Just Plain Ruff

good points one and all. but if the paramedic program is structured right then interpersonal skills should be part of the program. What I'm trying to say is that any bad habits that you get from working at this service will be very very difficult to retrain, not saying that it is impossible but when you get in a rut and who can not say that doing transfers every single day of your work life will put you in a rut. IT will. I'm saying is that if you have the resources to go to paramedic school then use those resources and get your medic which is where you really want to be anyway right? I've worked a transfer service, I know what it's like to run transfer after transfer day after day. Of the hundreds of transfers I did in my one year of transfer work I think I used my skills that I was taught in emt school 10-15 times. The rest of the time it was take one set of vitals, sit back and enjoy the ride to Grandma's nursing home. So to say you are going to get experience when doing transfers I don't buy it. Unless you are transferring really sick people from hospital to hospital which should require a medic anyway the only thing that an EMT is really going to be doing is driving. What kind of experience is that. If you are truly transferring sick people bls then yes you can get experience but I'd bet that this service the person is talking about is one that does transfers from the hospital to the nursing home and back etc etc. There is no real experience to gain from this type of work. If you are working at this service and all you are doing is driving then you can get real life experience driving a big van thru the streets of the city. Not much experience there. Now before those who do this type of job chastise me, I'm speaking from personal experience and also experience from several of my close friends doing this type of work. If you have a different level of experience in this type of work then kudos for you. I still think that you are better served by going to medic school directly after emt school. There are those who disagree but I'd be surprised if there are many who disagree with me.

would the trauma of fighting with the policia be an exclusion though? Just askin!!!! Doc says we have a virtual pharmacy and ED in the ambulance, can we cath the guy is what I want to know

I already know what AK looks like and he fits in fine over there. Hey AK and 5045 what beer did you get?

nope nope nope you aren't gonna throw us with that red herring on his lung sounds, nope not gonna do it.

what is the result of the inclusion and exclusion criteria for thrombos? or can we cath him in the ambulance?

ok, now as a parent, I'm gonna go kill the babysitter because first off she didn't tell me that my daughter got into the pills and second, she didn't seem concerned. After I kill her (which is only figuratively) I'm going to go the DA and ask to file neglect charges against her and then I'm gonna sue her sorry little butt. As a parent, this is something that is very very scary to me. We have two babysitters who we trust implicitly but the first time that we had one of them over was a scary time for us. Putting our child in the hands of another was very scary and we worried the first time but when we got home and our son said "I had a great time" was all we needed. The babysitter in question needs to be set straight.

I found two different games on a website I go to frequently. I'll have to go back and look there but... I can't remember the games names.

The bad habits that you develop at this company will definately follow you. I agree. But..... how much experience can you get doing IFT's as an EMT? I mean really, Sure you can get vital signs and other stuff like putting on oxygen and holding a hand but I take exception to the get your feet wet and then go to medic school. If medic school is your ultimate goal why gather bad habits that will follow you into your paramedic class when you can forego those bad habits and get medic experience in class. EMT is not rocket science, there is a limited scope that you can do and if you begin to do things half assed, which most emt's at transfer services I've seen in the past actually do then you shoot yourself in the foot. If you have the means to go to medic school then by all means do it. Don't waste your time getting your feet wet in a non-emergency transfer service. The experience you gain in this system will oft be wasted for your medic school..

Childrens Mercy hospital in KC MO also has a ambulance service. I believe that they fall under a lot of the KC MO scope of EMS. But since docs and rt's are on board the protocols may not be the same as KC MO's.

Ipecac will still work when she's unconscious. Get the airway secured if you are gonna give ipecac. It's my understanding that most ambulances do not carry ipecac anymore. Too many risks.

One of the key questions that needs to be answered here is what does the vomit smell like. Does it smell like drain cleaner, bleach, wintergreen??? are there pill fragments in the vomit Do we have any evidence of pill bottles that were opened or previously filled and now empty?

Like I said in an earlier post, even though the ibuprofen would be a likely culprit for this overdose there is never any overdose(intentional one) that ever fits the mold of what you would expect. If they say they took one medication intentionally I'd bet donuts to dollars that there is more than one drug that was ingested. The bottles of ibuprofen could have contained Ibuprofen or they could have been a storehouse for any number of other drugs such as tylenol, ASA, narcs, psych meds and many many others. Consider that this is more than likely a multidrug overdose but all the symptoms fit for a very very bad ibuprofen overdose. Treat the seizures, think of RSI since we've given activated charcoal. You need to protect the airway and if she vomits the charcoal and aspirates then she is in real trouble. Protect the airway, stop the seizure and go from there. And remember, death from ibuprofen overdoses are rare(not unheard of though) so if she codes I'll bet it was due to another drug in her system. Remember the valium overdoses you run, don't hear of many straight valium overdoses dying but if they add alcohol to the mix, then it's a whole new ballgame.

what does the vomit smell like? ARe there pill fragments in the vomit?

What happens when we advance the catheter? Is the catheter clamped with the white clamp on the catheter? Could it be that simple??????

logic would stand here but when was the last overdose you ran logical. Maybe the bottles were all half empty and she finished them up today? I can't think of the last time I ran a overdose that was a cut and dried overdose. There are always nuances but if you look at my symptoms I listed she is showing some pretty hallmark symptoms of an ibuprofen overdose. The activated charcoal is not gonig to hurt her and it will only hurt you if she pukes all over you because then your uniform is ruined. But I can remember a overdose I ran once were the patient took one pill from each of his bottles over a period of 5 hours. It didn't help that he was a holistic healer and he had over 2000 pill bottles of different stuff. He said he took 1 pill from each bottle. logical I think not. He died. And the nurses were really pissed that I brought in all 2000 pill bottles. Sure some were the same but that didn't matter to this guy. We ended up coding him about 15 minutes into the transport. I've never seen such an overdose so I'm going to run on the assumption of that she's an overdose and keep a high index of suspicion of this being an overdose.

ok, she's overdosed on Advil for starters and I'll rule that out later. I'm gonna get her (if she's not already on it) 15lpm nrb IV At least 1 here are the symptoms of ibu overdose Some more side effects are unsteadiness, blurred vision, ringing in the ears, gastrointestinal, nausea plus vomiting, diarrhea, stomach pain, probable loss of blood in intestinal areas or stomach or both, headache, agitation, drowsiness, incoherence and confusion etc. Sometimes more serious symptoms are also noticed in some victims though very rare such as seizure, gastrointestinal bleeding, metabolic acidosis, respiratory depression, hyperkalaemia, tachycardia, atrial fibrillation, coma, hepatic dysfunction, renal failure, cyanosis, and cardiac arrest etc. Until and unless the victim is allergic to ibuprofen, there is a slim chance that the victim would die from Ibuprofen Overdose. I'm also gonna give at least 1 bottle of activated charcoal in the ambulance only and ONLY if her airway will allow it. I have been doing some research into this type of overdose and deaths are not common but we have to go on the assumption that she has taken other drugs with this. So even though death from ibuprofen is uncommon drugs that are mixed with ibuprofen will be the cause of her death if she dies. So get the charcoal on board and get to the ER. Treat seizures if they occur treat airway problems if they occur Treat any other problems as they occur.

is she on birth control - I'd consider those nasty clots that Birth control pills have a tendency to throw. We can do everything in the ambulance we need to do so let's just get her goin.

I always prefer intubating in a controlled environment and the area behind the ambulance is much more controlled than inside the ambulance going 65 miles per hour down the road. If the time it takes you to intubate the patient is going to make the scant difference between life and death for this guy then he's dead already.

why don't we first advance the catheter in just a little bit to see if the catheter is kinked or not? That woudl be a first step before we consider removing this catheter.

First jigsaw puzzle - for your review and fun times. If you can solve this one in less than 25 minutes I'll buy you a soda. http://www.emtcity.com/phpBB2/dload.php?ac...amp;file_id=135

I have a new computer program that will take a picture you have and convert it into a jigsaw puzzle. If you have a picture that you would like converted into a jigsaw puzzle please send it off to me at ruffems@gmail.com and I'll convert it. It will be in a .exe file where you can run it. You can even specify the number of pieces that you want the puzzle to be. I recommend less than 100 pieces but I just finished a 365 piece puzzle and it was lots of fun. Let me know. again send the pictures to ruffems@gmail.com if you want them converted to jigsaw puzzles.

have you ever felt a shock from the collar? Think stupid people tricks and you will get a picture of my wife's brother and a shock collar.

http://cbs4.com/video/?id=60601@wfor.dayport.com it appears that he was being given mouth to mouth when the first group got to him.

I hope by my previous posts that it was not misunderstood that I told the patient what it costs for the trip before we transport. I always told them if they asked but I never volunteered the info. I say if they ask you tell, if they dont' ask don't tell. But for those frequent fliers who you know are faking - ham it up. tell em that the service charges XX dollars and if you don't pay they wont' transport anymore. Tell the abusers that there is a credit limit for the services we provide and if they go over their credit limit then they have to pay cash or no go. This works really really well for those who are so drunk that they can't see straight. I hope you recognize the above was a joke?

whoever told you to not discuss the costs with a patient was a idiot. In fact, your service should be providing you with that information for the patient if they ask. If anyone uses the cost of the ambulance bill to be a aid to get a patient to refuse is out of line. I know it's never happened right? I always tell the patient and I've even gone down the road to list out our prices and show them what their approximate bill would be. You see what the price of gas is, you see what the price of the gallon of milk is and we know what the price of a car is so why not know what the price of the ambulance call is.