DFIB

Sometimes gratuity works both ways!

You look at your watch and it is 23:50 hrs. You just finished stocking your ambulance when tones drop. You are dispatched to a “possible heart attack” at 555 Chest pain drive. Your crew consists of: you as the proctoring medic, your partner Joe an AEMT, and an EMT-B that you can’t remember his name. He has just wandered around the Ambulance like he was lost since he arrived anyway, despite your efforts to get him involved in checking equipment and stocking the rig. Ladder 51 is also dispatched with one Lieutenant and three FF/EMT-Bs. A private company from across town is in route as well but will arrive approximately 4 minutes after your estimated time of arrival. You turn onto chest pain drive and into what you know to be a predominately white, working middle to low income neighborhood. It is quiet tonight. There are no people out. You arrive at a small frame house sitting on a double lot. Other than the hedges needing to be trimmed the yard is neat and recently mowed. There is an American flag hanging from the eve of the house on a short flagpole and a truck with a lift in the driveway. The truck has a “Semper Fi” sticker in the window and a “You voted for Obama? Thanks a lot A** Ho*e bumper sticker. There is a handicapped indicator hanging from the rear view mirror as well as on the license plate. A dog barks in the distance …

When BP is absent wouldn't gravity cause flow in both?

I am the idiot. I wrote that in Spanish. in English it is hyphema.

I bet Dwayne was disappointed when he found out the book was about physics!

Welcome Jake! That is a great first post and a interesting question. Working in rural USA we would leave necessary equipment at the ED and pick it up later. Working in the third world we retrieve the equipment before leaving the hospital which usually requires us to wait for the patient to be moved through x-ray before immobilization equipment can be removed.

Thanks for the vote of confidence but I don't have a clue. I mean, like I had never heard of either experiment or the theory of "particle awareness". It kinda ticks me off that I am gonna have to compulsively invest the time energy into researching it now. Thanks a lot! EDIT: It would seem to me, just from a third world laymen view, that the existence of a space (hole) at that level would create enough environmental disturbance or instability (not familiar with the terminology) to create a predictable pattern. Wouldn't the presence or absence of matter cause changes in electrical fields and probably other variables as well? I am counting on chris to tell me how far in the ditch that idea is. Now I will go read the theories and find out how goofy that idea is.

You are so smart!

Were there any signs of foul play? Ligature marks around the neck? Was there any evidence of anyone else being in the room? Did you get a chance to look at his sclera? Anything that looks like petichiae? Hifema? Did there seem to be any evidence of choking? Any blood in ear canal? Did the blackness look anything like a Battle sign pattern or raccoon eyes? Could a cerebral hemorrhage cause this sign? Sorry I only gave more questions and no answers but I just don't know what to think.

What is the patients age and approximate weight? Has she had any sudden weight changes? What does the house look like? Clean? Disorderly? What is the patient's ethnicity? Does the son look like a crack head? Does the patient look like a crack head? Does she track me with her eyes when I come in? Vitals including SPO2? Eyes? Smooth pursuit? Convergence? Ears? Does she have jugular vein distention? Is her trachea inline? Is her speech interrupted? Lung sounds? Does she have associated chest pain? Does she produce sputum? Color? Amount? Is she taking Medication? Does her condition change with exertion or exercise? Has she had a diagnosis by a DR? IF she presents associated chest pain When was the Onset?,Is there anything that Provocation or Palliation?, What is the Quality of pain?, Is there Pain Radiation?, How severe is her pain? Has this happened before? Does she have an altered mental status? Pupils? Nausea/Vomiting? Skin turgor? Mucouse membranes? Is her abdomen tender or distended? Is weakness weakness bilateral? What is her Cincinnati Trauma Scale score? EDIT: Is she a smoker?

There is no guarantee! CBR600 - Mike is right. Clinicals can be a great learning experience as well as a place to make good friends.

The crux of the story is The dad lives next to an aunt. The aunt calls to alert someone was trying to break in. The dad gets his gun and walks outside to investigate. The kid is in the yard and rushed the dad while wearing a ski mask. The kid allegedly had something in his hand. Dad shot him. The dad is a 5th grade school teacher. Very sad, but as with most things, there is probably more to the story.

Good for you on deciding for the larder but better route. Hang around and participate in the forums. We would love to know how your studies progress. This could sound like Dwayne is tooting our own horn, but, I have grown as a professional by participating in this forum. After you have been here for a while you will find that it is more akin to a community than a forum. I quickly evolved from a "trauma is cool" mentality to a more mature outlook of EMS, my writing is better and my thought processes are more clear. I might even be a little more of a "global" thinker than before, but only a little. It is good to have you. Welcome.

Just imagine if all the crazy things we did as kids got us a write up in the paper? Life would be over before it even began. I notice you said radical Christian and will take that as a recognition that there is diversity in every group. Not every christian would care what people do for kicks. I think PR is a perfectly valid rout of administration. Dangerous and gross but valid.

The older I get I become more convinced that one of the keys of being really good at EMS are our non-medical skills. Non medical skills like English. Math, Sociology, etc. definitely mark a difference in understanding the context of our patients overall condition therefore better enabling us to provide a more complete,kind, and comprehensive care. It also allows us economy of communication and thought that will make you quick and sure. I entered EMS as an adult so I had a lifetime of college learning and career experience under my belt. It made a difference in how fast I could integrate into the service and marks a definite difference in the care patients receive as compared to the care they get from other EMT's in the same service. A general education will make you a more well rounded person as well as a more complete provider. Don't get me wrong, I am not saying I am that great, I am saying that I am better that I would have been if I had not had the advantage of an broad education. All of those other courses will make you a more educated provider even if they are not directly related to Paramedical Sciences. Dwayne makes a good case for the fact that if you have the opportunity to go to an AAS program, you should go for it. As far as EMT anatomy goes, you have to acknowledge that in class you are only going to get a general idea of the materials you are expected to learn. This will be consistent in all of your EMT course. You will get the basics of every condition. For example: Your basic class will most likely define muscle contraction as the shortening of a muscle fiber. It will not explain active ad passive transport, action potentials, polarization, depolarization, Calcium and potassium transport, actin, miosin or the host of enzymes and metabolic processes that are involved in muscle contraction. This is why it is a basic course. It is up to you to fill in the planks using your book as a blueprint. depending on what book you have will have a complementary web page to help you study. Therefore it is up to you to have the initiative to read and learn the information in your textbook. Take advantage of all of the wonders of the internet to get explanations for things that don't make sense. If you just Google Human Anatomy you will find a host of free interactive programs where you can practice and hone your knowledge. Each module of EMT will build on the one before. Don't worry about clinicals now, just worry about anatomy. By the time you get to clinicals you will have had the opportunity to learn everything you need to succeed. Most of all, take a step back, relax, get a good cup pf coffee, roll up your sleeves and study hard. In a few months you can come back and tell us how easy it was to pass your finals and become an EMT.

This has been around for a long time but I can't seem to find a reference as to when the practice began. I remember reading or hearing something related to this years ago as a practice for alcoholics with severe peptic ulcers or something like that. EDIT: Enemas go back to the Mayas as a ritual. The engraved image depicts a person getting an enema and with a caracol breath sign coming from the mouth that often is used to represent a message to the gods. I am not sure if they used alcohol. Some say yes, where others disagree. It dos seem that they had the practice of some sort of PR liquid substance that moved them from a conscious state into what could be considered the spirit world. So but chugging may not be that new. There is at least one report from 2007 of a man using this method to kill himself.

I like to integrate this kind of interaction into a system of constant post-run debriefings for every run, from the MVC with blood and patients everywhere to helping grandma into bed. Every single run gets a sit down to talk about what we did well, and what we could do better next time. These routine conversations usually remove the veil from the guy you mention in the quote. It helps keep us all focused on reality. This was hard to do when I was doing my clinicals but without failure I would ask the proctoring medic. The conversation would go something like this What did we do well on this run? I would ask "you were fine" the medic would respond. Then I would ask "What could we have done better?" and the medic would respond "You were fine" Sometimes I would get more than that depending on the medic but it has a threefold effect on the team. One is the one I mentioned before, the second is like having a CISM session right after every call, and the third quasi parallels a CQI system, even when one doesn't exist. I like it.

But, wouldn't that makes all equal?!?

Welcome,

Good for you! Have a great and relaxing time!

I notice that you mention that you are having what you would consider negative behavioral changes. You mention snapping at people when you normally wouldn't, being irritated at other providers performance and loss of sleep because these issues that arise at work. I am not saying that you are showing signs of work related anxiety. That is something for you to evaluate with your team but I will mention it because it is often very difficult to join the dots from the inside, cant see the Forrest for the trees so to speak. I find that most often when I am feeling misunderstood it is me that is not getting the point. That my ambulance companion has always been a dunts, only now I am being a jerk about it. Most often for me, it is not my environment that has changed but my perception of the environment. The combination of school, work, family, and all the other stuff in life sometimes fills our BS meter to the top. I can always tell because it begins to spill out and get on others. Why should i be the only one that is ticked off? You know those first chapters of Paramedic School that talk about Paramedic Well being are often overlooked as Bull Sh*t filler pages. In fact they are pretty important and should be revisited with the same frequency as other subjects such as pharma or cardio. Look for the other, real reasons that you are irritable, take a day off, hold hands with the misses, hug a kid. You will be surprised. I think that sitting with your people and talking it out is a great proactive and very adult way to begin finding out what has changed. I congratulate you for taking the bull by the horns. Cheers

Doc, This is a very different question and not an attempt to derail but have you heard of any success in using narcan as a Labetalol antagonist for persons that would benefit from Epi, such as asthmatics and cardiac patients?

Heeeeheee

I hope they are not. The operating is a serious place for serious people that does not suffer fools or foolishness. I have worked transplants before and we never, never, never trash anything until we know where the tissue is, much less bagged chilled solutions,. In fact we check bagged solutions just to see if any instruments might have been dropped in the bottom. This is the kind of iatrogeny is not to be winked at.

The real question is, do you secretly enjoy the hickey producing suction cups?