medic001918

For the best advice, visit an accountant. They can guide you as to what kinds of things can be written off and what can't. I write off any uniform supplies (boots, equipment, etc). I write off a portion of my cell phone bill. I write off a portion of my internet provider (used for required CME's, email) I write off a portion of any new computer I buy (used for CME's, internet, company email). Those are a few that come to mind quickly, but check with your accountant first. Shane NREMT-P

I don't disagree with you. It's been my experience that capnography will give you a better indicator since the two often times (not always) go hand in hand. You always have to look at the total picture being presented by your patient though. Shane NREMT-P

The presence of CO does make the pulse oximetry inaccurate. The CO binds to the hemoglobin the same way oxygen does. The oximeter can't differentiate between the two, and sees the hemoglobin molecule as "fully saturated." Really, the pulse oximeter is only measuring a saturation of how full the molecule is. End tidal capnography tends to be a far better diagnostic tool for respiratory cases as changes are witnessed in real time. Pulse oximetry is about 3-5 minutes behind the patient in most cases. Shane NREMT-P

I have tattoo's that are all covered while I'm at work. I don't consider myself unfaithful or scum. I have a wife that I would never cheat on. So I guess since I have tattoo's...I'm scum. Shane NREMT-P

Should have reported it immediately and had him fired. Or to push the issue, requested a police officer and reported it that way. Shane NREMT-P

I'm going with rapid a-fib, with the possibility of WPW. I wouldn't jump to cardizem to treat this one though, with the chance of that WPW being a problem. I'm going to go with Amiodarone or Procainamide. If you're really not sure, you could always start with the electricity. But if he's mentating well and has IV access, I wouldn't want to go that route to start. I would want to know more about his dig. How long has he been on it? Any recent changes to the dosing? When was the last time he saw his doctor for a follow up? Shane NREMT-P

+1. There really isn't a question here. This is what has to be done for this patient. Shane NREMT-P

Spellcheck checks spelling. It's not a grammar check. Do a little proofreading before posting. If you struggle to read your own post, you might want to retype it to make it easier for everyone else. I know this has been brought up to you in the past, as I'm one of the people who raised the point. You had a good couple of posts after that. But it seems we've slipped right back to where we started. And there were certainly plenty of errors in one of your posts that spellcheck would have caught had it been used. Please represent us as a professional, educated group. You didn't misread. Someone actually thinks this is a good idea to get more people in their service riding. I guess when it's not someone's profession that they depend on to provide for their families, it's easier for them to look at the easy answer instead of the right one. Shane NREMT-P

There's actually a large difference between epi and vasopressin. Vasopressin works only on alpha receptors and has no electrical impact on the heart. Epi has alpha and beta effects, so you'll see an increased electrical activity with it's use. While protocol says they're interchangable, if you give some thought to the patient's problem (electrical, fluid or pump) you can figure out which might lend itself to your given situation. I tend to use vasopressin in VF/VT arrests (since there's an already irritable focus), and I'll use epi in the case of asystole or slow PEA's. Just my two cents. Shane NREMT-P

Actually, we have two towns that do this. Ellington is primarily staffed by their high school explorer program as well, at least during the day. That's even closer to us. Shane NREMT-P

I think a 16 year old EMT in Darien has as good of chance of recognizing anaphylaxis as any other EMT with the same training. The larger questions remains of if a 16 year old EMT has the maturity to handle the things they see and to deal with the public in a time of crisis. Shane NREMT-P

I post from work all the time. We either have staff computers, or wireless for those with our own laptops. Shane NREMT-P

Wonder what their medical control thinks of that? Where I live we can't practice as a medic when we're not off duty. I know in this case it was a family member, but I'm sure this type of things happens more than anyone would admit. Shane NREMT-P

Part of being a paramedic is knowing where to research answers to your questions. Use the search feature and you'll find this topic discussed at great length. Shane NREMT-P

An ALS crew may not have been able to do any more for this patient, but in the presence of a head injury an ALS provider can manage potential side effects of a head injury. Significant head injuries can come with respiratory compromise and seizures to name two big issues. That being said, I don't know enough about this call to make a good decision as to if ALS would have been warranted for this call. It sounds like it could go either way. I might have been inclined to work this patient up simply based on there being people there who know the patient and say that he's not acting right. That indicates a potential injury to me. Head injuries can go either way with signs and symptoms. Sometimes the signs and symptoms will progressively improve with time, and other times they become more pronounced. You don't know which way they will go without waiting. As far as c-spine, we can't spinally exclude someone if they have altered mental status per our protocol. But the whole spinal immobilization issue is a whole other topic that's been discussed. EMS as a whole tends to do it poorly, and more often than is really needed. Without knowing more about the call, where ALS was coming from and your proximity to a hospital it's difficult to say if you were right or wrong. The bottom line is that the patient was transported to a hospital and then transferred to an appropriate facility based on their findings. Shane NREMT-P