island emt

As a side question to this: What do you feel the appropriate dosing levels for Fentanyl are? The reason I ask is from personal experience when I dislocated my shoulder in January, They gave me an initial dose of 50 MCG followed 5 min later with 50 MCG more. The effect of 100 MCG was at best a reduction from 8/10 to 6/10 in pain level. Pain started raising again within 30 minutes, so the ER Doc gave me 2 vicoden po which had a much greater effect in pain relief.

While my views are a little bit jaded due to recent events with my brother in laws murder in Afghanistan, I do not believe that all afghan people are terrorists any more than I believe that ALL people who live in manufactured housing are trailer trash. Or ALL spanish surnamed people are drug dealers, or ALL Blacks are criminals, or ALL irishmen are drunks, or ALL jews are Bankers ,or ALL Mormons are polygamist who rape little girls in the name of their god. Do you see a trend here crotch? There are bad people of all races , religions , skin colors, ethnicity or place of birth. There have been religious wars fought since the beginning of time. There are many regular people in every country of the world that only want to survive and live without the threat of annihilation in the name of greed, religion or persecution for their beliefs.

If the hospice folks don't want us to treat and transport when medically necessary , then they need to have medical directives or POLST orders for us to follow. Our state has a standardized DNR form and protocol that we can follow per the pt's or families wishes. We have been visiting this Pt's home repeatedly over the past several months and it's usually a lift assist and put back to bed or clean him up , change his pajama 's and back to bed. He gets a thorough eval on each & every visit. If the hospice folks don't want us to respond , then they need to have someone there to take care of the Pt's. I will not allow someone to suffer if we can help resolve an emergent issue. Kinda like the discussion I had with a case manager from hospice when I showed up at the home of a pt who was bedridden and was developing skin breakdown. His wife had called me and asked if there was anything that would help. I happened to have an alternating air mattress in our lending library of equipment, so I brought it to the pt's home. The nurse manager asked me why they hadn't supplied that item. I looked her in the eye and asked the same thing.

Ugly : If I had a dollar for every time a pt's story changed from our initial exam to when the nurses or Dr's ask the same questions, I'd be a millionaire. Question: Have you ever had a problem with diabetes or history of it in your family? Answer to us : NO! Answer to nurse: Well i had the sugar once , but now i take these shots so I don't ! Question: Do you have any cardiac history? chest pain , shortness of breath? Answer : No problems at all. We happen to open shirt a few minutes later during exam to listen to lung sounds, and they have a neck to navel sternum split scar. when asked about the scar PT:Oh that ! I had a five way CABG ten years ago. Some Pt's just don't co-operate with us until you point out the reason for you doing so.

Ran a call the other night for one of our regulars who is under hospice care for his stage 4 Alzheimer's and big cardiac hx. we have been there quite frequently to give a lift assist , but this night his major problem was severe dehydration and vomiting which was causing an arrhythmia and triggering his AICD . I could have chosen to wait while we got in touch with the hospice folks : or we could provide him with the care he needed. IV started wide open and O2 along with anti emetic and we took him to the ER for further care. I don't really care if the hospice folks get their knickers in a knot, the Pt had an issue that we could help resolve and he didn't need to suffer because he was under hospice care. Just because they are under hospice care doesn't mean they don't get emergent care provided . Don't know what it will do to the billing issues , and frankly I don't really give a damn.

A dab of Vicks vopo rub under the nose will do wonders.

Very sorry for your loss Kaisu : nothing we can say will make this easier for you to understand.

We have a frequent flyer that is very often post shock when we arrive. He wants us to transport him to get the device fixed. After several trips to the ER he was finally convinced that the AICD is doing the job it's designed to. It senses a lethal arrhythmia and gives a shock. Some days it takes up to half a dozen shocks to convert him. The other night it was resolved after only three shocks. The days of defective units are pretty much past, they were subject to a recall and have been replaced. Back to Ugly's question: There really isn't much more you could have done for your Pt. Very few Med control Docs will give permission to disable an implanted AICD unless they are very familiar with the Pt and the medic involved.

I think I was member # 131 back when the city started.

Up to a million & a quarter views on You tube for this one song video clip. Check out the rest of their videos. Sidewinder is a US Air Force band traveling throughout the war zones doing shows for the combat troops.

Sorry for your loss Ruff. Condolences to all the family and friends.

Yes ! You cannot speak to create a hostile environment, whether you think it's in a private group or not. He will end up getting the sack

One must always remember that even the frequent flyers are sometimes truly sick and need to be seen emergently. If you forget this, one day it will bite you in the ass, HARD! Every patient deserves a good head to toe assessment from us and if there is any doubt at all, transport to an appropriate medical facility.

I have seen this several times over the years. Most were in middle aged overweight males with diabetes. One was a good friend that it happened several times to. He had all kinds of lab work , stress test, and put on a holter monitor for two weeks to see what might be the underlying causation. never did discover any physiological reason. While your having all the lab work done , have them check metformin levels. Google metformin toxicity.

There is a syndrome related to this. It has to do with the sudden drop in blood pressure after middle of the night urination causing a sudden fluid shift and compensatory syncopal episode following. Let me wrack my brain for a while.. It sucks to get old and have to search the brain cells for info.

Crotch: this is not about racism: it's about discrimination against those that studied the material and tested better than others. How come they're not hiring white or spanish folks or native Americans that scored below the cut-off point. You tell me how a written test can discriminate against any sub species, gender or color? It's similar to 15 years ago when the detroit school system required all teachers to speak ebonics. How about requiring all to speak ENGLISH , the chosen language of this country? Yes a liberal judge decided he needed votes to get re-elected! This is sure to secure the black vote in the precincts where they're needed.

This will really solve all of Chicago's problems: NOT ! Let's force them to hire 111 people that didn't score in the hiring range over more qualified folks. On top of that give a bunch of other losers cash payouts for not being smart enough to test well on a fair entrance exam. I don't care whether an applicant is green , red , white ,yellow, black, or some combination thereof. If you don't get a passing score on the entrance exam, you don't get hired. This is not about equal opportunity, It's about lowering the standards so minorities can get hired.' Reverse discrimination at it's finest!

When the Vidacare reps promoted new system to us that is exactly what they were promising to do. Take any unused/unopened needles that had gone out of date and replace them with sterile needles on a 1 for 1 swap. When we asked about the high price of the needles and having to buy in packages of 5, it was thought that the smaller low volume depts might be wasting a lot of expired equipment. Now it appears that they have had a change in corporate policy. I was just wondering if anyone else is getting this response from them.

The title of the thread was Cali steady burn: By the time he plugs all that whacker crap into his cigarette lighter ,the nissan will be a steady burn pile

How many are using the EZ IO drill and are you having a problem getting the company Vidacare to replace expired needles on a 1 for 1 swap out as they promised when they were promoting the benefits of using their product.

You said she's 94 blind and non-ambulatory. Does she live with family as care givers? Strong smelling urine = UTI or sepsis causing an imbalance in her system in someone with CHF, sends up a red flag for me. What was the color of the urine? dark & cloudy? Sometimes it hard to see the Elephant in the room through all the trees. Yes she has a cardiac issue going on, But whats causing the underlying issue besides being really old? good presentation

I think I've only started lines in the AC twice this year. One was a donorcyclist with both hands raw meat and a FX radius.ulnar, & the other a cardiac arrest.. The normal medical pt gets a 22 or 20 in the hand or if needed an 18 in the forearm. Starting up at the AC is lazy and wasting a lot of valuable venous real estate. What happens when you start high and they infiltrate? Then what? EJ or IO? had a chemo pt last week with nothing for veins in either hands or arms, but a tremendous access in his left foot. After getting a look from the receiving nurse at the ER she poked him half a dozen times before giving up and admitting that our good flowing 18 in the foot was the right solution.

Great pipes! Too bad the cameraman has dystonia

Ruff: many years ago, I had the same call, Once we finally found a key with a neighbor to gain access the elderly pt had died. Ever since then I have never let the problem of locked doors or windows stop me from making access. I figure it's better to ask for forgiveness after the fact than to wait around and find out my patient has died. I keep several small tools in the truck at all times. A 3 pound short handle sledge, a 2 foot flat bar and a strip of bleach bottle to use as a lock slip. If the doors deadbolted, most window locks take very little to force. never had a pt complain that I made access to their home when they needed help.

Sounds like you had an exciting week and are no longer a virgin. Good pick up on the AAA. Remember the first rule of EMS All patients will die eventually! sometimes we can prolong the inevitable.