AnthonyM83

Don't have a comment on what may be going on, but I appreciate the well-written post. Paints a good picture of a real call versus just throwing VS and numbers at us.

What kinds of treatment are done for them at the ER? I once had a patient strongly request the county hospital that was much further away. He said that when he does to certain hospitals they have special medicines that the local ERs don't all offer. At the time I assumed just a stronger pain med . . ?

Now I know there's not strict pattern and set rules for a lot these, but wondering if people wanted to discuss different differential diagnosis they might come upon based on different presentations of abdominal pain. For example, lately I've gotten a few where pain starts at umbilicus and then moves to right flank. I've also had some that start on one flank and move to umbilicus. Of course there's some like RUQ suspect cholecystitis, live problems, etc. RLQ appendix. Then there's stuff on onset of symptoms. Sudden versus gradual. Constant versus on/off or worsening in waves. And there's other s/s that might go along with them . . N/V, Diarrhea, Weak/Dizzy, Fever, Dec. Urine output, etc... I'd just like to have more to consider when reassessing my abd pain patients that are BLS'ed. Might as well...don't have much else to do.

Responsibly it probably shouldn't. That's not what LA EMS is about though . . . ALS will just lie to you about vitals or what happened and write in a different chief complaint to BLS it. Nothing much seems to happen when hospital complains to their station captains.

Cheapest flight I can find is AirTran for $180 round-trip, 8.5 hour flight with the layover in Atlanta. Not that it's not stellar, but can anyone find a cheaper roundtrip from LAX to Dayton, OH? How cheap do you think I can get a room? I'll go the ghetto man . . . I'll sleep in a barn. Heck, I'll call 911 and sleep in the ER lobby... But really...$200 I might be able to pull, but with room and meals and taxi to the event, I don't know . . . . Anyone have frequent flyer miles to give away . . . ?

Naw. I've even heard of the occasional femur fracture being BLS'ed without pain management. NEVER seen it for something like dislocation (as MUCH as they hurt). Imagine the agonizing ambulance rides 15 minutes to the hospital, plus wait time in overcrowded ERs.

I know a lot of books say it that way, but I hate the 1 being no pain part. I say 0 being no pain. Just makes more sense to have zero pain. Then if it's barely hurting anymore it can be a 1 or less. This also gives them a whole ten integers to rate it with and it makes five be in the middle of the scale. (if you do 1-10, 5.5 is in the middle of the scale. Cause remember 10.0 is where you max out...you can't actually count the entire 10 number.... But i'm just being anal

Interesting story. Thanks for posting it. The article is good. As far a the "success" it describes, I'm not paying it attention until I hear about it a few more times. Like Eydawn and others said, there's a lot that still needs to be validated. BTW, Approximately one in ten people are resistant to AIDS. Doesn't even have to do with evolutionary resistance to it...it's just a gene that's been correlated with non-infection. It's been a few years since I studied this stuff (back in HS), so maybe they know exactly what it does by now.

I love the ridiculous situations these jokes setup in order to get the punchline. Good joke, though. "they had too many officers and decided to offer an early retirement bonus. They promised any officer who volunteered for Retirement a bonus of $1,000 for every inch measured in a straight line between any two points in his body."

UMStudent, I was going to bring up the same pain studies. In addition, I'm always sure to emphasize "WORST PAIN IMAGINABLE" to get an accurate reading. Even someone who hasn't experienced much pain and imagine excruciating pain somewhat. It stops everyone from automatically rating it a 10/10. But when someone honestly tells me it's a 10, even if they're handling it well, I'll take their word (unless they've been drama the entire ride).

Nooooooooooo...... Don't tell me you're one of THOSE. . . . You'll be hard pressed to see morphine pushed in LA County for anything less than a femur fracture. Severe Abd pain, MI, non-femue long bone fractures, NOPE I say, just mix it in a cocktail and slam it into their heart....

That seems to be asking for problems. Just because someone doesn't want to come back if they die, doesn't mean they want to deteriorate with increased pain and suffering. Even people with terminal illnesses can have unrelated treatable problems.

In what situations would percussion be the determining factor for needling someone?

Let us know how your next doctor's visit goes and what he has to say . . .

Sounds like case of koro... But more likely acute corpus cavernosal wingaling atrophy . . . mainly a sign of . . . disuse. Remember: if you don't "use" it . . . you "lose" it

Can you get a pressure on the opposite arm? Skin signs, cap refill...aka perfusion signs? Move to lidocaine? And can we get a manager/foreman to secure the scene and find out what kind of electrical sources were up there?

Thanks all

Copy. The protocols I've read say to use diminished LS only to determine which lung...but I keep forgetting I'm in my crappy Los Angeles bubble ...

Isn't decreased lung sounds the criteria used to choose which side to decompress? It was explained to me that percussing helps decide whether it's a pneumo or hemopneumo. But yes, I agree with at least being practiced with percussing during your training. If you end up working in an area with such short transports you hardly get to do it, you'll at least have the base knowledge in case you ever move systems or for some reasons have delayed transport.

Anything further upon a detailed assessment (after exposing patient, cutting equipment, etc)? O2sat, any spontaneous respirations, skin signs, any known hazards where he was working (chemical, electrical). Could the blister be from a thermal burn? Does it look more like an allergic reaction? Does it look new? History, Allergies, Meds?

Hopefully they can move on to human trials soon! How exciting

Can't think of a good reason not to . . .

Tell them to look at the CO2 reading and the range to keep it between. Tell them to do it deeper, harder, faster until that number gets within range.

I see the difficulty. Simply explain difficulty to your instructor and ask to watch him do a mock lead assessment to get the feel for what he wants. Also, Narcan incident might not be a problem by itself, but combined with other incidents, they're not sensitive to it. Also, make sure you're verbalizing the right things (actions and findings versus discussing a med) DURING the call. Limit considerations to: "I'd call ALS for possible Narcan use" or "I'd consider suctioning due to gurgling" (Even that's a bit much, instead just suction, then state why at a basic level: gurgling. Or "I'd call ALS") Make sure he doesn't want just BLS stuff, too, btw. Ask your instructor: "What's the best way I could have brought up Narcan?" He might say, "Call ALS for Narcan" or "You shouldn't. Just show me BLS". Questioning mid procedure, SPECIFICALLY AS A TRAINEE, is the problem. One of the things you're learning in training is how others on-scene question (or don't question)...you're not actually there doing it, unless blatantly obvious. And I submit, there's many things you won't know aren't blatant until you have more experience. Assuming medic isn't new or stupid, his way works...it's been working out years. You don't know what the medic knows and he doesn't have time to educate you in the moment every time don't know something ALS (and there will continuous flow of those moments). Medic says put patient with peanut allergy on Atrovent? That's simple, just say: "He says he has a peanut allergy. Is that okay?" (Neutral tone, not worried, excited, forceful, abrasive) You'll Yes or No. THAT'S IT. AFTER, you can learn why it's okay (Medical Director's opinion since you also carry anaphylaxis meds, severity of patient outweighed risk, specific dose, whatever it is) MAYBE he wasn't aware of the issue...but slim chance every single time he's not aware of the issue AND it's serious enough consequences...we can't just have every call run that way You need to develop the mindset that there's a lot you don't know. A lot you don't understand. A lot of reasons they know what they're doing. IF after a lot of time and experience, you realize you DO know more, change agency or go become a medic...but keep that mindset or 1) You won't get along and won't enjoy your job or 2) Medics will start owning you when you're wrong and they won't give you as much leeway on-scene to practice assessing and get good.