firedoc5

For me, they were tubed correctly or not at all. Either I monitored the airway or someone I totally trusted did. Had very, very few dislodgings. A new doc (who turned out to be the new Medical Director) and I had a side chat about that. When they were moving the pt. from our cot onto the ER bed the tube did get moved, but not displaced, just got moved up a little. The RT didn't catch it, but the doc was standing right there and he saw it when it got moved. The RT rolled his eyes almost like he was going to blame me. Afterwards I made it clear to the doc that the tube was correct. He said he knew it was, and we became close friends after that. He liked that I spoke up. But for me, airway is almost an obsession. So whether a pt. was tubed or not, they had a patent airway, and I made sure of that. It always burns be when some one is complacent about an airway and does not make 100% sure it's good. Then has excuses why it was not. (I'm jumping off my little soap box now)

So who do I sue for when I had my compression fx of T-7? The nursing home, the patient, the wheelchair mfg., the ambulance serv. I was working for (even though workman's comp. paid, but not everything)? It's ridiculous. And what about all the sprained wrists, ankles, minor cuts and abrasions?

"Comin' Home" - Lynyrd Skynyrd

OUCH!!! In more ways than one.

I think the turnout gear is a little too much. :tongue3:

CINCINNATI -- If there's such a thing as a good time and place to have a heart attack, a Cincinnati man probably had one of the better ones during the Flying Pig Marathon Sunday. Bobby Edwards, 55, was running near mile marker 10 when he collapsed and stopped breathing. But only steps behind him were a group of firefighters and paramedics who were also running in the marathon. Patrick Conrey was running in firefighter turnout gear with a group of Cincinnati firefighters and paramedics to raise money for the families of Oscar Armstrong, Robin Broxterman and Brian Schira, all firefighters who died in the line of duty. That goal quickly took a back seat as the group came upon Edwards. "We rendered aid to him. We found a man who was unresponsive," Conrey said. "We roll him over and realize he's not breathing enough, he's in anagonal respiration. We checked a pulse, there's no pulse, so we rendered CPR," Cincinnati firefighter Kory McDonald said. The group performed CPR until an ambulance arrived, aid that was critical to Edwards' future. "Time is muscle. If nothing is done, what quality of life are you going to bring back?" McDonald said. After Edwards was safely on his way to University Hospital, the firefighters went back to running -- and finishing -- the marathon. "Today is definitely something special. Just Pat coming up here doing what he did for Oscar Armstrong and Capt. Broxeterman's kids. That's special itself, then for us to help someone firsthand in the marathon, it's a good thing," McDonald said. "Today is one of those days I will take to my grave," Conrey said. Edwards is expected to make a full recovery.

Red Bull and those other energy drinks gives me migraines. I never snorted Coke, but I got some Root Beer up my nose once.

No sniping taken. You know what they say, "There are not "absolutes" in medicine. There's always the potential of diverse circumstances. The cuff (top) of the boot was wedged in between the tib/fib, but according to the one doc you handle as an impalement. We did cut the boot off but leaving enough around the wound to prevent the bones from reducing. It was already like hamburger. There was good pedal pulses which we checked very often, especially after any movement. Also had to contend with the hip. (turned in ward). There was not a hip fx. but it was dislocated. Prior to x-rays we were concerned of multiple fx, hip, femur, knee, all down the leg. Turned out no other fx., luckily.

Coming out with the "Speed Racer" movie. Curious to see how it compares to when it was on TV. I loved that show.

"Joy to the World" - 3 Dog Night

I find it hard for a one month old to move around enough to "fall out of bed" in the first place. Even if they do move around a bit, I don't think they can actually motivate enough. The mother must have had the baby near the edge or even dropped the baby and blamed it on a fall. Seen it all too often.

When this was presented to some EMT students in a class I was helping with I had answers of leaving the boot on, cut the boot completely off and removing it from in between the bones, cutting off the sole only. What I was trying to convey to them was to cut the boot off but leaving the top of the boot which was impaled between the bones. Reminding them, "Never remove an impaled foreign object." It didn't occur to some that it was an impalement. But you also want to be sure that the tib/fib did not recess back into the leg, causing more muscular and vascular damage. And if possible, irrigating the would with NS. Since there was minimal bleeding and BP stable. Just one IV needed to be established. Later in the day I ran into the Ortho that did the surgery on him and he said that just the one IV was sufficiant as long as it was at least an 18g. I asked him because I put in a 14g. and debated another IV anticipating surgery. If another IV was needed it would only would have been established for meds. in OR.

I was referring to the field with short term treatment. In my experience we usually had no greater time to a hosp. of more than 20min. Our main concern was to tube the patient, get adequate ventilations established, and try and get PaO2 up to normal or even high levels. If using or attempting to use a CAP and having problems with the CAP itself, then it can be a hindrance that can interfere with establishing sufficient ventilation. In short, it can potentially be something else that can get in your way. I'm not against it's use. If you've got it, use it if you want. Just don't let it interfere with getting ventilations started. I agree on the long term where there is time for changes to occur, especially with a inter-hospital transfer. But even then you are still pulse and resp. frequently.

But to what extent do you cut the boot off?

I'm getting ready to make a trip down to LA to see my folks for about 4-6 weeks. When I get back I'm going to really try again. How is yet to be determined. For me the Chantix is out, I've used the patch with no help, and the lozenges helped but only to a point. So...what now? Fade back and punt?

Lose the weed, NOW. If you are wanting EMS as a career. If you're given just one p!ss test you'd be out the door. I don't know of a system anywhere that they don't have a "No Tolerance" policy. I've seen guys use "crank", "speed", "chrystal", etc. and all it did was eventually was cause trouble and job loss. One common problem in any job that requires long or difficult hours is "uppers" to keep going and "downers" to wind down afterward. Not good on anybody's system. It can become a vicious cycle.

That's better than a dude in a short dress. :puke:

Hx. of COPD and was on 15 lpm O2? How did he respond to the high flow O2? Pneumonia sounds right. Would need x-ray to confirm. Breathing treatment may not have helped in the field with that short of ETA to hospital.

I think your question has been covered in legnth. Just get to learn your acid/ base balance and it'll all make sense. But I wouldn't waste time doing vents. if there is a problem with the cap device itself. Actually I hated using them. If you have them tubed, and the tube is placed right you'll know it.

Jeff (my EMT-I) and I did, the other two wouldn't (wussies). Not a good way for me to help cert. them. We did go with full spinal immob. All vitals normal other than the eradict resp. No chest pain or trauma noted. No meds, no allergies. Note that some mud in leg wound with the compound fx. Top of boot still impaled between tib/fib. Pt. also complain of right wrist pain, slight edema to right hand.

I grew up raising and riding horses so I felt comfortable where we had one call. I had three others with me (don't ask). Luckily my EMT-I was a rodeo rider. The other two, nervous. OK, Call of someone fell off a horse, not uncommon in our area. When we get there. 35yr. old man. Horse slid while making a cut (turn) and laid on his left leg. The same horse and two others running around the pen. Obvious compound fx tib/fib. The patient's boot actually between tib/fib, minimal bleeding. Inward rotation of left leg with shortening. They finally do get the horses out of there. Question, do you give MS for pain at this point? Also, do you do full spine immmob.? Pt. breathing about 24 but hard to assess due to pain. We do put pt. on O2 per n/c. Nurse on radio actually asks how we know that there is a tib/fib fx. without x-ray. DUH! How would you treat and transport? Didn't know to put this here or in Scenarios, but...

That's one reason why the Fire Chief at the time and I were at odds. Guess because I was a Paramedic becoming a Firefighter full time instead of a Firefighter having to become a Paramedic. He didn't like that. And there were others too, not just me. But after I won an award for "Outstanding EMT/ Paramedic" for '89-'90, he really rode my back. And I guess whenever I said that the quality of the EMS will get lower because these guys are going to learn just what they have to and not what they need to didn't go over big.

Been there, done that, a number of times.

That's deep.

"Long Cool Woman in a Black Dress" - The Hollies