Just Plain Ruff

we might want to add the placement of a full body cast for the drunk who can't get up. or full body wrapping like we saw in MASH. Remember Frank Burns the Mummy? and for the really rambunctious drugged out stoned out of their mind, a full course of succ(sic) and intubation. that way they can get calm and we can just leave em be. Reminds me of a story of a stupid provider a number of years ago. I'll tell that story later.

oh one other thing, I forgot to add the bilateral art lines and maybe an esophageal temperature probe.

http://stroke.ahajournals.org/cgi/content/abstract/27/4/737 good article - study done on dogs but relates the changes you are talking about. I was always told that someone with a acute bleed can present with some pretty nasty cardiac rhythms due to the pressing down of the brain on the brainstem. I was also taught that getting rid of the bleed was key to getting rid of the cardiac events but it sounds like the more I read, the more pressing(no pun intended) these problems sometimes do not go away after the bleed is fixed. They stay around. This is why it is imperitive that you monitor a patient in this condition for cardaic abnormalities even after the bleed has been fixed. Another article I read says that many times the mortality due to cardiac events secondary to brain bleeds is pretty high. I'll have to re-find that article. (sorry no source on this one yet)

I'm confused, I'd have done a 12 lead on this patient. this should have had a 12 lead done but............... that being said, i was not there but my medical director would have taken one look at this call and report I wrote and I'd be in their office explaining why a 12 lead was not done. this rhythm actually demanded a 12 lead since you were admit you were unable to interpret it in the field. Now that's not a completely bad thing, this rhythm as pointed out by our esteemed colleagues here is a difficult one to interpret. Without the 12 lead we are shooting in the dark. The 12 lead would have given many additional clues to interpretation not excluding that nice little interpretation written out in black letters on the printout. (don't rely on it fully or exclusively though). Treatment would be dependent on what the interpretation of the 12 lead shows. I'm not trying to critique your handling of this patient (well actually I am playing armchair quarterback) but I think 12 lead would be in my top 3-4 items that I'd have wanted to get done before dropping this patient off in the ER. One other thing, Say I'm your medical director and I reviewed this run. I notice no 12 lead. I call you in the office and ask you one question. "What is your justification of not getting a 12 lead on this patient?" What is your response? If you wish you can reply back to me in a pm. I've been down this road and this question before so I'm speaking from experience. That's my 2 cents, take it as it is given or give me my change. take care. This is one of those cases that the patient turned out ok on but it could have been worse, look at it as a learning experience.

if all you say is true then the medics provision of care should get him fired. Doesn't sound like I'd want to be that medic right about now. No real assessment, letting the emt attend a patient with symptoms of something neuro goin on. Wonder what is medic license is worth right now.

Lee, I'm worried about your future career at that service. Any service that will fire you because the people who you transport cannot pay is a service that is a craphole of a service. To put it bluntly, your service sucks on that aspect. You have no control over what patients you transport will pay or not. How can they fire you for their inability to collect from patients. What I am gathering from your posts is that (and this is an assumption) some in your service will no service or try to push a refusal on a patient who they know can't pay. Sure you can say that never happens but if your job relies on the collection rate from patients then I can see how you might be tempted(not saying "you" in particular - just generalizing You) to push a refusal on someone. this is dangerous. Plain and simple. If you wish to move to missouri, I'm sure I can help you get a job here that won't fire you because they cannot collect on patients.

this should be good. just make sure you share with the rest of us.

that's the protocol for those types of patients. It gets worse for the ones who are faking.

well let's just put two central lines in, to internal jugular ivs, a rectal tube and a foley cath. when in doubt, plug all the holes. put two ng's down him too, and then intubate em. what the heck. The more the merrier

the instructor you referenced should have you running away from that class. The instructor is so off base that I don't think he even understands how far off base he is. I'd pick a different instructor to follow advice from. ONe thing to ask him, will he let you start bilateral 14 ga. IV's on him as a stable patient???? If his answer is anything but no then run away from him. One more thing, I would have someone start bilateral 14s on you so you know how it feels especially to someone who is stable. I can tell you one thing, I'd have chewed your rear end out if you brought me a patient with bilateral 14ga's and you couldn't justify why you started those on the patient. If you told me you just started em because you needed the practice. I'd probably be on the phone with your supervisor or boss. That's inappropriate treatment. remember this website www.malpracticeinsurancecauseIlistenedtocrappyadvicefromadumbassinstructor.com

HOLY CRAPOLA BATMAN - you can get fired if your collection rates on the patients you transport don't pan out?????? So if you have a run of patients who are homeless and cannot pay the bills then you get canned. There is no patient care support in your service - it sounds like if they can't pay the bill then you are urged to no-service them? is that a correct assumption???? If not please correct me but this is one of the scariest posts I've ever read. I am assuming this is a private ambulance service right? You need to run away, fast a quickly from this service. This begs the question, what are the collection agents or billing people like to the people who cannot pay their bills?

go to a community college, take their paramedic course and finance it via federal student loans. If someone with my credit can get a 40K loan for graduate school anyone can. At the time of my masters degree program 6 years ago my credit score was a little under 500. It's now 650 so you can do it.

and with Dust, because of where he's at I think his sweat glands are working overtime day after day. You bein safe over there dust?

think of the Nike ad "just do it"

I worked in a ER for 4 years one stint and then again for 3 years again about 4 years later. I took care of hundreds if not thousands of patients and only the unconscious ones that we could not get a oral or tympanic temperature we took it rectally. All peds from 8 and under got rectals and if the tympanic temp piece of crap gave a wierd reading, ie one that did not jibe with their skin temp versus the reading even adults got a oral or a rectal. Usually we were able to get oral temps on all adults except the notable few. I think rectal temps in the ambulance except peds do not warrant a rectal temp. It's no fun by the way trying to find the hole in a uncooperative child let alone a adult. If any patient is hypothermic or hyperthermic(markedly so I mean) they got rectal temps no matter how old they were. I have to argue the fact on the poster who said every patient got a blood glucose level checked. I don't think that is good medicine but you relayed that your protocols are your's and mine are mine so I'll leave it at that. it's sort of like the career day or the demo at a local day care. we used to put kids on the cardiac monitor until we spotted a abnormality on a 5 year old little girl. She had short runs of svt. Parents were pissed that we put a medical device on their child without their permission. We ended up having to transport this little girl to the ER due to this problem we found. Parents refused to pay the bill until the cardiologist advised her that this could have been a fatal event if left untreated and unchecked. Parents still were unhappy. The service that I was at at the time put a policy out after that saying we could not put cardiac monitors on children with out their parents permission.

Bigger/busier NICU's may be better than smaller ones. Interesting article. http://www.thekansascitychannel.com/health...281/detail.html

There has been quite a bit of discussion over the past year or so and I have a question. This is no way to diminish our distinguished poster wanting info on distance learning of EMS Masters level classes. That is a good post. I'm curious about this We've touted that a minimal education would be an Associates and even better if you have a bachelors So what in the world is a masters in EMS or emergency medicine good for? What can someone do with a Masters in EMS? EMS Admin? or that equivalent? If there is indeed a valid animal called the Master's degree in EMS or Emergency Medicine, wouldn't you be pricing yourself out of the EMS market working as a paramedic or emt? If you have a Masters degree in EMS should you even be working as an EMT or Medic? One other question --- What would the natural progression of education be for this line of training? EMT - Associates(medic) - bachelors - masters???? I'm just curious Dust I'm waiting on your response.

ok ok ok here is the synopsis of the show. Sounds exciting Risk Takers Paramedics TV-PG, CC Imagine driving at breakneck speed, and making split second decisions whether to go through busy intersections with a vehicle full of screaming patients, all while monitoring police, fire and EMS radio frequencies. That's routine, for paramedics. Full of screaming patients and monitoring police fire and ems radio frequencies. Yeah, that's our routine.

Hey Jake wasn't venturi mentioned in a popular song a while back. I can't remember the name but I think some of the lyrics were "Venturi Highway blah blah blah blah" not sure who wrote that song though. (oK OK OK horrible attempt at humor but I heard that song about an hour ago. Its still in my head)

let's not get caught up in the fact that this is an ALS call as the scenario writer did a 12 lead and mentions iv and drugs. I think that since the patient converted back into this rhythm again and we are 5 minutes out and the patient is not in acute distress now I'd notify the hospital that she's converted back and we are 5 mins out. Ask them what they want me to do. Maybe they have the cardiologists right there waiting, they have the OR waiting just in case they need to go and do whatever those cardiothoracic surgeons and cardiologists want to do. If I know the physicians I work with, well enough, they are going to say "wait, don't give her anything else until we see her"

correct me if I'm wrong but aren't kids more susceptible and more receptive to these types of changes? don't they show the results of this type of study more readily than older humans? I think this is a great study, more will need to be done but it seems that some evidence has been shown here that will make progressive and forward thinking physicians, especially medical directors of EMS services, begin to question how their crews treat their patients? If this reduces mortality and morbidity then the cost of retrofitting the many thousands of ambulances and emergency rooms in this country would be worth the effort. I do agree that until this is studied in a more varied age group and the results are similar to the peds age group then the study will be just as limited as the protocols and treatment guidelines that will derive from it.

I don't secure my patients whatsoever. I allow them to get up, grab a soda and sit back down. I've even been known to lay down on the cot and let the patient sit in the bench or captains chair. I often do massages on my patients and serve them mcdonalds when they want me to stop and get them something to eat. all kidding aside minimum of 2 straps, legs and chest. More often three straps and if my cot is set up with the shoulder straps I use them. I just remember a video shown here a while back of a shock comedy show where the ambulance picked someone up. Put them in the ambulance. the patient would then get up out of the cot and they put Rescue Randy the ems doll on the cot and as the ambulance started to drive away they would shove the cot and patient out the back of the doors. That video was so funny.

But doc, it could happen you know. Stranger things have happened.

"BNSF said crews will likely spend much of the day clearing the debris and assessing the damage" That's codespeak for drinking the spill.

Nifty this is why I like you so much. YOu are very articulate and your answer to my questions and statements give you kudos in my book. +10 for that explanation +10 for not getting pissed off at whatever I say. I certainly understand the LZ thing and the drive time thing. We need to get together and chat sometime. drop me a pm.