1 has since passed away and the other is on life support and is not expected to survive. The suspect is currently being sought in a city wide manhunt. The dead officer leaves a wife who is 9 months pregnant. The 2nd officer has a wife and 5 kids. I know the youngest one is 8 months old. Please keep the families of those involved in your thoughts as well as the entire emergency response community in your thoughts. Also hope for a quick apprehension of this subject who shot them. Hopefully he won't get shot himself but then again, anyone who kills someone just for doing their job so they can get away is the lowest of the low.

WEll I recently delivered a baby on the couch of a trailer home. Uncomplicated delivery. My last exposure to OB related education consisted of a 2.75 hour course on OB/Gyn complications and childbirth online. It's amazing what you remember when the time comes to go big or go home. Deliver head, suction Deliver body, dry, stimulate, clamp, cut cord, put baby on mom's chest wrapped in warm blankets, put mom on cot, clean up mess you made after crapping yourself after determining that this baby aint waiting till the hospital and then drive to hospital slow and smooth and deliver child to a nice warmed up baby warmer and the OB Nurses. Go back down to the ER/ambulance bay and get pats on the back for a job well done. Clean shorts Clean ambulance Write report Go home and get some sleep. A condensed version of the events above.

And hugs all around. But seriously, this is a great thread and it's resurrection is a good thing.

PM Me we'll talk. One other thing, do not hit me up privately to invest in your business or MLM scheme. Admin, this doesn't apply to you.

Went and looked at the websites of a few realtors on the pm you gave me. No place has the 100-500 acres that I desire. The wooded area is a given there though If can't hunt, then I'll grant fishing rights.

An investment that I have is about to mature over the next month or so. Small investment yielding Huge gains. I'm looking for a new place to live or put a 2nd home on. Convince me that I should come to live in your area. I'm looking for about 100-500 acres with a house (5 bedrooms) and a large amount of the acreage should be wooded, and there HAS to be a smooth running stream running through the woods. Convince me that your area is the place for me to relocate or put my 2nd home on. If you convince me to put my home in your area, I'll grant you exclusive hunting rights to hunt on my property. Convince away.

The company I worked for recently had the most AWESOME lifting system. 2 crew members and maybe a first responder. Isn't that the most awesome system? For those who have the funding to provide the level of support and equipment that are in the two above posts, KUDOS to your forward thinking department. Our system provides workman's comp as a benefit to it's employees who might be injured on the job. That's a great thing. Can you read my sarcasm towards the situation?

Dwayne, not everybody here googles things. I believe this illness has been in the news quite a bit over the past week or so. Even I heard it mentioned and I rarely read the news paper nor do I rarely watch the news. Some of us here know things when they are presented and for some things we don't need google, for other things, we do need google.

Call the funeral home? Seriosly though: ABC's Condition of house What does the patient look like other than posted Any foreign substances in the room such as cleaning supplies or strange smells? This disease also has a 1970's ring to it. Remember the reports of kids and young women with Toxic Shock Syndrome? This is a very very bad disease. Without intensive care unit help as well as Infectious disease consults and treatment he's gonna die. I took care of a 18 year old with Toxic Shock about 5 years ago. She died. She was one of the sickest people I've ever taken care of. This guy needs a University level hospital with all the bells and whistles. I do not wish this disease on anyone. RIP Manute (sic)

Make sure your father signs a medical release stating that you can be talked to about his condition. Most clinics and doctors offices have that. Have your father tell the physician and his nurses that you are to be included in the medical talks about him. Once you have that done, you should be good. If you don't get that done then they can refuse to talk to you about his condition and treatement plans.

http://www.medscape.com/public/blackberry that should work for you. Did you get any of my PM's?

[ First off Tracy, you started this. You said that medics are nothing without basics. I believe that that was your direct quote or at least close to it. But re-reading it I realize that you said that medics are nothing without knowing the basics. Your use of semantics threw me and for that I apologize. You also call me a hater. I am nothing of the sort. I simply asked you to respond to what I called some glaring misconceptions that you posted in your reply to the thread. Before you start calling me a hater you should get to know me better. You joined a month ago so you don't know me nor my thought process. So don't call me a hater. You also arrogantly stated in your thread this "P.S. Don't be hating on me because I can intubate as a Basic in Ohio! :-) Don't be hating on me now! I'm a newbie:-)" That to me was gloating that you can intubate as a basic in Ohio and I find that scary that basics can intubate. But that's another thread topic if you ask me. Plus, why do you assume that just because I'm a medic I've forgotten the basics. You made a lot of assumptions on your thread. I know a lot of basics out there who don't even know the basics. To put als procedures (which I feel Intubation is a advanced skill) in the hands of someone who has less than a semester of college is just wrong. Sorry if that rubs you the wrong way but that's my belief. you can disagree with that thought process but sorry that's my opinion. As for the assumption that you have on who gave me the byetta instructions, I was taught by my personal physician about the medication. A medical assistant did not have to show me how to give myself a injection. My physician is the one who educates all her patients. She runs a small practice. I do know in other practices that medical assistants play a vital role in the practice and they give education out all the time. That's a good thing if they themselves are taught right. Your post in my opinion was arrogant and full of misconceptions. Again that is my opinion. I do appreciate you calling me a nice hater though.

I'm not sure if this will work well in your EMS work but this application from Medscape looks really sharp. Extensive drug checking of over 7000 meds 3000 conditions with info on them all multiple cme and educational topics. This might be the poor mans Epocrates or what not. go here to see it and download it. Post a review if you can. I don't have a Iphone or a blackberry so I can't say it's good or not. Ruff http://www.medscape.com/public/iphone

The scenario was pulled from the medscape cme site. The website is http://cme.medscape.com/viewarticle/722659_2 But you need a user name and password to see the info so sign up if you want quality education for Free. I was able to use the CME's that I got from this site to relicense in Missouri. Here is the info I promised on Dengue Hemorrhagic Fever - definately a nasty one but not like Ebola or Marburg. This patient was diagnosed with dengue hemorrhagic fever (DHF), which is a complication of dengue fever (DF). The diagnosis was eventually confirmed by paired immunoglobulin M samples demonstrating an acute rise in antibodies. Dengue virus belongs to the family Flaviviridae (genus Flavivirus) and has emerged as the most common arboviral disease in the world. The disease is endemic to tropical and subtropical areas of the world, with about 2.5 billion people (40% of the world's population) at risk of acquiring the infection.[1] Dengue virus is transmitted to humans through the bites of infective female Aedes mosquitoes (particularly A aegypti and A albopictus). Mosquitoes generally acquire the virus while feeding on the blood of an infected person. After an incubation period of 8-10 days, an infected mosquito is capable, during probing and blood feeding, of transmitting the virus to susceptible individuals for the rest of its life.[2] Unlike malaria, which is more prevalent in rural areas, DF is spread via mosquitoes that thrive in highly populated urban environments.[3] Four distinct, but closely related, viruses (termed dengue virus types 1-4 [DENV 1-4]) cause DF. Humans are the main amplifying host of the virus.[4] Infection with 1 of the 4 serotypes of dengue virus causes a wide spectrum of clinical disease, including asymptomatic infection, undifferentiated fever, DF, and DHF. DHF occurs in a minority of patients and is characterized by bleeding and plasma leakage, which may lead to shock.[5] The major risk factor for DHF is prior immunity to a single dengue virus serotype. Infection with one dengue serotype confers lifelong homotypic immunity and a very brief period of partial heterotypic immunity (~6 months), but an individual can eventually be infected by more than one serotype. An individual could therefore experience a case of DENV-1 fever in one year, followed by a case of DENV-2 fever in the following year. Third infections are, however, very rare, and fourth infections have never been reported.[6] Several serotypes can be in circulation during a particular epidemic.[7] Some people infected with DF are asymptomatic. Young children often have a fever with a rash, but other symptoms are minor. Older children and adults may also have mild symptoms; however, they are more likely to experience classic DF.[2] Symptoms of DF include a high fever (up to 105° F [40.5° C]), severe headache, retro-orbital pain, severe muscle and joint pain, swollen lymph nodes, general malaise, nausea, and vomiting; a macular erythematous rash with petechiae may also be observed.[7] The differential diagnosis for DF and DHF is broad and includes meningococcal meningitis, septicemia and disseminated intravascular coagulation, other hemorrhagic fevers (Crimean Congo hemorrhagic fever, Ebola, etc.), thrombotic thrombocytopenic purpura, falciparum malaria, leptospirosis, aplastic anemia, acute leukemia, and yellow fever. Direct person-to-person transmission of dengue virus has not been documented. A few case reports have been published of transmission of DENV through exposure to dengue-infected blood, organs, or other tissues from blood transfusions; solid organ or bone marrow transplants; needle stick injuries; and mucous membrane contact with dengue-infected blood.[8] Dengue or dengue-like epidemics were reported throughout the nineteenth and early twentieth centuries in America, Southern Europe, North Africa, the east Mediterranean, Asia, Australia, and on various islands in the Indian Ocean, the south and Central Pacific, and the Caribbean. DHF has increased both in incidence and distribution over the past 40 years, and, in 1996, 2.5-3.0 billion people lived in areas potentially at risk for dengue virus transmission. It is estimated that there are 20 million cases of dengue infection annually, resulting in around 24,000 deaths.[9] The geographic distribution of dengue viruses and their mosquito vectors has expanded, and DHF has emerged in the Pacific region and the Americas. In Southeast Asia, epidemic DHF first appeared in the 1950s, but by 1975 it had become a leading cause of hospitalization and death among children in many countries in that region.[10] In Europe, the last dengue epidemic dates from 1927-1928 in Greece, with high mortality. However, there continues to be imported cases of DF in travelers returning to Europe from endemic areas.[11] In the 1980s, DHF began a second expansion into Asia when Sri Lanka, India, and the Maldives Islands had their first major DHF epidemics; Pakistan first reported an epidemic of DF in 1994. The recent epidemics in Sri Lanka and India were associated with multiple dengue virus serotypes. After an absence of 35 years, epidemic DF occurred in both Taiwan and the People's Republic of China in the 1980s. The People's Republic of China had a series of epidemics caused by all 4 serotypes, and its first major epidemic of DHF, caused by DENV-2, was reported on Hainan Island in 1985. Singapore also had a resurgence of DF/DHF from 1990 to 1994 after a successful control program had prevented significant transmission for over 20 years. In other countries in Asia where DHF is endemic, the epidemics have become progressively larger in the last 15 years.[10] A recent outbreak of DF in Karachi occurred in 2005 when Aga Khan University reported 30 positive cases out of 100. A recent trend of DF in southeastern countries is that it has become endemic, causing cyclical epidemics every 2-3 years.[12] A major challenge for public health officials in all tropical areas of the world is the development and implementation of sustainable prevention and control programs that will reverse the trend of emergent DHF.[13] Environmental controls, including solid waste management, decreasing vector breeding sites by eliminating standing water, improvement in public awareness by media, and the use of household insecticides and mosquito repellants can help prevent the spread of dengue virus. Active case surveillance is important for early detection and implementation of control programs in the setting of acute epidemics.[11] Unfortunately, there is no commercially available vaccine to prevent dengue.[14] Tetravalent vaccines are currently being studied. Clinically, the diagnosis of DF is suggested by the presence of fever, severe headache, maculopapular skin rash, and myalgias associated with either the isolation or identification of DENV from either serum, plasma, or tissue specimens, or by demonstration of a 4-fold increase of DENV antibodies in paired serum samples. The diagnosis of DHF is based on similar clinical features associated with a bleeding diathesis and/or thrombocytopenia. In some patients, a shock syndrome (dengue shock syndrome) may be observed. The treatment of DF and DHF is essentially supportive. Antipyretics as well as fluid resuscitation, monitoring, and support are often necessary. Monitoring of laboratory parameters and replenishment with blood products as necessary are indicated in severe cases of DHF. The World Health Organization has created a useful guide (Dengue Haemorrhagic Fever: Diagnosis, Treatment, Prevention and Control; available at the WHO Website[9]) that delineates recommended approaches to the identification and management of DHF patients. The patient presented in this case was admitted to an inpatient medical ward for 10 days and managed with intravenous fluids as well as repeated platelet and packed red blood cell transfusions. She was discharged when her platelet count reached 60 × 103/µL (60 × 109/L). She returned to the outpatient department after 3 weeks for follow-up, at which time her bleeding, rash, and other symptoms had improved. CME/CE Test

I can't believe I just read this drivel. Can you give me valid statistics that most calls don't require a paramedic. A large majority don't but how many stroke or heart attack patients have been saved by a strictly BLS crew?? Oh that's right, you don't need a medic. Tell that to the heart attack patient who got the aspirin and the nitro and the morphine which put less strain on his heart and he got to the hospital in a timely manner. ALS is not a waste of time. Your premise is flawed. When you have a heart attack and the only crews available are BLS crews let's see how you feel then. What about the diabetic who has a blood sugar of 20 and unresponsive? What the hell is a bls crew going to do for this patient other than give the "golden vapor - oxygen" and transport. All the while when the patient is unresponsive the bls crew is requesting medic back up. Wow, why the heck did I open this thread to echo Bushy's response.

I think that 1-4 is covered by your response - they are not licensed anywhere in the US to perform ALS procedures. But this happens every day. You have a close knit partner situation. One is in medic school and the medic partner allows the emt who is in medic school to start an IV. I have seen it happen, several times and I always say something about it but usually the offending people say "It's no big deal, the patients don't know any different" or something like that. When is it OK to allow it to happen?

On physical examination, she is alert and apparently well developed and well nourished. The patient has a regular pulse of 90 bpm and a respiratory rate of 14 breaths/min. Her temperature is 98.2° F (36.8° C) and blood pressure is 90/70 mm Hg. The cardiac examination reveals a normal S1 and S2, with no murmur, gallop, or rub Per physician. Auscultation of the lungs is normal, and no palpable organomegaly or tenderness is found on abdominal examination. Examination of the extremities reveals large bruises and a petechial rash across both forearms and lower extremities Conjunctival hemorrhages are noted bilaterally. Bruises are also apparent on her soft palate, and minor trauma from oral examination results in gingival hemorrhage. The laboratory investigation reveals a hemoglobin of 8 g/dL (80 g/L), platelet count of 11 × 103/µL (11 × 109/L), and a white blood cell count of 1.8 × 103/µL (1.8 × 109/L). Her serum blood urea nitrogen, creatinine, liver function tests, albumin, and electrolytes are normal. Coagulation studies, including a prothrombin time, activated partial thromboplastin time, fibrin degradation products, and serum fibrinogen, are normal. Blood cultures do not show any growth. Urine analysis and urine culture result negative. Posteroanterior and lateral chest radiographs, as well as abdominal ultrasonography, are unrevealing. EMS Has given 500ml of normal saline. Is this a critical patient or is she stable? Dave, you got the diagnosis right. She has Dengue Hemmorhagic Fever - sort of an oxymoron because she has no fever but she did. What do you think her hospital course is going to be? I'll post in a few where this scenario came from and what the site I got it from has to say about Dengue.

There was a reply on the Basics Doing ALS stuff thread that got resurrected here two days ago. I have a question. When is it ok for basics to perform ALS procedures. There are a few scenarios where this might occur 1. EMT in medic School - they have learned ALS Stuff like IV's, Intubations, Defibrillations, Medications. Do you allow them to perform those skills while you are watching and there. They are not performing in a student capacity but as an employee of the company. Do you let them do this? 2. EMT just waiting on his medic license - doesn't know if he passed but is sure he did. Do you allow them to perform ALS skills 3. EMT just starting medic school - do you teach him yourself? 4. EMT not in medic school but says he knows how to do it. Are any of the above scenarios acceptable? I say no, none of the scenarios are acceptable reasons to let a basic do an ALS skill based on the liability to the company, to the EMT and most of all the liability to you the medic. If you think it's acceptable for the basic to be doing skills they are not licensed to perform but have learned in a school setting I'd like to hear your reasons. REMEMBER - the basic is not performing as a student on his/her ride-alongs. But they are working in the capacity of an EMT only. I remember one call I was on as a new EMT/employee. My preceptor was working with a very good medic. Called on a near respiratory arrest and I went out to get the backboard and when I got back, the EMT was intubating the guy.(the guy died from a missed intubation) I asked why she was allowed to intubate when I knew she wasn't supposed to and they told me to shut my mouth if I wanted to work there for very long. Ending to this story was that I didn't work there very long. I told a close friend who was a medic there about what happened and he walked me to the supervisors office and told me to tell the supervisor. The supervisor took a report and my next shift I was told that I was fired for some silly reason. Not a good week for the Ruffemster but I learned a valuable lesson that week. Principals are worth standing up for and I stood up for mine and although the patient did not fare well, my conscience was clean. The person who missed the intubation and her partner are still at the company.

All this information that has been given to the OP is what this forum is all about. Sharing knowledge and insight as to life issues that we all face. It sort of overpowers the negativity of many posts. Even though this situation is not my own, I've learned somethings today.

Tracy, I mean no disrespect here but let me ask you this. Do you know the actions behind the drugs that as a medical Assistant you are able to give? Do you know the pathology behind why one drug does one thing while another acts a different way. Do you know why you are giving a medication to a patient or are you just going by what the MAR says to give? If you are just going around giving medications to your patients without knowing what that medication is really going to do for the patient then do you have any Business giving medications to anyone? I'm a diabetic, I give myself daily injections of a medication called Byetta. It is to help me with my diabetes by lowering the blood glucose level as well as regulate my pancreas. It was developed from Gila Monster Venom. I know that if I take it on an empty stomach I know that my blood sugar will fall. I also knwo that a side effect (good one to me at least) of this medication is weight loss. Using diabetics or heart patients that give themselves injections as a reason for you as a basic to be administering medications is an improper analogy. Those patients who are giving themselves medications usually are better versed on the medication than you are as a medical assistant and those patients are better informed of why they have to give the meds to themselves. I don't understand why a medical assistant can give medications anyway. With no pharmacology or a very basic pharmacology knowledge I have seen medical assistants giving many injections yet they usually cannot tell me why they are giving the meds. Physicians do their patients a disservice when they have a person with no training in medications giving me or anyone else a med. That's a recipe for disaster and I'm sure that medication errors and adverse reactions occur with surprising frequency yet are not reported because they happened in the confines of a private physicians office. Your argument that you can train someone to do something has been put out there but do you train that same person what to do when the unthinkable happens? I'll bet your training doesn't encompass that aspect does it? Honestly, the thought process that a basic can do everything a medic can do SCARES THE HELL OUT OF ME. With 400 hours of classroom work and 48 hours on the ambulance, sure EMT's can do what I can do after 2 years of school and clinicals. I guess the next thing the do more with less education group will advocate is Open heart surgery by Nurse Practitioners. This is what gets me, we as a society want to get more for less. More money for less effort, more this for less of that. What ever happened to working for it. To prove yourself and then getting more and more responsibility. We have raised a generation of "I want it now" kids who are now in society as a whole as "contributing" members but they want to take the short cut. I went to school for 2 years to get my paramedic and when I see these people advocating for more responsibility on a EMT's training level, I want to say NO NO NO NO. I worked for my medic and they should also have to work for theirs. Am I holding those whiny little snots back from their dream, nope, not at all, I'm merely making a stipulation that they put in the same level of commitement that I did, and giving advanced skills to someone with 3 months of education rubs me the wrong way. Tracy, I look forward to a reply.

Actually CH, you do indeed need a emt to help you complete your job. Remember the old adage "Paramedics Save patients, EMT's save paramedics" You never knew how true that was until this person came here telling us that without them there EMT's we paramedics couldn't do our jobs. Good on ya Mate!

My responses are in red above. Ruffems

Good job on ya, congrats to your son.

12 lead is unremarkable IV is started NO photophobia Some mild pain when flexing knees All travel immunizations are current Mild nausea but 2 episodes of vomiting with blood in the emesis Diarrhea yes, per patient it also had blood in it. She has no fever right now Doc. She had a febrile illness that ended about a week after she returned from Uganda. She relates to you that there was some sort of outbreak in Uganda but it wasn't Ebola. You have given the fluid bolus and the lady says in broken english that she is feeling better. You are now at the ER. What are you going to want to do with her now. Remember, your ER and hospital have all the newest lab tests and evaluation tools. They do not have ever have to send out labs. Due to the breakdown of the population with many of those people in your community being from Africa there are lab tests that the lab can do that most communities cannot. So far someone has said Ebola but there are other illnesses that mimic Ebola out there.

Prayers for you. Over time it does get better but the loss is still always there. It just makes it a little less painful.