Ace844

WTF !?!?!?!? Some how I suspect our efforts here were:: Out Here, ACE844

"Rid," As usual i agree with you. Yet, i do believe the Natl Registry still has a number of test questions which relate to this and the meds use, I ask as I am not 100% sure. ACE

First welcome to EMTCITY!!! Next, if you utilize the search function button in the upper R hand corner of your screen you will find A BOATLOAD OF INFORMATION ON THE PRECEEDING MENTIONED MEDICINE. To answer your question; I'm sure you'll find Romazicon somewhere in your answer choices.. ACE844

Jack Nicholson Batman

You are correct. It is a fine line and one which MANY MD'S walk every day just BECAUSE of these types of laws which prevent them from (although in a very different environment-situation than the one being discussed) from following a patients or families wishes not to continue futile efforts or sustain a patient to an outcome which is undesirable, or leads to no-poor quality of life.. Another example would be an order written as follows; "Pt to recieve increasing and or escalating doses of XYZ medication for percieved discomfort, distress and pain as needed PRN". Out Here, ACE844

CONTENT REMOVED

SSG, It's Tojm Cruise as Lt Pete Mitchell from Top Gun... You guys have yet to answer this one.... :roll:

That's just wrong, best way to deal with that medic.... Give him a single dose of 300mg's Succs in the R buttock and stand back and let him stew for about 5 mins... :twisted: :twisted: :evil: :x :twisted: see how he likes that as a practical joke :roll:

Dr Harry Wolper the Creator (circa 1985)

The movie is Armageddon...

"Scarmedic," I don't see all that much of a difference in that the rules and precedence of survival as well as the clinician trianing and STANDRDS OF CARE in this situation are THE SAME. Fact of the matter is, in a 'LARGE' MCI type situation like the one in which we are talking about, or a battlefield, or even a protracted amount of patient care in an adverse environment dictate a different view of the patients management and outcomes. Also, we rae all taught...'DON'T WORRY, ALL THE RULES ARE OUT THE WINDOW, YOU DO WHAT YOU HAVE TO DO AND NO ONE WILL COME AFTER YOU AS LONG AS IT WAS IN THE BEST INTERESTS OF THE PATIENTS AND TO THE BEST OF YOUR ABILITY'!! Furthermore, they treated the patient and both conditions and their ilnness-injuries progressed to the point where adequate care was no longer working or warranted. I guess what I am saying is that if they did NOTHING, or were deliberately trying to cause harm, pain, discomfort, etc... That would be one thing, but they did all they could and then did their best to be humane about it when they could do no more and were forced to make a tough call. They DESERVE OUR SUPPORT!! This is no different than when in your analogy when you work a critical 'RED TAG' patient and their illness progresses to the point where ressus, is futile and the end point will remain unchanged. It is actually the same mindset of 'START' or rapid triage just over a longer time. You do what you can for as many patients as you can until it becomes unteneable for the group and you to continue their care at the same standard level especially with or in the case of physiologic decompensation and or non-response to this treatment. Conversely, what 'discussion' and 'charges' do you think these clinicians would have faced if they did the opposite and dedicated all available resources and care to these patients only later to have a suplly issue or have the other patients sufferr and recieve no to negligent lacking care? It was and is a no-win situation. If they had the intent to 'murder' no care would have been given, and many more patients would have been killed, and or they would have fled for their own safety as oppossed to 'sticking it out like they did. Out Here, ACE844

"spock," Just curious where you got the thought that the patient has no reserves left? As for the etomidate it is being used 2nd to TCP, and to be augmented with fentanyl as needed. These 2 agents were chosen because of their cardio-resp protective properties... Out Here, ACE844

"Ruff," Well said, but I disagree with your statement of I will preface that with the following points. 1.) Uneven application of these laws in this situation. How much do you want to bet that this happened many times in this area and at this time. Where are the investigations and prosecutions for those situations? 2.) If these clinicians are guilty of murder as soem here are implying, why weren't the hospital and gvt officals charged as accessories for failure to follow or provide the menas for these patients to be evacuated before the hurricane struck. Are you going to try to tell me that they had time and resources to evactuate prisons but not a hospital and ICU???!!! Where is the blame there? By the standards being applied here agianst these 4, the others are at least 'conspirators,' or 'accessories'... :!: :!: in this and belong right next to the others with charges being filed as well.!!! !! 3.) What are the teachings on this type of situation WHICH EVERY MEDICAL PROVIDER OF EVERY LEVEL GETS TAUGHT!?!?!?.. It's rhetorical. The fact is that we are ALL told that in an extreme MCI-Extremis situation you need to rise above and make tough decisions like these clinicians did and do the best you can for everyone. Also, we are taught that THE RULES DON'T APPLY HERE AND YOU WILL BE BACKED UP AND SUPPORTED ON YOUR REASONABLE ACTIONS..!!! Where is the MEDICAL PROVIDER COMMUNITIES SUPPORT FOR THESE INDIVIDUALS???? Is there really any question that this is an extremis MCI-battlefield type situation. We all make these types of 'tough' decisions in these situations in different ways but with similar consequences...THINK ABOUT IT!! 4.) As said previously there is a lot more to this story, a few are being made scapegoats for the many, this is a distraction from something else major we all are missing, there is a personal vendetta-agenda involved.. 5.) As "dust," pointed out... to the lawyers!!! Out Here, ACE844

"Brother AZCEP," I brought alittle something for ya... I'm only on my 2nd cup so bear with me as my logic maybe alittle hazy here. I am quite comfortable with my abilityt to read and know the what the box contains, both inside and out. :wink: :shock: 8) The reason I didn't mention RSI, or CPAP-BIPaP, is that clinically this patient didn't warrant it with their spo2, and degree of distress noted. I do think that if at some point that the patient developed occult or worsening CHF these are definately among the additional modialities to consider. But without further information or a 'changing' accurate clinical picture being posted on these matters I think it's too early to say. The end point here is truely the cath lab and or CABG. Out here, ACE844

In short, note that I wrote, these therepies under THINGS TO CONSIDER.... Menaing that I may not necessarily use this meds, and it would depend on what I 'see' clinically in an evolving situation.I think in a situation such as this so much depends on actaully being able to 'see' the patient in real time. That being said, I will say the following. B-Blockers although contraindicated in occult failure also have many properties which MAY be beneficial in this pateint. Also you should note that I used a multifacted approach. For example, a vasopressin drip in combination with another pressor in critical patients has shown to have the following beneficial effects. Up regualte vasopressing receptors in the periphery having the benefit of better glucose-sugar metabolisim in diabetics as well as increasing SVR. Next, it will also potentiate the effect of another differnt MOA pressor and augment it's effectiveness, as well as performing many other functions. So as I have mentioned previously many individual independently liscenced clinicians will often use meds which have undesirable side effect profiles in the long term for their short term benefits. A prime practice is some ED docs using Albuterol in acute presentation CHF-Dyspnia with lasix and other therepies. The evidence and efficacy is there, it is just more a matter of the individual clinicians comfort and knowledge as well as training and opinions on which therepies and the level of aggression they would use in a particular case with a particular pt's clinical presentation. At the end of the day, if you sit down and think abit 'out side' the protocol box, there are many benefits and interventions which one could provide here with various end points of sucess. Still, I acknowledge not every provider is comfortable enough in their knowledge, skills, abilities, etc... to step up and 'take that chance'. Hence my aforementioned statements where if you obsserve emergent and acute care MD practice you will see this variation between theses indivuals practice preferences. Out Here, ACE844

For the record...

: I posted the link to make you aware that there was a related 'topic' to the one you posted with relevant related discussion going on there in case you were unaware...of its existance...thats all...Post containing answers to your questions to follow.. Out here, ACE844 ::

Actually it seems to me that leaving 'Point of care' and FINAL DIAGNOSIS-INJURY CARE 'follow up instructions,' would require the individual EMS provider to have made a FINAL diagnosis, than accepted a pt refusal; which would put you and your service in an unteneable legal position in many 'areas'. Seems to me we do diagnosis, but it is a working diagnosis, not a final one, and furthermore, you would need to assess and treat a pt to get a FINAL DIAGNOSIS which i am sure your Med con and many others would disapprove of .. Out Here, ACE844

What's the deal with the personal attacks, WPM-Josh,et.al.?

Here's what i say .. [stream:9ed4e3d112]http://www.moviesoundscentral.com/sounds/training_day/story.wav[/stream:9ed4e3d112]

http://www.emtcity.com/phpBB2/viewtopic.php?t=5225