DFIB

Luv ya man. You can take my patient with cyanosis of unknown etiology any day.

She is quickly moving beyond my scope of practice. insert an OPA and begin ventilating with a BVM. Follow whatever Terri tells me to do. Would she benefit from vitamin K? Does she have Dengue or septicemia? I am not sure why I am asking since she has no fever. Could she have Von Willebrand disease, Leukemia? What is her temperature now? Notify receiving hospital so they can have blood, and surgical team on standby.

Dwayne - I agree with your history taking and evaluation assessment. I have ridden with medics where the basic discovered the lower right quadrant rebound pain, took the time to get the complete history, uncovered a patient with TB from his med list and documented previous surgeries from scars. Good history taking is about sleuthing the information with care. Most can do it well if they take the time, many don't.

I agree he needs rapid intervention but should I risk my certificate and livelihood to take a patient off a facilities hands The facility has treated him with multiple meds for two days and now wants to turn him over to a BLS unit. Don't they have to transfer care to an equal or higher level of care? Wouldn't giving this patient to a BLS team constitute negligence? He is not at home and it is not a 911 call. He is in a facility and under the care of a physician. Is it appropriate to transfer this patient to a lower level of care?

I believe this is an inter facility transport and he is already at a clinic or hospital. So is the seriousness of his condition my responsibility or the attending facilities? I think they should call an ALS for this guy. A BLS unit would not be very useful to this guy if his condition goes south.

Since Terri is meeting me in 5 minutes we are going to be ok. I would get a tourniquet on arm to stop the bleeding which is more obvious now because every drip is one I will have to get out of my ambulance. I would transport supine because my patient is A&O and change to a trendelemburg if her alertness and general impression deteriorate. I would medicate her with O2 according to her SPO2 reading via a non rebreather mask. My driver will travel with lights and siren. I suspect an serious abdominal internal bleed that could be stem from several reasons. It could be a spontaneous bleed that developed post-partum that is aggravated by anticoagulants. She could have a perforated uterus post D&C. She could still have and incomplete placental birth. I am leaning toward the first. Has she had any kind of abdominal trauma?. Since it has been 15 minutes I need another set of vitals.

You are correct. I have to stop the bleeding first. Add an additional compress and increase direct pressure. Ask how long she has had the rash. Ask if it has been diagnosed before and if she is taking anything for it. Why is she taking Plavix and ASA after having an abortion? Did she have a dilation and curettage done after her abortion? Surprised she doesn’t have fever otherwise I would be very suspect of Toxic shock to me but without fever possibly internal bleeding Is her abdomen hard? Is there any guarding? Does her abdominal pain radiate? Are there any palpable abdomninal masses that have a pulse? Does she have any bleeding in her eyes or other mucous tissue? Does she have any vaginal bleeding? As a EMT-B Regardless of finds she is going to be a load and go. What is my transport time to decide if I need an ALS intercept or even a Helo for transport/ Revisiting the vitals I say she is in decompensated hypovolemic shock or very close to it. She needs at least two large bore IVs quick. What is quicker an ALS intercept or the transport to the hospital? Do ALS units carry albumin? Oh, I am guessing the rash is not a rash at all but a subcutaneous bleed.

Attractive, and hot are different concepts to me. Being attractive involves the entire persona, style, demeanor, the way they carry themselves and interact with others. Being hot simply refers to physical qualities. Laura Bush is an attractive first lady. Michelle might be hot but definitely not attractive. I may have a twisted perception but when I see her picture I think of Chewbacca.

How about a cowboy with his ceremonial pistol?

Welcome Lunno. I will be excited to see your experience and knowledge posted in the threads. I learn great things from you more experienced guys/gals all the time so jump in share,

Lets consider that thie transport unit is a BLS unit. Would we consider this patient stable enough for a BLS unit to transport or would it be acceptable to deny transport and recuest a ALS unit?.

Thanks friend.

Anybody want ot put the squigglys in English?

It is like you organized and completed my thought.. Quick Clot damaged the liver and Surgicel is what I have seen used in surgery with success .

Sorry mate. The squiggly lines are above my pay grade.

So, why was he blue?

We do not use it here but I tried a demonstration on a pig once. The pig was not on coumadin. Works pretty well. I have seen it used in plastic surgery with good success. A surgeon friend says he tried it on lacerated liver with very poor results. He said it "burned" the internal organs and only recommends it for peripheral bleeds.

Welcome to the City. I will be looking forward to hearing from you in the threads. We have a lot of fun tossing ideas around and trying to presume how smart we are. Just jump right in and let the good times roll.

To take official exams one must prove identity with a picture ID. If we don't have to show our face I could get a higer level provider to take my test for me. It would of course be cheating. A failed attempt at hyperbole.

I have never lived in Afghanistan but would love to have the opportunity before our guys pull out. It will never happen and is not on my bucket list but would be a cool experience none the less. Do any of you lawyers out there know if there is a law or statute that states facial discovery as a legal means of identification during legal procedures. I mean we all carry picture IDs for a reason right? Defendants have the right to face their accuser. Do judges and other officials have the right to confirm identity and intent by looking at our face? I think i will get a Dr. in a burka to take my next exam. I wonder how that will work out?

Is it the same as teabagging? I think you should go ahead and start it Ruff. I would be a client.

Hello Matt and welcome. Your HART unit looks like the kind of place I would be at home in. Medical Rescue is "the bomb" as far as I am concerned. High Angle, confined spaces, structure collapse, wow! I will be looking forward to your input in the forums.

I witnessed a Dr. give an IV injection to a patient today for pain management. He did not want to run an IV but administered the medication no problem. I am simply not buying the idea that it is a "bad" way to administer meds.

Wearing turbans in EMS? I think it would possibly approximate being appropriate if the user was willing to sew a company patch onto it. I think it is about as appropriate as a Christian wearing a big cross on his cap while he is at work or cowboys wearing a ten gallon hat in the ambulance. Would we accept a female medic that would hide her face from her patients? What if non Muslim women decided to hide their face while on the job? Would that be acceptable. The biggest hurdle I think is that if the turban wearing medic is working with non turban wearing people and the stereotypes that exist. How could he ever win their confidence and trust on a single ride intervention? Would the non Muslim patient be more or less comfortable by the medics attire and obvious desire to let the patient know what he is possibly more than treatment. This remark is not a personal fear but the obvious tone of the forum indicates that there is indeed a stereotypical fear among non Muslim society wither it be well founded or not. Some jobs have work uniforms. If a person has a dress code, belief, or custom that is inconsistent with the industry standard then the person should accommodate the industry standard, not the opposite. I am not sure that a turban would meet health standards for emergency services with all of the folds that could hide and harbor fluids and other nasties. Does anyone know? Should we be so afraid that we are willing to accommodate an individual against established standards? If one individual gets to do what they want then all should be allowed the same freedom. Where would it ever end? Disclaimer: I call them turban wearers because it is my understanding that Muslims are not the only ones that wear them. I could be wrong but do not wish to offend so I generalized the term. Edited to insert disclaimer. I have never lived in Afghanistan but would love to have the opportunity before our guys pull out. It will never happen and is not on my bucket list but would be a cool experience none the less.

I have had CO poisoning when I was about 6 years old. I fell asleep in the floorboard of a VW bug that had an exhaust leak and a hole in the floor. I almost died and have been very sensitive to CO in the air every since. I get the exact same symptoms as you describe but at a very low concentration and begin vomiting. Too bad that happened to me, who knows I might have been a genius. Edited to insert