hammerpcp

Also, I said "misinterpretation", not misrepresenttaion. Possibly related, but different words. I thought it was blatantly obvious how slanted this article was. If not.................well, I'll try and explain some things to you.

Your first step should be to skip around in a cirlce singing "No fire, No wire, No gas, No glass." :blob3: After doing this the scene will magically become safe.

Especially the women. :protest:

All I have to say is: Huh? If I wasn't so apathetic I would write them a letter about statistical misinterpretation.

Well, that’s terrific if you feel comfortable using percussion in the field and it can be beneficial in your field assessment, great. But, as I said before, it is very seldom if ever (other then Lithium) used in the field for the afore mentioned reasons. A PCP calling themselves a paramedic to someone in he US who is unaware of the differences in training and assumes that any paramedic is an ALS provider, is misleading, yes. I find you calling yourself a "nurse" with no validation, to be a misrepresentation of your skills. I thought I had made that clear by now. You should be aware of that, if you are not already; to the lay man a nurse is a nurse is a nurse. They don't know that an RN has a four year university degree and an RPN has a two year college degree. Perhaps this was in fact inadvertent on your part; I will give you the benefit of the doubt. It is the same problem as when some one calls an EMT an "ambulance driver", or calls a PCP an EMT. It is not accurate and is in fact overtly offensive because.....well that has already been discussed in detail on this board. As far as saying something as a "point of interest", implying that you are not interested in discussing it, it would probably be a better strategy not to bring it up in the first place. I thought that your repeatedly asking why ACPs can take extended periods of time on scene was taking issue with it. No? In any case, blah. If a PCP takes an average of 15 mins on scene and an ACP takes 30 mins on scene doesn't that equal the ACP taking DOUBLE the scene time of a PCP? Oh, forgot, you weren’t taking issue with that. :roll: PCP's could easily take it upon themselves to learn how to effectively use percussion. Simply put, we don't get enough clinical experience in school so it would be independent learning, as far as recognizing and interpreting different sounds. Also because it is so seldom used, hospital personnel would probably not take your word for it. (I don't think I have ever even seen an ER nurse perform percussion). But really, anyone can teach themselves to use any diagnostic aid as long as it isn’t an invasive procedure and they can somehow get their hands on the equipment. Spirometry, for example. :wink: Finally, of course you wanted to hear about people missing things. It was your original post. Perhaps this conversation will meander back in that direction, although like I said, I far prefer this tangent.

Horton electrical problems? OH NO! .................................Is there still going to be coffee available?

=D> Well said. I absolutely agree on all accounts. My eyes are burning.

TZETAH, please continue with the scenario. Perhaps a little clarification on certain points is necessary but don't take it personally. (VS-eh? is an ugly bastard Does that help?) Anyway, communication breakdown is not an irreparable problem.

I agree to a certain point. This technique is taught in sales to manipulate the buyer into feeling a kind of camaraderie and commonality with the sales person. However, the only reason this work is because it is also a naturally occurring behaviour in humans. As Anthony mentioned, we often inadvertently or subconsciously mimic the body language of those we are interested in or feel close to. So yes, in certain circumstances this body language can be used to manipulate, but in others it can be used to communicate more effectively, and put the person you are interacting with at ease. Use your knowledge for good rather than evil. :wink: I'm not sure I completely agree with the above statement. Not as a blanket statement in any case. It can often be quite detrimental if you agree or play along with a pt's delusions. It also raises the ethical question whether you are enabling educated, informed choices to be made by the pt. Decision making capacity is a spectrum rather then an all or nothing state of being. For the most part though, these are great points and deserve to be emphasized more in the medical field. Mind and body are not separate and this is truly an archaic way of looking at things. Take stress for example. It may be the precursor for more diseases and illnesses than we are even currently aware of. Certainly there is more and more research coming out supporting this theory. I can’t over emphasize the importance of not asking leading questions to the pt. Not only in the interest of attaining accurate history and symptomatology, but as was mentioned, in contributing too or retracting from the pt’s final outcome. And yes we can label this “psycho babble” but the fact remains that more and more scientific evidence is arising that supports this type of thing. I would love to hear this woman’s lecture.

Trichinosis? But I am feeling much better, thank you.

Never heard of it. Thanks for the info. Alhtough I have heard the "red as a beat, etc etc" in reference to anticholinergic od before.

You just spelled it wrong. paten Clearly this is what was being referred to. :roll:

L&D= Labour and Delivery OBS= Obstetrics PT= patient kg=kilogram F=female HPI=history of present illness BM=bowel movement abdo=abdominal AM=ante meridiem Vag=vaginal doc=doctor bld=blood FHR=fetal heart rate BPM=beats per minute LLQ=left lower quadrant PMHx=past medical history hx=history norm=normal O/E= on exam NAD= (not sure about this one) no anal discharge? just guessing. CAOx3=conscious alert and oriented resp=respiratory trach=trachea JVD=jugular vein distention H/S=heart sounds A to B=apices to bases extrem=extremities ROM=range of motion CSM=circulation sensation motor/movement bilat=bilateral V/S=vital signs HR=heart rate RR= respiratory rate BP=blood pressure RA=room air GCS=glasgow coma scale mm=millimeters pearl=pupils equal and reactive to light EMS=emergency medical service/system Did I get them all? :wink:

Explain passive stretch. I'm not familiar. Compartment syndrome usually occurs in the lower limbs or forearms due to the finite amount of space in these locations. Injury causes swelling but the forearm and leg can only expand outwards so much, so after a certain point the swelling begins to impinge upon nerve and blood vessels compromising distal sensation and circulation etc. The muscles are incased in fascia, a thin layer of connective tissue (which doesn't stretch) so they also can only swell to a certain point. Hence, the "compartment". Am I explaining this well? This is just from memory, which is severely damaged BTW due to recreational activities :wink: joke. But anyway. You will find with these pt's a seemingly imbalanced amount of pain to the appearing severity of the injury. Of course, you will also have distal circulatory and sensory/motor deficits. Treatment in hospital includes fasciotomy to release some of the pressure (since that is what's doing the damage). Crush syndrome is basically cells rupturing (from being crushed :roll:) and this is bad. We prefer to keep what is inside the cells inside, and outside, outside. Namely potassium. Potassium can cause cardiac arrhythmias and death. If a person is crushed by a heavy object they can present as fully canscious and alert and seemingly doing well until the object is removed. This is due to the return of circulation to injured areas which in turn carries toxins to the rest of the body. Please Google for further information. Helpful?

WTF is EVOC? I backed into a pole yesterday. :oops:

Special news buletin......this just in. Hammerton EMS will now be changing it's motto form "promoting and protecting quality of life and public safety" to "Errors have been made. Others will be blamed." :shock:

Akroeze you are contradicting yourself, and thus I am having a hard time taking your word for anything. You said initially that you have never seen or used chest percussion in the field, and then you say that you do have enough experience in using the skill that it can help you as a diagnostic tool. WTF? A monkey (if monkeys could talk) could describe what sounds they expect to hear/not hear when a certain condition is present. Does that mean that they can recognize those particular sounds when they hear them? No. Does it mean they can apply a certain sound to attain a working diagnosis? No. I call bull chit. As far as nursing goes, you are not trained to the same level as an RN. To call yourself a Nurse to the public or people from a different system is misleading. Maybe this is inadvertent dishonesty but I doubt it. Just because nurses "used to" only have two years of college training is irrelevant. Ambulance attendants used to have only first aid, and before that they had only a driver’s license. CPR used to be a designated medical act. I could go on and on but I won't. I hope my point is clear. If you feel that you can use chest percussion effectively as a diagnostic tool in the field, be my guest. But don't misrepresent your training or skills. It is very unattractive. I think Lithium did a great job of describing his point. Maybe when you get out in the field your question will get answered to your satisfaction. As of now the best thing may be just to take peoples word for it that a half hour scene time is not uncommon and is not necessarily detrimental, in fact it can be quite beneficial to the pt. We did give ACP's all these extra toys so that they can use them in the field. Ultimately, it is in the pt's best interest to get treatment as fast as possible. And if they are receiving this treatment while still at home then what is the problem? On the other hand I do not support delaying transport of a pt to which an ACP can make no difference. I have seen this happen on many occasions as well. The ACP gets so caught up in performing a particular skill that they do not initiate transport to the hospital where the pt can actually have some beneficial interventions performed. Oh, and MedicMal, yes we have strayed from the original topic but I find this one so much more interesting don't you?

That's what I was going to say. The scoop works well for this too. More hand holds.

Correct me if I'm wrong, but is it not a requirement that you have a mediastinal shift (hypotension, trach. dev. AKA a TENSION pneumothorax) in order to do a needle thorocostomy? Is the pt presenting with this? VS?

No ultrasounds at this clinic.

I like bunk beds.

Is that the new gold standard of treatment? Swear at the anaphylactic pt? Man, I new you all were progressive but that is just astounding in its innovativeness. I knew I was ahead of my time.

Compartment syndrome?....... How about crush syndrome? Trach deviation? Is pt hypotensive? Do you do a needle decompression if he is not? I'd be thinking hemo/pneumo at this point. VS? Incident hx: what was the object? and where on his body did it fall? How long was he pinned? "He does know his name and what happened to a point." To what point? LOC? ECG? arrhythmias from cardiac contusion or cellular waste products and potassium? SpO2? abdo distention? etc, etc. Head to toe exam. Vital signs. Management: c-collar continue vents via BVM- lung compliance? Paradoxical chest movement? sensory/circulatory deficits? Pupils? Load and go.

Waackerdan, I think you should reconsider your position on profanity.