P_Instructor

Ha....love it, except the nurse would probably shove him out of the car.

Court order was another option thought of, but according to RN, these unavailable in that county????? Again, was thought of, but no go. The best option would have been the staff getting the resident for a psych consult the day he jumped out of the van.....not two days later. Duh!

Assessed patient, full mental capacities. Patient does have POA for medical affairs. Called POA who only has authority when patient unresponsive. POA out. Medical control contacted, agrees cannot transport for patient wishes. Family physician contacted and will come speak with patient. Arrives, assesses, and realizes patient requests not to go. Cannot force him. Patient due for dialysis, decides to take day off. Now two day without treatment. Sugars fine. Lab work unobtainable. Options: 1. Patient decides to go....NOT 2. Med control authorizes...NO 3. Patient out to lunch....NO 4. Physician authorizes...WILL NOT 5. POA authorizes....NO 6. Call law enforcement?....WHY 7. Sedate patient and take him?.....I THINK NOT Best option......leave him there. Wait a couple of days when his bloodwork is out of whack (four days of no dialysis), reassess and take him. A lot of moral/ethical/legal crap in this scenario. Need to think of all options.

Your ALS service is dispatched to respond to area nursing home (30 miles away) to pick up a patient to be returned back to your city for a psychological consult. You respond and while enroute, your supervisor radio's you and lets you know that you might have to sedate the patient prior to transport. No further information is obtained. You arrive at the care facility and enter where met by staff RN. She states the patient has doctor's orders to be sent for the consult. Prior history is that patient jumped from the facilities van two days earlier nearly getting self run over. Also, patient apparently in brittle diabetic where glucose reading can "go from 800 to 30 within seconds". Patient is also on dialysis, next treatment is due today. You enter the patient's room and find him sitting in chair watching TV. You address the patient whom is conscioius and awake, alert, etc. After telling him you are there to take him to the hospital, he politely states " I'm not going to go with you". You assess the patient where all findings are normal in vitals, blood sugar, mentation,.....everything. He is refusing to go. You advise the RN that the patient is refusing and you cannot take him as he has all mental faculties intact. This sets the RN off stating that he is a danger to himself, etc. For scenario purposes, what are some options you can think of for this type of call. (I will address each option provided with response in what I did. I will also acknowledge any new idea concerning the case)

Just being the smartass here........cause of death.........the heart stopped beating. Reasons to be announced later.

Hiya from Iowa. Great to see someone with a developed passion for the profession. Are you looking ahead to getting into a Paramedic program? If not, you should.

Welcome from just up the road a piece.

"Sounds to me like there is a supervisor with WAAAY too much time on their hands writing stupid policies. OR the company is to cheap to have more than one of these items available for each truck." Oh, does this sound so familiar. The policy is really bogus and I agree with medicgirl that patient care is not being taken into account. Your company should have extra equipment available to get you back to service as soon as possible. I am not sure how many hospitals you serve, but here, we have the ER put equipment out in secured lockers for retrieval later if needed. It is 50/50 if the equipment is cleaned or not.

Welcome, and you now have to supply the orange juice for everyone.

"Officials are not saying why they believe the paramedic tampered with the medicines, but the incidence of health care workers stealing drugs to use for themselves or sell is not uncommon." Yikes! What is wrong with these idiots that are giving EMS a bad rep. The easiest way to avoid this is not give the medics the prefilled syringes of medication. Go back to the vials that are sealed and cannot be tampered with.

Typically the mouthpiece is preferred, however the patient must maintain a good 'bite/seal' on mouthpiece to have it more effective than the mask. Patients can hold their own nebs to free your hands, as long as you monitor them maintaining the seal. The mask should be utilized if the patient cannot hold the mouthpiece, and you cannot assist. Of course, if the patient is not having adequate inspiratory effort, then bag the med in or identify if CPAP would be better. Many options available with different lines of thinking. Do what's best for the patient in the situation you are presented.

Must have been manufactured in Pacific Southwest The just put there 10 fingers spread across the chest and cross there toes and interpret what they feel.........just a joke guys.

They listen to everything but only hear what they want to!!! Diarrhea. http://65.55.72.71/a...6e10&oneredir=1 A little boy with diarrhea tells his mom he needs Viagra. The mom asks, "Why on earth do you need that?" The little boy replies, "isn't that what you give dad when HIS shit won't get hard?!" I'm still laughing at this one!!!!!

1964 Oldsmobile Jetstar 88 1974 Chevy Nova 1979 Oldmobile Omega 1979 Chevy Impala 1980 Oldmobile Cutlass Supreme 1988 Ford Ranger 1990 Ford Bronco II 1996 Chevy C1500 Silverado 2001 Chevy C1500 Silverado and with the family fleet: 1999 Pontiac Grand Prix, 2000 Pontiac Grand Prix, and 2003 Chevy Malibu side family vehicles include: 1957 Ford Fairlane Tudor, 1970 Ford F100, 1963 Oldmobile, 1994 Ford Expedition, 2001 Nissan pickup, 2010 Chevy Acadia.

BIG - Bogus Interosseous Garbage Go with the EZIO for kid and adults, and the Jams for infants.

There flippin' looking at using Ziprasidone (Geodon) here for agitated delirium....I looked the junk up and not so sure with all the contraindications and side effects. I'd rather use a ball peen hammer.

I basically think it not what you know, but if you can read a question. I practice with students on how to read a question and then respond. Tell the medics to always treat first as a basic (like you did) and then go onto the advanced crap. Seems to be effective with good results. As for me, being old, still do the arse way (paper trail) recertifying. With the Alzheimer's setting it, the only thing I have to worry about is where I put all the documentation.

Part of the exam is the realization that 'other' services may be needed. For the EMT crew, it is always better to call and cancel if needed. The cognitive part of the testing is that you are prioritizing and thinking (as well as stating) that ALS services may be needed, or at least 'additional help' dependant on the scenario. When taking the psychomotor exam, perform AND verbalize everything. It's like documentation, if you didn't write it down, it wasn't done.......if you didn't verbize it, and the examiner didn't see it, it wasn't done. A good examiner should be able to follow, write down, and observe all at once, but this usually never happens. Best action is to not leave any doubt. again say and do together.

Initial question.....sucking chest wound on left and tracheal deviation to the right? What is the tension from? It's kind of cork the holes and diesel bolus the patient with the other interventions inbetween.

Written done, have you finished the practical portion? Also, great job on passing the written.

No matter what level you are at, you study about morals and ethics. Chbare put it out there for you..........

Concerning the comment not aware of any bites or stings, are you sure that he wasn't harpooned with a blow gun in that area? Just joking. I am still formulating an opinion, but I can see your pucker factor is a little on the high side with this. Keep going.....

REDDING, California — A Cottonwood man accused of trying to kill two paramedics and an emergency medical technician by ramming his pickup into their ambulance outside Mercy Medical Center on Saturday night expressed disappointment when told no one was killed. "That's too bad," he said. "Next time I'll drive through the front doors." That information is included in a Redding police report issued after the Tuesday arraignment of Joel Michael Haller, 26, in Shasta County Superior Court. Haller, who pleaded not guilty to the charges against him, including three counts of attempted murder, remains in Shasta County Jail in lieu of $1 million bail. According to the Redding police report, Haller smiled and "nodded his head up and down" when asked by a police officer if he would do it again whenhe got out of jail. But he told a witness he would wear his seat belt the next time. Haller, scheduled to have a preliminary hearing on Feb. 29, was arrested on Saturday after allegedly plowing his pickup into an occupied and parked ambulance outside the Redding hospital. "It was totally intentional," Sgt. Mike Wood with the Redding Police Department has said. "There's no doubt this guy did this on purpose." Ironically, police have said, Haller was treated by one of the three men he allegedly tried to harm in the crash. According to the police report, Haller's father told police after the crash that his son, who went to the hospital to seek treatment for a headache, has a history of mental illness and has been violent in the past. The elder Haller said his son recently served 30 days in Tehama County Jail and had assaulted a sheriff's deputy. In his police report, officer Justin Duval said he spoke with the younger Haller in the hospital's emergency room after the crash and asked him whether he rammed the ambulance on purpose. "That's obvious," the officer reported Haller as saying. When Duval asked him whether he had seen the paramedics in the ambulance, "Haller looked at me and chuckled but failed to answer my question," the police report said. The men in the ambulance were Gregg Franz Herrman, 26, an emergency medical technician from Redding; Drew Alan Barnett, a 29-yearold paramedic from Redding; and Ryan Michael Samualson, a 35-year-old paramedic from Fortuna. Herrman was treated for back pain, while Barnett and Samualson weren't injured, police have said. In November Haller was arrested by Tehama County deputies on suspicion of battering a peace officer while deputies conducted a welfare check on him at his Cottonwood home, the Record Searchlight has reported. At 7:49 p.m. on Nov. 3, two Tehama County deputies were checking on Haller's welfare when he threw a rock at them but missed, according to the Tehama County Sheriff's Department. Haller also kicked shut a cruiser door as another deputy was trying to get out of the car, deputies have said. He faces three counts of attempted murder. Kudo's to the medic to treated the guy after he tried to kill him.

Good point, however not condoning the actions that took place, there was lack of responsibility in many other facits of the call. They probably did have an adequate tube initially, but it could have dislodged when the accident occurred (speculation), the attending medic didn't recheck it after the accident because he's pissed about the crash and 'his' ass. Stupid rule to stay on scene if other driver is OK. I wonder how long it took the second ambulance to arrive? Then the secondary ambulance, whether it was the same attendant or a second, should have reconfirmed tube placement prior too and after the move to second rig and transport. Easiest check are breath sounds, equal chest rise, and perfusion of the patient back in 'those' days. Ahhh, the colormetric device was available back then. Either way, I'm suprised that it is only 1.75 mil.