Arizonaffcep

If there is a risk of a tension pneumo, then I would think you would need to get unimpeeded access to 3 sites, 1st is the wound itself (if you plan on burping it, rather than needeling the chest) and the others are the insertion points for needle decompresion of the chest. If the patient is alert and able to FIND a comfortable position, that would be most prudent.

I did a FSBS, normal, and he admitted to the meth. They were not happy because I refused a person who had taken meth, and should have transported because it was "mind-altering." But yes, he was A&O x 4. I didn't get in a lot of trouble, just a wrist slap.

Once in a while...just hope they don't take anyone else out! :roll: There is a clause in the protocols that says ultimately, it's up to the medic who is providing care. I have seen it go either way. I can see the point on both sides of the argument. Then again, I've also had the patient who has just done some meth, A&O x4, talking coherently and carrying on a good conversation. I got him to refuse...and he promptly ran across the street and got tagged by a car in the process. My wrist got slapped because I let him refuse. It's the unpredictability of the drugs and patient that carry the concern, and the rather rapid "shift" they can have between rational and irrational.

That's what my wife said! :oops:

Here's the problem with gun control things...it truly only prevents the law-abiding people access to the weapons. Which is good and bad, but a fully auto AK 47 in the hands of a law abiding citizen vs same weapon in the hands of a felon? Who would you rather trust? Who has easier access to the weapons because they don't get them through legal channels? We need to enforce the laws already on the books and get rid of the "black market" on guns. Once that happens, gun "control" will be achieved. Until then it's akin to pissing in the wind.

The worst part was, she blew a tire on the interstate, over corrected and took out a portion of the guard rail. Not her fault, but they still arrested her for driving under the influence of Pseudofed. Even though it didn't have anything to do with it (mid-day, windy, alergy strewn day).

Seems like a fairly simple, uninvolved request...why not?

If we did go to just a football game for the election...just imagine the commercials!

When I'm in the trauma bay...we usually see 2-3 GSW's a night (sometimes more...like this past Sat. night we had 6 "reds" chest/abd shots in about 45 minutes). Maybe once in a great while they hit the spine. The VAST MAJORITY of spinal injuries comes from MVC's/falls, etc. I can honestly tell you I've only seen 2, maybe 3 in my 2 years at the hospital. So I wouldn't exactly say it's a "frequent" occurence. Or, maybe the vatos down here are bad shots... :shock:

Good point, although I was getting at illicit drug use. However, beware AZ DPS (highway patrol)! I have seen them bust people who have taken Pseudofed, and are NOT having a reaction to it, but they crashed into a guard rail anyway. No joke...they carted her away in cuffs to jail. I theory, in AZ you can NOT have ANY substance (even caffeine) while driving. Quite the extreme, and you don't see them caring much for stuff like that...but you do run into the lone "looser" on occasion.

Here's the thing though...they take those substances specifically to ALTER their mentation/perception of reality. With that in mind, how CAN they refuse if they are under the influence of them? From my own experience, those who have taken drugs (not specifically ETOH, sorry for the hijack) DO show they are under the influence and are not able to make rational decisions for themselves. Its not a criminal thing, so PD (unless they are already involved) doesn't come into play. We take them to the hospital for observation/treatment (if needed)-nothing goes on a criminal record, so to say we are doing PD's job is bunk.

I do have to disagree with you a little on this Dust. How can you expect anyone to (reasonably so) commit at LEAST 1-2 hrs of study for EVERY hour in class with a 6 month program? If you work it out...then they have a 4-5 day period where they would get no sleep. Now clearly, I know that's not terribly realistic, but study time is HUGE in a medic class. With a 6 month program, you get less study time=less understanding, my 2 cents worth. Hell, just expand it by a few months=greater "sink-in" time, more study time. I can tell you, the 6 month program that the CC does here generates a lot of patches and not medics. As a preceptor at UMC (level 1 trauma center), I eventually see most of the students in each class. There are a lot that don't know their ass from a hole in the ground on most things.

Not sure if that would qualify as symptomatic. Paraloco-trying to control the rate because-worry about inadequate fill time? If that's the case, Pt would be hypOtensive, not hypERtensive. Of course, if they're at 200 and hypertensive...it won't last long. Cardizem (Diltiazem)=great drug. Just be careful pushing it with other meds...ie beta blockers...etc.

I got to see a person with SJS on the burn unit in St. Mary's in Tucson (when it was still considered a burn center). According to them, SJS, TENS and other similar disease processes are best treated in a burn center because of the loss of the integumentary system. Quite an interesting disease...although definitely not pleasant.

ooooohhhh!!!! Sooooo hottttt! :^o

No "Good Samaritan" laws? Assuming its a real event.

If you would remind them that the little white plastic thing at the "external" end of the tube hooks real nicely to the end of a BVM...and not so well to a mask

I have always preferred rural EMS over city EMS. Longer contact time, greater skills usage (when called for), greater need to think on your feet, be creative, etc etc. None of this, "well, just transport and let the hospital figure it out" crap you see in the cities all too often. You really want a fun time? Work for a long distance interfacility transport company. Wow...when I was part time for one, I can't tell you how many times we got REALLY SICK Pts that needed to go to Tucson for higher level of care (ICU/Trauma, runny nose, whatever, we were stationed about 2.5 hrs SW of Tucson). We had one guy who was shot multiple times in the chest, post traumatic arrest (Sierra Vista managed to get a pulse back). It was monsoon season and the helicopters were all grounded at the time, so flight=not an option. The guy managed to code again south of Benson (still about an hour & 15 or so from UMC-area Level 1). Well...needless to say, he didn't fare well . But it was fun...and quite a test of skills.

I could see this if it was an NPA...not a tube. Was this person's GCS less than 8? Drunks vomit all the time...it's a subspecialty for them (liver failure being primary). Ok...not really, the hard core people don't really puke, the newbies do. If they are able to maintain their airway and clear it themselves after each episode, then there was no reason to intubate. If, however they couldn't clear their airway after each one, fine...but they would be so stuporous their respiratory drive would be affected--meaning they would need to be "bagged." Just please tell me this was not a punitive intubation.

Can't...no glasses!

I'm sorry if this stirs the pot, as that's not what is intended. First-In my experience, there are good and bad SNF's. Some big ones are good-you get in, they know their patients (and occasionally, other RN's patients). It is clean, there is not the overwhelming stench of feces and urine. I enjoy going to those. Then-there are those that aren't. There is one place on the east side of Tucson we call (with all due affection) "Human Stables." :roll: No joke...the RN's there can be (unprovoked) RUDE, with a near complete lack of empathy for the patients. The most attractive thing about it though...you are greeted by a wall of brown-and an overwhelming stench of feces and urine. I have even been told I can't look at the transfer paperwork, that it's a HIPAA violation, and yet their report consisted of "just take him." These...I don't like. Most of the time, if the staff is curtious, I don't even mind if they really don't give me a report. I just read the paperwork (sometime, if I'm feeling frogy, I'll open the sealed envelope in front of the "you can't read it" RN/CNA/Whatever). What gets me is when we go for difficulty breathing, AMS, whatever (cause you know...I was dreaming of some good lookin gal doing something...) at 0200, code 2 (normal traffic). Of course, when you get there, the RN says "I really don't know this PT" (I would assume shift change was several hours ago, and I know they don't have the same turn-over as an ED, so also assuming the patients haven't changed). Then...she says that (insert problem here) as been going on for 6 hours. You get there, the patients guppy-breathing, with a POx in the oh 70's, with cyanosis, etc etc etc. I have several problems here...first...shows an inability to assess Pt's. Why wait 6 hours to call for transport? Why code 2-clearly this Pt is CTD? Second, why doesn't the RN know his/her patients? In the ED, we are MANDATED to give report to the on coming shift. Is this not true in a SNF? --This is the type of situation that gets me kinda upset. The first thing that comes to my mind on THIS type of situation is neglect. Now...on the ED side of things, it is kinda, well irritating that--this did just happen not 3 days ago--a SNF called for a transport to the ED because, as part of his NORMAL dementia, he got up and wandered off. He came back and they sent him to the ED because they "didn't have room for him in the higher acuity unit." WTF?!?!?! Truly-I swear I'm not making that up. He sat in hallway 4 until we could find a different SNF for him to go to. This situation--totally, unequivicly unacceptable. What about the elderly female Pt with a foley cath, who has a UTI, but is NOT septic? They (a couple of SNF's in the area, not good ones) will send these out. Bad RN's in this case? No. Lazy Dr. who doesn't want to do an assessment and prescribe antibiotics...leave it to the ED! We can solve everything :twisted: This is what gets me about SOME SNF's. To lump all together as "bad" is profiling...and that's WRONG! But Vent, you must admit, there are SOME out there that are NSNFs (non-skilled nursing facilities).

From my understanding, glucagon is also a smooth muscle relaxer, so it can help for those "hard" stick dm pts.

When in doubt, we contact medical control...but that's the standard here...now we don't involve PD unless we have to, because, like you said the hospital is not a jail. But it is a place (because they, under the standard, are unable to make an "unadulterated decision" about their health care) where they can go and get medically cleared, then discharged as Dr's see fit.

Didn't know there was a photo gallery. I'll check it out!

I agree he is a dick. I really think he could have gone about it in not only a better way, but a more effective way as well. Although I must say-I have no problem with the check points. BP does get a bum rap a lot, most of it unfair. BP are doing a job that not many want and most have a problem with. They are good people doing a most difficult job. We get them as patients from time to time, most MVC's, but occasionally some as GSW by some unknown spineless prick on the other side of the line, presumed to be a Mexican drug person, sniping at them. At least they are paid well with large amount of firearms.