funkytomtom

Dispatched to a suicide attempt at a local motel, dispatch tells us pt called a hospital and told them he had taken 200 aspirin and was "tired of living." We arrive and talk to pd briefly. Apparently his story has fluctuated between 2 and 200 aspirin and he is now saying he took 20, "just for attention," and has now thrown them all up. We enter the room, and while my other two partners assess the pt, I look around the room and in the bathroom for any pills, pill bottles, vomit, etc. Nearly empty Aspirin bottle and half full vodka bottle found, I re-enter the main room to assist. Pt's vitals are well withing normal limits (I don't recall exact numbers) and stable. He says he never said he was tired of living, but that he said he was "tired of living in this particular place." Pd contacts the hospital to confirm and hospital states that they cannot as there was no recording. I recall distinctly that when the subject of transport was brought up, pt was adamant about not going, and threw the word "lawyer" around quite a bit. We asked him what he was going to do if we left him, and he said he planned on going to work and was not, and never had been suicidal. He did admit to taking 20 aspirin with vodka however, but didn't see that as a suicide attempt, just a try for attention. Crew leader has him sign a refusal and we leave. I personally consider that a suicide attempt, and was not comfortable leaving this guy alone. The crew was split half and half on taking him in when we talked later. Crew leader says that because there was no hard evidence of suicide on-scene, pt denied, and pd wouldn't take custody, there was nothing we could do. From reviewing my book it seems that this is one of those gray areas where there is no real answer. If we feel he is a threat to himself, we can take him in, although I'm sure this opens us up to lawsuits? Any thoughts?

It wasn't even ABBA haha, it was an ABBA cover band Anyways, I've been reading some of my intermediate textbook before class starts on August 24th, and due to this call I skipped ahead to the chapter on diabetic emergencies, which brought up MORE QUESTIONS!!!! I was reading about hyperglycemia and came across something not addressed in my basic class: hyperglycemic hyperosmolar nonketotic coma. I believe I understand the concept, but these lines gives me pause: "high levels of glucose in the cerebrospinal fluid leads to dehydration of the brain and decreased levels on consciousness," and "it is a relatively common cause of hyperglycemia." How do high levels of in the glucose in the csf lead to a dehydrated cns? Decreased levels of consciousness meaning disorientation, syncope, or all out coma as the name suggests (I'm betting on a wide range)? And it seems to me it is caused by not a cause of hyperglycemia? I decided to post these questions with my previous diabetes question thread...I hope someone sees it! Thanks

The pulse was too faint to palpate radially. BP was 160 over 110. It's hard for me to know all the vitals because I wasn't really "patient guy." Dehydration sounds very possible, it had been in the 90's all day, but about 1800 hours the temperature dropped significantly and it rained for a bit (call at about 1930 hours), this plus the fact she said she had been keeping hydrated throughout the day makes me wonder about all the different possibilities. I talked a bit with the intermediates on ski-patrol I work with and they didn't have much to say except possible dehydration. I don't know if their medical assessments are the greatest because they deal with so much trauma and pretty much ship anyone serious right away. It seems like there is a lack of in depth assessment both places I work, hopefully I get the job on the rig I just applied for! Thanks for the replies, and the obvious thought put into them!

I was working the concert through the venue itself, so we passed her off to the fd, which took her to the hospital...follow up might be hard.

Thanks for the respones, it seems I will never really find the answer, just more questions...but this all helps with my "real world" learning which is great!

Resp rate was normal, pt was diabetic, and I was under the impression (purely from the textbook) that dka needed a much higher bgl, as in over 400 mg/dL? Pedal edema (not so much feet as lower legs, so pedal?) would suggest congestive heart failure or some other problem with the right side of the heart. Thanks for the thought provoking in your response!

So...I have begun to delve into the world of ems and am starting to see some patients (scary I know). I was working a concert the other night (an abba cover band :confused) when we were called to an older woman who feeling faint and self checked here bgl-it came up at about 260. I wasn't the head emt on this particular call, so my roll was relegated to fighting apparently quite painful involuntary muscle spasms in both her legs. They would both extend for periods of about two minutes, relax for about ten seconds, and then spasm again. The bgl level is too low for anything like dka, and she claimed to have been hydrating properly throughout the day...so what gives? If it helps (or complicates) the picture she had some obvious edema in her lower legs that she claimed was "normal" for her. What I'm wondering is the actual pathophysiology...thanks!

Farrah Fawcet arrives in heaven and God says, "Well, you've led a good life and I feel like I owe you one, I will grant you one wish," to which Farrah says "I just want all the children to be safe."

I'm actually enjoying a beer right now, which I don't see a problem with. I'm not driving anything more than my couch tonight either

How does one figure out if they have "it?" Do you even believe in the concept or can hard work and commitment yield all necessary results? Anecdotes?

I blew the same ba 3 years ago. I ended up pleading out to an ARR (alcohol related reckless). I had a stressful first couple of weeks in EMT class trying to get in touch with the proper individual at the local bureau of ems to find out if I would be considered for certification. They said that they would want to set up a hearing to ask me some questions, but that never materialized. I am currently a certified emtb. DO NOT get a DUI!!!!! Try anything you can to plead out to a lesser charge, they will give you a VERY hard time with a DUI on your record. I know many will probably disapprove of me in these forums having said that, and I understand that, I will say that I am a different person and passionate/compassionate EMT now.

Yes...the fact that obama swatted a fly and slightly pissed off peta"proves" him to be a phoney. A beautiful use of logic dust.

I was taught the only compound fracture that you can pull back in is the femur. Funny related story, while off duty biking with my friend the other week, he sustained a compound tib fib. I assessed for pms, splinted as was, and we carried him off the mountain. I got to sit in while the orthopod put traction on it, and it did seem complicated indeed, he had a portable x-ray machine to get everything in place correctly. Feel bad for the guy, out for 4-6 months.

Hahaha...I thought at first this was gona be a thread about an air ambulance. Not encouraging the watching of porn (I would never!) but the video is pretty funny too. On the tmz vid link, everything explicit is blacked out, but still quite amusing..."That was fast!"

The most hilarious thing is that from that conversation I think they would probably do better on their practical exams than much of my emtb class did! There were four or five kids that I would be TERRIFIED to have show up at my scene, I hope the system worked and they are not certified (a little off topic). Anyways, cute story.

I should have heeded your disclaimer, not too glad I read this as I already have a fear of flying.

Pretty boring honestly.

Perhaps it's time to plan not for zombie apocalypse, but for ridiculously over-equipped layperson apocalypse!

ignorant^

Good lord...I just read through a bit of the thread on the acls kit on the zombie killer website. Someone brought up how unrealistic most of these things are and just got slammed by all these whack-jobs.... This is quite the expensive, dangerous, and quite frankly creepy toy. The whole spirit of it goes against the whole responsible medicine thing I'm sure all of us have learned. Good for a laugh I guess, and as long as it keeps the guy sorting in the basement and away from me, I'm okay with it.

Wow, I just re-stumbled upon this thread...leave it to the internet to create consensus right? Well for the record my clinical time was a blast, and I am now an EMT basic. I can see both sides of this argument. I wanted to be helpful as possible, so I went even so far as to clean up a couple of rooms after the pt had been discharged, I imagine this actually falls under the job description of the janitor. But, it WAS noticed, and at the end of my shift, a couple of the nurses and the EMT I worked with asked me for my name so they could write it down and put in a good word for me if it was ever needed. That said, MOST of my time was spent actually doing things, and I would have been very frustrated if I felt that I was being taken advantage of to do things like make beds. I think it is obviously valuable to get medical experience during your clinical time, but if you have some down time, showing that you're part of the team and not "above" anyone else will certainly gain you some credit.

Paramedic mike has some good points. I can't believe that you're all getting up in arms over incompetent henchman NOW! And this dude wasn't even a cabinet level advisor. "Your doing a heckuva job brownie!"

OWNED! Haha...its nice to see reactionary drivel shot down.

recommended for state certification! Also, top of my class of 35! I still have the state written and practicals to go through, but with some luck and a little more practice, I could be certified by the end of next week! This is a shamelessly self serving post and I don't really have any questions, but if you have some advice for a brand new emt (hopefully), I'm all ears. I have a job lined up working summer concerts at a ski resort as an emt, and maybe doing a little bit of bike patrol. Super happy I worked really hard and I beat all those other jokers in my class!

I think Herbie has some great points (and a killer closing line too). I've seen the same thing throughout my school career, it seems that many AAmericans simply do not value the educational opportunities they have been given. It seems much more culturally acceptable for them to be a sports player or a drug dealing gangster. Which gets to the heart of the issue like Herbie and Wendy were saying, why is this such a common cultural phenomenon? I suppose after reading all of this, I still can't get past the fact that we all have the same opportunities. Is it much harder for most AAmericans to do well in school and/or EMS than I? Maybe, certainly not for lack of intelligence, but possibly from underfunded schools and bad surroundings...but it seems the really smart thing to do in that situation would be to study that much harder and laugh your ass off when you end up on top. What are you getting out of complaining? Like Herbie said, we could probably all find reasons to paint ourselves as "victims" and let that define us, or we can answer a higher calling, take stock, shut up, and do whatever is required to get where we want to go.