DFIB

Was Koresh a terrorist? Did he ever commit an act of terrorism? Who killed innocent women and children at Waco? I would be more inclined to think the terrorist in that case were Clinton and Reno with their Jack Booted thugs. As far as the mosque. We should not be naive to believe that the location was chosen out of convenience. Do they have the right to build? Yes Does it piss me off that America haters all over the world will laugh and cheer that our freedom is used against us? Yes Is there a fair solution? Not one that I would like.

Did the patient pee sitting down and create an orthostatic change by abruptly standing?

I drove through Alabama a few years ago and was suprised to see a prison chain gang picking up litter, stripped uniforms and everything. Welcome

I am gonna jump in with Dwayne on this one for a little while and do an virtual exploration of this lady's abdomen. Here are some more questions What does a hernia feel like under palpation? What does a AAA feel like under palpation? Is it possible for an AAA to bulge out the front of the abdomen? If there were an AAA what vital signs would you expect? What would possibly pertrude when abdominal pressure is increased by changing position? What would be more urgent, the bulge or the BP?

The reporter does sound like a jerk. I wonder if the medic could have let the guy enter his own number or write it down. I wonder what he will do when hi has a real emergency?

Hospitals require patients to fill in their SS# (if they have one) upon admission. Should EMS require it as well? http://www.bizjournals.com/buffalo/blog/small_business/2011/08/would-you-give-your-ssn-to-an-emt.html

Thanks buddy. I am impresed all the time by everyones post. There is an occasional "goober smooch" but most of the post are dead on. I will start EMT-I next month. I am really looking forward to movin' up the food chain. Your question is not juvenile. We all wonder about the unknown. I hate funky smells. Melena, "fromundacheese", bacterial vaginitis you can smell across the room, and other degrees of nastiness make me puke. So if I have to barf I get it over with and get back to the task at hand. Boood is not gory when placed in it's proper context. Blood is the life sustaining fluid that must remain in the body. So a blood leak is simply a problem that must be fixed. A friend and I were talking about the guy that got his penis droped in the food disposal. His oppinion is that it would be appaling and traumatic to see. I opine that it is simply a bleeding flesh wound that needs attention (no touriquet of course). :0 Don't ever feel like less of a provider if some particular incident makes you "toss your cookies". As long as you keep a clear mind and get the job done it will be OK. Some jerk might give you grief about it but "screw him". Keep asking the good questions.

To be honest am not sure if i was responding to you or not. Mainly just expressing an idea. I guess I was thinking about the guys who treat their patients like they were a machanical part that needs to be fixed. The guys that don't respect their patients or their dignity don't deserve the job. Doing the job well includes caring as well. Not at all. I think we are on the same page. I was on a MVA with a 15 yr old DOA in the back seat. The dad shows up on the scene asking about his son and wanting to see him. I had gone to high school with the dad but did not know the kid. We sat on the sidewalk and shared a cry then I walked over to see the boy. That was a turning point for me. I decided to care and to care deeply. I don't think caring is baggage it is more like a privilege. .When I mentioned dehumanizing I wasn't implying that the science can be ignored. I have to constantly work not to have tunnel vision toward the condition and ignore the person. Yea, thare is a time to ignore their screams (or thank God they are screaming) as well a time when I know I am about to inflict pain to give them the best chance I can at survival. There is also a time for a soft touch and a kind word. Most of our patients deserve both. I had never really considered calls in those terms but I like it. We can either win or loose against the condititions. It will be food for thought on my next call. I guess every call is a fight, against nature, trauma, time. We either win or loose. [ We all express love in different ways, protecting is one of them .... loving patients will make a good medic great.

You don't have to be religious to be pretty sure that the outcome is never our to decide. We do our job and the science gives us stats on what the outcome should be but nothing is sure. Someone else is always deciding the outcome. I have a little different take on this subject. The dead are very low on my priority list. The truth is that we really don’t get to save that many. I don't think about or worry that much about the dead. I don't get to decide who lives or dies. If I do my job well I get to sleep at night. The idea that we would have to dehumanize our patients to cope with their pain in my opinion is flawed. I never want to forget that my patients are real people that are usually in a desperate situation, possibly the most desperate situation of their life. To dehumanize them in their time of need is to dehumanize myself. I am enormously gratified to think that I was able to make their life better. I don't want to feel my patient’s pain, but I don't seek denial that I cannot empathize with each one. It helps me be a better provider. If I can empathize with their pain, fear, uncertainty and sometimes even death, I can be a better help to them. I have no problem with shedding a tear with the hurting although when the call is over it is over. I don't take it home. Everybody copes a little different. I am sure you will find your own way to deal with your own experiences. I wish you the best.

Stephanie, You have come to the right place for quirky. There are a lot of really smart folks here that don't mind sharing their knowledge, so jump in and enjoy!

Welcome Sarah, Congrats on chasing your BS, I have always enjoyed college so I hope you are having a blast! If you like no nonsense discussion ... this is the place ... except when folks are talking nonsense,

Pi Pink shears is a great idea. Who is gonna steal pink shears?

Has anyone tried the s-cut cutting device?

Decreased turgor = fluids More so if i know the etiology of dehidration ie. diarrhea, vomiting etc

Good idea, EMT-B student here. Just aced Skills testing. I will change ocuppation when I pass NREMT in a couple of weeks. NREMT scares the poo out of me. Edited to check spelling (po didn't have the same effect)

Keep up the good work and enjoy the ride.

I would love to hear the take on Boyle's law,

EMT-B is important as an entry level and therefore requires the student have abilities and skills prior to entry. Drug test, background checks and shot records all have good reason. The evaluations of other areas are important as well. Students do have to have a reasonable degree of intelligence and reasoning ability. Students should demonstrate emotional stability and sound judgment ability. Students need to have a good reading comprehension level. A well structured entry exam would give indications of problems in any of these areas. EMT-B isn't a "load and go" job description although many medics act like that is all the "basics" are good for. It is mucho more. So ... yes a well formulated test that addresses psych, IQ, and basic academic knowledge would be beneficial to the student and instructors Why take a person's money that simply doesn't have the ability to pass the course or who will be a dangerous provider?

I think we are missing the the crucial point. She was a nitro taker that had already taken one with no effect. Radiating crushing chest pain. Doesn't sound like pectoral angina. I would have requested ALS intercept as soon as I suspected an MI. High priority transport. Load and go. ASA was a good call. If MC recomended nitro that is his business I think i would have questioned his call on a direct line and recuested confirmation after he had a chance to review the case again. I agree with scratrat and jake EMTP. I would begen assisted ventilations and prepare the airway adjuncts, AED, and suction as a precaution.

I wasn't trying to be conflictive and I don't think you were either. I simply believe we were thinking in different directions. I guess i could have said that in 10 words or less! Health, Grady

I guess I misunderstood. I thought you were letting volunteers off the hook.

Thanks, I had not considered pulses paradoxus. It is a good read if we were talking about systolic presure chages caused by respiration. Very true that the baroreceptors react to the change of pressure in the aortic arch and carotids trigger sympathetic nervous system to initiate a cascade of neural and hormonal responses in an attempt to restore the pressure back to a normal state. But the end result is vasoconstriction. Kinda is correct. Hyperactive is a poor choice of words. Stimulated seems better. Thanks for pointing it out. Yep, I made no mention of the level of hypovolemia. If you want to pitch an extreme number out to sustantiate your argument a guess it is you can but from a basic level it is kinda weak. At 40% blood loss is pretty extreme and most likely decompensated so ... of course, I would expect a decrease in BP diastolic as well. When the diastolic pressure falls the cascade of vasoconstrictive hormones and neurotransmitters could no longer keep up with the blood flow. My bad ... I was thinking of a hypovolemia caused by less blood loss. I should have been more clear. Yes this is true especially in pulse paradoxus as seen in your wikipedia reference. It is also present in hypovolemia. And of course there is vasodilation in septic and anafilactic shock. I only mentioned them as a comparison. Thanks for the help.

Volunteers should be just as responsible as paid personnel. Just because we don't get paid doesn't mean our behavior should deviate from professional or the scope of practice. Where I live we volunteers set the bar for our service. We live with the same scenarios and the same work related situation so volunteers should take care of ourselves as well, probably more because we are damaging our health for free.

Hindsight is a luxury we dont have. I was thinking that if she was the only green then an update would have had the same effect. Being tha last yellow is the same as the first green.

Muchas gracias Mister Dwayne. Sometimes posting on this forum can be a risk. I do it anyway you know, no pain no gain.