Just Plain Ruff

Ok for my mantra - you can all use it if you feel you want to whit wants a manhattan I'll take either Chocolate, or Gold Haribo Gummy Bears(8 ounce bags and lots of em) or Barbeque Who else?

I think I can see the holes in and through your argument but I digress

Yeah that's my new mantra but our signature block is not long enough to include it here. So I'll just continue to cut and paste it. as a matter of fact I've got a chocolate bar in my hand now.

And did we really save them? I ask just what the heck did we SAVE them from? I've always thought of death as something we all do. It's really the only thing we all get to do. It used to be death and taxes but some of us don't pay taxes so all we are left with is death. I have been comfortable with my impending death, may it be tomorrow, next week or in 40 years but in the end I'm fully prepared to go and be with my maker. I don't want to be saved if after working in this line of work, I've seen what some of my end results are. Up till about 6 years ago I transported on a routine basis what the end result of one of my "heroic" efforts was. We transported a ventillator dependent 28 year old who I "saved" from a trauma code. It did him no good to be saved. I often wonder what we are saving these people from. My family knows my wishes and they have said they will abide by them and if I ever code they say they will not resuscitate me but it might be different when it happens. I have a living will that is very very specific to a good many things. I've taken my EMS Experience and put it in the living will. I just wish everyone was as prepared. I've decided that this is my Mantra from here on out Life should NOT be a journey to the grave with the intention of arriving safely in an attractive and well preserved body. But rather to skid in sideways, chocolate in hand, body thoroughly used up, totally worn out and screaming "WOO-HOO what a ride!"

A ROSC is someone who had return of circulation but also may have eventually died. A save is someone who had an arrest and survived to discharge. My opinion of a save is one who left the hospital with minimal function loss. Someone who leaves the hospital a Ventillator dependent person or someone with significant loss of function and a large decrease in Activities of daily living I don't classify as a save. Did we do them any good?

ok PQRST SAMPLE

Ask the child if he got hurt in the spine/back during football and find out where he hurts. If he has pain in t7 or so then I'd suspect more strongly my last post. ok, how bout exam questions HEENT: exam shows? Neck: exam reveals Chest: exam reveals Back: exam reveals: Abdomen: exam reveals Pelvis: exam reveals Cardiac/resp: exam reveals GI/GU:exam reveals Extrem: exam reveals - are his fingers only affected or is it the entire hand? ask where did this cyanosis start - the fingers first or hands or did he notice? this is a biggie on the line of questioning in my opinion. Skin: cyanosis anywhere else? lips, ears, toes/feet?

is he on any of these meds or has he gotten ahold of any of them and took them?? Amiodarone Certain medications Dapsone High nitrite ingestion Ingestion of nitrates Potassium chlorate poisoning I'm probably going to far in my posting and taking it to extremes but does he or his family have a history of any of these? Cyanosis as a symptom include: Atrial septal defect (ostium primum) Cirrhosis of liver Ebstein's anomaly Eisenmenger's syndrome Fallot's tetralogy Hydrogen sulfide Patent foramen ovale Phlegmasia alba dolens Pulmonary valve stenosis Transposition of great arteries Tricuspid valve stenosis Ventricular septal defect I'm really leaning towards this until more info is posted Posttraumatic Sympathicotonia and Raynaud's of the Hands Secondary to Thoracic Outlet Syndrome: The "Blue Hands" Syndrome

History especially history of Raynaud's syndrome???/ Meds allergies last meal was he painting at all during the day? was he outside does he have anythign like a rubber band or something like that around his hands? Pain in his hands? what have they done for this so far? Vitals pulses in the wrists? Pulse ox Check cardiac monitor Transport to ER unless you call the ER and they say go to his doctor's office. But from what I'm reading if this is Raynauds, this isn't something that we can do anything about in the ambulance

We recently had a heated argument/thread over idiots and I'd like to add this one to the bunch of bonafide idiots http://www.msnbc.msn.com/id/16298599/ i'd also like to ask the question, why didn't someone who was in line with her stop her and say "What the F are you doin?"

Timmy, are your rave events different than those in the us? Usually when someone says Rave they mean an undergroud party with drugs and sex and all that. I think our terminology is different as we in the states would never know when a rave was goin on until either a dead guy call came in, the police raided it or one of our kids needed to be picked up and brought home. Tell me what your rave's consist of?

That is so funny and so true. I always say -- Better living thru chemistry

The only codes that I consider success are the ones who walk out of the hospital. Those that I get to the ER witha pulse but still die are not successful codes - they are dead dead dead. I had one lady who arrested in our ambulance, 2 shocks later , cpr and meds in the er and then flown to a cardiac center and she went home a week later. That in my book is a success. Ventillator dependent vegetable is not a success.

Hey NS I'll bet the guy in handcuffs goin to jail wishes that there was a 1/2 arrest and 1/4 arrest. But yeah, if i'm bringing a patient in the er I'll say cardiac arrest or resp arrest but being on the other end, many nurses and physicians after hearing that the ambulance in bringing in a cardiac arrest will say "The guys are bringing in a code" or something like that. You hear code more often in the hospital than in the ambulance because that is what they call arrests, Codes.

no what it means is this Patient at the nursing home needs to go to the hospital. The nursing home will call 911 and say the patient needs to go to the hospital for chest pain or something. They also say Oh he's a full code meaning that he's a full code on the chart so if he codes you have to code him. goodness could I have said code enough coding times? Does that cryptic code make sense?

It sucks when someone deciphers your handwriting. I like to think that as a profession us EMS'rs have better handwriting.

billions and billions of loans to third world countries and not much paid back They all seem to hate us but they sure love our foreign aid and loans. I'll bet they'd sing a different toon if we stopped giving out all this money.

I think the negatives outweigh the postitives when it comes to Hortons. I've worked in a service with 11 hortons and another with 5 hortons and in any given week at least 2-3 of the 11 were out of service. There are better ambulance manufacturers out there.

ok, thanks for that clarification AK I don't have a issue with Emt's starting iv's as long as they have been trained in doing so. I do have a problem with them giving anything but a small number of meds. Albuterol, aspirin and the like. But nothing more than that. Territorial, no, I just think that this is asking too much of them. Nifty, after AK explained it and my looking it up on the florida depart of EMS page http://www.fl-ems.com/EMT_Paramedic/EMTParamedichome.html I have a better handle on what florida allows. no offense intended in disputing your claims.

so AK as a basic in florida are they allowed to start iv's I'm still skeptical If it's a county thing then wouldn't he be practicing out of his scope as an EMT starting iv's?

Brock, you are absolutely correct. I can tell you for one thing - if it's between my license and another person's license you can bet that I'm gonna cover my ass like heck(don't want to swear twice in one post). The scenario was this - the emt pushed the morphine, the medic lied about this on the report. That is WRONG And I'm not sure why this is such a hard thing to understand. But then again it might just be me. And Nifty, it is hard to detect sarcasm in such a post as yours. But I do apologize if Florida does allow iv starts by emts I did not know and unfortunately assumed that as an emt you could not do that type of skill. Kudos for florida for allowing that. But we're not really talking about iv's here are we are talking about a medication that many if not all emt's are not trained to give at any time. That is the issue we are talking about.

NiftyMedic What Kool Aid are you drinking Your attitude is disoncerting. You are off base on quite a bit my friend: This is why we have a "shortage" of medics. ---- This whole forum reeks of the "Paramedic God" attitude. Your reply reeks of "I'm an EMT And I can do anything I want to, to hell with the rules" What is the difference between ALS and BLS in a trauma scenario? The difference in a trauma scenario is that as a medic I can start an IV, give medications if needed and insert an ET tube. I can also watch the heart monitor also and treat those rhythms that are not conducive to life for very long. so my friend there is a significant difference between ALS and BLS. The ALS provider can watch a heart monitor and push medications. Yep als providers can watch the heart monitor and do something about it if we need to. All an EMT Can do is watch the heart monitor and tell the driver to "Go faster" BLS Provider can : Insert Large bore IV's in both AC's running wide open with Ringer's ( oh wait a minute but thats an ALS medication right? Don't just exclude the narcotic's if your gonna be pissy about MS then you might as well be pissy about Ringer's or NS.) ---- You are wrong there - in the US starting an IV Is a ALS intervention - don't tell me that down in Ft. Myers you can start iv's?? We're not being pissy just about the MS, we are pointing out the fact that it's out of the EMT's scope of practice to do anything that is considered ALS We'd be making as big a deal if it was a IV start or a manual defib also. It also revolves around the fact that the medic lied and falsified his report. Saying he did something ALS when his EMT actually did it. You really need to re-read what some of us are pointing out. Airway Adjuncts and/or suctioning the airway in case of respiratory failure or compromise --- YEP BLS Use BVM to ventilate p/t. ---Yep BLS Splinting and immoblization in life threating and non life threating instances ---- YEP Bls Rapid GCS assessments ---- Yep Bls Shock and Hemmorage Control ---- yep bls Can apply an AED in instances of trauma arrest, in which pretty much the only thing in a trauma arrest your gonna give is the fluid challenge, normally the p/t is asystole to try and fix why the heart is not beating. Unless it's V-Fib or V-tech pulseless, then it's your current ACLS protocol, which is ALS (watching the monitor for heart rhythm and giving ALS medications) ---- VA-fib and V-tech(spelling) are als and all other rhythms are not als rhythms Where did you get that from? The most important thing a trauma p/t needs is what? Rapid transport to a facility with the necessary surgeons are on staff awaiting p/t arrival. ( aka Golden Hour) ---- No one disputes this fact But I bet in instance's where you state in your report that you administered NS or LR at the appropriate rate with an appropriate size IV but in reality the EMT (BLS) spiked it, aligator clipped it to the IV hub and let it rip while you (ALS) were trying to maintain airway, while fire was boarding the p/t. (OMG, thats lying on a run report). ---- I believe the EMT Can spike a bag of NS Or LR. Aligator(again spelling) and letting it rip (what do you mean by this??) IV STarts are ALS and I've never nor will I ever let an EMT start an iv that needs to be started. Stop with the God attitude it's making the rest of us sick over here. (puking noises) ---- and your ranting about things above reeks of I'm better than anyone here. Everyone does it one way or another. For you to deny that you've seen it or let it happen just means your too naive to have a real open mind. ---- NO ONE is denying that it happens. and to say that those of us who deny it happens or have let it happen is elitist because you have no clue about many of us here. Kudos to Dust, should it happen no. Does it happen, Yes. But to deny it when in stances a medic could be busy with something else, Shame on you. --- and yes nobody is denying that it happens but I can count on one hand with 3 fingers missing the amount of time that I've been told of a co-worker letting someone of lesser certification/licensure do an ALS skill. I don't really believe that you Niftymedic are really posting here in sincerity. You're attitude disturbs me. But don't sit there and bitch about when that EMT that sits right next to you and watches your back and life to make sure you go home at the end of your shift is in charge of a 80 y/o with "flu" like symptoms, who could use NS or LR to perk up b/c of dehydration, her sat's are borderline and she has some junk in the lower bases (possible pneumonia) but you don't want to treat her and you leave it to him to treat the p/t. While you sit up front and drive blaring the radio at 0330 AM on a Sunday morning sipping a nice hot cup of Joe and it's 28 degrees outside. Wow that last paragraph is a doozy Nifty. Are you saying that you had an ALS patient and your medic did not take care of her and left her to your ultimate wisdom? You say she could have used a IV of NS or LR? Did you start that IV on that patient? IF you did you broke the law. Don't come here and spout off the old PC term of EMT's save medics - that old and a stupid saying. I think that you have a lot to learn and to come here bashing and making outlandish statements as to being able to start two large bore IV's in the AC's. Go back and read your state standard of practice rules and what Florida allows emt's to do and what are als versus bls skills and then take a look at what the penalties are for going outside your scope of practice. You really scare me with your attitude. At least I don't get down to Fort Myers very often, I'd hate to be treated by you who obviously think it's ok to practice outside your scope or your lazy fat bottomed medic partner who put you in back with a patient who qualified according to your description for ALS interventions.

so you don't see a problem writing on the report that you did the als advanced skill? or gave an als drug but yet you didn't but your emt did. do you let your emt's start iv's? do you let them defib how about intubate? You are playing with fire my friend and in the end it will bite you in the ass. do you not see where you are wrong in this instance? When you get caught, and it's not just when But that you will get caught, I have a couple of friends who manage a mcdonalds or taco bell that you could probably get hired on at. I've never let a basic nor a medic student do advanced level skills. Unless the medic student is on his clinicals.

Stcommodore, no it probably would not have touched his pain but what happens when the patient arrests after given MS because he was allergic to it. How would you deal with the issue then?

These mystery shoppers are like consultants. there is a saying "Consulting, if you are not part of the solution there is plenty of money to be made in prolonging the problem"