HERBIE1

Excellent point. I've only been off work for 2 weeks and I'm already not a happy camper since I know it may be quite a bit longer, depending on the what the CT tomorrow shows. When you're used to running around, busting your arse, being forced to sit still is NOT something you want to do.

The continuing education and licensing mandates comes from a consortium of the resource hospitals, which are independent of the departments and organizations. They in turn report to the state's department of public health. For years they have been trying to get the department to be it's own resource, have it's own medical director, and be responsible for these things. Many reasons why it has not happened, but politics, power struggles, and egos are the primary issues. Our training division coordinates and assists with the hospitals, but the ultimate responsibility is with the resource hospitals. We have plenty of very bright people- with vast teaching and work experience, but they are underutilized. Training positions are more about WHO you know, then what you know. Things like prerequisites, background, minimum education, experience, qualifications, etc are often ignored. That's the way things go in a big city.

Having a drug rep come out sounds great- but entirely impractical for a large and busy department. For us, it takes nearly 6 months just to get everyone recertified in CPR. When I was working in an ER, we always had company reps coming out and giving training and updates on new devices, equipment, and medications, but that's also only a couple dozen employees, working on 3 different shifts.

Actually in my station, their most common activity is bickering with each other like a bunch of little old ladies- followed by watching sports in the recliners and on the couches. Well, online education is the wave of the future for universities as well. The only credits we can take online are the required basic NIMS classes. Around here, there have been severe cutbacks in the personnel at resource hospitals, which means they simply do not have the staff to offer as many con-ed sessions. Additionally, we get paid a flat OT rate for attending off duty classes, and the more on duty training they can do, the cheaper it is on the department. Online training can work for the didactic portions, but what about refreshers for skills not often used? WHat about the introduction of a new med or procedure? How is that handled?

Swallow your pride(and a couple pills PRN) and ask for a wheelchair for the ride through the terminal- they are free. Depending on the airport, it could be a considerable walk from the gate, to baggage, to transportation.

Wow. This isn't about one or 2 people scamming, this is HUGE. Fire them all is the answer, but yes, the unions will get involved and they will probably be receiving slaps on the wrist.

I think you misunderstand me here. I am saying that if someone is in pain, then waiting until it becomes unbearable is not proper pain management. Unless you are unconscious, rarely does an analgesic completely get rid of post op pain, or an injury. The idea is to make the pain manageable, not completely eliminate it. Trust me- I am dealing with this issue now. I fell down the stairs nearly 2 weeks ago and as long as I am sitting immobile, the pain is essentially nonexistent now, but if I walk a bit, move the wrong way, or do anything else, it's pure agony. After the first day or 2, I only take the Vicodin, Alleve, and Flexeril, at night so I can sleep. During the day I tolerate the break through pain and take Alleve. Xrays were negative, but I suspect I aggravated a bad disc I already have, tore a muscle, or damaged a nerve root. Waiting to hear from my doc if I'm going for a CT or MRI next.

Hang in there- take lots of drugs BEFORE the pain gets too bad. Hope everything works out.

I have 2 schools of thought on this. One, this was some type of domestic dispute and the woman was looking for attention, to get away from her hubby, has emotional problems, etc. I have also seen some pretty convincing "fake" seizures. In the ghetto, the vast majority of our patients either has "seizures", or asthma- or so we are told. In reality, their "asthma" can actually be bronchitis, and their seizures are either alcoholic DT's or a response to an emotional situation. It often takes a bit more investigation-and when you get the same patients, multiple times, you tend to get the "whole story". They had a bad cold and were given albuterol once, so they say they have asthma as a PMH. Some fake symptoms to get medications they can later sell. Whatever- not our problem. Your seizure patient may actually be an alcoholic who is going through withdrawals because it's the end of the month and their government check has yet to arrive, or someone who simply wants a fix. On the other hand, as Ruff mentioned, atypical seizures DO present in the manner described in the OP. The person is conscious, able to respond to basic commands, but does exhibit some muscle tremors or twitching, altered LOC, or all of the above. I actually had a person traveling from out of town tell me they had paperwork from a complete neuro work up that explained their condition and were instructed to call 911 if the symptoms persisted for more than a certain amount of time. She actually requested Valium because she could not stop her shaking. She explained that in the past, she has sustained musculo-skeletal injuries from her condition. She was oriented to person and place, but very agitated. We advised medical control, complied with her request and gave her a low dose. Her symptoms stopped. She explained that they cannot control her problem, they are still running tests- and because these "attacks" happen so often, she always carries these papers because she knows often times people(EMS and ER's) think she's faking it, is a drug seeker, or has a psych disorder. It was certainly an eye opener for me- until she presented me with those papers(she carried them everywhere in a pouch), I did not believe her story. Bottom line- treat the patient PRN. As for treatment- as long as the person has good vitals- I would go with routine medical care and monitor their airway, and protect the patient from injury.

Good for this guy. Problem is, I am NOT a fan of rap/hip hop- regardless of the topic. I would have much preferred a spoken narrative.

Interesting point of view about right and wrong. I think by the time we are "grown ups", our basic wiring, parents, and life experiences determine what we perceive as being right or wrong. We no longer "think" about the concepts, we simply act, based on our own moral compass.

Skipping insulin to kill yourself? That's like ingesting a poison, one molecule at a time. You'll eventually die, but not for a long time. This guy didn't really want to die.

I would equate this with buying a used computer. Your first step would be to reformat the hard drive and wipe out any possible bad stuff that may be on there. I never thought about a copier in the same manner, but it seems logical.

The doc mentioned an ASA OD because of the tinnitus. I wonder what other issues could cause this. Maybe a red herring- the tinnitus could be a chronic condition. Who knows?

I guess I'm a kid, then. I'm also a professional. Time and place for fun, and a time and place for work. I know the difference.

Disclaimer- this post is fueled by Vicodin and Flexeril, so here goes... How did we get here? Simple answer- evolution. WHY? Well, personally I think to be successful, we need to make a positive impact on someone else in this world. Family, friend, coworker, or even a totally stranger. If we can honestly say we've made a difference in someone's life, then we are winners. In our business, we have the potential to do this on a regular basis, and I think often times we forget how important this is. We get wrapped up in our fancy toys and skills, and sometimes the BEST thing we can do is simply make someone's moment a bit better than it was. Pretty powerful stuff if you think about it.

Sounds like he has multiple issues going on. Obviously DKA, and noncompliant with insulin, and probably noncompliant with other meds which would explain the HTN. Dark brown emesis- GI bleed? Renal issues? Lot's of issues here. Good medical call. I'd be curious about the diagnosis(es).

I'm having trouble playing the link, but I assume this security issue would be with copiers that are networked and/or are able to directly send documents to a remote location or computer. A simple, stand alone copier shouldn't have this issue, or am I mistaken here?

Welcome to da hood! Jump right in and post...

Can you imagine all the images of bare butts and other body parts they would find if they went into these memories? LOL

Bingo. I thought that was understood, but I guess not.

Sounds like an epidemic, Richard... LOL

Wow. Where do you work- in communist China? I worked in discipline, and of the hundreds of cases I reviewed, NONE stemmed from a practical joke gone bad. As long as nobody gets hurt, no personal or company equipment is damaged, I see no harm in an occasional prank. It's a stress reliever, and when your department does over 300K calls each year, it's a safety valve. Gawd knows we all need an occasional laugh to lighten the load a bit.

Not bad, Richard. A bear attack certainly qualifies as unusual- at least for us city folks. Our victim was actually a trainer who screwed up. She left one of the gates to the outdoor enclosure open while she cleaned up. Quite intense. Apparently she was quite familiar with the animals and one of them appeared and slowly approached her as she was scrubbing the ground. Another lion came out, and the first lioness either became protective of the trainer- or wanted to keep her for a meal- and grabbed her and pulled her down to the ground and towards her. All her injuries were from the lion's claws, not teeth. Personally, I think the lioness was protecting the trainer from the 2nd lion because if she was serious about killing this woman, it would have been over in an instant. Other trainers chased the lions away with fire extinguishers and hoses, but nobody was able to get the doors closed to secure the enclosure. The woman was badly gouged- back, buttocks, breasts, bleeding horribly, but was still able to climb out of the enclosure via a ladder with assistance. One of her first questions- "Are the lions OK?" As we were trying to figure out how to rescue this woman, the police had sharpshooters set up all around the enclosure and the zoo keepers were screaming- "Don't hurt the lions!" A SGT came up to the head zoo person and calmly said- "I am an animal lover, but we have an injured woman down there who needs help. If one of those lions pokes their head out of the door, the lion loses. Back off, lady." I wish I had a camera to capture the look on the zoo keeper's face. I'll never forget my telemetry report and the incredulous voices on the other end of the radio. "Yes, we have a lion attack." We transported to a trauma center I worked at for years, and the attending trauma doc was absolutely floored when we arrived. Despite the massive blood loss, the patient survived, had extensive rehab and skin grafts and returned a couple months later to thank us. She said her new assignment at the zoo was working at the butterfly exhibit. LOL Thankfully she remembered very little of what happened that day.

Well put Ruff. I'll give you an informal +1. We tend to look at things from the viewpoints of our own experiences. In one area, the single roles may be completely inept, while in another area, the fire medics are idiots. We pattern our opinions based on what we see and experience- that's natural. Yes, there are some generalities that could probably be applied to the vast majorities of areas, but you also need to be careful of such blanket statements- there are always exceptions to any "rule". I give everyone an even chance, but once you show me you are an inferior provider- either by skills, attitude, or bed side manner, I no longer trust you. Talk is cheap.