DFIB

The average temperature where I work is above 90 degrees. I usually only cover burn, shock and spinal injury patients that are suspect of spinal cord injury. I have often wondered about the temperature of IV fluids at the time of infusion as we can drastically change a body temperature with fluids. We pay close attention to fluid temperature in environmental emergencies and patients with high fever. We do not measure the temperature before infusion but simply judge the temperature by touch. If the patient is too hot we try to make sure the fluids are cool to the touch and warm if the patient is too cold. Without having any hard data on fluid temperature and hypothermia it would be difficult ot be accurate but I would be inclined to believe that we do actively and inadvertently contribute to the "cooling" of patients. In cooler temperatures I have observed that patients get a blanket when they manifest that they feel cold. It is a great observation and will influence my thinking and treatment in the future.

Following is a real life CPR video of a 20 something apneic and pulseless patient on the beach. As I was watching I can only contribute the success of the CPR to the young man’s metabolic reserve and resiliency as well as early CPR. There are a few observations that jump out at me. First the rescuers did a good job of getting him onto the dry sand. I don’t mean to bang on anyone but wonder if my observations are correct. 1. They walked past a guy with a surfboard, wouldn’t CPR been more effective if they had put him on the surfboard? 2. The compressions seem to have good depth but the rhythm seems slow to me. Is there any observations or thoughts that our pannel of experts would like to add? Edited for spelling

I called him offending to economize words. My driver was really the true offender. I was thinking of packaging him to cover all bases and be able to leave the scene promptly. What if I just loaded him in the ambulance and took him with me without packaging? Which do you think would work better?

My question is this; If the IV was medically nessesary for this patient, is it fair or correct to say that transport was delayed? Or would it be more correct to say that transport was rendered when the nessesary medical procedures were completed in accordance to the evaluation and treatment plan set forth by the medics on the scene.

I may be fixing to drive into the ditch here but I think that if my partner was a medic I would notify dispatch and request additional resources. Have my partner do a Rapid Trauma Assessment on the offending driver. package him with complete spinal immobilization, If additional resources arrive allow them to transport, if they do not arrive by this time, load the additional patient on the bench and transport both to ED for evaluation. So how much trouble did I just cause for myself?

Any "real" EMS provider has been drilled with the value and sanctity of patient confidentiality, trust and privacy. I take a lot of pictures and use them at the transfer of care. Any provider who would display their patients for a morbid rush or to prove how heroic or tough he/she is is a disgrace to our profession and should be ousted. All tools have a place when their usefulness and limitations are properly understood including cameras, oximeters, glucometers and all the other tools of our trade. It is sad that EMS tends to be negatively reactionary to circumstance. One misuse or abuse can easily limit these tools use for us all. So very sad that the protocol writers so often descend to the lowest maturity denominator in reaction to the poorest examples of prehospital care givers. .

I can diagnose breast masses by touch. Never fail. I have not misdiagnosed one that I can think of in 2011, so I am batting closer to 100%, but will only claim 99% for now.

We like quite as church mice, except for pedeatrics, of course.

Are you sure it was a museum and not a shrine?

Medicgirl. This is a different tangent but I am curious. When the policeperson boarded your ambulance; What did they do with their firearm?

They teach all to ask the same questions in school. Was your school different?

I think all medics are tough but I think you ladies are tougher than the guys. You put up with more crud than men and do it with grace. I have been groped and poked a few times on the job. It would be flattering if it were not so distasteful and insulting. I guess i was referencing a more ideal and just world. I do put on my white hat when working with you gals wither you appreciate it or not. Just can't quit being me.

Oh, my. I am sorry for my hypothetical stalker scenario. I was under the impression that you had not pressed charges. It is a dichotomous thing. I am in the middle of a dissertation in response to Dwayne and have pretty much talked myself out of all the arguments. I am sure that you didn't hurt the patient, you might have even saved him. You probably did the right thing although it was not your responsibilty to do so.I think it is remarkable that even though at this point this guy was no longer your responsibility you still went out all the way for him. And if it has been a few weeks the guy has already forgotten you and you shouldn't have to worry about that whole stalker scenarion thing I was just stressing a point. I also think LE could have found another way to keep him other than having you press charges.

Oh crud medicgirl05. Are you saying you did press charges? I was under the impression you did not.

There are a lot of things we are responsible for, other people's behavior is one of the things we are not responsible for. Ask yourself this question; Why didn't the police let him leave the hospital on foot and pick him up for Public Intoxication? I think they are dumping a lot on you that is not your fault or responsibility. You put up with his crap, took him to a place of definitive care and made a lawful transfer. Why would you be responsible for his actions beyond this juncture? Why would you hazard yourself by harassing an already unstable individual? Think of this. He gets out of jail, goes to the closest liquor store where he looks in the phonebook for where the station is. He goes home for his gun and car and drives to within a block of the station and waits .... drinking and sulking about the medic that put him in jail. All his shortcomings are now compounded and focused on a single person that messed up his plans. Waiting, drinking, sulking, getting more angry by the drink, planning the extraction of vengeance as a means to calm his frustration. He already said what he would like to do to you and he didn’t have a grudge then. Waiting, drinking, planning ... Pretty spooky. Our wellbeing does not end with scene safety and the call. I say you did the right thing for you and have nothing to feel guilty about.

The hospital can keep him with good reason. Pressing charges should be your personal decision based on how you perceive his aggression. Once you transfer care it is the hospitals responsibility to watch after the patients care (I am sure you know this). If the cops screwed up the paperwork that is not your responsibility either, it is theirs. What would be your responsibility is pressing charges against your psych patient that may or may not want to take revenge at a later date. I think the cops were pretty chickensh!t for standing by while you were verbally assaulted and then asking you to press charges at their convenience. That is BS and you should feel no guilt for refusing to do so.

At what point does the responsibility to the patient end and the responsibility to self begin? Dwayne, amigo, I have to tell you that I am kinda freaked out about what I am fixing to write because you are probably gonna hand me my butt. I am calling BS on this statement. Just because a woman decides to work in EMS does not mean that the laws and rules that regulate our society are suspended because the offender is a patient. Nor does being intoxicated of sick suspend a patient’s responsibility to civility. We put up with a lot of crap and bad behavior because we choose to do so. It is not our obligation to do so. The right to act or not to act, legally or otherwise, when assaulted, wither it be verbal or otherwise, is a personal choice but not an obligation that comes with the job. It will not suffice for me to simply say well that is EMS. I would think not. I am surprised none of the ladies have pointed this out.

You know, none of us mentioned keeping this patient warm. OOPPS!

I must say this is a bad to the bone scenario. This thread has been very entertaining and educational. Very well run. You did not hide any details or spring new and obscure symptoms midstream. Scary as all get out. The kind of calls dreams are made of, bad dreams. I had never heard of DIC before but am all over reading up on it now. Can Toxic Shock present without fever?

What is DIC?

Begin suction with a French tip. I would consider modifying the tip with a naso-gastric tube so I could suction deep into the bronchi through though ETT. I would keep an eye on the SPO2 and ventilate and suction intermittently as needed. Make sure goggle strap is tight and face mask is pulled up. Put on a face shield if available. In the mean time my medic does all that cool stuff you do with the meds. We have a policeman or someone driving our ambulance.

If the definition of assaulted is being touched in an inapropriate manner do you think there is anyone who has not been groped at least once?

I should have jumped on the toxic shock/septicemia idea when it was first mentioned but the absence of fever derailed me. Darn, shoot dadnabit, doggonit and any other exclamation you wish to insert. If this is the case the patient is buggered before the call went out. Hemophilia discriminates against women but her clotting ability is definitely done. I wonder if runing a PTT would help at this juncture? Just kidding.