Arizonaffcep

They do smell bad, but there's nothing like snuggling in their guts...

No...had heard it from an RN that worked in that area a while ago...he was also a CEP.

Count me in, in whatever fashion you need. Edited to add: You might want to hit up Vent for some intricate respiratory questions...

At UMC, once the patient is admitted, the ED RN's carry out the written orders by whatever service has admitted them, and they get the same (although without the TV in the room) as they would on the floor/ICU/etc.. The only (until the Lasix order came through) med that was ordered was a Heparin infusion. Good point...hadn't thought about that. As far as that situation is concerned, when we came on shift, he had been there long enough to be "fluffed and buffed" (put into a hospital bed, tucked in, orders taken off and started). So, he had been there at least several hours already, and as the orders were already being carried out, the CCU team had already been down to see him.

What ever happened to "Hey, the bay will only accomodate a box this tall..." during the bidding process?

I'll echo some of what you said, that (this is except for LEO's and military folks) guns have no place on an EMS rig. That's what PD's for. We are not trained nor equipped to deal with things that might prompt a weapons usage, other than to "bug out!" Much like PD's not trained for dealing with a code arrest. Just my thought.

Hence why I said there were policies in place. Basically, if you get a call, you need to either wear "brush pants" or turnout pants for safety. But, off a call, it's ok.

Hell, in Arizona (Central and Southern) there are departments that wear shorts during the summer months (must be certain type, look, etc., as controled by uniform policy). There are very specific reasons why they do this (you know...like 120 degrees?). This is to prevent over heating of the staff. Now...clearly there are safety issues with shorts on calls, and there are policies in place for what to do if you are wearing shorts and you catch a call, but too lengthy to list here. In some places, it just isn't as feasable as others.

That's too bad. I had always heard they were really good.

Don't think that was it...the table itself is about 20 inches wide. Pt is about 3-4 feet wide. My main beef was, from my vantage point, it just seemed like not EVERY option was explored and developed, and regardless of if this patient hasn't taken care of himself up til now, this may be a turning point for him, so every option really SHOULD be explored to give this guy every chance he can get.

Vent...If I have over read your post, I apologize. It just seemed condescending when I read it. Right now, where I work, the only other paramedic school (at the CC level) is run by the local FD, and it basically cook-book to the max (2 of blue, one of purple, see this, do this, but don't understand whys). This was the view point I was taking, as it's a VERY offensive term here. I also made the assumption that it is standard everywhere. Now that I see what you are saying re:"cook book," I understand. Please accept my apologies, and if you would like, I can delete the post response in question.

AWSOME!

I actually did, and then I had my RN partner read it. Her reaction: "WTF? Does she think you're an idiot or something?" All I did was ask her to read the whole post (my partner) and that's the opinion formed...so...there must be something to it, no?

Please explain. If I'm wrong, then I appologize, it's just how it seems to me.

I don't actually think she's against me...just seems to be condescending to me. See the previous post RE: Eydawn (the underlined part).

(RE bolded text)I agree with you on that...but this is not the first, nor second or even third post of mine where I have felt that she has been condescending and talking down to me. (RE underlined text)Then why even say "The same cook book is not always followed for each patient."? This implies I follow a cook book when dealing with patients...hence...I'm a cook book medic.

Not really...think about it...the how big is the cervix and canal? It does expand to fit baby, but it is still a very TIGHT squeeze (hence why it hurts so bad). With this in mind, if baby and cord are present in the canal and cervix, the cord (much more pliable by comparison) gets compressed, thus effectively cutting off the blood supply and O2 source (until delivered). So...clamp and cut...deliver the baby, perform whatever resuscitation you need. **fixed some spelling errors**

That's a hell of an assumption that I don't. I do, what I meant by that statement was a cath/angioplasty, etc had been ruled out...according to the off going shift because of weight and size of table. Which, I take Pt's the cath lab all the time (I do work in the ED...), and have seen it. It's quite narrow. My thought...if that's a driving reason not to do it, find another facility with cath/angio abilities and transfer if their table is bigger, etc. etc. etc. Or, see if we (as a hospital) can come up with a way to "widen" the table so it would work. Adapt and overcome, especially for the patient, is the name of the game. I am still learning (as is everyone is medicine...or you need to get out). But...I have worked in the ED for 2 1/2 years, and as a street medic for 4 years before that, and have done literally every type of job a paramedic can do clinically and prehospital in Pima County (except work as SWAT medic...no real interest). It seems as though you think I am dumb, and am quite, um new(?) at this medicine thing. All I have to say on this is-KISS OFF! How DARE you assume I'm a cook book medic! My wife and own our own EMS school, where cook book medicine is left at the door! You don't know me. Don't assume you do. I know about risk vs. benefit and how it expands or contracts on your options list. In my OP, I didn't post much detail, because I was mostly venting. But...I knew they considered medical therapy for breaking up the clot, but the dosage required based on weight would have caused a CVA. So...that's about it. As I have worked at UMC for 2 1/2 years, I do know what floors can do what. He would have gone to 4W, the CCU floor-with remote tele. My thought on ICU was...if they aren't going to do anything to stop the infarct, then they can expect...oh, maybe CHF, sudden onset pulmonary edema, and any number of arrhythmias. 4NW (cardiac ICU) is much better equipped to deal with that than a floor with just tele. Trust me, I've seen how 4W runs a code...Also, as UMC is a teaching hospital...it was the reason I went there, to expand upon my knowledge in every way I can. Not at UMC, unless they say "oh the table can handle him now." While I don't remember specifically what his other labs were...I do remember that they were what was to be expected from a person infarcting. Hx...I believe he was a diabetic, with absolutely NO cardiac HX prior. He know's he's fat. But doesn't appear to do anything about it. I've already been around long enough to deal with kids at end of life--both expected and unexpected. Here's the thing...it's not really emotional, but that deep down "gut feeling" that SOMETHING needed to be done. Surely, you've been in medicine for a while...you know what a gut feeling is, and hopefully, you don't typically ignore it. Do me a favor...unless you are going to post to me as an "adult to adult" and not "adult to child/newbie/etc." don't post. Go elsewhere, as you have really succeeded in offending me, especially with the cook book part.

Sure...forced retirement might be a good thing. Just like there should be a law that when you reach 70...you should be killed (humanely). Really, do you know anyone who is 70 or older and USEFUL? :twisted:

I completely agree Spenac. It's a standard of care that if you can't get the cord from around the neck...clamp the cord and cut it. Anything less is negligence.

I've heard it's great for ulcers and esophageal verices...

Table top exercises! Get out (I'm serious here) some matchbox cars/trucks/whatever and set up a scene. Practice like you play. Get the radios, set up a formal command structure, etc. etc. It's the only efficient way to do it. Also, if you really want to get cool about it, don't know where you are, but if in the U.SA., get in contact with Border Patrol, see if they have any confiscated cars they would donate to your department. You typically have to pick them up, but hey, they're free, right? Really good for multi-agency drills, stage the cars in ways to be realistic (without having a person crash them...). From there, have patients inside, who can act their part. Moulage them and run that as a drill. Not as economical as the table top exercise, but more fun. Hope this helps!

That's the thing, I don't know what els they could have done...until his EKG started to change while still in the ED, which I would assume means that the MI is extending. It was a gut reaction. Sitting back and not doing anything for a 31yo AMI...feels WAY weird.

Ok...I was working in the ED the other night. One of the patients (was the medic for a 3 bed zone) who had come in earlier in the day for shoulder pain was actively infarcting. It wasn't a STEMI, however, his first trop was 8.something. No...that's not a typo. Second was over 13.00. So...why did it make me angry? Actually sick to my stomach is a better description. First, this patient is 5'7" ish (I'll give no HIPAA info away...so easy folks ), 540 lbs (probably the reason??). CCU had been down to eval, and the CCU attending had said that the only thing to be done was a heparin drip and admission to the floor (NOT the ICU). I can kind of understand based on the thought that with his trop that high, he'd been infarcting for a LONG time, and nothing would reverse that damage. The problem...HE'S 31!!!!!! From my understanding, another issue was he was "too big for the cath table." Which I might understand, the table is THIN...would hardly hold me (and thanks to Dr. Burbee, I have a 36 inch waist!). This whole thing has me irritated and angry. It seems like they should have done SOMETHING! So...to make it worse...as the night progressed, the RN and I noticed his ST seg. in a couple of leads (mostly II) was starting to raise. By shift change, he was still in the ED, awaiting a second visit from CCU (due to us nagging them to come see him). Am I alone in this? I hope not. This really is the first thing that I've seen. I feel that the system has really let him down. One thing I hadn't mentioned, is at about 4am, he did get orders for Lasix...gee I wonder for what?!?! His lungs were starting to fill...I work again on Sunday, and plan to follow up on him, and will post what I find afterwards. Thanks for letting me vent.

Why not? It's hypoallergenic... :twisted: