Just Plain Ruff

give me a break nifty don't get your heart rate up it's bad on your psyche - I meant no offense. But you gotta agree, saying you will haul ass with this patient gives the impression that you would not be so careful. Here is what you wrote "Haul ass to LZ, wait for Medstar 10-97 (arrival), transfer pt, call the hospital, and clean up for the next one" so you are saying that you would haul ass to the landing zone to wait for the helicopter. I'd like to know why you would drive to a landing zone while hauling ass when part of that time driving to the landing zone could be spent driving to the two hospitals that could deal with the patient. Tell me how far you would drive to get to a landing zone? Can you justify driving a certain amount of time to the landing zone, waiting for the helicopter arrival and then the time it takes for the helicopter to fly to the hospital that will take the patient. Wouldn't waiting for the helicopter and your drive time to get there be offset by going on to one of those two hospitals. Second, does this patient really get a choice on what hospital to take her to? what if she says, take me to xyz hospital where you know they cannot treat her, do you take her there cause it's her choice? or do you make a determination that hospital xy or yz are the two that can take care of her and bypass her decision? Even though it's a figure of speech, using it makes you sound like you would be careless. I've had medics and emt's who would drive like bat's out of hell and nearly wreck when I told them to haul ass to the hospital. Yeah, "haul ass" is a figure of speech but too many people take it literally. By the way, how do you know I don't have a phd? Just because its not in my profile doesn't mean I don't have one. Oh wait, that was a figure of speech too. You know Nifty, I respect you quite a bit. I didn't mean for you to take offense at my comments but too many people are careless and when you use a "figure of speech" some of us take it literally, not figuratively. but take it however you want. No need to get your Knickers all bunched up (another figure of speech) we could go on and on.

Dust, that's just too much info. Isn't the don't ask don't tell policy still in force?

could it be that helicopters are called because the medic is overwhelmed or not comfortable with their skills and knowledge that they push these types of patients off on the helicopter crews? I am guilty of this early in my career but you get over it. One thing I'm wondering is do the number of helicopter calls increase due to inexperience level? This patient does not warrant a helicopter. She warrants what most have said, either medications or cardioversion with Cardioversion being the treatment of choice.

That post you referenced Dust reminds me of the Hindenburg recording. OH THE HUMANITY A little overdramatic methinks. You mean you get a second unit if someone is getting tubed? Must be nice to have all those extra resources. And hauling ass to the LZ is inappropriate - that makes you sound reckless - I agree that rapid transport is warranted but hauling ass to me means that you are beyond your skill level and your response HAUL ASS is a reactionary response rather than a response that is appropriate. If you haul ass and hit another car or roll your ambulance then you have bigger problems then a girl with a heart problem.

VS EH the only reason she got all those firemonkeys and medics out there was because they were on TV. The show is total trash and I will not watch it again. What was up with the dead guy and their auscultating something, were they trying to find out when he would pop?

There is a new and improved term out there for this lady DRT---- Dead right there

http://www.emedicine.com/MED/topic1786.htm

the cops would have been the least of that yahoo's worries. Honestly I don't think that this offense is a lawsuit worthy offense. I wouldn't have sued but you can bet your top dollar hat that I'd be getting some free stuff from mcdonalds. Like maybe all the toys from the next 10 series of happy meals. I could sell the entire set to a collector and pocket some good money. Plus free food for a year. that would suffice

Yeah I missed that too. I was looking at the trees man, I swear!!! I didn't see the forest.

Imagine finding this in your happy meal. It's funny because I thought it was but those of us with kids, Me included, would have ripped the dumb arse's head off for putting what he put in the box. Read on: http://www.foxnews.com/story/0,2933,272774,00.html

I love that guy. His characters are so funny. My favorite is bubba and then the old guy. Does anyone know where I can get a compilation of his stuff?

If I am wrong and this is pericarditis, oops I probably just killed or did major harm to my patient, but that is why we practice. I wont mess up next time.. AK that made me laugh so loud that I have people asking me what is so funny. I think I peed my pants.

I'm leaning towards a blood clot - PE secondary to birth control pills.

Doc, it would be a gut decision to make. I believe that I would do it and give the medicine. I may get my arse reamed for doing it but if I felt it was absolutely the right decision to do then I would. Let me turn this around you have a medic who gave thrombos due to a communications breakdown and he brought the patient to you. He had all his ducks in a row and gave em. How would you react?

I'm calling it an MI. I am also going to be following the communications breakdown and going to give the thrombos. If he has no contraindications - relative nor absolute then I'll give the thrombos. in order to do this, I have to be fully sure of my diagnosis and with elevation of leads 2, slightly in lead 3 and definately in AVF coupled wiht the atypical chest pain I'll give the thrombos. As long as I can give the rationale behind my decision to give the thrombos, signs, symptoms, and presentation along with the adjunctive devices that show MI on the 12 lead I feel comfortable giving the thrombos. I have to have a total loss of communication capabilities in order to give the med without a docs orders especially a medication like a thrombolytic. THE LOSS OF COMMUNICATION must (imperitive) be total. If there's any other way to contact medical control and I use the excuse of communications breakdown then I'm screwed. Err on the side of the benefit for the patient and do what is best. Is that what you were asking Doc?

birth control pills would lead me into a blood clot causing this. I'd probably iv o2, monitor and such. Take her to the er. She may just be hyperventillating but let's play it safe.

actually I had several patients who came in to our business office(this was a number of years ago) and paid their bill in full even before the insurance paid. One said, she didn't think his transport should be paid by medicare since it was a simple hosptial to home run. She felt that medicare was for people who needed it. She paid 535 bucks in cash. A very honest and awesome woman. That woman was my Great aunt Louise. She died shortly after that.

true but I'm leaning towards the mi but I could be wrong. Let's see what the cardiac enzymes are when he gets to the ER.

I saw a patient who actually paid his entire hospital bill at least the part that insurance didn't cover. does that qualify for this thread?

The dude's having an MI elevation in leads II, III and AVF atypical MI Presentation. Take him to the hospital following your MI Protocol. ASA, Morphine, IV, oxygen, prep for thrombolytics or whatever else you want to do. Draw some initial labs if you have the equipment to do that and if you have the blood tubes. There has to be some reason he's having an MI, any cocaine abuse history? family history or is it just luck of the draw he got a crappy ticker.

First off Congrats - congrats as for the pants thing - does your employer pay for them? if so then there's not an issue If not I'd go out to EBAY tons of pants on this link alone http://search.ebay.com/EMS-Pants_W0QQfromZR40 for 9.99 you can buy several of each size. I'd go one or two sizes larger than you are now, then 2-4 sizes larger also. you can have a reputable tailor fix them for you. Or for 9.99 you can't beat those prices.

well dust, wouldn't DIB on your terms be dead in bed but he seems to have gotten better so maybe DIB dead in bed isn't correct. For the scenario posters out there. please don't use abbreviations. It's the same argument for 10-codes too. Your abbreviations may not be the same as others have. If you are going to post abbreviations please put their definitions out there in parenthesis or somewhere in the scenario. I assumed it was Difficulty in Breathing but your scenario doesn't mention DIB until the EMS people get there.

Dust, I believe it might be Difficulty in Breathing. But I like to think of it as Dead in bathroom or dead in boat or dead in Ballpark I think she had the following happen to her Her mom yelled at her that morning, she failed not one but two tests, her bff jill is no longer her bff, and her boyfriend broke up with her. I think she's just hyperventillating at some stressor and if we give her time she will calm down. Did the paperbag help?

I suspect the following 1. hiatal hernia 2. GERD Both due to the fact that he took a zantac after lunch and he's starting to feel better as well as the history of this starting after he ate those toxic wings. I have a hiatal hernia and GERD and I get these symptoms all the time. A zantac clears em right up.

That was good.