Arizonaffcep

Describe the fall? Ground level? Elevated? How old was the Pt? Pts? HX? All that can play a role in my choice to c-spine a Pt or not.

Hey! Don't knock it until you try it! You ever seen those corn kernels bounce in a red bikini?

With pericarditis, you'd expect global ST segment elevation.

This whole thing is similar to a moral dilemma that was presented to me when I went through EMT class. It came down to (for me) if I had prior training in the procedure (maybe something in the military) and it was a loose one or both pts, then I'd do it, with the understanding that I'd probably end up in jail and out of a career...but my conscious would be clean.

Good call.

I'll bet this was a PE. How did his legs look?

Can you describe his pain? Onset, etc? When was the pericarditis??

Interesting strips...Right off the bat, IV, O2, Monitor (sounds like you've done that), NTG, ASA and Morphine. I would really like to see a 12 lead on this guy...I was thinking of possibly using Lido to control the PVC's, but as they are perfusing, you don't want to shut those beats down. Any other HX? Maybe make him inhale some dust on the way in (to stimulate the cough... :shock: ).

Other than the racoon eye EMS got from it. I don't know how it's done in DC, but here is AZ, we are certified and cannot make a "diagnosis"-something about practicing medicine without a license. Not a reason to know what's going on with the patient and gaining as much info about medicine as possible...but it's outside our scope of practice to say "its acid reflux" or whatever. Quick way to loose your medical direction.

Even if he did adamately refuse treatment/transport of his own accord...I'm fairly confident that EMS would be blamed either way-thus the responsable party.

It's about time we got some respect 'round here! (just don't tell my wife I said that... :shock: )

Which was what? That you didn't know the expectations? Or you didn't know what was being discussed and included every "frequent flyer" in the discussion?

Ya...I can't stand what might be the medical equivalent of a "rekindle." :shock:

Here's my definition of a frequent flyer. Anyone who calls 911 on a regular basis...for what turns out to be no medical emergency. An example...the 82 yof who calls for "difficulty breathing" and she won't be quiet, who when asked, lives alone, vitals all better than the respective providers vitals. This same patient, when all tests are back from the hospital, is discharged with no significant findings. It is this type of person who doesn't necessarily need medical care...as opposed to someone to talk to. Now, there are other frequent flyers who have ETOH, drug problems and such, and are transported all the time. They either refuse rehab, says they will go to rehab, only to refuse and walk out in the morning, etc. etc. These type, while I have no use for on a personal level, although one is quite funny once he's sober...but when drunk usually ends up assaulting staff. These are the more intensive frequent flyers who wouldn't be helped by going over to their house to see how they are and carry on a conversation. They need lots of other services, if they are willing to utilize them. They are NOT who we are talking about.

Correct...the only "blockers" that we carry are 2 calcium channel blockers...Verapamil and Diltiazem.

Basically, that's what happened (TAA). The pain can (especially with "text book patients" end up being tearing, etc. They usually do have the look of death, although that is kind of an "oh crap" sign. The way the Dr who ran the simulation was telling us was, one of the best indicators to determine AA vs. cardiac CP is pain-in that cardiac CP takes a little while to happen, vs. AA where the patient can usually tell you to the nano-second when the pain started. For instance, "I was reaching for my coffee" or "I was getting out of bed..." Clearly, a main goal should be to bring this pts bp down, don't want to dislodge a clot that's hanging on by a platelet:)...in AZ NTG and morphine would be the way to go.

I was actually referencing "good enough for us" as far as documentation of the encounter. But thanks.

Not sure if this is just a local thing but we term it "spinal precautions."

What is the difference between EMT I, II, and III? Are they ALS? If you call for ALS assistance, and it would take longer for them to reach you vs. "load and go" to the hospital, IMHO, load and go...don't waist time waiting for ALS IF you can get to the hospital faster than ALS can get to you.

I agree! After all how many of us do "blood pressure checks" for the public? Even if it's out of "whack" we advise the patient that they should get it looked at, but it's their responsibility to carry that out. If they want transport then-not an issue. Otherwise, make a note in the daily station log about what has happened and that's good enough for us.

I hear its cold up there....

So what are the signs and symptoms?

Well ya! I AM a paramedic. We are well schooled in the art of what to do when...not what to do to prevent. At least here in AZ, that's our role in life=reactionary medicine.

"When the fecal matter hits the air circulation device..." -Dave Klienman AZ Department Of Public Safety