chappy

For those of you who don't know me, I work for a convalescent service. Recently, I had was injured at work (a minor injury and I'm okay now. Thanks for asking!). My injury was the result of moving an obese patient. Over the last few weeks, we've had four different people go out with various injuries: Shoulder, back, etc. - all related to moving large patients. So, my question is how much is too much. When do you call for lift assist? Are there any guidelines as to when a service should provide barbaric equipment and additional crew members? What do you do if you ask for help and you're told to "suck it up."

Since there is no previous cardiac history, I have to believe there is an infarct. Typically, I would followup with NTG and ASA. Yes, we were moving.

Okay, I am humbly submitting myself for review - not humiliation or ridicule, but some good, constructive criticism. I've had my Paramedic card in my wallet for two years, but I work for a convo service. Our service has just started transporting ALS and well, here I am. I am proud of the fact that I am a fairly good student, but a good student is not necessarily a good practitioner. I have no experience and I am working with a Basic EMT. So, can we do a case review? I may ask for more of there In short, I feel like I missed something. So, here goes. Patient history: 58 yom, CVA with slight right side weakness and speech deficit, HTN, NIDDM. NO CARDIAC HISTORY. We are dispatched to a nursing home for a "routine transport" of a patient who has fallen and has a head laceration. On arrival, we found an elderly man seated in a wheelchair, with a patent airway, spontaneous respirations, slightly pale skin color, with a bulky bandage on his head. Facility staff stated the patient had fallen while attempting to transfer himself from the wheelchair to the commode. Stall also states the patient had been discharged from the ER earlier today for hypoxia, as indicated by their pulse oximetry meter and that the patient had expierenced numerous syncopal episodes over the las four days. Regarding his LOC, the staff said he seemed more disoriented than normal. Despite his injuries, patient was very independent and insisted on transferring himself from his wheelchair to the stretcher. A cervical collar was placed. The patient resisted being placed on a long backboard and was not forced. Vital signs were obtained: 138/68, 70 and irregular, 18 c/e. Pupils were slightly irregular and slightly sluggish to respond. Patient's hands were cold and appeared blanched. Though he had good radial pulses, we were unable to obtain SpO2. Based on the history of falls and likely history of syncope, a Lead II ECG was obtained. Initially, Lead II indicated a sinus rhythm with tri-gemini PVCs. The patient did not appear hypoxic, but he was placed on high-flow oxygen via mask. PVCs seemed to resolve. Patient's ECG converted to A-Fib at a rate of 50-100. A twelve-lead ECG was obtained. The initial twelve-lead indicated 2-3 mm elevation in V1 and V2 with reciprocal changes in V5, V6. After about ten minutes, a second twelve-lead was obtained. The second twelve lead indicated continued elevation with the return of the PVCs. IV access was obtained in the LAC and a saline lock was placed. Due to the patient's head laceration due to a fall and possible closed head injury, Nitroglycerin and ASA were withheld. Like I said, I feel like I missed something. Did I? What would you do differently? ECGs are attached, Chappy mw.pdf

Please don't misunderstand. I don't mind doing my job. And, yes, as restrained my chuckles, I was compassionate to the patient. However, I am very frustrated with the staff at the sending facility. That was the point of my rant. This woman is in hospice because she is dying. She is taking numerous opiates and she may have been using some form of cocaine. To that, I say SO WHAT! I don't generally endorse drug abuse, but this lady is dying. Who cares is she is a little high or a lot high. My frustration is that an ALS unit was tied up so she could go for a pee test. What would the pee test show us - maybe she's using crack in addition to all the other prescription narcotics? Therein is the waste of time.

So, recently, I transported a pt from a hospice house to a hospital. The pt was a woman who is not quite eligible for social security, very ambulatory on hospice care for a dx of cancer in multiple systems. As I was getting my pt's history, I discovered that she was allergic to many things such as bee stings, penicillin, ASA, Advil, acetaminophen (yes, she said acetaminophen) and some others. I held back a chuckle as she recited the list of things to which she was allergic because I had the inside scoop. Since she was coming from a hospice house, I had her MAR. I could see exactly what medications she had been prescribed. So, restraining my laughter, I said, "Ma'am, it says here that you take Tylenol-3, is that right?" She said "Yes, I have to have that number three for pain." : Oh, ok," I said. Then I asked her, "what happens when you take acetaminophen?" She said, "I tried that acetaminophen once and they had to rush me to the hospital and put a tube in my throat so I could breath. Then they kept me in the hospital all day with that tube in my throat." "Oh, okay," I said, "don't worry, I won't give you any of that. Why are are you going to the hospital today." She answered, "Some dumb@#$ nurse thought she saw me sucking on a ink pen and now they want me to go pee in a cup so I can stay." As she went on ranting about how that nurse didn't like her anyway, I politely said, "I'm gonna sit right behind you for a few minutes, let me know if you need anything." So, this cancer patient is prescribed MS and tylenol 3 for pain. With cancer, I get that. She was also prescribed Methadone. Hmmm. And she's not allergic to "Tylenol-3" but is allergic to acetaminophen. Getting the picture? The hospice people thought they saw her smoking crack. So, when all was said and done, our PARAMEDIC ambulance was out of service for three hours so this granny could go get a positive on her pee test. HELLO - with all she's taking by prescription, she ain't gonna pass no drug test. Why bother?!?! If this weren't such a colossal waste of time, resources and taxpayer money, I'd laugh. More importantly, that is potentially three hours of napping I will never get back. But, seriously, here is an end-of-life woman who has every appearance of a serial drug abuser, who takes numerous opiates for various reasons. WHO CARES IF SHE'S DOING A LITTLE CRACK ON THE SIDE AND WHY ARE WE THE PEOPLE PAYING FOR A TEST WE KNOW SHE WILL FAIL???

I still do not know why, but for some reason I managed to fail the BIAD station three times. After failing three times, I took the remediation, showed my instructor EXACTLY what I did, and he said I should have passed. So, I get my remediation letter and go test again. Guess what - I did the exact same thing again and passed (also passed my other stations). This week, I took the written, finished in 77 questions and the results were in before I got home - I passed. Now, I am just waiting for the paper. After 18 months of class and two years of stress and no life - I did it! Chappy,

In all seriousness, I am also an amateur radio operator and when those are retuned, they are great radios for amateur use and they are extremely easy to come by. I know several hams who have those or similar radios in their cars for amateur bands.

Yea, erm, I've been shopping on E-Bay and Amazon. That, plus I picked up some stuff that, erm, fell off an in-service bo-lance. Now, I have everything: lp-15 (plus a spare), lots of gauze, 'trodes, all the pharmaceuticals, IV start kits, admin sets, fluids, etc., I've even gots a red-light and a scanner in my chevette. I've been thinking about making sure I "happen upon" some calls so I can feel good about myself and tell everyone how good I am. {note sarcastic, mocking tone in voice and tongue firmly planted in cheek}

83 on my final exam for an overall final average of 88... I passed ...

Well, this is it. We have completed our final skills exam and tomorrow is the final exam for my Paramedic Class. We started one year ago, with 39 people in our class. Since then, we have had all of our class time, in class skill training, 500 hours of clinical time, tears, debates, hypertensive crises, laughter, fun, frustration, testing, (ugh) mega-codes and merit badges. Now, we have 14 people taking their final exam. Please pray for us. If you have any advice, I'll be here at the computer studying.

As most people have said, there are many ways of dealing with the pain and stress of someone dying. Some claim they feel nothing. I am going to say this: if you are at the point where you feel nothing when someone dies, you need some help and you probably don't need to be in EMS. Second, some resort to various anesthetics. Alcohol (and other drugs) do not help anyone deal with the pain. They are simply anesthetics. They numb the pain. The pain will continue to exist until it is dealt with. When people numb that pain with alcohol, it will come home to them. There will be a day when they must deal with the pain. Often, as the medic accrues more deaths, the pain will grow. As the pain grows, more anesthetics are required. The cycle is a vicious one. Before long, that medic is dependent upon their anesthetics. We all know anesthetics are not a cure. They are not the answer for the emotional pain. So, to answer the question - I don't know that I can. All I can tell you is that you have to find your way to actually deal with the pain and not merely mask it.

Well, I wish...Here in North Carolina, many of the rescue squads even have Jr. Members, riding the ambulance, who are 13-17 years old. Anyone who can pass a reading test at a seventh grade level can take the Basic EMT course, even before the age of 18. One cannot test until the age of eighteen. Once you have your Basic EMT and HS Diploma, you are immediately eligible to take the NC Paramedic class. Our current Paramedic class will last exactly one year. We have one person in our class who just turned nineteen and we graduate in September. She's not old enough to drink, but she will be able to push narcotics.

When I was in EMS the first time, back in the late '80s - early '90s, I was 18 and on fire. I thought I was "IT." I knew everything, I knew I was all grown up, I knew I was mature, etc. In other words, I had the typical thought process for a young adult. Now, with more than twenty years of life-experience, I have somewhat of a different view of things. I see now that I was not on fire like I thought. I wasn't the uber-mature, end-all, gift to paramedicine (or the world) that I thought I was. Granted, in a lot of ways, paramedicine is a young person's sport. But is there some room to consider the idea of requiring paramedics to be at least 21? If you think about it, we have 19 year old medics who can push narcotics, but cannot purchase liquor! I know the debate about degree medics is also raging, but should there be a requirement to work at a certain level for some time before advancing? That would build in a waiting and maturing period.

I have a bag with a handful of assorted gauze, some tape, a meter to check a BGL, some oral glucose, some ASA, some instant Gatoraid packets, a pair of scissors, a Sam Splint, OPA's and a cool little pocket BVM. Everything I carry fits neatly in a canvas tool bag.

First, let me say that I am replying from a point of view where I weigh in excess of 300 pounds. So, I am not picking on anyone. As you said, it would be impossible to have a "one-size fits all" solution. So, that would leave us with the burden of carrying equipment to fit anyone from an infant to a morbidly obese adult. So, this would beg the question: how do we balance the need to provide for any contingency with the financial reality? With the space limitations of a modern ambulance? Let's take the example to an extreme: What do you do when the morbidly obese (>500 lbs) arrests? Will a Lucas device work? Is there room for a bariatric stretcher and three or four crew members in the back of your ambulance? How will you perform CPR? Can we reasonably expect to be prepared for every contingency on the ambulance?

LOL ... I didn't notice it was a three-year old thread.

The weather is not bad - there are a few weeks of really cold (lows in the teens, highs in the thirties) and about six weeks of over ninety degree days. The area has everything you can want to do. I, too, would recommend looking for a home outside of the Char-Meck area - really, at least two counties away. IMHO, I would recommend looking for a home in a little town called Clover, SC. It is close enough to the Medic HQ to be real convenient but far enough away to be very inexpensive. Wages: I know one basic EMT who, with overtime, makes in excess of 50k per year. If you're careful, you can rent a nice but small home in Clover for $350-$450 per month, or purchase nice homes (1500-1700 sq feet) for less than $100k. You can expect an electric + heat bill of $150-250 per month, depending on your usage. If you're in SC, gasoline is around $3.00 -$3.35 per gallon (from clover - you're about 35 miles - all four lane - from Medic HQ). Property taxes are lower in SC, etc. etc. As for the work environment, I have heard it is excellent, but I have no personal experience. However, I am scheduled to test with them when my Paramedic class is complete in September. Good luck!

It would seem that if you make contact with persons at the scene of the MVA, you have initiated patient care. If you leave the scene without transferring patient care or obtaining written refusals, you would be guilty of abandonment. So, the question is: whether to make contact or not. I would have to say in most cases, you should make contact and wait for other responders to arrive. Of course, you will have to weigh that decision in the light of your current patient as well as the potential for injury of those in the MVA. In any case, be prepared to document and defend your decision. It is an ugly hypothetical.

If only one Pt can b e transported per truck: Pt 1 accepts OPA and has a sat of 99 ... BLS and high-flow diesel. Pt 2 has a neuro deficit, monitor airway, consider fluid replacement, high-flow O2, high-flow diesel By the way, around here, you should never begin an ALS intervention and pass the pt off to a BLS crew.

Without reading the article, could it be an acid/base thing? If the child has compensated to living at a lower O2 sat, wouldn't blowing a lot of O2 into the kid put him into Respiratory Alkalosis?

Sorry, folks... I'm not sure why that posted like that.

Something like this: 911 operator: "911, what's your emergency" Victim: "Umm, my baby-daddy need a ambulance ... he really hurtin in his belly." 911 operator and victim have a dialog about the location, onset, etc. All the while, the caller never reveals the true nature of the call. As short time later 911 Operator / Dispatch: "Medic 18, county, prepare to copy emergency traffic..." Medic 18: "County, 18, send the call..." Dispatch: "512, respond to {insert address here}, report of sickness. Patient complains of severe, sudden onset abdominal pain pain." Medic 18: "County, 18, en route" Few minutes later Medic 18: "County, 18, show us on scene" Few minutes later... Medic 18: "County, 18, please respond law enforcement, emergency traffic, reference a stabbing. The suspect is still on scene and is not allowing us to access the patient." Dispatch: "Medic 18, understand you need law enforcement reference a stabbing, They have been notified." Supervisor: "18, Medic 1, are you still on scene?" Medic 18: "Medic 1, affirmative, armed suspect is not allowing us to gain access to our vehicle." Law enforcement arrives, tazes the suspect. We find our patient whose severe, sudden onset abdominal pain was the result of a stabbing to the upper right abdomen. Yes, it really did happen. To answer your question ... yes, patients lie to avoid law enforcement. They also lie to manipulate the system in an attempt to get priority in the ER when they have a headache, tummy-ache, in-grown toenail, etc. Something like this: 911 operator: "911, what's your emergency" Victim: "Umm, my baby-daddy need a ambulance ... he really hurtin in his belly." 911 operator and victim have a dialog about the location, onset, etc. All the while, the caller never reveals the true nature of the call. As short time later 911 Operator / Dispatch: "Medic 18, county, prepare to copy emergency traffic..." Medic 18: "County, 18, send the call..." Dispatch: "512, respond to {insert address here}, report of sickness. Patient complains of severe, sudden onset abdominal pain pain." Medic 18: "County, 18, en route" Few minutes later Medic 18: "County, 18, show us on scene" Few minutes later... Medic 18: "County, 18, please respond law enforcement, emergency traffic, reference a stabbing. The suspect is still on scene and is not allowing us to access the patient." Dispatch: "Medic 18, understand you need law enforcement reference a stabbing, They have been notified." Supervisor: "18, Medic 1, are you still on scene?" Medic 18: "Medic 1, affirmative, armed suspect is not allowing us to gain access to our vehicle." Law enforcement arrives, tazes the suspect. We find our patient whose severe, sudden onset abdominal pain was the result of a stabbing to the upper right abdomen. Yes, it really did happen. To answer your question ... yes, patients lie to avoid law enforcement. They also lie to manipulate the system in an attempt to get priority in the ER when they have a headache, tummy-ache, in-grown toenail, etc. Something like this: 911 operator: "911, what's your emergency" Victim: "Umm, my baby-daddy need a ambulance ... he really hurtin in his belly." 911 operator and victim have a dialog about the location, onset, etc. All the while, the caller never reveals the true nature of the call. As short time later 911 Operator / Dispatch: "Medic 18, county, prepare to copy emergency traffic..." Medic 18: "County, 18, send the call..." Dispatch: "512, respond to {insert address here}, report of sickness. Patient complains of severe, sudden onset abdominal pain pain." Medic 18: "County, 18, en route" Few minutes later Medic 18: "County, 18, show us on scene" Few minutes later... Medic 18: "County, 18, please respond law enforcement, emergency traffic, reference a stabbing. The suspect is still on scene and is not allowing us to access the patient." Dispatch: "Medic 18, understand you need law enforcement reference a stabbing, They have been notified." Supervisor: "18, Medic 1, are you still on scene?" Medic 18: "Medic 1, affirmative, armed suspect is not allowing us to gain access to our vehicle." Law enforcement arrives, tazes the suspect. We find our patient whose severe, sudden onset abdominal pain was the result of a stabbing to the upper right abdomen. Yes, it really did happen. To answer your question ... yes, patients lie to avoid law enforcement. They also lie to manipulate the system in an attempt to get priority in the ER when they have a headache, tummy-ache, in-grown toenail, etc.

I love coffee beans!

Amen. If you're on an eight hour shift, you shouldn't need a recharge. Otherwise, I would agree that the assessment was right on. As a responder, you MUST be calm when everyone else is falling apart around you. When you get excited (or even, dare I say, a little panicked) the excitement (and panic) of the bystanders goes up a hundred fold. After all the comments and critiques, remember this: it was your first emergent call. Experience will help. I am certainly no pharmacologist, but I wonder what the effect of the caffeine and other stimulants in energy drinks is when combined with the adrenaline rush of a rookie on his first (or tenth) emergent call.... I feel a new thread coming on. Anyway, don't beat yourself up over anything but the energy drink.

What do you all think of using energy drinks? It seems that there are a lot of Paramedics & EMT's dropping from strokes and coronaries. I'm sure the fast food, eat on the run, lifestyle is a part, but do the energy drinks play a part as well? For all of you pharmacology experts, what the effect of the caffeine and other stimulants in energy drinks is when combined with a good adrenaline rush? What about the letdown when all the stimulants wear off?