Just Plain Ruff

This link here http://www.statlock.com/cost_benefit.html should be all you need to prove the cost-benefit analysis for your management.

that was exactly the answer I wanted.

Well the page on bob pages stuff includes the multilead medics course book. I have not found anything yet on the right sided ekg but I'm slowly sorting through it. If anyone has a diagram that they can link that would be great. I guess what I'm waniting is the procedure of doing the right sided ekg do you put the leads on and then do a 12 lead like normal or is there other prep work. I can do a regular 12 lead in my sleep, interepret it in my sleep yet I'm not fully grasping the process to do the right sided 12 lead. Call me dense but I just want to do the best for my patients.

Anyone got a quick down and dirty reference for doing a right sided 12 lead? our service does not do these right now but I'd like to start a trend. Googling this gives me many many choices but some may or may not be right.

I am usually the lone guy on my shift in the ER. I can think of 3 days out of the last 12 that I worked with another male co-worker apart from the doctors who are all male except for 2 making it a 60/40 split. I feel at times that I need to grow a uterus to survive in the ER there. But guess who they call to put that foley in the drunk asshole? Yeah, me. They need me for something I guess.

At our hospital, we have IV start kits that include Stat-Locks in the kits. They protect the iv from getting pulled in the event of a dropped IV bag or a over-active patient. Has anyone used these devices before? I personally love them and think they should be standard equipment on all IV starts. The only drawback is the removal, you have to have alcohol swabs to remove them, the alcohol dissolves the adheasive of the statlock. Anyone else feel they are as good as I feel they are?

One thing I would recommend if you are going to get new pumps for your trucks and your trucks have never had them, is to contact the hospitals that you take patients to and see what Kind of tubing they use. If you get a pump that will fit the majority of the hospitals tubing then you save some money for the patient. If the hospitals do not use the same tubing then make sure you are starting IV locks on patients because nothing frustrates me more than a EMS service who tape down IV's that I have to untape to get to the hub of the IV. If you have a lock started then it's a simple unscrew and pull your tubing and replace with my tubing. I personally never start and IV without starting a lock first.

Each of our ambulances have a three channel pump on them. That way if we start three drugs that need pumps we have them available and ready to go.

I always thought is was the other way around. Open wide open and then titrate down for effect.

I was taking care of a woman in the ER while being the primary ambulance crew medic. I was almost ready to discharge her when we get a call on a man unconscious but breathing. I knew this would be a code,what at 3am you rarely find a unconscious man breathing but hey one can hope. On arrival we see a firefighter doing cpr so we go in to start to work the code. Drive time was 31 minutes, fire was on scene for 18 of those 30 mins and cpr was in progress the entire time. Wife said that the last time she noticed he was breathing was a short time before she called 911. Well this guy was in asystole and I asked his wife if he had a dnr and she said it was up at a hospital in KC MO. She did say he said he never wanted this to happen. I called the doctor on duty in our ER and we dicussed ceasing the code which we did. So while talking to the wife a man walks in the room and goes directly to the wife and hugs her, he said something that I didn't understand but it sounded like "I'm glad you're here Mike" and then I turned around and saw his wife. This was the woman I had just been discharging from our ER. It was her father in law who we just called. She said "I'm so glad it is you here and not someone we didn't know" Just had to share.

I think that the mass thing you are having problems with I can help you with. Take a single strand of spiders silk. By itself it can really only catch a small insect like a gnat. But when you add the entire web you can get insects as large as butterflys and the like. The single strand by itself is strong but you add the entire web you get Greater strength. I hope that helps.

I have been tested several times after being in an accident on duty. Funny thing is that I was not the one driving but they test both people so they can say that there is random testing going on but both of us were tested. Our hospital also tests employees if the medication count comes up wrong. The last person in the drawer for the narcs get tested if the count is wrong.

In the right atrium, behind the crest the internal surface of the atrium is smooth, while in front of it the muscular fibers of the wall are raised into parallel ridges resembling the teeth of a comb, and hence named the musculi pectinati (pectinate muscles). In the left atrium, the musculi pectinati, fewer and smaller than in the right auricula, are confined to the inner surface of the auricula. This is due to the embryological origin of the auricles, which are the true atria. Some sources cite that the musculi pectinati are useful in increasing the power of contraction without increasing heart mass substantially http://faculty.ucc.edu/biology-potter/heart.htm go here this is interesting reading

pectinate muscles The right atrium has a forward extension into its auricle. This space is lined by ridges of muscle called pectinate muscles and are not shown in the diagram Blood leaves the right ventricle and passes through the pulmonary trunk to the lungs. Oxygenated blood returns to the left atrium of the heart from the lung through the pulmonary veins. The left atrium doesn't have much to talk about. There is an extension into the small auricles which have pectinate muscles in its walls. The muscles line the atrium and look like the ridges of a leaf. They assist in providing additional contractile force for the atrium. If you look at any diagram of the heart or drawing and you will see in the atrium what looks like ridges in the drawing. those ridges are the pectinate muscles. It seems that all they do is to provide additional musculature to help the atrium contract a little more forceful.

I printed acopy of this off for every one of my co-workers and the docs we work with. several of them have said WOW great article. Thanks JP

ok the guy had a very feisty ventricle and every little movement caused the runs of v-tach. He indeed lost a pulse when this happened. The ER was able to stabilize him with amiodarone and then fly him on to the city. the cardiologist told me that if we had tried to defib the vtach without the pulse we would have likely put him in v-fib and he more than likely would have died. The unfortunate thing was that every time he went in this rhythm by the time I checked his pulse and LOC and then charged the defibrillator he would convert. Had I have shocked him he more than likely would have converted right before the shock and then we'd have shocked a perfusing rhythm and then we're talking v-fib and then coffin.

patient has a history of open heart (triple bypass) I cannot remember what medications he was on but I know there is a beta blocker and a blood thinner. There were occasional pvc's but there were more before the lido. Patient keeps pleading for me to help him. The v-tach is getting longer each time, about 8-12 seconds by the time we get him into the ambulance We find out that the bird is now flying and they will meet us at the helipad. 25 minutes out. Patient now in sinus tach and waking up. 12 lead shows when he isn't having the episode a sinus tach with what looks like to me a little bit of elevation in 2 3 and avf but not enough to trigger the MI reading.............yet

this was exceptional reading. I hear where he is coming from 100%. Now if someone will do a actual evidence based study to prove this article we will be better off. But until that day comes, we will still be immobilizing everyone.

monomorphic, patient is semi conscious when his heart is beating at a rate of 80-90 sinus rate but he keeps going in and out of these 4-8 second runs of v-tach with complete loc and loss of pulse when this happens. He lives about 35 minutes away from the closest ER and an hour or so away from a cardiac center via air ambulance but the birds weren't flying due to snow coming down.

Call i ran a week or so ago - think hard on this, one treatment will kill him. chest pain call, you have a 67 year old man who has short runs of V-tach which cause him to lose consciousness and no pulse with them. The v-tach spontaneously converts with perfusing pulse. 30 seconds later this happens again. You have given lidocaine for this with no response. The patient goes into v-tach again for 6 seconds with no pulse and it converts again spontaneously. What are your treatments and what order?

I have been in two fields that have high infidelity rates. EMS and travelling consulting. EMS is sometimes labeled the bad guy because you are with a partner(usually of the opposite sex) 24 hours or 12 hours and that to your spouse is very threatening especially when the spouse may have low self esteem. Many times I have had to sit down with my partners spouse or significant other and discuss how things are and that I'd never do anything to jeopardize MY marriage let alone theirs. After those talks the spouse or sig other feels better and is less threatened. Sometimes not. I had a partner one time whose husband would follow us out on calls, follow us pretty much anywhere and in the end we had to get different partners in order for her husband to not be so damn insecure. She ended up being fired when her husband started to confront the patients asking them questions. As for travelling consultants - you are out of town 4 days a week, no-one knows you where you are at so there is tremendous opportunity to get a little action on the side. I can say proudly that I never did anything like that. I feel that my wife trusted me enough to not think I was cheating on her each time that I left to go to massachussetts, florida or wherever. I'm not saying I didn't have the chance I just chose to ignore any temptations. What you choose to do with your partner when you are working with him or her is your choice, there is no-one else that you have to blame if something happens. If it does then it is your FAULT not anyone elses. I am not chastising anyone here but the warning is there. You have to be mature enough to handle your relationships at work and for those of you out there who do indulge in an extramarital affair then that's just wrong. Your husband needs to really understand what your job entails and one way to have him deal with the emotions that he is feeling which he undoubtedly is feeling threatened is to get him to know your partner and let him see that nothing will come between you and your hubby. If you let your marriage falter without working on getting it fixed then you are bound to be on the lookout for hubby #4. This is not something that you want at least I get the feeling it isn't. I have always looked at it this way, If the shoe was on the other foot how would I react and then I would address those feelings. good luck and god speed.

If you are going to wear a t-shirt for work make sure you have or do the following 1. Keep it untucked 2. make sure it is at least 1-2 sizes too small 3. make sure that if you do wear a t-shirt that your big fat belly button can be see when you sit down 4. make sure that yesterdays spaghetti and todays taco bell stains are prominently displayed on your shirt 5. make sure that the blood and vomit that was on the shirt didn't get washed off in the washer. 6. if there are no sweat stains on the shirt then go run a couple of blocks and sweat up a brew. If all else fails, make sure that you at least sleep in the shirt and if you can, drop some hostess cupcake crumbs on the bed before you lay down to sleep. If you follow all the above rules, you will never cease to look professional.

I've always found that putting lasix in their drink, make sure you do it on a really really hot day and on a day you know you will get no rest. Make sure he doesn't get dinner or lunch and make sure he doesn't drink any water or fluids for the entire shift. Then watch for him to pass out err. no wait, don't do that. That's too evil.

The human abnormalities called Kleinefelter's syndrome and Turner's syndrome both result from an unnatural presence or absence of a Barr body. In the case of the former, the male possesses a Barr body that it would normally not have, and in the latter case the Barr body is absent If the female did not have an inactivated X chromosome there would be much more genetic material than men and that would be a problem especially with reproduction.

anti abortion, pro death penalty and PRO PRO PRO euthanasia, if we can put our animals down don't humans deserve a humane death rather than tubes and meds keeping them alive? I believe humankind deserves better than a prolonged uncomfortable death.