usalsfyre

I'm not an officer but as a resident of and taxpayer in the state of Texas I would very much appreciate it if you followed up on this issue.

Yep, I am. Maybe it's the fact I like to tilt at windmills, I don't know. Understand there may be consequences from taking the easy way out too. Remember, integrity is doing what's right when no one is looking.

That's another reason I'm asking he turn the camera on. Appropriate response here is be overly polite and non-threatening, but firm in denial. Cite the appropriate laws. Remind him that if you show him the charts your each liable personally for any resultant fines. Which can be substantial. If this is on video, they're going to have a VERY difficult time making this stuff stick, considering they were in the wrong in the first place.

The trooper didn't, but you can't break one law to enforce another. It's sounds like the whole stop was pretty damn shaky in the first place, and I would have declined the search request(legal and NOT probable cause), asked for a supervisor and ensured he was recording. If he refused? Dial 911 and request a supervisor as your being harassed.

They had no right to the info, whether it starts a battle or not. DPS administration would not take a kind view on the actions of this trooper when they found out the legal ramifications.

No, unless they have a warrant. If they insisted I would them call for a supervisor immediately, and make sure their dash cam is recording. In the meantime I'd educate the crew on appropriate action, as well as call and file a complaint with the LE agency.

This is a pretty common one as well and the reasons I've always seen cited are the assessment crap (this one's been around since the late 1800s, will it die already) and vasodilation from morphine, which if your using Fentanyl shouldn't be a concern. One are where you DO want to be careful with pain management is the profoundly shocky young patient who has a significant loss of blood volume and is compensating through severe vasoconstriction. Anything that affects the sympathetic stimulation and resultant catecholamine release will cause vasodilation, which can rapidly lead to death. Even when the patients are placed under general anesthesia for surgery usually very little anesthetic and a large dose of paralytic is administered.

Probably the best reason to use it for things like abdominal pain and head injuries. Gives the patient relief, but allows for "skilled surgeons hands" to do an assessment (ok, probably applicable for neuro but who goes in an abdomen without a CT anymore?)

Anyone here stating they're using morphine as a vasodilator needs to look at CRUSADE. If I'm trying reduce preload/afterload I've got other meds that do it much more reliably rather than relying on the side effect of stimulating an inflammatory mediator. Fentanyl has always done ok for pain relief in my experience. I've never had it, but from surveying patients it doesn't seem to give the "high" that morphine does when given in typical EMS doses. There's a lot if people who equate "pain relief" with "gorked to the point I can't remember the pain" (which is why I there's some of the narcotic dependence issues we see. I'm big on pain management, but some people I just want to tell "harden the fuck up"). Even those who rate pain reduction from an "11" to an "8" are usually sitting still without notable tachypnea, ect. While I'm not someone who believes we can quantify pain based on physiologic signs, you also have to realize appropriate dosing may be getting someone to a level where the pains "tolerable" not "absent". I do agree that 2mgs of morphine might as well be homeopathic.

Why are you avoiding EJs outside of arrest? Certainly not my first choice but entirely appropriate for patients who REALLY need a line, conscious or not.

Maxiscope by Ultrascope. 39.99 retail, I got mine engraved and delivered for just over 60 bucks. I've had it a month and so far I can hear better through it than any other scope I've had (including my Classic SE).

If I could only have back all my "seemed like a good idea at the time" moments....

Understand what your saying, and I don't understand the reasoning behind cutting the bra either. The shirt, yeah. Bra? Probably overkill. How many people do you see that don't assess the patient though? I guess I'd rather see overkill and counseling than the alternative.

Have you ever sat down with your medical director and asked him how he felt about protocol deviations with sound reasoning? Reason being I've found it's not usually the medical director that has an issue with protocol deviations, it's the "can't think out of the box" supervisors who do.

In an unconscious/unresponsive patient of unknown or yet undetermined etiology I'm going to strip them too, looking for trauma and signs of infectious process. As for the I/O...uhhh,no. Luckily we have MAD devices here. I'm not 100% sure in the hemodynamically stable patient who's oxygenating themselves I would even give Narcan. Good chance it would be an NPA, 2L via NC and suction PRN.

Probably the second most underutilized tool in airway management behind NPAs. If you don't empty gastric contents in a controlled manner it's entirely likely the patient can aspirate even with a ETT in place.

I agree with everything Paramagic said except for this... The primary reason to my mind he's got a 30+ bpm RR is the fractured ribs and the resultant pain interfering with good respiratory effort. Which means he does indeed need to be intubated and have mechanical ventilation initiated. But not with long-term paralysis and not on SIMV. Controlling pain and meeting O2 demand will reduce his respiratory rate. The first will be accomplished via LARGE doses of sedation and analgesics. The second mechanical ventilation will take care of. SIMV was (and still is) a weaning mode as developed. Weaning is not something we do much of in EMS, the reason it's a popular mode of transport ventilation is it's perceived as "safer" than A/C. However, SIMV (especially with pressure support) can deliver somewhat erratic ventilations to the point of becoming uncomfortable for the patient. In addition it may increase work of breathing, if the initial mandatory MV is inadequate the patient will now be trying to meet his O2 demands by breathing through the circuit. A/C is a better choice to reduce WOB, however requires closer monitoring, which shouldn't be an issue as your at bedside 100% of the time. Long-term paralysis has been shown to worsen outcomes (I'll dig up the references today). It also hampers assessment. Usually the only time you see long-term paralysis indicated is with your more exotic vent modes (HFOV, inverse ratio). Asynchronous interface with the vent is usually a sign of inadequate sedation.

If I'm not mistaken, it was taken out two or three editions ago.

So do you just enjoy playing agent provocateur or are you views really this screwed up? As for being judged by society who I've dated, isn't it just as judgmental to call me a racist based on who I haven't boinked?

So I'll buy that everyone has some level of bias towards their own race. But I dont think the "who are you sleeping with" game is necessarily valid. I'm white. I'm married to a white woman, and we've made a couple of little Arryan children . However, prior to this I've dated African Americans and very nearly married a Hispanic girl. My family knew about everyone of them. My wife has dated African Americans prior to marrying me. So by one part of the measure, I'm a racist (married my own race), by another I'm not, as I've "had relations" with multiple other races (granted not at the same time...I would have tried if I had ever had the opportunity though ). I'll admit, on some basilar level I'm a racist. I think it's somewhat inborn, "birds of a feather flock together". It's also conditioned somewhat by society, especially in the area i live in where there tends to be some level of practical segregation simply based on demographics, whites live in one area, blacks another and hispanics a third. To me the important thing to understand is that you and everyone around you has some level of bias. If you accept that, you can examine objectively how it affects you decision making and correct areas where issues arise. I don't think society will ever be truly "colorblind". The best we can hope for is to have people examine their decision making and understand how bias affects it.

When it's midnight on a 24 hour shift, you've written 10 charts and put 400 miles on the ambulance. It's been a long day...

It's usually not blood, in the past 12 months I've probably only had to change uniforms twice from blood. It's usually a little bit of coffee, or lunch, or grime from checking the fluids, or dirt from laying down to access a patient...stuff that never seemed to show up as badly when I was wearing dark blue. Probably the most "functional" uniform I've ever worn was a flightsuit. There were enough pockets I could keep everything handy and seperated. It was also the most uncomfortable thing I've worn in EMS by a mile. First they always seemed a little too long (I'm 5'6") and Nomex is truly a miracle fabric, hot in the summer, cold in the winter and seemingly as non-breathing as vinyl. At the end of the day you smelled...interesting. I once took four showers in a 16 hour period thanks to that fine piece of modern engineering. It would probably be better in a different fabric. I'd be happy with an Underarmor type polo (stays wrinkle free) and EMS pants. I don't use the shirt pockets at all, and wearing an undershirt grows tiresome when it's 100+ degrees and >85% humidity like we have for three month stretches around here. I also don't think tees are unprofessional after hours at a 24 hour service, I also think this is where the cotton-blend lightweight jumpsuit would come in handy.

I hate white. With a serious passion. There's a reason nurses don't wear it anymore, it looks professional right up until you actually have to DO something. I don't care what the uniform is as long as it's functional and comfortable. The current white uniform shirt so popular in EMS (and that my service wears) is neither.

Your not even making sense now. Comparing teenage sex with elder abuse? Intent means something here... What about the fact that reporting prosecuting this "crime" creates two registered sex offenders? Ya think THAT may have an effect on the rest of their lives, especially given the lynch mob attitude that seems to go along with that label? You also seem to only be focusing on the consequences for the female which is an outdated, sexist and incredibly narrow point of view. If we prosecute one party, they both need to be prosecuted. Part of the parents job is to prepare and educate their kids about the risk involved in sex and protecting themselves from those risk. Relying on archaic laws and idiotic "abstinence only" education programs is burying their head in the sand to reality. When my daughter is 15 I hope she's not having sex. However I'm not going to try to forcefully stop her from it. She damn well will have information on the risk, possible consequences and how to protect herself from those. Making her a convict accomplishes what?

Brilliant!