DFIB

EMS is an emotional job. It is littered with the realization of our limitations, weaknesses and failures. EMS is also marked by our training, fortitudes, skill and positive qualities. Each one of these situations teach us valuable lessons that most people never have the opportunity to learn, each experience can strengthen us or weaken us. Every time my patient does well and recovers I feel good, my confidence increases and I feel I made a real difference. When the illness or trauma surpasses my ability to help. I feel the pain of impotence, the fear of inadequacy and the desperation of defeat. The important thing is that every single service I feel. EMS makes me live life and life to the fullest. Don't get sucked into that stemming pile of crap that we should not feel for our patients. That we should not care. That we should turn a blind eye to others pain, illness and misadventure. Caring makes us more human and better providers. Simply think of what the situation would have been if you had not been there. You made a difference in all the patient’s life. The fact that you where there freed up resources to care for the child. You were not only helping your patient. You were helping them all. As for being angry at your patient because you thought he caused the accident, there are just too many factors you don't know for you to validate the feeling. The other driver could have been texting, putting on their makeup, fiddling with the radio spilling their coffee on their lap or all the other dangerous stuff people do while driving. Was the child properly restrained? Were they driving at a safe speed? Had they put off the break job just one day too long? You get the picture. I know you made a difference. What you are feeling we all have felt and learned to live with it. Some build a emotional wall to block out their feelings, some ignore it, others embrace them. I choose the latter. I choose living. I wouldn't quit just yet. Go for the card. Work for a few months and then decide. You will be surprised at what a huge difference time and experience will make. At least after time you will be sure.

When are you going to do the right thing amd make her Mrs. Tyler_EMT?

I am an EMT-B. I just finished school in August. No cert. I will take NREMT in Dec. Considering that both patients would be packaged with full spinal inmobilization. Scenario one: If the ALS unit can carry two patients. I ride with ALS and the two patients. My ambulance follows. Scenario Two: If ALS can only take one patient and cannot administer meds prior to BLS transport, ALS would take Patient 2 and BLS Patient one. Scenario three: If ALS can administer meds to the BLS transport I would request a IV with a hypertonic solution (D5NSS?) on patient one, an osmotic diuretic (Manitol), Dexamethazone, and whatever else the medic recommends (Zofran or Ativan?) and transport him BLS. Patient two .would be transported by ALS. The Ambulances would travel in caravan and maintain communication. I only mention capillary refill because it is a primary component of the start triage. Since patient one is in a decorticate position the scenario becomes simpler for me. Moby – Please critique my rational as I consider this a learning experience.

I routinely take pictures of things that I think I would want to see if I were a receiving Dr. For example: Patient with hematemesis 600 - 800 ml. Compensated shock. BP 80/40 RR 26 SPO2 92 HR 120. Picture was taken of vomitus. Arrive at hospital. Doc is writing a report. I report I have a patient with a hemorrhage. He ask Trauma? before I could continue with vitals? He seems distracted by his report. Hematemesis I said about his much and show him the camera he glances at the picture, left his report and began doing the things that make ER Docs Rock Stars. Pictures have been very useful to me .

My fifteen year old thinks I am a wild man that willl redily embarass her if her suitor isn't to my liking. She is right.

Patient one: what is his respiratory rate? Is he in a decorticate or decerebrate position? Patient two: What is his capilary refill? Is he bleeding and how much? Can the medic administer ALS meds and sent the patient via BLS? What is the ETA to the hospital?

During my EMT training our instructor stressed that crash scene photography would lead to disciplinary action and the loss of employment for EMS workers. In short, “Cameras are prohibited and pictures will get you fired” Newgard, Martens & Lyons have some very interesting studies that seem to indicate the usefulness and validity of crash scene photography as a diagnostic guide for ER physicians. I would extend the assertion that photographic evidence is useful in describing many incidents other than trauma. It could be useful to describe both MOI and NOI to ER physicians without violating HIPPA so long as the patient’s image or likeness or otherwise recognizable personal traits are not recorded in the images. So, what is the problem with photography? What is your service policy in relation to photography? Do you take pictures at the scene?

I might have it tatooed on her forehead

You mean you have never treated Martian butt lice? Now that we are done I think, I will confess that my thought process was more intuitive than intelligent or clinical knowledge based ( I am sure it was obvious). As soon as you were "banned" from the thread for having "insider knowledge" I knew it was going to be something that would be considered exotic for the civilized world. That really narrowed the scope for me. I was beginning to believe that my suspicions were going to be as wild as Barbarella booty bumps but decided to ride it out just to see where it would go. Thanks chbare, Great thread. It is my privilege to get to learn from all of you guys. edited to spell check intelligent

Holy mechanicaly separated body parts Batman! Please, please, please tell me it's not SPAM!!!

Ha! I had totally forgotten about that movie.

glenoid cavity (or glenoid fossa of scapula from Greek: gléne, "socket") is a shallow pyriform, articular surface, which is located on the lateral angle of the scapula. It is directed laterally and forward and articulates with the head of the humerus; it is broader below than above and its vertical diameter is the longest. Taken from wikipedia

Are you really accusing "the corporate medicine machine" of willfully killing people. What do they do with them? Sell their organs on the black market? They are responsible for their employees mistakes but don't encourage, endorse or promote them. It is true they should not, but you imply that the motivation for business it kill, kill, kill. It is a serious accusation. The kind of accusation that legally constitutes slander in a public forum. It's probably good none of them are watching or take your words to seriously. Of course you can have a lawsuit, with or without information. You can have a lawsuit for almost any reason at all like, let’s say, slander. Are you really accusing Dr.s of lying to patients’ next of kin to cover for a medic they might not even know? Are you saying that a ER doc would falsify documents to cover for anyone much less a person that may not even be a part of the same health system? Are you accusing ER doctors and medics of conspiring to commit fraud and dishonesty in reporting? Can you see how crazy that sounds? What you are doing sounds a lot like slander to me.

lol

I was thinking that we would need to review his travel for four weeks but reaearch says it could be as long as a year from infection to the first symptoms. Amazing. Here the doc would add quinine to the doxicycline. The net mentiones tetracycline or clindamycin as well. I have never had malaria but suffered through Dengue twice. The second time I thought I was dying. I wasn't but it felt like it.

chbare - Those are really good pictures and a good presentation as well. Is that your voice in the video? Here is a picture I took through a scope with a Sony Cibershot. It took a couple of tries to get it lined up .

P. falciparum commonly known as malaria or blackwater fever. ERDoc thanks for holding back and letting us take a shot at it.

I don't have a clue, but aren't we all supposed to check the five "rights" before giving a medication. It seems to me that this is a error that is a symptom of a grater mal. Medics that don't pay attention to their protocols or training. That just sounds like sloppy work. I think If I were in charge I would have to levy some sort of discipline. If ambition were not lofty it wouldn't really de ambition, right. EMT shoot for the stars

Who was the wise man that said "I only know that I know nothing"?

It's because of our inquisitive nature, probably just nosy.

Bienvenida a la ciudad!

So we don’t have a history of CHF but could his non compliance of Toprol be messing with his ticker and be a factor in the general malaise and headache although probably not related to the fever. I think this could be significant. Does he have any history of asthma? Toprol XL is contraindicated in asthmatics. Does he have edema in any of his extremities? Unilateral, Bilateral? Would a diuretic benefit our patient? What has he been eating? I mean could he malnourished and have a low serum protein level? He is anemic and Iron is essential to myoglobin production. If he is only eating the crackers out of his MREs he might be malnourished. Does he take aspirin? How would I know if the effusion is secondary to a thrombus? Is a PTT available? I suppose we would change the antibiotic to something of a wider spectrum and more specific to gram positive bacteria. Possibly a diuretic but I am not sure, I would also supplement his diet with a multivitamin + Fe and ASA 81mg once daily. Recommend that he eat a balanced diet (if such a thing is possible over there). I would also stresss the importance of compliance to Toprol XL.

I tell my wife she can never leave me, "If you leave" I say "I'm going with you"!

Does he have jaundice? Hepatomegaly? Blood in urine? Is malaria endemic to this area? On another vector. Does he work with chemicals? Could he have a toxicity causing fever? Any word on the febrile antibody test yet?

I was thinking of Rickettsiae. I don’t know which the more common cause of fever Afghanistan is. With no flu vaccinations possibly viral fevers are more common. But with US aid they may be better vaccinated than Americans. I would suspect they have a pretty good dose of both.