uglyEMT

You are right. I guess I was punchy this AM. Mods you can delete as necessary

OK I have been reading on threads that it is now standard protocol to use Glucagon IN. Apparently it is cutting edge but I can't find any literature on this. Can anyone help me?

Ass clown

WOW missed a good thread LOL Dwayne your an ass clown Hell your the ass clown I WANT on my rig when TSHTF. OK let the Basic have a stab at the ridiculousness (is it a word?). If I understand correctly, Dwayne you had a diabetic PT that was unconscious and possibly CVA due to facial droop which was a new symptom as per witnesses. You ran through your brain and found your diabetic algorithm and realized D50 would be best BUT also realizing the time window for a CVA and doing ninja brain math realized a very short window thus moving to your CVA algo. Realizing the hypoglycemia could be masking the CVA OR cause CVA like symptoms you decided to go D50 which normally would be given IV. Upon trying IV you couldn't get a stick due to dehydration collapsing the veins (or prior venous issues). Upon trying to move the patient's extremities you felt resistance and possible crepitus thus not wanting to further injure the patient you decided on a IO which upon me researching means you drilled the bone to inject directly to the marrow (hopefully I understood that right)My link . Knowing this would cause extreme pain if and when the patient regained consciousness decided some lidocane, a pain killer, would be appropriate. Now I had to look this up so bear with me.... My link Upon realizing this is the only contraindication and not knowing if she was, guessing here witnesses said no, you felt OK to use this mode of pain relief under the assumption she would regain consciousness due to the overlying symptom being low blood sugar and D50 would correct this issue. Also noting what possible side effects could be caused and anticipating them you felt you were within specified area protocols, likely standing orders, so no consult was needed. Now thinking ahead the benefit to the patient at this point would be coming out of a depressed state of consciousness and also possible resolve of the CVA S&S which would not necessitate the call to have the team readied. If the CVA S&S did not resolve all you have done is give the clinical team access to add whatever meds they need once in the ED without any wasted time. Thus again keeping your ninja skills sharp and wielding the time window for proper treatment of the CVA. After all this at some point your employer for whatever reason decided to terminate you and used this call along with two others. Even though at this point I am assuming (see now I am making an ass out of you AND me) the previous call was all within protocols and standing orders. So basically you stood your ground with an inept manager and walked instead of betraying your belief in patient care. Ok so did I miss anything? If no then why all the hostility? You followed protocol, stood within the bounds of excellent patient care, used sound clinical judgment and moved forward in your algorithms to the benefit of the patient. Nowhere do I see a "cowboy" mentality, nowhere do I see anything outside good clinical judgments, nowhere do I see anything wrong except a bad management decision. Now if a Basic can follow this, ok had to look up a few things but linked my sources (see not that hard), then how does a seasoned medic with advanced (well according to them, no link to source no dice) protocols not follow the mention used, the pathways used, or drugs used? 12 year old? Naaaa they would follow too. Troll? Ding Ding Ding we have a winner!!!! Here is your prize To everyone else, too bad this thread got derailed, it seemed like a great one, even for the Basics and Intermediates out there. We all need to be thinking this way. We have guidelines not handcuffs. BTW johnboy with just these few posts in this thread to go by I would rather have my probie and a firemonkey in the back with me helping then you Mr. Paragod. Please stay off my rig. Also if your wondering who gave you the minus in the Beiber jab it was me. That kid has a great future as a medic and has the balls to admit his flaws here and moves forward as a better provider for it and I as one of the members here am glad he is part of our profession. edit to add link for lidocane no other changes made

I have been following this thread after my initial every call every patient statment. Yes that still holds true, its part of my "bag o' tricks" that I use to see the status of my patient. Especially during my normally long transport times from scene. I want to add something here. I see both Paramagic and Dwaynes side of the coin. Yes in my area we use it as one number (yes each of the three get their own value but it is reported as one) so telling a nurse GCS 10 doesnt really say anything BUT during your handoff saying what is depressed gives the complete picture. So in Dwaynes case the number doesn't even need to be given but what does is a proper handoff to the ED staff and a complete write up on the PCR. On Paramagics side it is a useful tool when seeing trends in patients status. If you are running the numbers in your head while doing your vitals and notice a depression in one of the areas it could change your course of treatment. As far as patient outcome I know there is a begining of a paradigm shift twords pre-hospital providers thinking of patient outcome and factoring that into their interventions. I am not there yet personally. Yes I want all my patients to leave the hospital don't get me wrong. But long term doesn't equateinto my interventions, I concuntrate on giving my patient what they need at that moment. (OK I have a limited playbook but hell I work with what I got) I will still use my GCS and give spot on handoff reports (both verbal and PCR) and using it as a tool and not just a number. Oh and to Tcripp I know what you mean, I had a patient with a glucose of 12 yes TWELVE and a GCS of 15 going on and on about her grand daughters new boyfriend. Needless to say 2 tubes of glucose and a push of D50 the medics got it to 72 and still not GCS change.

Glad your second ride was better then your first Also glad to see the fire lit and the EMS bug has infected you. As has been stated the crew means everything when on a ride along. I currently have a probie with me and my crew and am doing my utmost to keep it educational while being enjoyable. Keep up the good work and never stop learning. As far as the BP goes... comes with experience. The limited time in the nice comfy, quiet classroom setting does nothing for you really. Check friends and family at home, the more arms the better. Not everyone will have that awsome thumper of an artery that you want to see if there is a volume knob on the scope. If you do more ride alongs try them then, with all the road noise and such. You will learn to train your ears to block out certain sounds and pick up on the sounds needed. Little trick to try as well lift your heels! Sounds stupid I know but for me if I raise my heels off the floor of the rig I can hear better.

Every call, every patient I have it pretty much down cold but if I forget the back of our PCRs have the scale plus burn scales on them New Jersey

Here is a nice simple chart for helping with all the numbers being thrown around in the media about the nuclear meltdown. Helps with real world numbers and simple explanations.

From here US Flag.org Our dress whites are setup following that guidline. The full shirt is our EMT cert patch on the right sleeve one inch below the top. Left sleeve has the flag on top one inch below the top star field foward. Below that, one inch, is our Corps insignia. Badge (line officers only) is over the left breast with name plate below that. Right breast above the pocket has our commondations (cpr save pin, stork pin, ect). On the left collar is our EMT pin, right collar has an American Flag pin. Line officers have their bars on the collar as well (those are foward on the collars, all others behind) Hope that helps. BTW our shirts are the 5.11 series white that look like button down but are actually zipper front.

Depends on your area, country, ect. Its not universal. In the system I work in police respond to all ambulance requests regardless of call type. So in my area, yes a police unit would be on scene with us. So you have a can of worms here, from a writers perspective, being a PD unit is there does the EMTs notice signs of this person being pushed? If they do or the PD sees signs of foul play, it turns into a crime scene and detectives are called yada yada yada. If no sign of foul play, your golden. From a writers perspective only.

Ummm quick Google search... http://www.ct.gov/dp...a=3136&q=388584 CT DPH: TB Control Program. (excerpt)The TB Control Program (Program) works in collaboration with health care providers and municipal health departments to conduct surveillance for TB disease and latent TB infection, screening, treatment, and containment activities. And here is OSHA stance on the issue. Maybe the gentelman you spoke with didn't know. http://biotech.law.l...sisControl.html OSHA excerpt, follow link for full explination [Proposed Rules Department of Labor Occupational Safety and Health Administration. 29 C.F.R. part 1910, Occupational Exposure to Tuberculosis, Friday, October 17, 1997, 62 Fed. Reg. 54160–01 (1997).] emergency medical services Again I side with the rest on this thread, if you have no problem doing the test, if you do it anyway, then what is the problem here? The fact you were told to do it? Welcome to the world of EMS. Protocols are in place that some might not agree with but because they are we must follow them. Been there done that. Simple chest X-ray solves the problem. I have had flase positive 2 years now. I don't get the ppd in the arm anymore (have an exemption from the medical director) I just need a chest X-ray once a year. After 5 years I can start redoing the ppd. Something about resistance in the body.

Thats the current NJ protocol as well soon to be changed though after the research faking stated. Direct pressure Tourniquet Glad to see our Medical Director is foward thinking and used sound research in protocol making.

Volunteer Squad here. 1 12hr shift a week. 1 24hr shift a month. 1 48hr shift a year 2 rigs. 24/7 staffed. State requierment to dispatch is one EMT-B in the back at all times (ALS is hospital based and meets with us in route with a chase vehicle). Driver can be a FF or EMT. Our normal crew is 3 members sometimes 4 We have 20 members full time (all basics). 4 secondary responders(not on a "shift" but available). and 2 Jr members (kids in high school below the age of 18 can only do 4rs during the week and 12 or less on weekends) Some of us do pull extra shifts on occasion if someone is sick or can't cover their time. If you can't cover your shift you have to find a replacment.

Gave it a shot

So far spot on Metalmedic The fact the leg is shortened and rotated already tells you that the femur is injured. Nothing penetrating tells of closed fracture. Quick assesment will tell where the break is located if low enough (mid femur) then a traction splint would be advised. Higher or lower then thankfully he is in the ED and the Docs will be able to set it properly. If it was out in the field then either a reverse KED or regular splintin would be advised as well as some traction before placement to get PMS in the foot. As far as the OP goes. Get this man warmed up and get me Xrays being no CT is available. The tender ab is worrisome. Im thinking spleen at this point. Bloody urine is noted but also a seat belt mark, so the urine could just be from the impact (had a few accidents myself and peed blood for a few days after do to the second and third organ impacts) depending on the amount of blood though. Breathing is leaning me twords either a punctured lung (any bloody sputem noted?) or ribs. Due to the other vitals I am not leaning twords a tension pneumo. The fact that POC breathing will help leads me twords ribs (they suck being broken). Until we know more I will monitor breathing and vitals, get traction on that leg to restore PMS then splint or set in place, want Xrays or even a ultrasound for the abdo to check the spleen and other organs. Can't wait to hear more

Car accident with damage and deployment and your Pt comes in with cloths on? wet ones too? FAIL time for the BLS crew to take a refresher on trauma triage. This guy should have been down to his underware and had a warm blanket on.

You know it is a bad day in EMS when..... your partner calls in sick 5 min before shift, your given the probie, first call you get puked on, second the patient craps their pants in the rig, you get a flat leaving the ED and to top it all off its your day off but was called in to cover.

Got mine last night. Thanks Dwayne and everyone else involved! Looks freakin awsome

A massive 8.9 earthquake off the coast of Japan has caused a basin wide (Entire Pacific Ocean!) Tsunami. Waves are expected to reach Hawaii around 8:15am EDT and the West Coast from Alaska to Chile later in the day. Im not going to link every website talking about this, its EVERY news site. Lets hope everyone heads the warning and loss of life is minimal. This is going to be a HUGE humanitarian crisis as well as an EMS crisis. Hopefully we all can do our part. Check in if your in an affected area or will be! More as it developes

Almost sounds like it. I dont see why you would need ALS to do initial then hand off to BLS and complete a PCR of initial contact. To me it should be the other way around BLS does initial hands up to ALS if necessary BLS completes PCR. Unless at one point in the future PA wants an all ALS setup. Every rig is a medic rig and no more worry about ALS vs BLS. Giving the stepping stone now to get folks ready to up their education type of thing. I know in my area by the end of this round of recerts (6/2013) the new Cores will be adding several things to "up" the scope of basics. They have already added it to the curriculum but in 6/2013 all basics will have been recerted to the "higher" standard. Not really much but a few things that were strictly ALS are now being taught to and allowed to be BLS (quick example would be BGL) kind of a hogpog of basic and intermediate scopes. I guess in PA they may be phasing in the higher standard OR they feel ALS is loosing its BLS skill set (ie initial assesments, basic interventions, ect) and this is a way of keeping those skill sets fresh and up to date. Who knows, someone does, but not I

OK a quick google search and I get tothe Texas College of Emergency Physicians EMS protocol page My link pick your geographical area to find the current protocols. I picked Houston as an example. Protocol 6.13 (F) states the Non Transport of Minors. According to protocol all minors should be considered for transport regardless of appearence or presentation. Unless an EMS Supervisor and base station physician authorize non transport. In the Panhandle area 16 and older is allowed to RMA only if they are emmancipated, in the armed forces(wierd), pregnant, or living apart from the parents but not emmancipated but taking care of their own affairs (M-10 protocol) I would suggest going through the list and finding out your protocols. Hope this helps

I have no way of knowing about kids, friends, family unless they are present. If I spot a family photo and ask about them while getting my "cocaine MI" packaged then hear they are on the way home I would possibly try and remove the substance down the toilet. But again scene safety comes into my mind and I am not going to touch an unknown substance and possibly contaminate myself or my partner. Don't forget cocaine and other powders can be absorbed through the skin, don't need that ball of wax. Real world example (it happened to myself so no HIPAA here). I worked for an airline at their international inbound terminal. We worked closely with CBP. One day as I was moving a bag from the cargo bin to the conveyor belt it broke open. I turned into the Pillsberry Doughboy. CBP called 911, I was rushed to a decon shower and yet the few minutes exposer until I was cleaned off had me spend the next several hours feeling "unstopable" in the local ED and a crap load of paperwork for the next several days. I have been in this situation many times in my area. Usually if PD wasn't contacted we leave it alone unless we feel their is imminant danger of a minor. No not "if" he/she comes home but is already home and this is the caregiver or parent we are treating. Thus it goes from a drug issue to a abuse issue and that we have to report. I would document what I found at the scene pertanant to my patient status and treatment and leave it at that. Meth lab is a Hazmat Scene and I wouldn't be entering it until it was secured by Hazmat. Im talking glow worm suits and all. So in this case PD would definatly be notified as they would need to secure a perimiter for safety and possibly aid in evacuation of neighbors. FD would be on scene in case of explosion (hell I have heard some of those labs go up if a mouse farts) and also because they may be the Hazmat responders. As for the original scenario. What was the chief complaint that brought her to the nurse? If "something happened" as you say then we may be talking about abuse here. If we are talking plain remorse then I would let the nurse handle it and recomend to the girl AND the boy they need to speak with someone they trust about what they did and why they feel bad about it. I would only report if suspected rape or abuse occured. As you also stated being she is a nurse it is also his/her duty to report and hopefully before we arrive the PD is there. As far as telling the family directly, it is a slippery slope. On one hand you have HIPPA so by betraying confidentiality you are doing your patient harm but on the other hand you are dealing with a minor and parents should know. I would say that unless I am on the stand or being asked by a DA or detective I would just state bare minimum to the parents ie MY findings, not what was discussed or said or implied.

In space no-one can hear you scream