Just Plain Ruff

This guy didn't get a butt enhancement from some backstreet clinic did he? You know to make his ass look like a movie stars? Did they inject cement or something in there that they shouldn't?

yep, big city on the way. Do we have the ability to get a third person to ride with us just in case we need em? Be nice to have a second set of hands when this lady decides to shit the bed on us35 minutes out.

I'm no expert, but that sure looks like elevation in 2 3 and aVf and I'm thinking that we might want to begin to be a little more agressive with this lady. Sounds like a MI induced vagal plop to the bed.

My thoughts are that if you are that unsure of yourself, a good quality refresher course might be in order. OR.... if you know of a particular kind of patient that you are specifically haivng issues with, why not schedule some time with some specialist that you trust and work out some specific scenarios. I was specifically troubled by sick respiratory peds patients and I set up some time with a pediatric resp therapist and shadowed him for a couple of shifts and he put together some really good educational materials for me. It worked wonders. That's if you can get access to this type of thing. I would bet your medical director could help you out in this.

I mean if the OP isn't going to come back to clarify, then I guess it's up to us to do so, right?

Depends, is this internship above and beyond the clinical hours(eg 48 hours ICU, 120 hours ED, 480 hours ride time) required for the course itself?

This is actually the story guys This is an off the books operation to go hunt al quaida. It's an elite group of super soldiers going into the extremely hostile highly volatile terrain of the Byers Peak in Colorado. The are worried about avalanches and the occasional rabid squirrel and chipmunk. The mission is so secret that they can't even tell their CO's because well it's buried so deeply classified that if word got out (damnit word got out) that cats and dogs would be running rampant in the streets (see image - . http://www.google.com/imgres?safe=active&biw=1600&bih=703&tbm=isch&tbnid=Z63zI5X3usC6uM%3A&imgrefurl=http%3A%2F%2Fthetravellingvet.com%2Fworld-vets-cusco%2F&docid=B0PX0gGKkyxDNM&imgurl=http%3A%2F%2Fthetravellingvet.com%2Fwp-content%2Fuploads%2F2013%2F09%2FDSC_0454_3.jpg&w=553&h=700&ei=cZ8HU4mDAYfI0gHCrYGgDw&zoom=1&iact=rc&dur=1390&page=4&start=70&ndsp=24&ved=0COUCEK0DMFo) The current group of soldiers includes Captain America, The Green Lantern, Aquaman, Wonder Woman, Iron Man and the elusive Batman (of which no one has seen the OP and Batman together in the same room so they might be the same) and it includes one very seasoned off duty emt with absolutely NO freaking experience in wliderness medicine or watching out for avalanches. But if a small booboo or scrape comes along to Captain America, Super EMT's got it covered with his Super trauma pack, which you can find here (http://www.google.com/imgres?start=126&safe=active&biw=1600&bih=703&tbm=isch&tbnid=t-oTzmJoxWsCJM%3A&imgrefurl=http%3A%2F%2Fwww.onesixthwarriors.com%2Fforum%2Fsixth-scale-action-figure-news-reviews-discussion%2F633486-ccs-random-wips-01-07-sewing-pouches-why-god-why-2.html&docid=UVAlIpce_cMfrM&imgurl=http%3A%2F%2Fimg69.imageshack.us%2Fimg69%2F6362%2Fdsc06428jj.jpg&w=1280&h=960&ei=V54HU7jBEui80AGc7YDwAg&zoom=1&iact=rc&dur=9703&page=6&ndsp=28&ved=0CHIQrQMwJDhk) Air Evac will not be an option for this elite team of warriors but the USS Enterprise will be on standby to use their transporter and sickbay on as as needed basis. Go get em tiger, The fate of the world is at stake and your team is our only hope. Just make sure you don't wear a red shirt like one of those Enterprise Ensigns wears when they go on a away mission. You do know what happens to them dont' you?

My thought is that this guy has WAYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYY to much fiber in his diet.

Actually what would be worse is being the guy who was the loser of the very First Darwin Award.

I already asked the question, but he/she hasn't returned.

Yeah, I've had that one guy too, put a bunch of birdshot in his brain and nasal cavities. Not nearly a lick of blood anywhere. Or the guy who get's killed by "the mafia" with a .22 cal bullet to the base of the skull and all you have is an entrance wound with no exit but someone just as dead.

Don't forget they need to be whistling dixie when they are shot, that way they suck all that blood back in. I remember a training video we were shown, titled "Da bloodless gunshot wound, they do exist" by PDiddy and Big Momma, you can get it on Netflix under "Urban legends and all things great and small"

Either or, this just looks like something you would say "HOLY F"

Yeah, we are much less likely to walk away from the traumatic arrest because of the urgency honestly. Many times we do witness these arrests and we can't walk away from em.

just poking the bear

I think that this is a huge grey area and you need to discuss this with your medical director prior to it coming to the situation that it did like the one I had personal experience with or you will be following protocol which will always say until the laws are changed "work the unconscious patient". It's a good discussion to have sooner rather than later. But to answer your question Stamey - if you treat the pt against their will that's bad if it goes directly against their wishes, If they expressly tell you not to treat them, and you do it anyway, that's bad mojo unless you have a good compelling reason and can back it up by your protocols or state laws. If the patient tells you no then no means no. I'll let others chime in.

Doc did you get patient permission to post his picture? :):):)

Wheres the original poster to let us know more of what his question is about. There's got to be more to the question especially with a forum name like Researcher. I'll bet he's writing a book about bloodless wounds. Come on back OP, we're just having a bit of fun with your question, it's nothing personal. Or maybe it's some bloodless massacre of your question.

yeah, the physician and I had a long discussion over this call. It made it to our hospitals m&M conference. The ED physician backed up his thoughts and the patients personal physician also had no issues with this outcome. nor did I. Again, what changes other than their LOC? But I'll bite Doc, you have a guy who is pinned under a steel beam, crushed from pelvis below. you tell him that there is a good chance that he will die when the beam is lifted off him. He opts to have no treatment done. He's right with the lord and whatever other gods he worships. You lift the beam and he does indeed code. Do you work him? The only thing again that has changed is his level of consciousness. He went from alive to dead. Did his mind change? now if he said when the beam was being lifted off him to save him "I don't wanna die" thats a different story. But he already said don't save him. For this one I don't see a gray area.

What a question. The patient when conscious could give informed consent yet the minute they go unconscious they give up that right. What changed? the only thing that changed was their going unconscious. If they remained conscious they would remain refusing right? I'm all for a patient being able to make their own decisions. I had a case just like this. Critical CHF'r patient. He adamately refused me to even touch him. He said he was ready to die. No one could talk him into going to the ER. I called the ER doc and we discussed this and both of us came to the conclusion that when he went unconscious that we would continue to honor his wishes as nothing changed other than he lost consciousness and that if he were conscious his decision would be the same, to let him die. Well he did code and we did not code him. His daughter actually thanked us for not working him. She said he had been ready for weeks and so was she. It was the right thing to do.

Was the question a serious question? I mean a bloodless gunshot wound is like an Artesian, yep I've seen em.

And to think, it sounds like the originator of the program, Shepherd Center will do whatever they can to help you get this implemented in your community. It may cost some money up front though. I'm sure some knowledgeable grant writer can write up a grant proposal to get you money to start this from some federal agency.

Probably a school that has a focus on nursing but decided to offer a paramedic/emt course as well. It's probably run by nurses and not medics etc and what's good for the nurses in the program is good for the paremedic/emt students. I have a friend who went through that type of school. He said that the medic students always got the short end of the stick. The program that he went through was a pilot program and it's no longer offered.

This article written by a firefighter who suffered a traumatic brain injury and overcame such an injury is really good. It seems like a plug for a program but the underlying theme is to get you to think of how your agency deals and rescues disabled people. I've never thought of in the service area where I used to work we knew where most of our disabled people were, sequestered in nursing homes and extended care facilities, in homes with handicapped ramps and other assistive devices but in my coverage area it was not a surprise to respond to a home where the person was disabled and we did not know it until we got there. How do you respond to them? Can you get a database built around this type of thing and provide better care by moving resources into play when a call comes into that disabled persons home. many times a 2 man crew(just like we used to run with) didn't cut it and we had to either wait for additional resources or get em out the best we could. It would be a great boon to have a database where people were listed with what type of disability and what resources would be needed to respond to them. Those are my thoughts. But kudos to this guy to come back from the injury. Please read and discuss. Link: http://tocmsspp.umm.edu/sites/CBTransformation/SitePages/Home.aspx?RootFolder=%2Fsites%2FCBTransformation%2FShared%20Documents%2F08%2E%20Testing%2FTest%5FScripts%2F1%2E%5FApplication%2DSystem%5FTest%2FASAP&FolderCTID=0x012000E47B3F314980664B9F03A0726A1A1517&View={283A74ED-A487-4239-9915-5BB6C824BB50} Full text: Now, About the 56.7 Million - Better Rescue of the Disabled by Mike Kennedy “According to the Federal Emergency Management Agency (FEMA), “People with mobility impairments represent a segment of the population with one of the highest risks of dying in a fire.” Based on recent U.S. Census Bureau information, this represents about 21.2 million Americans.” “According to incident reports filed by local fire departments, physical disability was a factor in an average of 380, or 14%, of home fire deaths per year between 2004 and 2008.” - National Fire Protection Association Fire Analysis and Research Division (1) Had anyone asked me before November 1st 2013 to guess how many people in the United States were disabled, my answer probably would have been a vague “not very many” or “a very small percentage.” To me that answer is not surprising because before that day I wasn’t disabled and I submit that most of us tend to think that way. However, on 1 November, I suffered an accident that left me disabled. Before November 1st 2013, I would never have believed that in 2010 there were an estimated (2) 56.7 million disabled Americans (3). According to a U.S. Census Bureau report by Matthew W. Brault and issued in July 2012, 38.3 million have disabilities that are categorized as severe. The Census Bureau report categorizes severe disabilities into three categories; communicative, mental, and physical. Severe communicative disabilities include: 1. Blindness or difficulty seeing. 2. Deafness or difficulty hearing. 3. Difficulty having their speech understood. (Also see in this issue, “Q&A with Tracy Wallace”, an article on Aphasia here) Severe mental (cognitive) disabilities include: 1. Learning disability, intellectual disability, developmental disability or Alzheimer’s disease, senility, or dementia. 2. Some other mental or emotional condition that seriously interfered with everyday activities. Severe physical (mobility) disabilities include: 1. Use a wheelchair, cane, crutches, or walker. 2. Have difficulty walking a quarter of a mile, climbing a flight of stairs, lifting something as heavy as a 10-pound bag of groceries, grasping objects, or getting in or out of bed. 3. Arthritis or rheumatism, back or spine problem, broken bone or fracture, cancer, cerebral palsy, diabetes, epilepsy, head or spinal cord injury, heart trouble or atherosclerosis, hernia or rupture, high blood pressure, kidney problems, lung or respiratory problem, missing limbs, paralysis, stiffness or deformity of limbs, stomach/digestive problems, stroke, thyroid problem, or tumor/cyst/growth as a condition contributing to a reported activity limitation. How does your agency rescue and treat someone if they cannot see, hear, or whose speech is difficult to understand? How do you know that those needing rescue and/or treat have severe disabilities? Train and Prepare to Respond to the Disabled One program to assist responders and those with disabilities was developed by a partnership between Shepherd Center, a rehabilitation hospital for catastrophic injuries in Atlanta, Georgia, and the DeKalb County Fire Department, DeKalb, GA., to create the RESCUE program. This is a community service program providing home alert labels and education for people with physical and or cognitive limitations who find themselves in emergency situations. The mission is to aide in quicker response times and creation of better emergency plans. http://www.shepherd.org/resources/rescue This program can be duplicated and implemented in your local community. The program resources include a sticker to be placed in a visible front window of a disabled person’s home, an information card, and a letter the disabled person can give to the local fire department. Shepherd Center can help your community start or implement a RESCUE program, regardless of where you are located. For further information, additional stickers or to implement a program in your community, please email Tuwanyo Willis: rescue@shepherd.org. Additional resources: National Fire Protection Agency- www.nfpa.org/disabilities A detailed Personal Emergency Evacuation Planning Checklist can be found at this website. United States Fire Administration www.usfa.dhs.gov This organization will mail complimentary pamphlets including “Fire Risks for the Mobility Impaired” and “Protecting Your Family from Fire.” National Fire Protection Association www.nfpa.org You can find a copy of the “Personal Emergency Evacuation Planning Checklist.” American Red Cross www.redcross.org/services/disaster/beprepared/disability.html Home Use Devices: How to Prepare and Handle Power Outages for Medical Devices that Require Electricity. A guide from Texas Governor Rick Perry's Committee on People with Disabilities and FEMA's Office of Disability Integration and Coordination. http://www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures...