HERBIE1

What are your concerns about this instructor? Are they clinical issues, skills issues, or is this a personality clash? Tough call- unless this is a safety issue, clinical judgment problems, or is this a personality clash? I guess you need to ask yourself what you hope to accomplish by an "honest" evaluation or critique? Will it address and/or correct a serious problem, or is this more of a personal problem? If you plan to move ahead, I would be as objective as possible- specific examples to support your opinions and claims, and try to leave any personal opinions out. Either way-tough call. I would say that unless this problem is a deal breaker, I would bite my tongue. As you say, this could seriously impact the remainder of your time in school.

I would treat the wheezing, and reassess the lungs often. I would also ask how long his ankles were swollen. If they just got big in the last few days or so, then clearly it's an issue. He may very well have rales but the sounds could be hidden by the wheezing and/or diminished lung sounds. Often times I have had folks where I only hear wheezing, but after albuterol they open up enough to the point where you can hear the rales. A good indication would be if the broncodilators did little to alleviate his SOB, my suspicions would be leaning more towards failure. He was normotensive, so I wouldn't be as concerned about acute heart failure. Were his other joints(knees, wrists, etc) just as "chubby" as his ankles? Sounds like your guy simply liked to eat. As for describing his size, I would simply say in my comments(PRN) something like "A 45 year old, 150kg male found sitting, with moderate to severe resp distress..." That way you state right off the bat the person's size, and it would be obvious he was obese. Most forms have a space to list a patient's weight, but if you also include this in the comments, you emphasize a fact that is pertinent to the exam.

I know the area well. Beautiful area- Giant City( The lodge has the best fried chicken and dumplings in the world), Devils Kitchen, Lake Kincaid, - had a great time down there. I'm at the other end of the state now. Ever go to Buncombe? There used to be a small general store there that sold shoes- specifically cowboy boots- from a back room at greatly discounted prices. (Apparently they would "find" shipments that fell off trucks. LOL) Back then, it was one of the coolest small towns I had ever seen. I really need to get back down there and see my alma mater- SIU. It's been too long.

Very true, Richard. Problem is, unless you are going into an area that is high crime, and known for issues, it may be hard to foresee a problem. As anyone who has been around for awhile knows, some of the worst problems come at the times when you least expect it: A domestic breaks out at the scene of a medical call, you get caught up in some peripheral issue that has nothing to do with your call, or a family member/friend/bystander decides that messing with you is on their to-do list for today. In a "safe" area, we tend to become more complacent, and not as aware of our surroundings. SItuational awareness- ALWAYS important. Experience also helps you develop a sixth sense about things. You get a gut feeling- maybe based on attitudes of the bystanders, a sudden change in the affect of a patient, a general feeling about what is happening in the area, the specific circumstances of the call, or simply a little voice in your head tells you something is not right. You ALWAYS need to listen to that voice and like you said, get that help at the first sign of trouble. LEO's are always happy to help, and they would much rather be cancelled, than to show up and be put in the middle of chaos. The other day we had a guy who the fire company dismissed as a drunk. Yes, he admitted to drinking, but was not really unsteady, not slurring his words, but he claimed he did not know his name, nor how he got there. Something was not right about this guy. He allowed us to check him briefly and get vitals- all normal, and he allowed us to transport him. He vehemently denied doing drugs, and I saw no evidence of it. Upon questioning, he admitted he was bipolar, and was noncompliant with his meds. Problem is, he just had this look in his eyes- like I am just waiting for an opportunity to go off on you. As we were enroute to the ER, he began to get agitated and threatening, and I immediately called for police. He began making threats, telling us we better let him go or we would be sorry. No amount of TLC was going to talk this guy down. Thankfully psych patients seem to have problems with seat belts, so it bought me some time. I got out, and he was still fumbling with the belt when PD arrived. They cuffed him and escorted him to their car. Problem solved. In my younger days, I may have tried to restrain this guy, but with age comes wisdom. He could have trashed the rig for all I cared- stuff can be replaced, but we cannot.

Welcome back. What part of southern Illinois? Went to school down there- a LONG time ago, volunteered for the local Red Cross, and rode with Jackson County EMS while taking EMT classes. How long ago, you ask? They did not have ALS capabilities back then. LOL

We need more Biebers in our profession. It's great to see someone so motivated. Keep it up, bud and you will have a bright future in this business.

Interesting comments from our neighbors to the north. Thanks, folks. I am enjoying this- and learning a lot. Keep it up, please. Reading about politics and issues vs actually hearing from the folks affected by them- are 2 entirely different animals.

We have a couple municipalities around here that are "Public Safety", which means they are police, fire and EMS. Not sure how all of it works, but they've been doing it for years. It must be a very odd situation.

So what say the Canadians about this election? What changes do you folks want to see in your nation? What changes have the conservatives promised to make that earned them a victory? I have to admit I am ignorant about much of the politics going on north of the US- other than the issues with your health care system. I am curious to hear what you folks think.

As a male, I simply do not get the fascination with someone else's wedding. Other than being concerned about folks having a good time at my reception, I was barely concerned about my own wedding. LOL As someone from the states, I simply do not get the whole idea of a monarchy. Their duties are mostly ceremonial, they are not essential to the operations of the UK, so what's the point? I get that this is part of a long and rich history, I get that it's the one constant in the British society, while PM's and the House of Commons folks may come and go, but it seems an incredible waste of money to me. BUT- since I don't live there, knock your selves out, folks. If enough folks got fed up with it, they would eventually abolish the notion, but clearly that's not happening any time soon. God save the queen!

Sorry, but there IS evil in this world. Does anyone think we aren't better off being rid of people like John Wayne Gacy, Hitler, Sadam, OBL, Ted Bundy, or any one of dozens of other mass murderers? Justice, revenge, the price of war- it's just a name. Does any nation- besides die hard pacifists- really think less of the US because of what we did to OBL? Even the "real" Muslims are happy this guy is burning in hell right now. Call me a thug, unevolved, vicious, vengeful- whatever. I have no problem with ridding the world of someone who has gleefully accepted credit for killing over 3000 innocent men, women, and children. The terrorists don't need another reason to hate us- they already hate everything about us and they have repeatedly sworn they are mortal enemies, and if this triggers another attack- so be it. Does anyone really think they weren't already planning something else? We have broken up multiple plots since 9/11, and many more that will never be publically known. Celebrate? Depends on your definition. Cheering in the streets- well, I do not agree with that, but hoisting a drink to honor those who died on 9/11, and to everyone involved in the fight against terrorism? Absolutely, and the first round is on me. I would be proud to buy that entire Navy Seal Team a round as a thank you for what they did.

This is your question: Since you're so keen on those particular social values, and that way of life; let me ask you this in all seriousness….if your wife/girlfriend/significant other gets a little bit 'mouthy', do you crack them in the teeth to show them the 'errors of their ways'? If not, then please explain why not; after all, it was ACCEPTABLE 'back then'….. How should I take a statement such as this? It's a direct question, asked in "all seriousness." So it's all or nothing? Jim Crowe, no women's rights- there was nothing good about society, and it's all lumped together? I think you know better than that. Solid work ethic? Manners? Common courtesy? Decorum? Standards of behavior? Appropriate public conduct? I'm anxious to return to a time when it was OK to label aberrant behavior as such, when God or religion were not four letter words, when teachers were tasked with teaching instead of being surrogate parents, when a parent was responsible for raising their kids, not the government, a village, or the taxpayers. Clearly you did not read the definition I posted of pornography. BTW- a USSC ruling depends on the composition of the bench at the time of that ruling. Their ruling only means it's their interpretation of the Constitution, and highly dependent on the political ideas of the sitting justices. In other words, depending on the prevailing political winds, the same issue before the USSC could result in 2 very different outcomes, depending on the composition of the courts. It means it's the opinion of the USSC, not necessarily of the majority of the people. Subtle, but important distinction. Think Roe v Wade. The debate rages on decades later- despite USSC rulings. (Just for the record here, I am pro choice) Think the Death Penalty. I disagree with the celebrity opinions on the gun control issue, but I do take notice that their arguments DO remain the same. Same with me- I can wholeheartedly disagree with how lax our societal standards have become, and regardless of how the laws may change, I take heart in knowing that my opinion is not from a lunatic fringe. Estimates say that 20% of our country identify with a liberal ideology, and around 40% say they are conservative. Funny, but our policies have actually become more liberal, despite the fact that twice as many folks disagree with that ideology. In other words, a vocal minority is driving our policies. But I digress- but only slightly. I can only hope we return to more traditional social values. What about all the post 9/11 issues related to travel? The Patriot Act? Are you in favor of these things, which many believe infringed on our Constitutional rights?

Why are standards such a bad thing? Read the definition of pornography. The term never existed before the mid 1800's, and It certainly does not apply to classical art. We have no way of knowing the intent of the artists who made those nude paintings and sculptors, nor do we really know how their work was perceived by their peers. The definition of militia was one of the main legal arguments about whether or not gun bans violated the 2nd amendment. The issue certainly did gain traction with the anti-gun left, which actually proves my previous point. Do you really think the views expressed by the celebrities you mentioned are representative of most Americans, or those of a vocal minority? Regardless. Did that deter the anti-gun crowd, or are they still making the same arguments? Did they simply accept the USSC ruling? Call me narrow minded, a prude, paranoid- a right wing lunatic, a throwback- whatever label you wish. Guess what? I still believe there is NO REASON why we should allow pornography in a public library where children are present. None. Last time I checked, it was NEVER acceptable to hit a woman. Not 60 years ago, not 100 years ago, not 200 years ago. Did it happen? Yep. Probably no more often than it does today. The only difference is women had no rights or recourse back then. I seriously hope you are not suggesting this behavior is something I condone or engage in. I'm not liking the tone or insinuation in that last passage.

Let's try a different tactic here. Think back on what was considered to be offensive over the years. Let's keep it simple- just the past 100 years or so. Think about what was deemed acceptable vs offensive or vulgar, and compare it to today. Think about what we would tolerate on TV, on the radio, in print, and in the movies. Think about societal standards for conversations and personal interactions. Does anyone disagree that we as a society have become infinitely more tolerant of damn near anything and everything? Is this a good thing? My point is, just because something is pervasive does not mean it's a good thing, or that we should simply adopt it as the new "norm". The Constitution has not changed over all these years, but our interpretation of it certainly has. Think about gun laws. Think about how our views on gun ownership have evolved. Has the 2nd amendment changed, or have we changed in our interpretation of it? Guns are actually banned in many places based in large part on our current interpretation of what defines a militia. Some things SHOULD change, and have. Civil rights, a woman's right to vote- nobody would argue the merits of these changes. Saying that someone has the "right" to view pornography in a public library? How well do you think that would have gone over back in the 50's? Yes, society DOES change. It's inevitable, but I suggest that not every change is something we should be proud of or we should embrace. Change has consequences- and again- not all of them are positive.

I am quite certain that my nephew did not die in Afghanistan so that someone can check out porn at the local library. As for a definition- how about this one from Merriam Webster? the depiction of erotic behavior (as in pictures or writing) intended to cause sexual excitement 2 : material (as books or a photograph) that depicts erotic behavior and is intended to cause sexual excitement 3 : the depiction of acts in a sensational manner so as to arouse a quick intense emotional reaction <the pornography of violence> Now- even better- the origins of the word: Greek pornographos, adjective, writing about prostitutes, from pornē prostitute + graphein to write; akin to Greek pernanai to sell, poros journey — more at fare, carveFirst Known Use: 1858 Does this sound like something in any way educational? Does this sound like the definition should include books and publications about STD's, sex education, or classic nudes? Although I was not around at the time, nor can I say for certain the intent of the artist, do you think these definitions are applicable to classical works of art like nude paintings or sculptures? Who knows, maybe these things were the pornography of their times, but it's certainly not the way we view them today. Obviously it would depend on the age of the child. There is a huge difference between a 14 year old and a 7 year old. Well, considering the internet has not been around for that long, I would suggest this is a relatively new problem. Offended? Again, depends on the age of the child here. I really do not think an early elementary school kid understands what "offensive" really means. Confused, upset, angry- I can think of many descriptions of how a child may react to something like this, but offended is not one of them. Free speech? Is that what you call looking at pornography in a public library? See above. I honestly did not think pornography needed to be defined- it seemed pretty straightforward to me. I certainly did not intend to dodge the question. Based on the above definition, it's not simply about a naked body, it's about WHY that body is naked. Let the librarian decide? Hell no. If you saw our local librarian, I shudder to think what she may find "appropriate". {Think troll doll here...} Again- if you use a definition such as the one above, it really is not very complicated, nor is it ambiguous. Yes, I know teen boys can somehow find sexual stimulation from an algebra textbook, but that's another story. No, sadly the majority no longer does rule, or we would never even be having this discussion.. Vocal minorities often get their way in today's society. He who has the most money and the backing of media to promote their message not only gets their message heard, but can actually get legislation passed in their favor. Often times the majority needs to simply shut up, accept something they disagree with so as to not offend a fringe group. I also would not call the responses here indicative of a consensus of opinion. There are thousands of registered users of this site, maybe a hundred post with any regularity, and only a couple are actually involved with this discussion.

Different context. The Starbucks reference was about someone surfing porn on their lap top. In terms of private property.businesses, unless there is an ID check at the door, ANYONE- man, woman, or child can walk into that business. Either we find it acceptable to place limits/controls/restrictions on things, or we do not. Do the profits of a business trump individual "rights"? Sigh. This country is in worse shape than I thought. The rights of our children are to be protected. Period. I seem to recall a former first lady who's mantra was "It takes a village". Does that not apply here? Gawd help me- I am actually quoting Hillary Clinton here. Sorry, but no prudent parent would WANT their child to be exposed to such things, and I do not think it's unreasonable to expect that a public library should be a safe environment. Will they be exposed to things in their everyday lives? Of course, and each time we defend things such as this, our societal standards take yet another hit. We bemoan how the kids grow up too fast, how they are exposed to inappropriate content on TV, in the movies, on billboards, etc. Obviously the internet has opened a whole new can of worms. How do you think these things happened? Someone decided to defend someone's right to be disgusting, inappropriate, immoral, unethical, lewd, or just plain nasty. Each time we acquiesce, society's acceptable standards drop another notch, and the door opens a bit wider. The information is not IN the library. The library- and the computer- are merely a point of access for that information. You can obtain that information anywhere- as in the privacy of your own home, sitting in your car on your PDA, sitting in the middle of a park in a trench coat, on your lap top... Education, entertainment, and pursuit of happiness? Nobody is denying someone's access to these things. Time and place. It's not the subject matter here, it's the place you are obtaining it, and the children who are exposed to it. In our jobs, we are supposed to be advocates for those who cannot help themselves, and who are the most vulnerable. That includes mandated implied consent when caring for minors. Thus, we make moral and ethical decisions based on some "common" standard of decency and morality. We ASSUME that in their absence, a prudent parent would want us to do everything possible to help their child. What if that included care/treatment that somehow violated their religious, cultural or ethnic beliefs? Do we withhold care for fear of violating the rights of the parents to practice a particular religion? There is NO rational, logical, educational, moral- yes, I said MORAL- reason for PORNOGRAPHY to be permitted in a public library.

All I can say is- OMG, Richard. What would I do? Well, the infamous scene in "Airplane" comes to mind: "I guess I picked the wrong day to give up smoking, sniffing glue..." Did you guys actually table top this scenario?

Bravo, Ruff. This whole censorship, rights, and freedoms thing is a non starter in my book. We can refuse children admittance to an NC17 or R rated film, yet banning porn on a public library computer is BAD? Really?

Sheesh. Posting wait times? Around here, the billboards aren't big enough to post those huge numbers. Can you say 8, 10, 12 hours or more?

7/11 and other places generally have their porn magazines partially covered, in wrappers, and/or generally behind their counter. Some kid can't just pick up a copy for a quick thrill. As for art museums- are you really equating internet porn to a "David" or other classic nude paintings or sculptures? Come on. Eliminating a kid's access to porn? Hardly. Any kid who is even remotely internet savvy can get as much porn as they want from their phones or lap tops. We were talking about an ADULT surfing porn in a public library. Again- are you really equating classic literature and culture with PORNOGRAPHY? No, once we start down this road, we are protecting KIDS from being exposed to some pervert, sitting in a public library, getting off on internet porn. Are you really more concerned about the "rights" of John Q Pervert than the "rights" of children? I have no idea for sure, but my guess is that legit adult magazines do not offer free access to their material on the internet. I am talking about all the free stuff out there, and easily accessible to anyone who wants it. I'm thinking the guy in the library is not accessing that stuff, nor is the NEA providing funding for any of the sites he was surfing. I had no idea that wanting to protect children was crossing such a fine line. Weak. Creative processes? Really? We are talking about internet PORNOGRAPHY, not about great nudes in Greek and Roman history. Again- I suggest that 'my' morals- at least in terms of thinking potentially exposing kids to pornography is a bad thing- are not exactly a fringe belief. This is not some abstract debate in a university classroom about Constitutional rights and freedoms, this is a real world thing, with very real consequences. If someone gets off on midget porn, seeing barnyard antics, or gawd knows what else- knock yourself out- IN THE PRIVACY OF YOUR OWN HOME, not in public. We limit the sale of porn mags to 18 or even 21 and over. We provide ratings systems for movies that keep kids from seeing explicit movies. We rate TV shows, and most TV's and cable/satellite providers allow us to block "inappropriate content" from kids, but saying no pornography on a public library computer will lead to the collapse of our society? REALLY? What about all the indecent exposure laws we have in this country? Topless beaches are common in many places around the world. Not here. Whether you agree with them or not, this country has standards that say we do not approve of this. It's not WHAT this guy is doing, it's WHERE. I'll take my chances. If some pervert is doing this around my kids, the FCC and ICC will be the least of his worries. If some pervert is sitting in a library, surrounded by kids and checking out porn, do you really think he is exercising his constitutional rights, or is he actually getting a cheap thrill by surfing this porn surrounded by children? Sorry, but with the advent of computers, smart phones, and lap tops, someone who is simply trying to indulge in porn has more than ample opportunity to do it in total privacy. I prefer to err on the side of caution when it comes to kids. If a parent thinks it's perfectly acceptable for their kids to see internet porn, they can buy them an online subscription to Boobs R Us, or something similar. As disgusting as it may seem to most folks, they ARE the parents. We cannot control that, but it seems to me that protecting kids in a public library is a no-brainer.

You are lucky to live in such a place.

Sounds like a great opportunity- and dirt cheap. Sadly, the next month is horribly busy for me. Thanks for posting this, Dust.

I guess we hang around in different circles. The vast majority of people I know would never think it's a good thing to allow someone to check out porn at a public library. In fact, I submit that most people would agree with this and 99% of them would have no fear that our entire society would crumble and we would become a military dictatorship. It's not censorship, it's common decency. Agreed about the Starbucks comparison-it was stupid. Blame it on fatigue- long shift yesterday. I will reiterate that if my kids are in a public library, and they tell me there's some pervert surfing porn while they are there, I WILL be paying visit to that library and explain to him my "right" to make it difficult for him to continue surfing the web. There is a huge difference between being overprotective of your kids and having a problem with porn in a public library. I am amazed you cannot see the difference here. Don't hide behind that liberal dodge of rights and freedoms. I really think it's OK to say that something is wrong and inappropriate. I'm by no means puritanical, but I am old fashioned- especially when it comes to my kids. I think we need to get back to a time when there were societal standards and norms. It's not about being offended, it's about exposing children to things that are inappropriate. Porn doesn't offend me. Just because kids are exposed to plenty of things we may not agree with, it does not mean we should throw up our arms in resignation, hiding behind the guise of rights and freedoms. We've always had an open society. We also had a set of fairly universal standards of what's appropriate and acceptable, but these things also tend to be cyclic. At one point we were a puritanical and prudish society, and now the pendulum has swung wildly in the opposite direction. There should be a happy medium.

How about this? Stunningly simple- NO PORN IN A PUBLIC LIBRARY. What would you say if Starbucks set a policy that forbid porn in their stores? Is that infringing on someone's rights, or simply a place of business establishing rules and a code of conduct for customers? Yep, and as a parent, I see no reason why I should have to worry about what my child might see in a public library. Last time I checked, the library was about lending books, doing research, offering a quiet place to study, and yes, in recent years, use the internet- primarily to conduct searches for information. If you want to check out porn, do it in the privacy of your own home, not in a PUBLIC library. Sorry folks, but someone's alleged "rights" end as soon as they infringe on mine- or those of my children. ...edited because I screwed up the quotes...

They are called rules. Make them and enforce them. If you want to surf porn in the privacy of your own home- knock yourself out. What about surfing porn on your lap top at the local Starbucks? It's also a public place. I'm sorry, but I see nothing "unConstitutional" about being protective of children.